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"content": "\u003cp>\u003cstrong>Here are the morning’s top stories on Monday, August 3, 2026\u003c/strong>\u003c/p>\n\n\n\n\u003cul class=\"wp-block-list\">\n\u003cli>California lawmakers are returning to Sacramento from summer recess on Monday — and a fight is already brewing over \u003ca href=\"https://www.kqed.org/news/12093409/inside-the-fight-for-the-future-of-californias-climate-dollars\">the future of the state’s climate fund.\u003c/a> Governor Gavin Newsom’s administration has changed environmental rules to prevent higher gas prices. And that could lead to less money for affordable housing, transit and other projects to reduce carbon emissions. \u003c/li>\n\n\n\n\u003cli>The executive board of the California Democratic Party threw its support behind Proposition 40, the so-called billionaire’s tax on the November ballot. If approved, the measure would impose a 5%, one-time tax on billionaires’ assets to pay for healthcare. \u003c/li>\n\n\n\n\u003cli>The CARE court mental health program has seen \u003ca href=\"https://laist.com/la-county-says-a-program-meant-to-help-people-with-serious-mental-illness-is-gaining-traction\">an increase in participation\u003c/a>, according to officials in Los Angeles County.\u003c/li>\n\u003c/ul>\n\n\n\n\u003ch2 class=\"wp-block-heading\">\u003cstrong>\u003ca href=\"https://www.kqed.org/news/12093409/inside-the-fight-for-the-future-of-californias-climate-dollars\">Inside the fight for the future of California’s climate dollars\u003c/a>\u003c/strong>\u003c/h2>\n\n\n\n\u003cp>As state lawmakers return to the Capitol from summer recess on Monday, Democrats are spoiling for a fight with Gov. \u003ca href=\"https://www.kqed.org/news/tag/gavin-newsom\">Gavin Newsom\u003c/a> over the future of California’s signature climate fund. \u003c/p>\n\n\n\n\u003cp>Less than a year ago, Newsom and the Legislature \u003ca href=\"https://www.kqed.org/science/1998536/newsom-signs-climate-energy-bills-charting-state-course-through-perilous-mid-transition\">extended\u003c/a> the cap-and-trade program to 2045, renaming it cap-and-invest — a clear signal about lawmakers’ thoughts on the fiscal benefits of \u003ca href=\"https://www.kqed.org/news/12052825/whats-next-for-californias-landmark-climate-program\">the system\u003c/a>. By requiring major polluters to purchase permits to account for their emissions, it raises billions of dollars a year for programs ranging from high-speed rail to affordable housing. \u003c/p>\n\n\n\n\u003cp>But the climate fund could shrink by as much as half due to new rules governing cap-and-invest, forcing lawmakers to make tough choices about how to spend the polluter proceeds — all while Newsom argues the program was never meant to be a permanent source of revenue. Their negotiations could come to a head in the next few weeks, before the final legislative session of the governor’s tenure comes to a close. \u003c/p>\n\n\n\n\u003cp>The cap-and-invest rules, \u003ca href=\"https://www.kqed.org/news/12085401/amid-opposition-california-regulators-approve-major-changes-to-cap-and-trade-program\">approved\u003c/a> by the California Air Resources Board this spring, are expected to drastically reduce the number of pollution permits, known as allowances, that are auctioned off to fill the Greenhouse Gas Reduction Fund over the next three years. Instead, more pollution allowances will be given away to companies covered by the cap, such as oil refineries and factories, to prevent them from leaving California. “There is tension here insofar as there was an effort to rebrand the program as cap-and-invest — and now there are some serious concerns about the magnitude of the investments that will be coming out of this program,” said Kyle Meng, a professor of environmental economics at UC Santa Barbara. \u003c/p>\n\n\n\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Newsom signed the reauthorization of cap-and-invest in September, as part of \u003ca href=\"https://www.kqed.org/news/12055461/california-lawmakers-reach-last-minute-deals-on-climate-energy\">sweeping negotiations\u003c/a> on climate and energy that included a bill meant to boost the state’s oil industry by making it easier to drill in Kern County. Air regulators at CARB got to work designing a cap that would allow the state to achieve its climate goals — including reaching net-zero greenhouse gas emissions by 2045 — while also \u003ca href=\"https://www.kqed.org/news/12053867/affordability-concerns-at-center-of-cap-and-trade-renewal-debate\">addressing affordability\u003c/a>, a top priority for lawmakers during last year’s reauthorization debate. \u003c/p>\n\n\n\n\u003cp>The first set of cap-and-invest rules unveiled in January drew fierce lobbying from the oil industry, which had already seen the \u003ca href=\"https://www.kqed.org/forum/2010101910826/california-considers-more-drilling-and-other-concessions-to-big-oil-as-gas-prices-rise\">closure of refineries\u003c/a> in Los Angeles and Benicia in the last two years that supplied roughly 20% of the state’s refining capacity. A Chevron executive \u003ca href=\"https://www.chevron.com/newsroom/2026/q1/californias-economy-faces-threats-with-new-energy-policy-changes\" target=\"_blank\" rel=\"noreferrer noopener\">warned\u003c/a> in a March letter that the regulations would “cripple the survivability of the state’s remaining refineries.” CARB’s final blueprint, approved in May, increased the free allowances granted to polluters over the next three years. It also created the Manufacturing Decarbonization Incentive, which could grant companies additional allowances above the cap if they make investments in clean air technologies. The initiative is still being developed, but critics worry it could increase emissions and depress demand for allowances. \u003c/p>\n\n\n\n\u003cp>The tradeoff is a decline in the allowances given to utilities (which help fund a Climate Credit on customers’ bills) and a significant drop in allowances auctioned off to fill the Greenhouse Gas Reduction Fund. As a result, CARB projects $2 billion annually will be deposited into the fund, roughly half the amount in recent years. \u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">\u003cstrong>CA Democratic Party leaders support billionaire’s tax\u003c/strong>\u003c/h2>\n\n\n\n\u003cp>The executive board of the California Democratic Party \u003ca href=\"https://cadem.org/california-democratic-party-endorses-insurance-commissioner-and-statewide-ballot-measures-ahead-of-2026-general-election/\">threw its support behind Proposition 40\u003c/a>, the so-called billionaire’s tax on the November ballot. If approved, \u003ca href=\"https://calmatters.org/california-voter-guide-2026/proposition-40-billionaire-tax/\">the measure \u003c/a>would impose a 5%, one-time tax on billionaires’ assets to pay for healthcare.