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EDITORIAL: Newsom's CARE Court a start, but program needs to address shortcomings

Santa Cruz Sentinel - 9/19/2022

Sep. 19—Political stunt or true reform of California's lagging mental health system?

Or, could the new CARE Court (CARE is the acronym for Community Assistance, Recovery & Empowerment) system signed into law by Gov. Gavin Newsom last week be a game changer in getting help for the homeless mentally ill frequently struggling on our streets? The new system will allow courts to order people found in crisis to submit to treatment —including people living on the streets who often won't voluntarily agree to accept care. But CARE Court also faces likely challenges.

For Newsom, who first advanced the program last March, establishing the court is seen as another step forward in his ever-more-obvious attempt to show he is presidential fodder.

Politics aside, few of us would argue that too many people living on our streets, including in homeless encampments, have serious mental health challenges and that they aren't getting the kind of help they need. The state estimates between about 7,000 and 12,000 Californians would be eligible for CARE Court.

The program targets people with severe, untreated schizophrenia and other psychotic disorders and allows their families, first responders and other stakeholders to refer them to CARE Court where a judge could then order them to follow an individually tailored plan that addresses their mental health and substance abuse treatment, medication and, hopefully, housing needs.

The plan would last for one year and could be renewed for a second year. If a patient does not comply with requirements, they could be referred to a more restrictive form of treatment in a locked facility —or jailed if they have a pending criminal case. Participants in the program, however, cannot be forcibly medicated or jailed solely for refusing to comply with a treatment plan.

The first CARE Courts must be set up by Oct. 1, 2023, in seven counties (San Francisco, San Diego, Orange, Riverside, Stanislaus, Tuolumne and Glenn) with the rest of the state, including Santa Cruz County, required to follow by Dec. 1, 2024. Newsom budgeted $63 million to help counties roll out the new system, although many counties have voiced concerns that this won't be enough or that treatment facilities and housing just won't be there for patients.

Newsom also has set aside $1.4 billion to hire, train and retain new social workers, counselors and other employees to help overcome the state's shortage of mental health care workers.

The legal challenges will likely come from the ACLU and other civil rights groups, who say the system is coercive and unduly takes away patients' rights to make decisions on whether to accept treatment.

The real problem, critics say, is a lack of adequate shelter for homeless persons. No doubt. The legislation would face broader support if it required some form of housing in place for homeless people suffering from mental illnesses. Instead, it sets housing as a priority, which won't do much to increase the state's woefully inadequate supply of shelter or treatment beds.

And it could cost hundreds of millions of dollars to meet the needs for housing and psychiatric beds that will be created under the Newsom CARE Court program, a state Senate analysis found.

But what's the alternative? As many cities know all too well, the cycle of life on the streets, short jail stays, infrequent access to scarce psychiatric facilities is not working. Depending just on self-determination also doesn't do much for those who clearly need treatment and aren't receiving it, while endangering their lives and others.

California needs ambitious policies to address its housing and homelessness crises and bolster psychiatric care. CARE Court, while providing new hope for families, first responders and providers who have been unable to get people to voluntarily enter treatment, could address some of these issues.

Ultimately, though, CARE Court's success in alleviating the mental health crisis on our streets will depend not just on court systems, or even more trained mental health professionals, but upon the resolve of Newsom and legislators to address the need for more treatment facilities and shelter.


(c)2022 the Santa Cruz Sentinel (Scotts Valley, Calif.)

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