Trouble predicted for program designed to help those with severe mental health issues
Community Assistance, Recovery, and Empowerment (CARE) Court is designed to help people with serious mental illnesses, including about 14% of those without housing here. But both supporters and critics are pointing out its potential flaws.
By Kendall Balchan ● Homelessness ● August 29, 2022 September 1, 2022
Lawmakers hope Community Assistance, Recovery, and Empowerment (CARE) Court would be able to help homeless community members with serious mental illnesses. Many are unwilling to undergo treatment.
Is a new court proceeding passed into law by the California State Assembly this week the answer to helping members of the homeless community who refuse to help themselves? Riverside County officials are wary.
In March, Gov. Gavin Newsom unveiled the proposal he calls the Community Assistance, Recovery, and Empowerment (or CARE) Court. The program would create a new framework to help people with serious mental illnesses including schizophrenia or psychotic disorders. While not specifically aimed at the homeless population, data shows 14% of those without housing in Riverside County face severe mental health issues.
Under the new system, family members, behavioral healthcare workers, and first responders such as police officers would be able to start a civil case against a person with mental illness. A civil case can be opened even if a crime has not been committed.
Newsom hopes the effort will fill the gap between the current 72-hour involuntary psychiatric hold and incarceration. His administration estimates 7,000 to 12,000 Californians would qualify for CARE Court.
How it would work
Take the case of Patti Ricketts and her 25-year-old son Chad, who was diagnosed with paranoid schizophrenia. Chad is facing a felony charge for allegedly injuring an officer when he was in the midst of a paranoia episode. If incarcerated, he will become part of the 30% of those incarcerated in state prison who are mentally ill.
But Patti says she couldn't get him into involuntary inpatient care because he never threatened to harm himself or others.
Under CARE Court, Patti would be able to start a civil case before Chad reached the level of assaulting an officer, thus evading jail time. CARE Court judges would then work with clinicians and order a specific plan to be created that would include a combination of counseling, housing, and medication.
Chad would work with a public defender, county behavioral health, and a trained "supporter" assigned to him. Future participants like Chad could be placed under court-ordered care for up to two years, and if they fail to recover, they would be forced into conservatorship.
Participants do not have to be homeless to qualify for CARE Court, but one of Newsom's stated goals for the plan is to alleviate the number of people living on the streets with mental illness.
Despite support, a dose of reality
Legislators and the mayors of the state's major cities overwhelmingly support the bill, but unfortunately the CARE Court dream may soon go up against reality:
The state's 58 counties will actually be responsible for carrying out the program through existing court and behavioral health infrastructure – much of which is already overburdened. Worse yet, if they don't implement the program, they face punishment.
County leaders say that say they are unprepared and simply do not have the funding to take on the onus of implementing a complex new bureaucracy. But if counties don't comply, they will face fines of $1,000 a day.
In a statement, the California State Association of Counties (CSAC) warned that county behavioral health programs are already woefully underfunded and struggle to meet current goals.
"The CARE Court proposal is targeted at a narrow population and will not solve or end homelessness in our communities until housing and other major systemic problems – including underfunding for county specialty behavioral health services – are also addressed," the statement read in part.
Greg Rodriguez (right) speaks with a community member as volunteers were reporting to fan out throughout the Coachella Valley earlier this year during the annual Point In Time count of those living outdoors.
Statewide, many county leaders say they have reservations about CARE Court mainly because of the lack of clarity on funding. Locally, Greg Rodriguez, the deputy director of government affairs and community for Riverside County's Housing and Workforce Solutions Department, agrees.
"We need tools like this," he said recently, "but we've got to be able to have the resources."
Before starting his current role, Rodriguez was on Riverside County Supervisor V. Manuel Perez's staff. He laid out the county's money situation bluntly: "I see what budget is allocated, and I see how much money we have. We're tapped out as far as money goes."
"I'd love if the county were in a position to allocate another $5 or $10 million to our department or behavioral health, but it's just not there," Rodriguez said. "And I can guarantee that it would be impossible for us to carry out a program like this without funding from the state."
Rodriguez doesn't disagree with the premise behind CARE Court and said he and others working in behavioral health and homelessness outreach think it's a good starting place. Still, he added, there are too many unanswered questions.
"It's a really good idea, but is there funding to meet the requirements?"
As currently written, counties are mandated to provide treatment for CARE Court participants. But the bill itself does not guarantee funding for housing or treatment for counties. So far, the only funding that is for sure going to the program is $65 million this year and $49 million annually to fund training and other costs for the county courts.