\u003c/p>\n\n\n\n\u003cp>Supporters argue that the people who would pay the tax are the ones who benefited the most financially from recent federal tax reforms. Congress also cut tens of billions from Medicaid, known as Medi-Cal in California, which provides health insurance to low-income people. \u003ca href=\"https://www.kqed.org/news/12093303/the-union-man-taking-on-the-democratic-establishment-with-a-billionaire-tax\">SEIU-UHW argues\u003c/a> those cuts will cause hospitals and clinics to close, costing thousands of jobs and worsening access for all patients.\u003c/p>\n\n\n\n\u003cp>Opponents include Silicon Valley entrepreneurs, business interests, and some health and labor organizations. They say the proposal will backfire, causing billionaires to leave California and decreasing tax revenue in the long run. Health groups say they weren’t consulted in designing the measure and that it does not solve the long-term fiscal challenges of funding healthcare. The same groups backed propositions 41 and 42, competing measures that would place limits on new special taxes.\u003c/p>\n\n\n\n\u003cp>The proposal has split the Democratic Party. Progressives like Vermont Senator Bernie Sanders and Bay Area Congressman Ro Khanna support the measure. But Governor Gavin Newsom, gubernatorial candidate Xavier Becerra and a growing list of labor unions have spoken out against it.\u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">\u003cstrong>\u003ca href=\"https://laist.com/la-county-says-a-program-meant-to-help-people-with-serious-mental-illness-is-gaining-traction\">LA County says a program meant to help people with serious mental illness is gaining traction\u003c/a>\u003c/strong>\u003c/h2>\n\n\n\n\u003cp>After a slow start, a program that aims to bring thousands of Angelenos living with serious mental illness under court-led care has seen a spike in petitions filed in recent months, Los Angeles County officials said.\u003c/p>\n\n\n\n\u003cp>CARE Court allows family members, first responders and others to ask a court — by way of a petition — to step in with a voluntary care agreement for someone living with serious, untreated mental illness, such as schizophrenia, to receive community-based mental health services. If the agreement fails, a judge could order the individual to sign on to a treatment plan.\u003c/p>\n\n\n\n\u003cp>Since launching in L.A. County in December 2023, the program saw thousands fewer petitions each year than were initially projected. But county officials said petitions filed in L.A. County jumped by about 85% between November 2025 and March 2026, with March seeing a total of 68 petitions.\u003c/p>\n\n\n\n\u003cp>Martin Jones, a program manager with the L.A. County Department of Mental Health, attributed the increase to working with hospitals, first responders and other groups to identify and refer people who might need help. “We’re doing quite a bit of work to put tools in their hands to also help them identify and refer folks to us who might benefit from the support,” Jones told LAist. “I think we’re approaching the project from several fronts and we’re seeing the results of that.”\u003c/p>\n\n\n\n\u003cp>Proponents of CARE Court say it provides a less restrictive and structured way to stabilize people living with a mental illness, and they say the recent increase in petitions shows that the program is gaining traction. \u003c/p>\n\n\n\n\u003cp>Some mental health and civil liberties advocates don’t see it as a positive development. “The number of petitions says nothing about outcomes, which is the real point of the program,” said Eve Garrow, policy analyst at the ACLU of Southern California. “Positive outcomes are really miniscule compared to the population in need.” \u003c/p>\n\n\n\n\u003cp>Analysis of the program statewide has shown that about half of the petitions end up getting dismissed, but L.A. County officials say more than 4,000 Californians statewide have been set up with alternative county services when a CARE agreement or plan is not appropriate.\u003c/p>\n\n\n\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003c/p>\n\n",
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"innerHTML": "\n\u003cp>Less than a year ago, Newsom and the Legislature \u003ca href=\"https://www.kqed.org/science/1998536/newsom-signs-climate-energy-bills-charting-state-course-through-perilous-mid-transition\">extended\u003c/a> the cap-and-trade program to 2045, renaming it cap-and-invest — a clear signal about lawmakers’ thoughts on the fiscal benefits of \u003ca href=\"https://www.kqed.org/news/12052825/whats-next-for-californias-landmark-climate-program\">the system\u003c/a>. By requiring major polluters to purchase permits to account for their emissions, it raises billions of dollars a year for programs ranging from high-speed rail to affordable housing. \u003c/p>\n",
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"\n\u003cp>Less than a year ago, Newsom and the Legislature \u003ca href=\"https://www.kqed.org/science/1998536/newsom-signs-climate-energy-bills-charting-state-course-through-perilous-mid-transition\">extended\u003c/a> the cap-and-trade program to 2045, renaming it cap-and-invest — a clear signal about lawmakers’ thoughts on the fiscal benefits of \u003ca href=\"https://www.kqed.org/news/12052825/whats-next-for-californias-landmark-climate-program\">the system\u003c/a>. By requiring major polluters to purchase permits to account for their emissions, it raises billions of dollars a year for programs ranging from high-speed rail to affordable housing. \u003c/p>\n"
