California ‘CARE courts’ raise concerns over forced treatment

By Sarah Martinson | May 20, 2022, 8:02 p.m. EDT

California Governor Gavin Newsom is pioneering a court model he says supports and empowers people with serious mental illnesses, but civil rights advocates oppose the plan, arguing it submits individuals to involuntary mental health treatment.

Under Newsom’s plan, family members, behavioral health providers or first responders can apply to Community Assistance, Recovery and Empowerment Courts, or CARE Courts, to seek treatment ordered. by the court for adults with schizophrenia or another psychotic disorder who lack decision-making capacity.

Civil rights advocates who oppose Newsom’s plan take issue with the governor’s criteria and wording of the proposal, arguing that courts cannot empower when people who lack decision-making capacity are subject to involuntary treatment.

If people under CARE’s court supervision lack the capacity to make decisions, they cannot voluntarily accept medical care, the lawyers say.

jessica cruz


Matthew Gallagher, a former county attorney and deputy director of Cal Voices, a local mental health advocacy and support organization, told Law360 in a recent interview that there is an inherent conflict in the CARE tribunal criteria.

“All the reason an individual would miss [decision-making] capacity is the basic premise that they cannot consent or refuse treatment,” Gallagher said. “That’s why a petition is being filed, and that’s why the court is ordering them to get treatment because they can’t make that decision on their own.

Newsom unveiled the CARE court framework in March at a mental health treatment center in San Jose, saying the courts would provide support to thousands of Californians who are homeless and have serious mental illnesses.

The following month, complementary legislation, SB 1338 and AB 2830, was introduced by the Sens. Thomas Umberg, D-Santa Ana, and Susan Talamantes Eggman, D-Stockton, and Assemblyman Richard Bloom, D-Santa Monica.

The bills would require all counties in California to establish CARE tribunals that could order treatment plans for up to 12 months with periodic review hearings and be renewed for up to 12 additional months. People who do not complete their court-ordered treatment may be hospitalized or returned to guardianship.

In April, the Senate bill, which is supported by local lawmakers, the California Hospital Association, California Fire Chiefs Association, Families Advocating for the Seriously Mentally Illness and National Alliance on Mental Illness-California, was introduced to committees Judiciary and Health of the Senate without amendments. Meanwhile, the Assembly bill stalled.

Umberg told Law360 in a recent interview that he supports CARE Courts because of his 20-year involvement with collaborative courts like Mental Health and Drug Courts which are cousins ​​to CARE Courts.

“Communities and individuals benefit from avoiding incarceration and addressing underlying issues,” he said of collaborative courts.

Jessica Cruz, executive director of NAMI-CA, said the alliance supports the CARE courts but has suggestions to “ensure fairness, preventative care and choice remain paramount in the delivery of the court itself,” including making the services offered by CARE Courts available to the general community on a voluntary basis.

“CARE Court gives us hope that our loved ones will avoid having their rights taken away by the criminal justice system or one of the other horrific trajectories [our] relatives find [themselves] due to serious untreated mental illness,” Cruz said in an email to Law360.

On the other side, CARE’s courts are opposed by more than 50 advocacy organizations, including the American Civil Liberties Union California Action, Bazelon Center for Mental Health Law, California Psychological Association, Disability Rights Advocates, Human Rights Watch , Mental Health America of California, the National Homelessness Law Center, Psychologists for Social Responsibility, and the Racial and Ethnic Mental Health Disparities Coalition.

In a letter of objection to Umberg, chairman of the Senate Judiciary Committee, the ACLU California Action and more than 40 signatories said current state law requires the offer of a voluntary treatment plan before be able to conclude that a person does not have a medical decision. manufacturing capacity.

“In the language of SB 1338, the process is reversed: a person is first declared incompetent to make decisions about medical treatment and, only after such discovery, offered information about the proposed treatment,” the letter reads. of April 21.

Opponents also said the bill’s use of the terms “supported decision-making” and “support” obscures the involuntary element of CARE tribunals.

John Raphling, a senior researcher at Human Rights Watch, an international human rights organization, said in a recent interview that the bill proposed by the CARE court contains a lot of puns and lawmakers get adopted without asking enough questions.

It’s forced care, and it’s very problematic from a civil and human rights perspective.

John Raphling

Human Rights Watch

“The [CARE court] the process is either you make an agreement to have the treatment that we want you to have or the judge orders you to do the treatment that we want you to have, so that’s coerced care, and that’s very problematic from a civil and human rights perspective,” Raphling said.

California already has two laws that allow certain people to be given involuntary medical treatment. Under the Lanterman-Petris-Short Act, Californians can be involuntarily placed in medical care for 72 hours if they are deemed a danger to themselves or others. The law also allows severely disabled people to be placed under guardianship.

A 2002 law called Laura’s Law – named after Laura Wilcox, who was killed by a man who suffered from a serious untreated mental illness – allows people with serious mental illness to be placed in outpatient treatment involuntary assisted by the community.

“Why do we need a third involuntary program? If you want to improve involuntary treatment, if that’s your real goal, why not reform existing programs?” Gallagher said.

A spokesperson for the governor’s office said in a statement that those “advocating for the status quo are supporting a cycle of homelessness, incarceration and death that simply cannot continue.”

“There is nothing compassionate about letting individuals live on our streets while struggling with serious mental health issues and substance abuse disorders,” the spokesperson said.

Kevin Baker, director of government relations at ACLU California Action, said in a recent interview with Law360 that CARE’s court plan is also flawed because homeless and seriously mentally ill people are unlikely to come to court to answer. to a petition against them.

“This model assumes that the person who needs services is somehow the bad guy who needs to be brought to justice,” Baker said.

Another concern of opponents of the CARE tribunal is that more black and brown people will be under judicial supervision because they are disproportionately homeless and diagnosed with serious mental illnesses.

Shonique Williams, statewide organizer for Dignity and Power Now, a Los Angeles-based grassroots organization that advocates for incarcerated people and their families, said she’s experienced firsthand how black people are diagnosed. mistakenly with severe mental illness by behavioral health specialists.

Williams, now 30, said at the age of 15 she was misdiagnosed with bipolar disorder after the murder of her best friend, although she experiences normal grief and loss at the time.

According to Williams, her best friend was the only person she confided in about domestic abuse, and after her friend was murdered, she became depressed and attempted suicide. She was hospitalized for her suicide attempt.

“If I hadn’t had a few little therapists along the way who were willing to hear my story and learn [that] this is the result of trauma, i would have been here misdiagnosed as bipolar [disorder]taking medication that wouldn’t have been beneficial to me and my mental health,” Williams said.

Mental health advocates say a better alternative to CARE courts would be more affordable housing and voluntary community mental health services.

According to a 2001 study by the RAND Institute and commissioned by the California Senate Committee on Rules, court-ordered treatment is by itself no more effective than voluntary treatment. Instead, the success of an outpatient treatment program is determined by its resources and ability to provide services.

Gallagher said California would not be able to expand its voluntary mental health services if the state continued to funnel funds into involuntary treatment programs.

“There will never be enough services to meet volunteering needs as long as we continue to divert funds from volunteering,” he said.

–Edited by Marygrace Anderson and Brian Baresch.

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