Orange, Riverside among first counties that will implement mental health courts

Over the next few years, California’s 58 counties will need to set up new court system proponents say will help people with severe mental health conditions find both housing and care.

Orange and Riverside are among the first counties tasked with implementing such programs.

Gov. Gavin Newsom signed his mental health plan into law on Wednesday, Sept. 14, establishing a new court program that propels — advocates say connects; opponents say forces — unhoused people with severe mental health or substance abuse disorders into treatment.

“This problem is solvable,” Newsom said from the bill signing in San Jose. “We can meet this moment, and we can create many many moments in the future to do justice to those that need us and are suffering and are struggling.”

The new law allows family members, first responders, social services or other authorized adults to petition a court to enroll a person with a severe mental illness, such as schizophrenia and other psychotic disorders, into a CARE program. The CARE plan, which includes housing, medication and support services, can be ordered for up to 24 months.

The idea is to help people with such severe mental health disorders that they lack the ability to make medical decisions, proponents have said. It’s not just for homeless people, but it is tailored only for people with severe mental health disorders who are not likely to survive in the community without help or are at risk of harming themselves or others.

Now, homeless people with severe mental health disorders can be held at psychiatric hospitals for up to three days — released if they promise to take medication and follow up with other services — and bounce from jails to hospitals to the streets.

Orange, Riverside, San Diego, Glenn, San Francisco, Stanislaus and Tuolumne counties are the first seven that must implement the CARE Court program, beginning October 2023. The other counties must commence the program by December 2024.

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Sen. Tom Umberg, who authored the legislation, said Orange County’s Be Well OC mental health care facility positioned it in a “unique” position where it made sense for it to be one of the inaugural areas to implement the CARE program, a first-of-its-kind program in the U.S.

And although about 7,500 to 12,000 people in California have schizophrenia or similar illnesses, Umberg said, the number of families impacted “is exponentially larger than that.”

“This bill is about providing a stable environment with accountability for people to get well,” Umberg, D-Santa Ana, told the Southern California News Group. “That’s one of the things that has been lacking: We’ve got a whole bunch of different programs, but the one thing this adds to the equation is accountability.”

“Orange County has experience and has done quite well with collaborative courts which are alternatives to the normal criminal justice system,” Umberg said.

Too far or not far enough

But Republicans and civil liberty groups have expressed concerns about the impact the CARE Court program could have.

Eve Garrow, a senior policy analyst and advocate at the ACLU of Southern California, said the program “unravels” progress made over the past several years by disability rights groups. Garrow said the focus should be on providing permanent, safe and affordable housing for those struggling with mental health conditions, not on mandated treatment.

“A proposal that ties necessary mental health treatment and housing to courts is actually retrograde and will take Orange County back to an era when the forced treatment of people with serious mental health conditions is the norm,” Garrow said in an interview.

Garrow warned the CARE Court program could have a “chilling” impact on healthcare utilization.

“What could happen is people who have a mental health diagnosis might avoid the health care system and mental health and behavioral health care systems because they know that providers have the power to refer them to court,” Garrow said.

Assembly Republican Leader James Gallagher said the program was “better than nothing” but maintained it is a “new bureaucratic half-measure.”

“It’s not the groundbreaking policy change we need,” Gallagher said. “It will help some severely mentally ill people get treatment but will not stop the explosion of homeless camps in our communities. If we’re really going to make a difference, we need to reform our conservatorship laws by changing the definition of ‘gravely disabled’ to get people the mental health and drug addiction treatment they need.”

California defines “gravely disabled” as a “condition in which a person, as a result of a mental health disorder, is unable to provide for his or her basic personal needs for food, clothing or shelter.”

Human Rights Watch, Disability Rights California and other organizations that work with homeless people, minorities and people with disabilities also opposed the new law.

For Michelle Doty Cabrera, the executive director of the County Behavioral Health Directors’ Association of California, the CARE Court’s success is contingent upon cooperation.

“Californians are counting on our success with this initiative as a part of the state’s broader efforts to address homelessness,” Cabrera said in a statement. “Success will depend in large part on our state partners’ commitment to improve the availability of housing for county behavioral health clients, addressing the behavioral health workforce crisis, and investment of new funds to administer CARE Court without siphoning resources from the hundreds of thousands of county clients already counting on the vital behavioral health and substance use disorder services we provide.”

Counties that do not set up these special courts could be fined up to $1,000 per day.

Newsom is up for re-election this year in a race he’s expected to win easily. But questions have continued to mount about potential presidential aspirations in 2024.

The Associated Press contributed to this report. 

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