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"innerHTML": "\n\u003cp>But the climate fund could shrink by as much as half due to new rules governing cap-and-invest, forcing lawmakers to make tough choices about how to spend the polluter proceeds — all while Newsom argues the program was never meant to be a permanent source of revenue. Their negotiations could come to a head in the next few weeks, before the final legislative session of the governor’s tenure comes to a close. \u003c/p>\n",
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"\n\u003cp>But the climate fund could shrink by as much as half due to new rules governing cap-and-invest, forcing lawmakers to make tough choices about how to spend the polluter proceeds — all while Newsom argues the program was never meant to be a permanent source of revenue. Their negotiations could come to a head in the next few weeks, before the final legislative session of the governor’s tenure comes to a close. \u003c/p>\n"
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"innerHTML": "\n\u003cp>The cap-and-invest rules, \u003ca href=\"https://www.kqed.org/news/12085401/amid-opposition-california-regulators-approve-major-changes-to-cap-and-trade-program\">approved\u003c/a> by the California Air Resources Board this spring, are expected to drastically reduce the number of pollution permits, known as allowances, that are auctioned off to fill the Greenhouse Gas Reduction Fund over the next three years. Instead, more pollution allowances will be given away to companies covered by the cap, such as oil refineries and factories, to prevent them from leaving California. “There is tension here insofar as there was an effort to rebrand the program as cap-and-invest — and now there are some serious concerns about the magnitude of the investments that will be coming out of this program,” said Kyle Meng, a professor of environmental economics at UC Santa Barbara. \u003c/p>\n",
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"\n\u003cp>The cap-and-invest rules, \u003ca href=\"https://www.kqed.org/news/12085401/amid-opposition-california-regulators-approve-major-changes-to-cap-and-trade-program\">approved\u003c/a> by the California Air Resources Board this spring, are expected to drastically reduce the number of pollution permits, known as allowances, that are auctioned off to fill the Greenhouse Gas Reduction Fund over the next three years. Instead, more pollution allowances will be given away to companies covered by the cap, such as oil refineries and factories, to prevent them from leaving California. “There is tension here insofar as there was an effort to rebrand the program as cap-and-invest — and now there are some serious concerns about the magnitude of the investments that will be coming out of this program,” said Kyle Meng, a professor of environmental economics at UC Santa Barbara. \u003c/p>\n"
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"innerHTML": "\n\u003cp>Newsom signed the reauthorization of cap-and-invest in September, as part of \u003ca href=\"https://www.kqed.org/news/12055461/california-lawmakers-reach-last-minute-deals-on-climate-energy\">sweeping negotiations\u003c/a> on climate and energy that included a bill meant to boost the state’s oil industry by making it easier to drill in Kern County. Air regulators at CARB got to work designing a cap that would allow the state to achieve its climate goals — including reaching net-zero greenhouse gas emissions by 2045 — while also \u003ca href=\"https://www.kqed.org/news/12053867/affordability-concerns-at-center-of-cap-and-trade-renewal-debate\">addressing affordability\u003c/a>, a top priority for lawmakers during last year’s reauthorization debate. \u003c/p>\n",
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"\n\u003cp>Newsom signed the reauthorization of cap-and-invest in September, as part of \u003ca href=\"https://www.kqed.org/news/12055461/california-lawmakers-reach-last-minute-deals-on-climate-energy\">sweeping negotiations\u003c/a> on climate and energy that included a bill meant to boost the state’s oil industry by making it easier to drill in Kern County. Air regulators at CARB got to work designing a cap that would allow the state to achieve its climate goals — including reaching net-zero greenhouse gas emissions by 2045 — while also \u003ca href=\"https://www.kqed.org/news/12053867/affordability-concerns-at-center-of-cap-and-trade-renewal-debate\">addressing affordability\u003c/a>, a top priority for lawmakers during last year’s reauthorization debate. \u003c/p>\n"
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"innerHTML": "\n\u003cp>The first set of cap-and-invest rules unveiled in January drew fierce lobbying from the oil industry, which had already seen the \u003ca href=\"https://www.kqed.org/forum/2010101910826/california-considers-more-drilling-and-other-concessions-to-big-oil-as-gas-prices-rise\">closure of refineries\u003c/a> in Los Angeles and Benicia in the last two years that supplied roughly 20% of the state’s refining capacity. A Chevron executive \u003ca href=\"https://www.chevron.com/newsroom/2026/q1/californias-economy-faces-threats-with-new-energy-policy-changes\" target=\"_blank\" rel=\"noreferrer noopener\">warned\u003c/a> in a March letter that the regulations would “cripple the survivability of the state’s remaining refineries.” CARB’s final blueprint, approved in May, increased the free allowances granted to polluters over the next three years. It also created the Manufacturing Decarbonization Incentive, which could grant companies additional allowances above the cap if they make investments in clean air technologies. The initiative is still being developed, but critics worry it could increase emissions and depress demand for allowances. \u003c/p>\n",
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"\n\u003cp>The first set of cap-and-invest rules unveiled in January drew fierce lobbying from the oil industry, which had already seen the \u003ca href=\"https://www.kqed.org/forum/2010101910826/california-considers-more-drilling-and-other-concessions-to-big-oil-as-gas-prices-rise\">closure of refineries\u003c/a> in Los Angeles and Benicia in the last two years that supplied roughly 20% of the state’s refining capacity. A Chevron executive \u003ca href=\"https://www.chevron.com/newsroom/2026/q1/californias-economy-faces-threats-with-new-energy-policy-changes\" target=\"_blank\" rel=\"noreferrer noopener\">warned\u003c/a> in a March letter that the regulations would “cripple the survivability of the state’s remaining refineries.” CARB’s final blueprint, approved in May, increased the free allowances granted to polluters over the next three years. It also created the Manufacturing Decarbonization Incentive, which could grant companies additional allowances above the cap if they make investments in clean air technologies. The initiative is still being developed, but critics worry it could increase emissions and depress demand for allowances. \u003c/p>\n"
