A new initiative known as the “CARE Court” program, introduced in seven California counties, including San Francisco, aims to expedite the placement of individuals with untreated schizophrenia and similar psychotic disorders into housing and medical care, potentially even without their consent. This initiative, created by Democratic Governor Gavin Newsom, is part of a larger effort to address the homelessness crisis in California. Despite concerns about the inadequacy of housing and services, lawmakers approved it as a novel approach to assist individuals experiencing apparent psychotic episodes in public.
This new law is welcomed by families of those diagnosed with severe mental illnesses because it allows them to petition the court for treatment on behalf of their loved ones. It also brings hope to residents dismayed by the large homeless population in California, as it presents the possibility of providing assistance and shelter to those living on the streets.
However, critics argue that the program is ineffective and could coerce people into treatment. The effectiveness and beneficiaries of the program remain uncertain as petitions start to roll in, largely because the eligibility criteria are narrow, primarily targeting individuals with untreated schizophrenia and related disorders, excluding severe depression, bipolar disorder, and addiction as qualifying conditions.
The “CARE Court” program is designed to intervene early in deteriorating mental health conditions. Eligibility for this program includes adults believed to be in danger without supervision due to rapidly deteriorating mental health or those in need of support to prevent a relapse that would likely result in severe harm, even if not homeless. Eligible individuals must have a diagnosis within the schizophrenia spectrum or related disorders, but homelessness is not a prerequisite.
Each county will establish a special civil court to review petitions, with the county behavioral health agency determining eligibility. The individual in question will be provided with legal representation and the option to choose a support person. If eligibility is confirmed, the person will work with the county on a voluntary plan that includes housing, medication, counseling, and other social services, with the potential for a one-year extension.
Critics are concerned about potential coercion into treatment, but the statute allows for dismissal of proceedings if the individual declines to participate or follow the agreement. Building a rapport with eligible candidates may take time, and judges have the flexibility to grant extra time for voluntary agreements.
While the state has allocated funds for emergency shelters, critics argue that there is a chronic shortage of case managers, suitable in-patient treatment facilities, and supportive housing. Some argue that instead of establishing a new court system, the state should have invested in more housing and existing services.
For those who do not qualify for the “CARE Court” program, the National Alliance on Mental Illness in California suggests that other resources may still be available to assist their loved ones in accessing treatment and support.
The program has been launched in San Francisco, Orange, San Diego, Riverside, Stanislaus, Tuolumne, and Glenn counties, with Los Angeles County set to begin on December 1. Initial estimates suggest that approximately 1,800 to 3,100 people may be eligible in the first seven counties, with Los Angeles potentially increasing this number to 3,600 to 6,200, though actual uptake may take time. The remaining counties in the state have until December 2024 to establish their own mental health courts.
