There’s a bill making its way through the state legislature that aims to create new avenues for people living with a serious mental illness to get life-saving treatment.
The plan, first introduced by Governor Gavin Newsom in the spring, is called the Community Assistance, Recovery and Empowerment Act -- or CARE Court for short.
But the proposal, which has seen broad support so far from California lawmakers, remains very controversial, even as it clears major milestones in Sacramento.
The bill cleared the Senate unanimously in May and easily advanced out of the Assembly Judiciary Committee. The measure is expected to hit the governor’s desk this fall.
Here are the basics of the bill as it stands now: People living with a serious, untreated mental illness could be referred for a court-ordered care plan that would, after psychiatric screenings, last up to two years. The court intervention could be initiated by a family member, county behavioral health workers or even first responders. If the care plan fails, the person could be hospitalized or referred to a conservatorship. That might mean forced treatment and a stripping of individual rights.
During a press conference announcing the CARE Court plan in March, Newsom said it would be aimed at helping people who live with the most severe mental illness, like schizophrenia: “Folks that just simply can’t help themselves,” he said.
Mark Ghaly, Secretary of the California Health and Human Services Agency, said CARE Court could help between 7-12,000 Californians.
“One of the key tenets of CARE Court is to prevent, avoid conservatorships,” Ghaly told LAist.
Ghaly said there’s broad agreement that something needs to change. According to an analysis from the Kaiser Family Foundation, between 2018-2020, nearly 40% of adults living with a serious mental illness did not receive treatment.
But not everyone agrees more bureaucracy is the way forward.
A Long-Standing Tension
The L.A. County jail system, where thousands of people living with a mental illness are incarcerated, has become a prime example for many of how our mental health care system is failing. Champions of CARE Court see it as a way for people to get mental health help before the criminal justice system steps in. But some criminal justice reform advocates see it as another flawed solution.
Protesters with JusticeLA and other criminal justice reform groups held a rally in front of the L.A. County Board of Supervisors offices earlier this month. Among other things, they called for the county to bring online 3,600 mental health treatment beds with the goal of diverting some of the people in L.A. County jails living with a serious mental illness.
Depending on the day, around 40% of the people incarcerated in the L.A. County jail complex live with a mental illness.
“I don’t think we need any more court infrastructure to get people the care we need. We need care infrastructure,” said Dignity and Power Now Executive Director Mark-Anthony Clayton-Johnson, who spoke at the rally.
“We need those beds, we need services that prevent people from going into jail in the first place,” Clayton-Johnson said.
Some 40 groups including JusticeLA, Disability Rights California and ACLU California Action signed a letter opposing CARE Court. It reads in part that the plan 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.”
California Senator Tom Umberg, co-author of the bill that would create CARE Court, said he’s fully aware of the controversy surrounding the plan.
“There’s a tension between the folks that are concerned about those who have mental illness and whether or not we are subjugating them to measures and those — particularly family members — who [have] tried everything and now are tearing their hair out because they don’t know where to go and what to do.”
Umberg said the voices of those family members of people living with a serious mental illness are stronger right now, at least in his mind.
New York University Associate Professor of Sociology Alex Barnard wrote an article that was published this year looking at how the debate around California mental health law surfaced in more than 500 newspaper pieces spanning the last five decades.
He said the back and forth has changed remarkably little.
“The sort of civil rights organizations are exactly as dug in and the families are just as dug in,” Barnard said.
Barnard is currently writing a book on involuntary treatment in California. From his research, he said it can be difficult to untangle where families’ struggles are tied to refusal of treatment and when an “incredibly complicated” mental health care system is more to blame.
Experts estimate California should have at least 50 psychiatric inpatient beds for every 100,000 people. According to data, from 2016, it only had about 17.
What’s more, a RAND study from last year found the state had a shortfall of roughly 4,800 “subacute and acute beds combined.”