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"blockName": "core/paragraph",
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"innerHTML": "\n\u003cp>The tradeoff is a decline in the allowances given to utilities (which help fund a Climate Credit on customers’ bills) and a significant drop in allowances auctioned off to fill the Greenhouse Gas Reduction Fund. As a result, CARB projects $2 billion annually will be deposited into the fund, roughly half the amount in recent years. \u003c/p>\n",
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"\n\u003cp>The tradeoff is a decline in the allowances given to utilities (which help fund a Climate Credit on customers’ bills) and a significant drop in allowances auctioned off to fill the Greenhouse Gas Reduction Fund. As a result, CARB projects $2 billion annually will be deposited into the fund, roughly half the amount in recent years. \u003c/p>\n"
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"blockName": "core/heading",
"attrs": {
"text": "CA Democratic Party leaders support billionaire’s tax",
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"innerHTML": "\n\u003ch2 class=\"wp-block-heading\">\u003cstrong>CA Democratic Party leaders support billionaire’s tax\u003c/strong>\u003c/h2>\n",
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"\n\u003ch2 class=\"wp-block-heading\">\u003cstrong>CA Democratic Party leaders support billionaire’s tax\u003c/strong>\u003c/h2>\n"
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"innerHTML": "\n\u003cp>The executive board of the California Democratic Party \u003ca href=\"https://cadem.org/california-democratic-party-endorses-insurance-commissioner-and-statewide-ballot-measures-ahead-of-2026-general-election/\">threw its support behind Proposition 40\u003c/a>, the so-called billionaire’s tax on the November ballot. If approved, \u003ca href=\"https://calmatters.org/california-voter-guide-2026/proposition-40-billionaire-tax/\">the measure \u003c/a>would impose a 5%, one-time tax on billionaires’ assets to pay for healthcare.\u003c/p>\n",
"innerContent": [
"\n\u003cp>The executive board of the California Democratic Party \u003ca href=\"https://cadem.org/california-democratic-party-endorses-insurance-commissioner-and-statewide-ballot-measures-ahead-of-2026-general-election/\">threw its support behind Proposition 40\u003c/a>, the so-called billionaire’s tax on the November ballot. If approved, \u003ca href=\"https://calmatters.org/california-voter-guide-2026/proposition-40-billionaire-tax/\">the measure \u003c/a>would impose a 5%, one-time tax on billionaires’ assets to pay for healthcare.\u003c/p>\n"
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"innerHTML": "\n\u003cp>Supporters argue that the people who would pay the tax are the ones who benefited the most financially from recent federal tax reforms. Congress also cut tens of billions from Medicaid, known as Medi-Cal in California, which provides health insurance to low-income people. \u003ca href=\"https://www.kqed.org/news/12093303/the-union-man-taking-on-the-democratic-establishment-with-a-billionaire-tax\">SEIU-UHW argues\u003c/a> those cuts will cause hospitals and clinics to close, costing thousands of jobs and worsening access for all patients.\u003c/p>\n",
"innerContent": [
"\n\u003cp>Supporters argue that the people who would pay the tax are the ones who benefited the most financially from recent federal tax reforms. Congress also cut tens of billions from Medicaid, known as Medi-Cal in California, which provides health insurance to low-income people. \u003ca href=\"https://www.kqed.org/news/12093303/the-union-man-taking-on-the-democratic-establishment-with-a-billionaire-tax\">SEIU-UHW argues\u003c/a> those cuts will cause hospitals and clinics to close, costing thousands of jobs and worsening access for all patients.\u003c/p>\n"
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"innerHTML": "\n\u003cp>Opponents include Silicon Valley entrepreneurs, business interests, and some health and labor organizations. They say the proposal will backfire, causing billionaires to leave California and decreasing tax revenue in the long run. Health groups say they weren’t consulted in designing the measure and that it does not solve the long-term fiscal challenges of funding healthcare. The same groups backed propositions 41 and 42, competing measures that would place limits on new special taxes.\u003c/p>\n",
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"\n\u003cp>Opponents include Silicon Valley entrepreneurs, business interests, and some health and labor organizations. They say the proposal will backfire, causing billionaires to leave California and decreasing tax revenue in the long run. Health groups say they weren’t consulted in designing the measure and that it does not solve the long-term fiscal challenges of funding healthcare. The same groups backed propositions 41 and 42, competing measures that would place limits on new special taxes.\u003c/p>\n"
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"innerHTML": "\n\u003cp>The proposal has split the Democratic Party. Progressives like Vermont Senator Bernie Sanders and Bay Area Congressman Ro Khanna support the measure. But Governor Gavin Newsom, gubernatorial candidate Xavier Becerra and a growing list of labor unions have spoken out against it.\u003c/p>\n",
"innerContent": [
"\n\u003cp>The proposal has split the Democratic Party. Progressives like Vermont Senator Bernie Sanders and Bay Area Congressman Ro Khanna support the measure. But Governor Gavin Newsom, gubernatorial candidate Xavier Becerra and a growing list of labor unions have spoken out against it.\u003c/p>\n"
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"blockName": "core/heading",
"attrs": {
