Newsom Signs 'CARE Court' Plan, Overhauling Mental Health Care in California

Updated Wednesday 2 p.m.

Gov. Gavin Newsom signed a controversial bill Wednesday overhauling the state's approach to mental health care for people diagnosed with schizophrenia and other psychotic disorders.

The state Senate last month approved the Community Assistance, Recovery and Empowerment Act, which will allow family members and first responders to ask a judge to draw up a treatment plan for people deemed to be suffering from those disorders. Those who refuse could be placed under a conservatorship and ordered to comply.

Currently, unhoused people with severe mental health disorders can be held against their will at psychiatric hospitals, but must be released after three days if they promise to follow up with other services and take prescribed medication.

The new law will let a court order a treatment plan for up to two years, which may include medication, housing and therapy. Participants will have access to a public defender and an advocate to help make decisions about treatment programs and housing. In turn, the behavioral health department in that county would be compelled to provide treatment.

While it shares some elements of mental health programs in some other states, California's new system will be the first of its kind in the country, according to state Sen. Tom Umberg, D-Santa Ana, who co-authored the law.

Standing outside Momentum for Health, a nonprofit mental health care provider in San José, Newsom on Wednesday said the bill was about redesigning a broken system that often leaves people cycling among homelessness, jail and emergency rooms. 

"I'm not interested in the status quo," he said. "I'm not interested in the compassionless-ness of the approach we have today of people moralizing and normalizing that suffering on the streets and sidewalks."

But critics of the bill say it coerces people into care, which is less effective than voluntary treatment, and doesn’t provide the necessary health and housing resources.

James Burch, deputy director of the Anti Police-Terror Project, which is part of a statewide coalition opposing CARE Court, called the bill's signing "devastating."

“It ignores the very stark reality that we're living in in this moment,” he said. “We are tens of thousands of beds short in the Bay Area of the permanent housing that we need. … And we are woefully short on voluntary treatment programs.”

Gov. Gavin Newsom introduced the proposal in March. It passed the Legislature with overwhelming support, despite vehement opposition from disability rights and homeless advocates.

"It was just a matter of months ago that we stood right here and we laid out a vision," Newsom said Wednesday. "And here we are. We've made it a reality, and that is rare in politics, particularly on issues as vexing and challenging as this issue."

Santa Clara County Superior Court Judge Stephen Manley said every day he sees people caught in a cycle of homelessness, jail and emergency rooms, without ever getting the adequate care or housing they need. Manley oversees a mental health care diversion court for people awaiting trial for suspected crimes. 

"I think this is a major step towards building a system that is going to be effective, as opposed to the present system," Manley said, "where these individuals simply cycle through our jails over to the emergency room of a hospital, back to the streets, back to the jail, back to the hospital. And it doesn't stop."

Assemblymember Suzette Martinez Valladares, R-Santa Clarita, said CARE Court was coming 10 years too late. She shared the story of her cousin, a Vietnam veteran, who was homeless and living in an encampment for five years before he died.

"I wish that my family had the tools that this bill is going to bring forward so that he might still be alive and with us," she said, adding, "But there's more work to be done. This bill is great, but we need resources for the programs, for the services, for the workforce that doesn't currently exist."

The state faces a shortage of not only psychiatric facilities, but also the health care staff needed to operate those facilities. And Newsom’s administration estimates that between 7,000 and 12,000 people across the state will be eligible for CARE Court. 

“We're guessing there will be demand for this,” said Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California. “There's not a lot of give in terms of our workforce currently.”

The state is allocating $65 million to implement CARE Court within the judicial system, as well as additional money for county behavioral health care agencies, which would manage cases. To help pay for start-up and training costs, the first seven counties to implement CARE Court will receive $26 million, with another $31 million going to counties across the state, Doty Cabrera said.

Those first seven counties are Glenn, Orange, Riverside, San Diego, Stanislaus, Tuolumne and San Francisco, which will implement CARE Courts by Oct. 1, 2023. The remaining counties would have until Dec. 1, 2024.

“And, there’s an ongoing conversation around long-term funding,” Doty Cabrera said. The bill now requires the state to provide funding to county behavioral health care agencies for programs and services before counties are required to implement CARE Court. “What that is, what it looks like, how much — all of that is still to be worked out between counties and the state,” she said.

The other looming question is housing. The current version of the bill allows judges to order other government agencies, such as housing authorities, to prioritize CARE Court participants for housing. But in more rural parts of the state, housing with the appropriate services just doesn't exist, Doty Cabrera added. 

"Who exactly are we going to pull into the order?" she said. "No one. There is nothing."

Last year, nearly 14,000 people experiencing homelessness voluntarily sought mental health services, but only half were placed into housing, according to a survey conducted earlier this year by the County Behavioral Health Directors Association of California.

Beyond the logistics, members of the Assembly grappled with CARE Court's reliance on the judicial system. Although voluntary, the legislation also comes with a threat: Continued refusal could be used as a justification for conservatorship, where people could be forced into care against their will.

"At what point does compassion end and our desire to just get people off the streets and out of public sight begin?" said Assemblymember Al Muratsuchi, D-Torrance. "I don't think this is a great bill, but it seems to be the best idea that we have at this point to try to improve a god-awful situation."

Others worry whether it will do more harm than good, by disproportionately affecting Black residents in the state, who are diagnosed with schizophrenia, on average, three to four times more often than white residents. Black residents also represent 30% of those experiencing homelessness in the state, but only 6.5% of the general population. 

“It’s Black men, Black trans folks, Black folks in general who will be the ones who are disproportionately forced into CARE Court and disproportionately affected by this horribly myopic legislation,” said Burch, of the Anti Police-Terror Project. 

The bill requires an annual report on CARE Court, along with an independent, research-based entity to evaluate the effectiveness of the program, including “through the lens of health equity” to identify racial bias. 

Now that CARE Court has been signed into law, Doty Cabrera said it will be critical to keep those concerns in mind as counties try to imagine all of the program's "unknown variables."

“This is sort of like Chapter One of a novel,” she said. “We'll be working on this for a long time to come.”