California’s new mental health court rolls out to high expectations and uncertainty

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California has initiated a novel mental health court program named “CARE Court,” a part of the state’s extensive efforts to tackle the homelessness crisis. This program, created by Democratic Gov. Gavin Newsom, aims to expedite the provision of housing and medical care to individuals with untreated schizophrenia and related psychotic disorders, even if it necessitates involuntary intervention. Implemented in seven California counties, including San Francisco, the CARE Court has drawn both optimism and skepticism.

Families of individuals diagnosed with severe mental illnesses have welcomed the new legislation as it empowers them to request court-ordered treatment for their loved ones. Simultaneously, concerned residents, witnessing the plight of approximately 171,000 homeless individuals in California, have expressed hope that this program could provide much-needed assistance and alleviate the homelessness crisis.

However, critics have voiced their concerns, labeling the program as ineffective and potentially coercive due to its ability to mandate treatment. As the program commences, uncertainties loom over its potential beneficiaries and effectiveness, primarily due to its narrow eligibility criteria. Eligibility primarily extends to individuals with untreated schizophrenia and related disorders, excluding those with severe depression, bipolar disorder, or addiction as standalone conditions.

Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, elucidated that the program’s objective is to intervene before individuals’ conditions deteriorate further. Family members and first responders can now file petitions on behalf of adults they believe are at risk and rapidly deteriorating. Eligibility hinges on the presence of a diagnosis within the schizophrenia spectrum or other qualifying disorders, irrespective of homelessness.

Each county will establish a special civil court to assess these petitions, with the county behavioral health agency determining eligibility. Appointed legal representation and a support person of the individual’s choice will accompany the process. If deemed eligible, individuals will collaborate with the county on a voluntary plan encompassing housing, medication, counseling, and social services, lasting up to a year, with the possibility of extension.

Civil rights advocates have expressed concerns about the potential coercion of vulnerable individuals into treatment. Failure to adhere to the plan could result in conservatorship and involuntary treatment, although the court may dismiss proceedings if the individual declines participation.

Despite the allocation of funds for emergency shelters, critics argue that there remains a consistent shortage of case managers, appropriate in-patient treatment facilities, and supportive housing. San Francisco reports that only about 10% of over 2,500 beds are available for new occupants, spanning detox to step-down care. Detractors contend that the state should have prioritized investments in housing and existing services over establishing a new court system.

In cases where individuals are ineligible for CARE Court, the National Alliance on Mental Illness in California urges perseverance, emphasizing that alternative resources may be accessible to support their loved ones.

Seven counties, including San Francisco, Orange, San Diego, Riverside, Stanislaus, Tuolumne, and Glenn, have initiated the CARE Court program. Los Angeles County is set to commence its program on December 1, with an estimated 1,800 to 3,100 people eligible in the initial seven counties and potentially 3,600 to 6,200 in Los Angeles County. The rest of the state has until December 2024 to establish mental health courts as part of this significant endeavor to address mental health and homelessness issues.

Frequently Asked Questions (FAQs) about mental health court

More about mental health court

• California’s Mental Health Court Program (CARE Court) Official Information
• California Governor’s Office – News Release on CARE Court
• News Article on the Launch of CARE Court
• National Alliance on Mental Illness (NAMI) California
• Disability Rights California