"text": "LA County says a program meant to help people with serious mental illness is gaining traction",
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"innerHTML": "\n\u003ch2 class=\"wp-block-heading\">\u003cstrong>\u003ca href=\"https://laist.com/la-county-says-a-program-meant-to-help-people-with-serious-mental-illness-is-gaining-traction\">LA County says a program meant to help people with serious mental illness is gaining traction\u003c/a>\u003c/strong>\u003c/h2>\n",
"innerContent": [
"\n\u003ch2 class=\"wp-block-heading\">\u003cstrong>\u003ca href=\"https://laist.com/la-county-says-a-program-meant-to-help-people-with-serious-mental-illness-is-gaining-traction\">LA County says a program meant to help people with serious mental illness is gaining traction\u003c/a>\u003c/strong>\u003c/h2>\n"
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"innerHTML": "\n\u003cp>After a slow start, a program that aims to bring thousands of Angelenos living with serious mental illness under court-led care has seen a spike in petitions filed in recent months, Los Angeles County officials said.\u003c/p>\n",
"innerContent": [
"\n\u003cp>After a slow start, a program that aims to bring thousands of Angelenos living with serious mental illness under court-led care has seen a spike in petitions filed in recent months, Los Angeles County officials said.\u003c/p>\n"
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"innerHTML": "\n\u003cp>CARE Court allows family members, first responders and others to ask a court — by way of a petition — to step in with a voluntary care agreement for someone living with serious, untreated mental illness, such as schizophrenia, to receive community-based mental health services. If the agreement fails, a judge could order the individual to sign on to a treatment plan.\u003c/p>\n",
"innerContent": [
"\n\u003cp>CARE Court allows family members, first responders and others to ask a court — by way of a petition — to step in with a voluntary care agreement for someone living with serious, untreated mental illness, such as schizophrenia, to receive community-based mental health services. If the agreement fails, a judge could order the individual to sign on to a treatment plan.\u003c/p>\n"
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"attrs": [],
"innerHTML": "\n\u003cp>Since launching in L.A. County in December 2023, the program saw thousands fewer petitions each year than were initially projected. But county officials said petitions filed in L.A. County jumped by about 85% between November 2025 and March 2026, with March seeing a total of 68 petitions.\u003c/p>\n",
"innerContent": [
"\n\u003cp>Since launching in L.A. County in December 2023, the program saw thousands fewer petitions each year than were initially projected. But county officials said petitions filed in L.A. County jumped by about 85% between November 2025 and March 2026, with March seeing a total of 68 petitions.\u003c/p>\n"
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"innerHTML": "\n\u003cp>Martin Jones, a program manager with the L.A. County Department of Mental Health, attributed the increase to working with hospitals, first responders and other groups to identify and refer people who might need help. “We’re doing quite a bit of work to put tools in their hands to also help them identify and refer folks to us who might benefit from the support,” Jones told LAist. “I think we’re approaching the project from several fronts and we’re seeing the results of that.”\u003c/p>\n",
"innerContent": [
"\n\u003cp>Martin Jones, a program manager with the L.A. County Department of Mental Health, attributed the increase to working with hospitals, first responders and other groups to identify and refer people who might need help. “We’re doing quite a bit of work to put tools in their hands to also help them identify and refer folks to us who might benefit from the support,” Jones told LAist. “I think we’re approaching the project from several fronts and we’re seeing the results of that.”\u003c/p>\n"
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"attrs": [],
"innerHTML": "\n\u003cp>Proponents of CARE Court say it provides a less restrictive and structured way to stabilize people living with a mental illness, and they say the recent increase in petitions shows that the program is gaining traction. \u003c/p>\n",
"innerContent": [
"\n\u003cp>Proponents of CARE Court say it provides a less restrictive and structured way to stabilize people living with a mental illness, and they say the recent increase in petitions shows that the program is gaining traction. \u003c/p>\n"
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"innerHTML": "\n\u003cp>Some mental health and civil liberties advocates don’t see it as a positive development. “The number of petitions says nothing about outcomes, which is the real point of the program,” said Eve Garrow, policy analyst at the ACLU of Southern California. “Positive outcomes are really miniscule compared to the population in need.” \u003c/p>\n",
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"\n\u003cp>Some mental health and civil liberties advocates don’t see it as a positive development. “The number of petitions says nothing about outcomes, which is the real point of the program,” said Eve Garrow, policy analyst at the ACLU of Southern California. “Positive outcomes are really miniscule compared to the population in need.” \u003c/p>\n"
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"innerHTML": "\n\u003cp>Analysis of the program statewide has shown that about half of the petitions end up getting dismissed, but L.A. County officials say more than 4,000 Californians statewide have been set up with alternative county services when a CARE agreement or plan is not appropriate.\u003c/p>\n",
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"\n\u003cp>Analysis of the program statewide has shown that about half of the petitions end up getting dismissed, but L.A. County officials say more than 4,000 Californians statewide have been set up with alternative county services when a CARE agreement or plan is not appropriate.\u003c/p>\n"
