CARE Court Offers A Way To Get Family Members With Severe Mental Illness Into Treatment. Is LA Ready?

A highly anticipated — and controversial — new program, championed by Gov. Gavin Newsom, will begin in Los Angeles County on Dec. 1. It’s called CARE Court and will allow family members to ask a judge to step in with a treatment plan for loved ones living with severe and untreated mental illness.

The basics of CARE Court: People living with a serious and untreated mental illness, like schizophrenia, could be referred for a court-ordered, voluntary care plan that could last up to two years. The petition could be filed by people including county behavioral health workers, first responders or family members.

“I would have had my petition by the first day,” Mike Estrada said from his home in Berkeley.

A feeling that the process is ‘a constant slap in the face’

For years, Estrada struggled to get help for his mother, Josie Estrada, who lived with schizoaffective disorder. The experience exasperated him so much that in 2020 he produced a one-hour documentary on her story, Benevolent Neglect.

The film is sprinkled with grainy family footage and stills of Josie’s life in California’s Central Valley. Estrada points out that his mother was “adored by the family.”

The documentary also includes videos shot on Estrada’s cellphone during some of Josie’s more difficult moments.

“In 2007, my mom began experiencing hallucinations. During acute episodes, she’d hear people inside the house,” Estrada tells the camera.

Estrada said the voices would tell his mother not to take her psychiatric medications. For more than a year, Josie lived out of her car after her erratic behavior got her evicted from her apartment. Time and time again, Estrada would plead with first responders to hospitalize her.

Often the people who were supposed to help would be hamstrung by a lack of psychiatric beds and what Estrada sees as overly strict criteria for hospitalizing someone against their will.

“As a family it’s just a constant slap in the face. Constant disrespect. In the meantime, our loved one is suffering, deteriorating before our eyes,” Estrada said.

His mother died in 2019, but he’s hopeful CARE Court will give families like his more leverage to get help.

Gov. Gavin Newsom speaking in March 2022 with local mental health service providers and officials about CARE Court.

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Robert Garrova / LAist

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Officials report an ‘unprecedented demand’

There are concerns, however, about whether the county’s behavioral health care system will have enough staff to meet the need.

In June, L.A. County supervisors voted to expedite hiring for CARE Court.

“In order to meet a variety of our expectations, including CARE Court — we’re focused on setting up the court infrastructure — the point is the judge will have to have a place to send that individual,” Supervisor Holly Mitchell said during the board meeting.

“I think the supervisors were right to be concerned about what kind of infrastructure is in place,” Dr. Lisa Wong, director of the L.A. County Department of Mental Health, told LAist.

“We’ve been having this unprecedented demand for mental health services in our system, so we know that the system is stretched. And we know that with CARE Court, we’re going to be working with some really high acuity individuals,” Wong added.

Wong said hiring has improved this year, but it’s still a major stress point as the county works to bring thousands more behavioral health beds online. And, Wong points out, the initial petition is just the beginning.

“What happens when that person has to go into treatment and how do we keep them engaged?” she said.

Defense attorneys' role

Some of that help will come from the new Independent Defense Counsel Office, which is separate from but administered by the Public Defender’s Office.

A new panel of about 50 specially selected attorneys will work with an estimated 1,900 respondents within the first six months of CARE Court.

“It will not only be there to represent the client’s legal interests and protect their civil liberties, but also to serve as a facilitator and an encourager and a supporter throughout the treatment program,” said Marco Saenz, Independent Defense Counsel program director.

He said those lawyers might encourage respondents to follow through with treatment, but they’ll also work to hold the behavioral health system accountable in providing services.

But the success of CARE Court will ultimately hinge on the participant

“Under the statute, the respondent can walk away at any time,” Saenz told LAist. “It’s completely voluntary. How that will work, we will see.”

Coercion or voluntary?

CARE Court may be voluntary, but civil liberties groups continue to warn about stripping of individual rights.

If the care plan fails, the person could be hospitalized or referred to a conservatorship. That could mean forced treatment down the line.

Some 40 groups including JusticeLA, Disability Rights California and ACLU California Action signed a letter in 2022 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.”

Mike Estrada would have been OK with conservatorship for his mother.

“I wanted her to have some chance of building her life back. And there was no way it was going to happen without her being stabilized,” Estrada said.

Mike and Josie Estrada.

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Courtest Mike Estrada

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There are also continued concerns about whether the public guardians’ offices throughout the state will be able to handle the potential increased conservatorship caseload. Public guardians' offices are responsible for guiding care for people who are deemed unable to do so themselves because of a serious mental illness.

“Everybody keeps saying, ‘We need facilities, we need facilities, there’s no room at the inn.’ And that’s true. If you talk to my members throughout the state, they are struggling to find placements,” said Tom Scott, executive director of the California State Association of Public Administrators, Public Guardians, Public Conservators.

What's next

As CARE Court continues to roll out across the state, Estrada wants families like his to be allowed input in the process. And he wants to see counties held accountable for making it work.

Some counties, including San Diego, San Francisco and Orange County have a head start on L.A., because their CARE Court efforts launched in October.

According to California Health and Human Services, as of early November, there were a total of 80 CARE Court petitions statewide.

Saenz said the case volume in some places outside of L.A. County has been lower than what was anticipated.

But as a nearly 30-year veteran public defender who has represented “innumerous” clients living with mental illness, Saenz said he’s holding out hope that CARE Court will be able to help a population that is not generally reached.

“It’s another tool in our toolbox, and to the extent that we’re participants in it ... we’re going to be there to be supportive in any way we can,” Saenz said.

“But time will tell.”