Nonpartisan analysts estimate it could cost hundreds of millions of dollars just to meet the housing needs of the bill.
When pressed, Dr. Mark Ghaly, the secretary of The Department of Health and Human Services (HHS) for California, waved away most concerns about housing funding.
"The level of recent investment in housing and homelessness and additional investments this year total $14 billion, Ghaly said. "$1.5 billion of this year's proposed budget is dedicated to behavioral health bridge housing. That targets exactly the population that could become CARE Court participants."
That doesn't satisfy Rodriguez.
"I can't rely on getting a portion of that $14 billion," he said. "I would not be comfortable unless the state can 100% guarantee the funding is there. You can't launch a program on speculation."
Rodriguez also pointed out that the money for housing has only been allocated within the past year, but it could take three to five years to actually get the housing built to meet the needs of CARE Court participants as well as the people already waiting for affordable housing in the county.
"We're lacking in units already, and there's a provision in the bill that prioritizes CARE Court participants over people who have been waiting more than three years to get placed into housing," Rodriguez said. "That's not just homeless people. That's families and people in the workforce who are on the edge of falling into homelessness."
Courts already stressed
"These are called unfunded state mandates," explains Riverside County Public Defender Steven Harmon. "That means we will be required to commit resources to this program without additional state funding. It will absolutely put pressure on us from a funding resource standpoint."
"Overall, we embrace it and look forward to it," Harmon added. "We will do all we can to make it a success. And we will stretch if that's what it needs to be."
The Law Office of the Public Defender, in particular, will have to stretch its funding and its people. CARE Court requires each participant to be assigned a public defender to help them navigate civil court. But even before adding thousands of CARE Court cases into the mix, the county is already struggling to keep up with cases.
"High caseloads and high workloads are systemic throughout Riverside County. They are uncomfortably high for all of us," said Harmon. He stresses the county court system is working tirelessly to lessen the considerable number of cases that piled up during the pandemic.
A graphic from the governor's office explains how CARE Court would work.
"The backlog is really bad," Harmon explained. "The county has several thousand backlogged cases ready that should be going to trial. It will take us a while to work our way through that."
The situation is even more dire in the behavioral health department, which is struggling to find staff for open positions on their mobile crisis management teams.
"We're having a really tough time finding a clinical therapist to roll these teams out," said Rodriguez. "We have the same problem with staffing inpatient or outpatient clinics, especially in the eastern part of the county."
Soon after Newsom announced the proposal, state lawmakers quickly drafted a bill that passed unanimously in the State Senate and this week passed the State Assembly.
"Today's passage of the CARE Act means hope for thousands of Californians suffering from severe forms of mental illness who too often languish on our streets without the treatment they desperately need and deserve," Newsom said in a prepared statement Tuesday.
Added State Assemblymember Eduardo Garcia, the only state politician serving the Coachella Valley who responded to inquiries: "Without question we need to invest much more resources in mental health and ensure that those in need have access to housing, mental health care, treatment, and other vital wellness opportunities. (W)e hope that experts, advocates, local government, and other stakeholders can come together to help shape public policy efforts to best achieve these goals."
Rushed through?
Opponents of the bill say it is being steamrolled through committees so legislators and Newsom can score a critical political win before the November election. Several recent polls show Californians across the political spectrum rate homelessness as one of their top issues heading into the election.
"They don't care," said Western Regional Advocacy Project Executive Director Paul Boden during an online forum presented by the ACLU Southern California Economic Justice Committee. "This is about a political agenda to get brownie points to get reelected."
Counties and activists alike argue a bill as transformative as CARE Court should have more than just five months of deliberation. They want lawmakers to hear about the realities of the current behavioral health infrastructure straight from county leaders and people on the ground who work with these communities every day.
Rodriguez said the bill outlines a sort of trial period for CARE Court before it goes into effect in every county.
"The state would pick a couple of counties to pilot the program," he said. "I can't speak if Riverside wants to do it or not, but I personally wouldn't mind being a part of a pilot program. But only if they're going to give us the resources to do it."
He adds, "We're far more advanced than many jurisdictions in the state when it comes to the continuum of care on homelessness and housing."
The county frequently sends behavioral health workers to embed with local police, including the Palm Springs Police Department, to act as an alternative to jail and to provide a pathway to housing for people on the street.