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Here are the morning’s top stories on Monday, August 3, 2026\u003c/strong>\u003c/p>\n\n\n\n\u003cul class=\"wp-block-list\">\n\u003cli>California lawmakers are returning to Sacramento from summer recess on Monday — and a fight is already brewing over \u003ca href=\"https://www.kqed.org/news/12093409/inside-the-fight-for-the-future-of-californias-climate-dollars\">the future of the state’s climate fund.\u003c/a> Governor Gavin Newsom’s administration has changed environmental rules to prevent higher gas prices. And that could lead to less money for affordable housing, transit and other projects to reduce carbon emissions. \u003c/li>\n\n\n\n\u003cli>The executive board of the California Democratic Party threw its support behind Proposition 40, the so-called billionaire’s tax on the November ballot. If approved, the measure would impose a 5%, one-time tax on billionaires’ assets to pay for healthcare. \u003c/li>\n\n\n\n\u003cli>The CARE court mental health program has seen \u003ca href=\"https://laist.com/la-county-says-a-program-meant-to-help-people-with-serious-mental-illness-is-gaining-traction\">an increase in participation\u003c/a>, according to officials in Los Angeles County.\u003c/li>\n\u003c/ul>\n\n\n\n\u003ch2 class=\"wp-block-heading\">\u003cstrong>\u003ca href=\"https://www.kqed.org/news/12093409/inside-the-fight-for-the-future-of-californias-climate-dollars\">Inside the fight for the future of California’s climate dollars\u003c/a>\u003c/strong>\u003c/h2>\n\n\n\n\u003cp>As state lawmakers return to the Capitol from summer recess on Monday, Democrats are spoiling for a fight with Gov. \u003ca href=\"https://www.kqed.org/news/tag/gavin-newsom\">Gavin Newsom\u003c/a> over the future of California’s signature climate fund. \u003c/p>\n\n\n\n\u003cp>Less than a year ago, Newsom and the Legislature \u003ca href=\"https://www.kqed.org/science/1998536/newsom-signs-climate-energy-bills-charting-state-course-through-perilous-mid-transition\">extended\u003c/a> the cap-and-trade program to 2045, renaming it cap-and-invest — a clear signal about lawmakers’ thoughts on the fiscal benefits of \u003ca href=\"https://www.kqed.org/news/12052825/whats-next-for-californias-landmark-climate-program\">the system\u003c/a>. By requiring major polluters to purchase permits to account for their emissions, it raises billions of dollars a year for programs ranging from high-speed rail to affordable housing. \u003c/p>\n\n\n\n\u003cp>But the climate fund could shrink by as much as half due to new rules governing cap-and-invest, forcing lawmakers to make tough choices about how to spend the polluter proceeds — all while Newsom argues the program was never meant to be a permanent source of revenue. Their negotiations could come to a head in the next few weeks, before the final legislative session of the governor’s tenure comes to a close. \u003c/p>\n\n\n\n\u003cp>The cap-and-invest rules, \u003ca href=\"https://www.kqed.org/news/12085401/amid-opposition-california-regulators-approve-major-changes-to-cap-and-trade-program\">approved\u003c/a> by the California Air Resources Board this spring, are expected to drastically reduce the number of pollution permits, known as allowances, that are auctioned off to fill the Greenhouse Gas Reduction Fund over the next three years. Instead, more pollution allowances will be given away to companies covered by the cap, such as oil refineries and factories, to prevent them from leaving California. “There is tension here insofar as there was an effort to rebrand the program as cap-and-invest — and now there are some serious concerns about the magnitude of the investments that will be coming out of this program,” said Kyle Meng, a professor of environmental economics at UC Santa Barbara. \u003c/p>\n\n\n\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Newsom signed the reauthorization of cap-and-invest in September, as part of \u003ca href=\"https://www.kqed.org/news/12055461/california-lawmakers-reach-last-minute-deals-on-climate-energy\">sweeping negotiations\u003c/a> on climate and energy that included a bill meant to boost the state’s oil industry by making it easier to drill in Kern County. Air regulators at CARB got to work designing a cap that would allow the state to achieve its climate goals — including reaching net-zero greenhouse gas emissions by 2045 — while also \u003ca href=\"https://www.kqed.org/news/12053867/affordability-concerns-at-center-of-cap-and-trade-renewal-debate\">addressing affordability\u003c/a>, a top priority for lawmakers during last year’s reauthorization debate. \u003c/p>\n\n\n\n\u003cp>The first set of cap-and-invest rules unveiled in January drew fierce lobbying from the oil industry, which had already seen the \u003ca href=\"https://www.kqed.org/forum/2010101910826/california-considers-more-drilling-and-other-concessions-to-big-oil-as-gas-prices-rise\">closure of refineries\u003c/a> in Los Angeles and Benicia in the last two years that supplied roughly 20% of the state’s refining capacity. A Chevron executive \u003ca href=\"https://www.chevron.com/newsroom/2026/q1/californias-economy-faces-threats-with-new-energy-policy-changes\" target=\"_blank\" rel=\"noreferrer noopener\">warned\u003c/a> in a March letter that the regulations would “cripple the survivability of the state’s remaining refineries.” CARB’s final blueprint, approved in May, increased the free allowances granted to polluters over the next three years. It also created the Manufacturing Decarbonization Incentive, which could grant companies additional allowances above the cap if they make investments in clean air technologies. The initiative is still being developed, but critics worry it could increase emissions and depress demand for allowances. \u003c/p>\n\n\n\n\u003cp>The tradeoff is a decline in the allowances given to utilities (which help fund a Climate Credit on customers’ bills) and a significant drop in allowances auctioned off to fill the Greenhouse Gas Reduction Fund. As a result, CARB projects $2 billion annually will be deposited into the fund, roughly half the amount in recent years. \u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">\u003cstrong>CA Democratic Party leaders support billionaire’s tax\u003c/strong>\u003c/h2>\n\n\n\n\u003cp>The executive board of the California Democratic Party \u003ca href=\"https://cadem.org/california-democratic-party-endorses-insurance-commissioner-and-statewide-ballot-measures-ahead-of-2026-general-election/\">threw its support behind Proposition 40\u003c/a>, the so-called billionaire’s tax on the November ballot. If approved, \u003ca href=\"https://calmatters.org/california-voter-guide-2026/proposition-40-billionaire-tax/\">the measure \u003c/a>would impose a 5%, one-time tax on billionaires’ assets to pay for healthcare.