As the homeless epidemic in California continues, Democrat Gov. Gavin Newsom on Thursday unveiled a plan for “acting with compassion” to help get mental health treatment for the exploding number of people living on the streets.
The plan, dubbed CARE Court — Community Assistance, Recovery, and Empowerment — is a policy framework that would have to be approved by the state legislature.
“CARE Court is about meeting people where they are and acting with compassion to support the thousands of Californians living on our streets with severe mental health and substance use disorders,” Newsom said in the press release announcing the plan. “We are taking action to break the pattern that leaves people without hope and cycling repeatedly through homelessness and incarceration.”
“This is a new approach to stabilize people with the hardest-to-treat behavioral health conditions,” Newsom said.
The announcement included support from Democrat mayors of two major California cities.
“It’s time we face the painful, but obvious truth: our behavioral health system in California is broken,” San Diego Mayor Todd Gloria said. “All of us see it every day on our streets – and it’s long past time we fix it.”
“Governor Newsom’s groundbreaking CARE Court proposal breaks through on a key missing piece of the homeless challenge,” Democrat Sacramento Mayor Darrell Steinberg said. “For people who are the sickest and most vulnerable on our streets, the governments responsible for helping them must be legally obligated to act.”
The press release detailed the framework:
CARE Court does not wait until someone is hospitalized or arrested before providing treatment. CARE Court will provide an opportunity for a range of people, including family members, first responders, intervention teams, and mental health service providers, among others, to refer individuals suffering from a list of specific ailments, many of them unhoused, and get them into community-based services.
CARE Court offers court-ordered individualized interventions and services, stabilization medication, advanced mental health directives, and housing assistance – all while remaining community-based. Plans can be up to 12-24 months. In addition to their full clinical team, the client-centered approach also includes a public defender and a supporter to help individuals make self-directed care decisions.
The CARE Court framework was created using the evidence that many people can stabilize, begin healing, and exit homelessness in less restrictive, community-based care settings. The plan focuses on people with schizophrenia spectrum and other psychotic disorders, who may also have substance use challenges, and who lack medical decision-making capacity, and advances an upstream diversion from more restrictive conservatorships or incarceration.
The phenomenon of mentally ill people living on the streets in U.S. cities dates back to President John F. Kennedy’s attempt to create institutions at the state and local level to help those in need of treatment. But the well-intended policy resulted in states dropping the ball and more and more mentally ill people living on the streets or behind bars.
The San Francisco Chronicle reported on Newsom’s plan:
Under [Newom’s] vision, people suffering from psychosis — whether from a mental illness such as schizophrenia or triggered by severe drug addiction — could be brought before a Superior Court judge under three scenarios: Either they are suspected of a crime, an involuntary hold in a psychiatric emergency room is ending, or a family member or outreach worker believes they cannot care for themselves. A public defender would represent them.
A county clinical team would create a care plan with input from the person and their “supporter,” a county case manager who would help them navigate the process and make decisions. The plan would likely include clinical services such as visits with a psychiatrist, prescriptions for medications and housing such as at a board-and-care facility. The person wouldn’t need to be homeless to qualify. If a judge ordered the plan, the county would be mandated to provide what’s needed and the person would be required to accept it.
If the person suffering from psychosis refused at any point to participate, their criminal case would proceed. If no crime was committed, they could face the existing state process, in which people who are gravely disabled or deemed to be a danger to themselves or others are placed under involuntary holds and eventual conservatorship. Medication could be court-ordered, but would not be forcibly given. Failure to take mandated medications could mean the person reverts to the criminal court or eventual conservatorship. The idea is to help people long before either of those outcomes is necessary.
Even with Newsom’s proposed policy, mental health treatment in the state to date is still based on the Lanterman-Petris-Short Act, signed into law by Gov. Ronald Reagan in 1967 “in a bid to empower people experiencing mental illness. It allows for short, involuntary psychiatric holds if a person is deemed potentially dangerous, and allows a judge to appoint a longer-term conservator to make decisions for people who are ‘gravely disabled,’ according to the Chronicle report.
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