Newsom’s CARE Court mental health plan is flawed but has merit. California needs it to work

With almost universal support in the California Legislature to date, Gov. Gavin Newsom’s CARE Court proposal appears to be barreling toward enactment. State leaders have championed the proposed new branch of the judiciary as a tough but necessary means of alleviating the homelessness crisis by compelling mental health care, a talking point that seizes on public frustration at the problem and dubiously presents severe mental illness as the biggest hurdle to solving it.

But if the governor’s expensive program could deliver treatment to the as many as 12,000 people his administration estimates are suffering from schizophrenia and other psychotic disorders — many of them hopelessly failed by California’s inadequate psychiatric system — then we can’t turn away from a potential solution.

Our board was torn on this policy, but ultimately felt it deserves support — as do efforts to make it better, and as do all efforts to help unhoused people suffering on California’s streets.

Members of The Bee Editorial Board have documented harrowing stories of families that have been unable to secure treatment for loved ones because of California’s convoluted laws for psychiatric care. While the rest of us debate the politics of certain policies, these families need much more than words.

If Newsom’s proposal, contained in Senate Bill 1338, is poised to become law, California desperately needs it to be successful. Newsom and lawmakers cannot in good faith enact CARE Court without taking steps to address shortcomings that a broad and diverse opposition has meticulously laid out.

Under its current design, a family member, behavioral health worker, police officer or other first responder would be able to petition the CARE (Community Assistance, Recovery and Empowerment) Court to require treatment for someone suffering from severe mental illness. The process could also apply if they have been charged with a misdemeanor. With the support of a court-appointed attorney and case manager, a CARE Court enrollee would be subject to a one-year treatment plan and either “graduate” or submit to a second year. If they fail, they could ultimately be placed in a more restrictive conservatorship.

Essentially, CARE Court seeks to establish a humane process for involuntary outpatient care.

The most glaring weakness is the legislation’s failure to create or — at minimum — require some form of housing for the homeless people suffering from such illnesses. The bill would merely “prioritize” housing for them, which, as nonpartisan legislative analysts noted, does not increase the state’s woefully inadequate supply of housing or treatment beds. It could cost hundreds of millions of dollars to meet the housing needs under Newsom’s plan, a Senate analysis found. While the bill sets aside $50 million annually to establish civil mental health courts, it overlooks funding the type of shelter and psychiatric beds that the state’s own Health and Human Services Agency has deemed vital for maintaining treatment.

Additionally, the legislation would increase demands on a mental health care system already facing an acute shortage of workers. More than 11 million Californians live in areas designated as having insufficient mental health care, according to the Kaiser Family Foundation. Without major investment, California will be unable to attract and retain the number of behavioral health professionals needed to deliver on CARE Court’s promises.

The process outlined in the CARE Court legislation also invites a great deal of subjectivity and grants serious decision-making power over people’s lives to county courts and government workers. Newsom and other CARE Court supporters have taken care to present the program as less restrictive than rarely used conservatorships, but the program would nevertheless result in a reduction of individual agency.

At the same time, blind adherence to principles of self-determination has prevented people who clearly need treatment from receiving it, endangering their lives and others. For many in California who have been unable to get a loved one to accept care, court-ordered treatment represents a lifeline. That is worth supporting.

California needs ambitious policies to address its housing and homelessness crises and bolster psychiatric care. In the best light, CARE Court addresses gaps that leave some of the most severely mentally ill untreated, and for that reason, it deserves serious consideration. At its worst, it promises to ameliorate a homelessness crisis that it doesn’t begin to address while sending more people to court. If Newsom and the Legislature want CARE Court to be successful, they must address its pitfalls and be forthright about its limitations.

This story was originally published August 19, 2022 at 5:00 AM with the headline "Newsom’s CARE Court mental health plan is flawed but has merit. California needs it to work."