\u003c/p>\n\n\n\n\u003cp>Supporters argue that the people who would pay the tax are the ones who benefited the most financially from recent federal tax reforms. Congress also cut tens of billions from Medicaid, known as Medi-Cal in California, which provides health insurance to low-income people. \u003ca href=\"https://www.kqed.org/news/12093303/the-union-man-taking-on-the-democratic-establishment-with-a-billionaire-tax\">SEIU-UHW argues\u003c/a> those cuts will cause hospitals and clinics to close, costing thousands of jobs and worsening access for all patients.\u003c/p>\n\n\n\n\u003cp>Opponents include Silicon Valley entrepreneurs, business interests, and some health and labor organizations. They say the proposal will backfire, causing billionaires to leave California and decreasing tax revenue in the long run. Health groups say they weren’t consulted in designing the measure and that it does not solve the long-term fiscal challenges of funding healthcare. The same groups backed propositions 41 and 42, competing measures that would place limits on new special taxes.\u003c/p>\n\n\n\n\u003cp>The proposal has split the Democratic Party. Progressives like Vermont Senator Bernie Sanders and Bay Area Congressman Ro Khanna support the measure. But Governor Gavin Newsom, gubernatorial candidate Xavier Becerra and a growing list of labor unions have spoken out against it.\u003c/p>\n\n\n\n\u003ch2 class=\"wp-block-heading\">\u003cstrong>\u003ca href=\"https://laist.com/la-county-says-a-program-meant-to-help-people-with-serious-mental-illness-is-gaining-traction\">LA County says a program meant to help people with serious mental illness is gaining traction\u003c/a>\u003c/strong>\u003c/h2>\n\n\n\n\u003cp>After a slow start, a program that aims to bring thousands of Angelenos living with serious mental illness under court-led care has seen a spike in petitions filed in recent months, Los Angeles County officials said.\u003c/p>\n\n\n\n\u003cp>CARE Court allows family members, first responders and others to ask a court — by way of a petition — to step in with a voluntary care agreement for someone living with serious, untreated mental illness, such as schizophrenia, to receive community-based mental health services. If the agreement fails, a judge could order the individual to sign on to a treatment plan.\u003c/p>\n\n\n\n\u003cp>Since launching in L.A. County in December 2023, the program saw thousands fewer petitions each year than were initially projected. But county officials said petitions filed in L.A. County jumped by about 85% between November 2025 and March 2026, with March seeing a total of 68 petitions.\u003c/p>\n\n\n\n\u003cp>Martin Jones, a program manager with the L.A. County Department of Mental Health, attributed the increase to working with hospitals, first responders and other groups to identify and refer people who might need help. “We’re doing quite a bit of work to put tools in their hands to also help them identify and refer folks to us who might benefit from the support,” Jones told LAist. “I think we’re approaching the project from several fronts and we’re seeing the results of that.”\u003c/p>\n\n\n\n\u003cp>Proponents of CARE Court say it provides a less restrictive and structured way to stabilize people living with a mental illness, and they say the recent increase in petitions shows that the program is gaining traction. \u003c/p>\n\n\n\n\u003cp>Some mental health and civil liberties advocates don’t see it as a positive development. “The number of petitions says nothing about outcomes, which is the real point of the program,” said Eve Garrow, policy analyst at the ACLU of Southern California. “Positive outcomes are really miniscule compared to the population in need.” \u003c/p>\n\n\n\n\u003cp>Analysis of the program statewide has shown that about half of the petitions end up getting dismissed, but L.A. County officials say more than 4,000 Californians statewide have been set up with alternative county services when a CARE agreement or plan is not appropriate.\u003c/p>\n\n\n\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Gov. Gavin Newsom announced Monday that California is expanding resources to support its first-of-its-kind \u003ca href=\"https://www.kqed.org/news/12007175/care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going\">mental health court program\u003c/a>, but threatened to divert those funds from counties, including multiple in the Bay Area, where implementation is falling behind.\u003c/p>\n\u003cp>Two years after the launch of the CARE Court program, which aims to connect unhoused Californians suffering from psychosis with housing and treatment plans, Newsom’s office awarded an additional $291 million toward housing and behavioral health services. The governor’s office is also adding accountability measures to speed up the adoption of CARE Court programs for counties like San Francisco, where the programs are struggling to connect people to services.\u003c/p>\n\u003cp>“Through CARE Court, we have seen inspirational stories of recovery and resilience, but many counties continue to lag behind their peers,” Newsom said in a statement. “Local leaders have a moral and legal obligation to deliver this transformational tool for those who need it most. We will not accept failure and excuses when lives are on the line.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In October 2023, counties across the state began rolling out CARE Court programs created by the Community Assistance, Recovery, and Empowerment Act. All 58 counties implemented the programs by the end of 2024. The legislation aims to make it easier for first responders, doctors and family members to petition the court to help people suffering from psychosis due to schizophrenia and other behavioral health challenges.\u003c/p>\n\u003cp>If a case is accepted, a civil court judge presents a voluntary treatment plan, which can include access to housing, mental health counseling, medication and other services. If the person refuses, a judge can compel them into treatment.