"We also just finished the 24/7 inpatient and outpatient sobering center known as the Arlington Recovery Center in Riverside," said Rodriguez. "We have plans to build one in Hemet and another in Coachella."
The county also has three 24/7 walk-in crisis mental health clinics, including one in Palm Springs that is close to reopening after switching providers.
The county already has much of the crucial behavioral health groundwork, so Rodriguez said that should make it easier to transition to CARE Court when it passes.
"In a perfect world, if it passes and it's fully funded, it wouldn't change how we do stuff in the county. It would just be another tool in the toolbox."
A homeless Black woman is detained by police in Palm Springs in June. Critics say programs such as CARE Court often do more harm than good in communities of color.
Harm to those most vulnerable?
Funding issues aside, other critics say CARE Court has deeper issues. Chief among them is the fear that the program could perpetuate harm against groups vulnerable to institutional racism.
A coalition of more than 40 organizations, including the American Civil Liberties Union (ACLU), Human Rights Watch, and Disability Rights California, strongly condemned the proposal. Their major concern with the bill is its perceived reliance on involuntary treatment.
"CARE Court is a system of coerced, court-ordered treatment that strips people with mental health disabilities of their right to make their own decisions about their lives," read a joint letter from a coalition of opponents.
One of the significant red flags for activists is the couched language around involuntary treatment. They say lawmakers were careful to make it seem like a voluntary program while still allowing doctors, family members, police, and judges to commit participants to treatment without their consent.
"CARE Court is not voluntary if it begins with court involvement – a petition filed against the person supposedly being helped – and conditions compliance for specific treatment under court orders," opponents concluded in the letter, stressing that voluntary treatment is proven to have better outcomes than involuntary or coerced treatment.
"Have you ever been to a locked down mental health institution? It is like a jail," said Shonique Williams, founder of the NO CARE Court Coalition. "These folks are not free to go. They are not free to move at their liberty. They are told when to wake up and when to go to sleep, they are told when to eat, they are told when to shower."
Experiences like that, critics say, are traumatic and may even dissuade participants from seeking voluntary treatment in the future.
Rodriguez understands those concerns, but points to the alternative.
"I get their argument," Rodriguez said. "I'm not for forced incarceration, either. But it's my opinion that it's more of a violation of civil liberties to let people die on the street not knowing who they are or where they are."
Williams sees it differently because she's been through the system. She was homeless at 15 after enduring more than a decade of sexual abuse.
"I knew my mental health was in jeopardy," she said, "But you can't focus on that when you're concerned for your safety. I needed food, shelter, and resources before that."
Williams tried to break through to lawmakers during a short presentation before the California State Assembly Committee on Judiciary, warning them, "This was a ridiculous idea to bring this forward in such a short timeframe."
Williams, a Black woman, asked the committee how they could rush through the legislation without speaking to people like her who will be directly affected by its passage: "There is not one person sitting in front of me that is from the Black community."
"Black, Indigenous, and People of Color (BIPOC) and immigrant racial minorities are more likely to be diagnosed, and misdiagnosed, with psychotic disorders than white Americans because of clinicians' prejudice and misinterpretation of patient behaviors."
Ghaly said he takes those concerns seriously and proposed better training and standardized tools to ensure everyone is treated equitably.
"We will not change these systems overnight," he said. "We should challenge ourselves to improve our understanding of how these debilitating illnesses impact different groups differently."
Instead of CARE Court, activists said they want to see more funding for grassroots community-based mental health treatment and a true housing first approach rather than the $65 million already promised to CARE Court in the state budget.
"We should take that $65 million and give $1 million to different organizations throughout the state already doing this work, and I promise you we would do some amazing things with it," said Williams.
Most activists don't think the bill in its current form can even be salvaged. Even though many, especially those that are formerly homeless, understand how urgent the homelessness crisis is. Instead, they want lawmakers to take their time to craft legislation with more input from communities.
Williams added near the end of the ACLU forum, "Some of these people think they're providing care, and they think they know best. But they're inflicting harm. You can't correlate forced treatment and medication with care, especially to someone who can't advocate for themselves. That's not care."
Editor's note: We've updated this story to reflect passage of the bill.
Kendall Balchan
Kendall was born and raised in the Coachella Valley and brings deep local knowledge and context to every story. Before joining The Post she spent three years as a producer and investigative reporter at NBC Palm Springs. She attended both College of the Desert and the University of Oregon.
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