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Newsom’s mental health courts win Legislature’s approval. Here’s what they’ll do

Sacramento Bee - 8/31/2022

California will likely soon have a new program to compel counties to treat those suffering from severe mental illness, an idea that’s drawn vehement objections from homeless and disability rights advocates.

The Assembly voted 62-2 on Tuesday to approve Gov. Gavin Newsom’s Community Assistance, Recovery and Empowerment Court program, which would create mental health courts and require California’s 58 counties to provide treatment for those suffering from psychotic disorders and those on the schizophrenia spectrum.

The Senate approved Assembly amendments 40-0 on Wednesday, sending Senate Bill 1338 to Newsom for final approval.

Newsom cheered the bill’s passage, saying it “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.”

The governor first proposed CARE Court in March and has been pitching it as a way to help alleviate the state’s homelessness crisis. His office estimates 10,000 to 12,000 people would qualify for the program, but county offices say the number could be as high as 50,000, according to the Assembly floor analysis.

Various people could refer Californians to CARE Court for treatment, including family members, emergency first responders and mental health professionals.

Individuals accepted into CARE Court would receive one-year care plans from county behavioral health departments that would include mental healthcare, medication, housing and other services.

Those who decline to participate could be referred to the state’s existing system for untreated mental illness, which includes involuntary hospital stays and conservatorships.

The 2022 budget provides $39.5 million in start-up funding for CARE Court and $37.7 million in ongoing support, the floor analysis said. The Judicial Council of California estimates courts would need $40 million to $50 million to conduct additional hearings.

The program would be phased in, with Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne counties designated as the first to implement CARE Court by October 2023.

CARE Court opposition and support

Disability rights advocates have strongly opposed CARE Court, which they say would force treatment on people who may not want it, which could result in poor outcomes.

“CARE Court is antithetical to recovery principles, which are based on self-determination and self-direction,” Disability Rights California wrote in an opposition note in the Assembly floor analysis. “The CARE Court proposal is based on stigma and stereotypes of people living with mental health disabilities and experiencing homelessness.”

California county administrators have also expressed concerns about implementation when the existing behavioral healthcare system is already strained. Some disability rights and homeless advocates have also expressed frustration about the program’s lack of a housing requirement, which they say is sorely needed.

But Newsom and his team emphasize that CARE Court would be an important alternative to sending Californians with severe untreated mental illnesses to jails or hospitals.

“The idea is we should be able to serve more people before they have to be incarcerated and held against their will, with a very similar suite of services, frankly, that people can receive in state hospitals, or in prison, or in conservatorship,” Jason Elliott, a senior counselor to Newsom, told The Sacramento Bee in April.

“So let’s just take what we know works, what the evidence has shown to work, what clinicians tell us works, and just provide that before someone is in handcuffs.”

Assembly debates CARE Court

Assemblymembers were largely supportive of CARE Court, referring to friends and family members who have struggled to navigate the state’s mental healthcare system. Many praised the program as a way to help alleviate the state’s homelessness crisis.

“It’s frustrating to hear these groups out here that don’t want to do anything,” said Assemblyman Jim Cooper, D-Elk Grove. “They want these people to have freedom. They’d rather have them walking around outside — as you see downtown — with no clothes on, eating out of trash cans, walking in and out of traffic, in the name of freedom. Someone has to be the adult in the room.”

Assemblyman Al Muratsuchi, D-Torrance, said he voted in favor of the bill with “very mixed feelings.” He talked about a college roommate who was suicidal and underwent a traumatizing involuntary hospital stay.

“At what point does compassion end and our desire to just get people off the streets and out of our public sight (begin)?” Muratsuchi asked.

He said mental healthcare and homeless advocates always say the No. 1 priority is securing housing for vulnerable populations.

“Here on this floor, whenever we talk about housing, we spend so much more time debating the difference between prevailing wage versus skilled and trained labor,” Muratsuchi said.

“We’re not talking about what it’s going to take to actually get a roof over the heads of all the people on our streets who are struggling with mental health issues.”

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