New ‘Care Court’ aims to treat severe mental illness

by Steven Felschundneff | steven@claremont-courier.com

Los Angeles County has elected to fast track a new “court” aimed at delivering mental health disorder services to Californians who need it most.

Signed by Governor Gavin Newsom in September 2022, the Community Assistance, Recovery and Empowerment Act, called CARE Court, aims to break the cycle of incarceration and homelessness for people with severe mental illness by implementing a court-ordered 12-month plan to get those people into critical care.

Authored by Senator Thomas Umberg (D-Santa Ana) and Senator Susan Talamantes Eggman (D-Stockton), the act received bipartisan approval in both the state Senate and Assembly.

“CARE is an upstream diversion that prevents more restrictive conservatorships or incarceration for people with schizophrenia spectrum or other psychotic disorders, and is based on evidence which demonstrates that many people can stabilize, begin healing, and exit homelessness in less restrictive, community-based care settings,” according to a news release from the California Health and Human Services Agency, which oversees the program statewide.

The Los Angeles County Department of Mental Health will coordinate the implementation of CARE Court locally.

Los Angeles County will accelerate opening new civil courts intended to get severely mentally ill residents into treatment and housing under the Community Assistance, Recovery Act. Courier illustration/Steven Felschundneff

The county has committed to implement the CARE Act by December 1, 2023, one year ahead of schedule, joining Glenn, San Diego, San Francisco, Tuolumne, Stanislaus, Orange and Riverside counties. The act will be phased in for the rest of the state.

The act will be paid for through a portion of the $15.3 billion the state set aside in its budget to address homelessness. An additional $88.3 million in “startup” funding will be allocated to the counties and court systems that implement the program this year.

“CARE Court brings real progress and accountability at all levels to fix the broken system that is failing too many Californians in crisis,” Governor Newsom said in a statement. “I commend Los Angeles County leaders, the courts, and all the local government partners and stakeholders across the state who are taking urgent action to make this lifesaving initiative a reality for thousands of struggling Californians.”

The program is not for everyone who is unhoused or suffering from mental illness, rather it’s focused on helping adults on the schizophrenia spectrum and those with other psychotic disorders. To qualify for CARE someone must either be unlikely to continue to survive safely outdoors, or the services must be necessary to prevent deterioration into grave disability with the possibility that the individual might harm themselves or others. Additionally, it must be demonstrated that the person will likely benefit from the services, that the program is the least restrictive path to recovery, and they are not already engaged in voluntary treatment.

The CARE Act essentially establishes a civil court system in California and people who are referred would be assigned legal counsel and case managers.

The proceedings begin with a petition, which can be submitted by family members, roommates, first responders, a clinician, the individuals themselves, or others. It would then be reviewed by the court to ensure it meets the criteria. If approved, the county would investigate the case and respond within 14 days.

Each case will involve several hearings, and, if approved, a “CARE plan” will be established. The person would be notified of hearings, but would not be required to attend. Also, if the person voluntarily begins a treatment plan on their own, the CARE process would terminate.

Services offered by CARE include prioritized placement in a range of housing from bridge housing, licensed adult care facilities, or permanent housing. If necessary, the person would be prescribed a “stabilization medication” plan to mitigate underlying health conditions.

“I support bringing CARE Court to our county. It allows us to be on the ground floor of a new program where a lot of processes and implementation details still need to be worked out. Our county needs to have a seat at the table so we can effectively bring healing to individuals living with debilitating mental illness on our streets,” said Los Angeles County Supervisor Kathryn Barger, who represent the fifth district which includes Claremont. “We need a coordinated and consistent approach to help these individuals, and CARE Court is poised to help us meet that mission. Severe mental illness doesn’t resolve itself.”

The CARE Court has its detractors, including the American Civil Liberties Union, which published an article in June by Eve Garrow and Kath Rogers, stating that the organization “vehemently” opposes the new law.

“All Californians deserve permanent, affordable housing, and healthcare that meet their needs and allow our communities to flourish. Nobody should be forced to languish, deteriorate, and die on our streets,” read the article. “Unfortunately, instead of focusing on proven methods that prioritize permanent housing and voluntary healthcare, Governor Gavin Newsom’s so-called ‘CARE Court’ plan would create a new court system that subjects unhoused people with mental health disabilities to involuntary treatment. This is not the answer. California desperately needs more housing and healthcare — not more courts.”

The authors maintain that quality voluntary care is more effective than coerced mental health treatment particularly when it is coupled with permanent affordable housing.

The story also states that the CARE Court treatment plan “would strip people with disabilities of fundamental rights, such as the ability to determine what medications go into one’s body.”

However, state health officials have said no one will be forced to take any medication.

“Court-ordered stabilization medications cannot be forcibly administered. Seeking an involuntary medication order for a respondent would be outside the proceedings and subject to existing law,” according to a fact sheet from the California Health and Human Services Agency.

Still, refusing to take the stabilization medication could be seen as a failure to follow through with the CARE plan, which could trigger an additional hearing and carries the possible outcome of being committed to a state hospital or placed in a Lanterman-Petris-Short mental health conservatorship.

“If the respondent was provided all the services and supports in the CARE plan, the respondent’s failure to participate in the CARE process will be considered in any subsequent hearings under the LPS Act that occur within 6 months, and shall create a presumption at that hearing that the respondent needs additional intervention beyond the supports and services provided by the CARE plan,” according to the health agency’s fact sheet.

Claremont City Council member Jennifer Stark says she is glad Los Angeles County will be implementing the CARE Court a year early, even though she still has some concerns about the program.

“I am eager to work, support and advocate with nonprofits like [National Alliance on Mental Illness], the county, the court system, Tri-City and treatment facilities,” she said. “I have concerns about the capacity of facilities, mental health care providers, implementation, and ongoing funding that comes with a brand new approach. How will the Pomona Superior Court be utilized as a CARE Court? How will Charter Oak be optimized to take care of more people? how will Tri-City work with Claremont, La Verne and Pomona to address the needs of those individuals in our area who are suffering with severe untreated mental illness?”

She said our community needs to understand there is not going to be one solution that works in every situation.

“We [must] continue to build our understanding about the complexity and diversity of the unsheltered population and strive to understand that all mental illness is not severe untreated mental illness,” Stark said. “Believing that an untreated severely mentally ill person is in a position to make the best decisions for themselves is an ableist perspective. We have got to stop believing that the inhumanity of leaving people in tortuous deterioration is protecting their civil liberties.”

Finally, Stark expressed optimism that CARE Court will be a first step in a long road to end the suffering and indignity of untreated severe mental illness.

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