In L.A. County, former director of the Department of Mental Health, Dr. Jonathan Sherin, said he’s working with about half of the treatment beds that are needed.
Barnard said in countries like France, which has a public mental health care system, they don’t need judges ordering people around because the care infrastructure means people are guaranteed treatment.
“I think in the U.S. we believe we can innovate our way out of crises,” Barnard told LAist.
“You know, at some point, there’s the question of: just what is the basic infrastructure? Where are the clinics? Where are the housing units? Who are the professionals?” Barnard said.
Barnard also questions whether CARE Court could put further strain on public guardians’ offices throughout the state. Those offices are responsible for guiding care for people who are deemed too unable to do so themselves because of a serious mental illness.
Putting The System “On The Hook”
Scarlet Hughes, executive director of the California State Association of Public Administrators, Public Guardians, and Public Conservators,
said she thinks CARE Court would open the door for more conservatorships in the state and doesn’t provide for any long-term funding for a system that’s already struggling.
“Every single one of my members, every single county is having enormous problems finding appropriate placements for their clients,” Hughes said. “At all levels of care... We have people sitting in, say, an acute care hospital or in the jail longer than they should because we can’t find placement for them.”
Hughes said caseworkers at public guardian offices around the state currently have as many as 85 cases to manage each. She said her group has a current ask for $200 million in the state budget, but the Newsom administration has said it’s unwilling to take on any ongoing funding.
Even without CARE Court, Hughes thinks public guardians are underfunded in the state. “It’s just killing us,” she said.
In March, Newsom said CARE Court would come at a time of “unprecedented” investment in mental health.
According to a fact sheet for CARE Court, “it builds on Governor Newsom’s $14 billion multi-year investment to provide 55,000 new housing units and treatment slots as well as a more than $10 billion annual investment in community behavioral health services.”
But several mental health advocates still question whether there’s enough investment to expand services adequately enough to make CARE Court successful.
Lisa Dailey, Executive Director of the Treatment Advocacy Center, said that doesn’t necessarily mean the state shouldn’t stand up a plan like CARE Court.
Dailey said CARE Court could be a way of putting the mental health care system “on the hook” to provide services for people with the most severe mental illnesses who are currently being ignored.
“The fact that you would have trouble meeting the need doesn’t mean that you can ignore the need,” Dailey said. “The courts have the ability to demand that things be funded and they have the ability to order that services be provided.”
“Their Hands Are Tied”
Mental health advocate and writer Victoria Alonso grew up in Downey and now lives on California’s Central Coast. She’s also a new grandma. “My family is my most important thing,” she said with pride.
Alonso said that, back in the early 2000s, she suffered through hallucinations and thought she was receiving messages from god. In 2008, a team of doctors eventually diagnosed her with schizoaffective disorder, which she describes as now in remission.
Alonso likes the CARE Court provision that would allow family members to bring up concerns about their loved one’s mental health.
“Because so often people who suffer from a serious mental disorder that’s untreated, have no way to advocate for themselves,” Alonso said.
But Alonso worries that people could have unfair restrictions put on them if family members or other CARE Court petitioners don’t have their best interest at heart.
And she’s seen first hand Californians’ woes with a mental health care system that simply does not have enough capacity to meet the need.
About ten years ago, Alonso worked on a mobile mental health crisis team which went out on calls in Santa Barbara County. Oftentimes, she would respond to people who needed immediate care.
“I had to go two, three hours away to find them a bed,” Alonso lamented. “And they were suicidal and they needed help right away, so crisis teams, their hands are tied when there’s no beds.”
Alonso said she’d like to see more investment in preventative care and education so that maybe a court never has to enter the picture.
KPCC and LAist are part of the Mental Health Parity Collaborative, a group of newsrooms that are covering challenges and solutions to accessing mental health care in the U.S. The partners on this project include The Carter Center, The Center for Public Integrity, and newsrooms in Arizona, California, Georgia, Illinois, Pennsylvania, and Texas.
