Success of Newsom’s mental health proposal requires overcoming California’s biggest hurdle

The decision to place a loved one in psychiatric care can be traumatic, let alone the more overwhelming possibility that they might decline the care they need. Left untreated, psychiatric disorders can lead to homelessness, crime and incarceration or isolation in which the conditions may worsen.

Substance-induced disorders are a reality we can’t ignore in the unhoused population, either, and the pervasiveness of methamphetamine in Sacramento County is a major contributor. Meth abuse can cause psychosis, including paranoia, delusion and agitation, often requiring crisis intervention or inpatient psychiatric care. Research shows such disorders affect an estimated 40% of users, with many experiencing recurring symptoms that are indistinguishable from psychotic disorders such as schizophrenia.

This inhumane cycle plays out on California’s streets, where insufficient mental health care is compounded by a chronic shortage of housing and psychiatric beds. The consequences of inaction are dire, among them an increased risk of violence and death. Compassion for community members who need help — along with public health and public safety imperatives — demands major reforms.

Gov. Gavin Newsom last week unveiled a proposal that would essentially use a referral system or criminal diversion to provide court-ordered treatment for one to two years to people suffering from severe mental illness. Newsom’s “Care Court” program would assign a case manager, clinical team and public defender to each person, and the individual enrolled would be obligated to accept the treatment. As important, counties that fail to provide the mandated care will be penalized.

Care Court is a welcome departure from the usual canned talking points on mental health and homelessness that we hear from Newsom and the state Legislature. But even with safeguards that preserve individual decision-making and increase accountability for counties, its success will undoubtedly be hampered by the state’s intractable deficit of stabilizing shelter.

California is facing a shortage of nearly 4,800 psychiatric beds, according to a recent study by the nonpartisan Rand Corp. A California Health and Human Services Agency spokesperson said a housing plan would be part of each person’s treatment, but readily available housing is an oxymoron in much of the state, leaving a glaring hole in Newsom’s mental health prescription for unhoused participants. The state is still a few years from adding up to 55,000 new units through motel conversions and the governor’s $14 billion plan for homelessness.

Still, the Legislature should not reject Newsom’s proposal solely because of incomplete homelessness projects and inadequate housing supply. Nor should it be a reason for the public to discredit a reform that could boost care for up to 12,000 residents with severe mental illness, according to state officials.

Providing long-term care and a team of support staff, the proposal attempts to appease homeless advocates, mental health clinicians and politicians who have resisted involuntary treatment policies that infringe on individual rights. But Care Court enrollees who reject or refuse treatment could nevertheless face criminal charges if referred by law enforcement. They also could undergo a civil process that leads to conservatorship.

Unfortunately, these potential Care Court outcomes — jail, conservatorship or a return to the streets — are what California’s severely mentally ill have faced for decades.

Providing long-term court-ordered treatment and retaining individual agency could address the shortcomings of voluntary treatment under the Lanterman-Petris-Short Act, California’s foundational mental health law signed by Gov. Ronald Reagan in 1967. Under the law, a judge can approve a short-term emergency hold (known by many for its state code designation, 5150) if a person is too dangerous to release or appoint a long-term conservator who can make decisions for them if they’re “gravely disabled.” Of the more than 55,000 emergency holds in 2019-20, about 10% resulted in a conservatorship.

A 2002 reform, Laura’s Law, authorized court-ordered outpatient treatment but it is underutilized, with just over 200 people statewide subject to it in 2018. The Sacramento County Board of Supervisors approved a Laura’s Law service last year, almost two decades after it became state law.

Care Court is a logical next step for California’s mental health policies, but its efficacy depends on overcoming the systemic pitfalls that hampered its predecessors. Without meaningful increases in the state’s ability to adequately house and treat the severely mentally ill, Newsom’s proposal could go the way of previous attempts that failed to help everyone in need.

This story was originally published March 9, 2022 at 5:00 AM with the headline "Success of Newsom’s mental health proposal requires overcoming California’s biggest hurdle."