\u003c/p>\n\u003cp>So far, it’s \u003ca href=\"https://www.kqed.org/news/12073589/californias-care-court-is-falling-short-of-expectations\">failed to keep up with expectations\u003c/a> in some parts of the state. While Newsom’s office predicted CARE could reach \u003ca href=\"https://www.kqed.org/news/12007175/care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going\">7,000 to 12,000 people annually\u003c/a> when it was introduced, only about 3,800 CARE petitions have been submitted to courts. An additional 4,000 cases where people have been considered for CARE have been diverted by connecting them with services without court participation, Newsom’s office said.\u003c/p>\n\u003cfigure id=\"attachment_12047982\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12047982\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Orange County Superior Court will technically house the local CARE Court, though judges say they will more likely hold meetings with patients at a more neutral site, like a conference room at the county health office. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Le Ondra Clark Harvey, the CEO of the advocacy organization California Council of Community Behavioral Health Agencies, said she had “expected more” when the program was initially announced.\u003c/p>\n\u003cp>“I do believe that the trickle [of cases] may represent that there’s not enough thoughtfulness and planning around coordination and tracking,” she told KQED. “We know as providers on the ground that every handoff matters and that people can easily fall through the safety net if that’s not done and crafted very well.”\u003c/p>\n\u003cp>Still, CARE \u003ca href=\"https://www.kqed.org/news/12059464/newsom-expands-care-court-mental-health-law-to-reach-more-californians\">expanded in October\u003c/a> to include people experiencing psychotic symptoms as a result of bipolar disorder. Now, Newsom is throwing additional resources behind the program — and calling out counties, like San Francisco, that are underperforming.\u003c/p>\n\u003cp>Newsom said that his office would direct $131.8 million in Proposition 1 funding to eight Homekey+ affordable housing projects, which provide supportive housing with services for veterans, people who are at-risk or experiencing homelessness, or living with behavioral health challenges.\u003c/p>\n\u003cp>Newsom’s office estimates that the funding will create 443 additional homes across the communities, including in Stockton and Contra Costa County.\u003c/p>\n\u003cp>The other $159 million is in newly awarded Homeless Housing Assistance and Prevention funding, which will go toward 20 regions throughout the state to create permanent housing, sustain interim housing and “accelerate proven local interventions.”[aside postID=news_12073589 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/CARECourt_SFChronicle-2000x1333.jpg']Among those counties is Alameda, which Newsom called a “shining example” of CARE implementation. The county has one of the highest rates of petitions submitted per capita, and has seen an 11% drop in unsheltered homelessness since 2023.\u003c/p>\n\u003cp>San Francisco and Santa Clara counties, by contrast, are among 10 that have struggled to implement CARE programs. Both had fewer than 100 petitions in 2025, according to a new state dashboard, and San Francisco has seen a significantly lower percentage decrease in unsheltered homelessness than the state average since 2023.\u003c/p>\n\u003cp>“There are counties that haven’t gotten it done, like Santa Clara County,” Newsom said. “We’re calling [San Francisco] out as well.”\u003c/p>\n\u003cp>“They’re the care court ICU,” Newsom said, referring to the term his office has coined for the 10 “bottom” counties in terms of implementation.\u003c/p>\n\u003cp>Santa Clara recorded just 47 CARE petitions in 2025, equaling a rate of about two petitions per 100,000 residents, compared to the state’s six. New state data tracking counties’ progress on reducing unsheltered homelessness says that the county does not have publicly available data. But last year’s point-in-time count in its most populous city, San José — where Mayor Matt Mahan has also cracked down on street homelessness and encampments — reported a 10% drop between 2023 and 2025.\u003c/p>\n\u003cp>“Long before the creation of CARE Court, the County of Santa Clara has been at the forefront of innovative strategies to address the behavioral health crisis facing California,” Santa Clara County Executive James Williams said in a statement. “Our approach is grounded in what works: rapidly connecting people to clinically appropriate treatment and housing, rather than defaulting to lengthy, costly, and often inadequate court-based processes that do not produce better outcomes.”\u003c/p>\n\u003cp>Williams called the CARE program “one tool among many. He said via email that counties need sustained funding and partnership, not “reducing a complex system to a single scorecard.”\u003c/p>\n\u003cp>In a statement, San Francisco Mayor Daniel Lurie’s office, which has been focused on the homelessness crisis since taking office in 2024, said it “has been using every tool in our toolbox to address the crisis on our streets — reimagining street outreach and adding recovery and treatment resources so we can get people off the street and connected to the support they need.”\u003c/p>\n\u003cp>“Today, encampments are at record lows, more people are getting connected to shelter and treatment, and San Franciscans feel safer than they have in years,” a spokesperson for the office said in a statement.\u003c/p>\n\u003cfigure id=\"attachment_12070970\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12070970\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/01/260123-SIGNATUREKICKOFF00606_TV-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/01/260123-SIGNATUREKICKOFF00606_TV-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/01/260123-SIGNATUREKICKOFF00606_TV-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/01/260123-SIGNATUREKICKOFF00606_TV-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Mayor Daniel Lurie speaks on his support for California Senate Bill 63 at a press conference at Embarcadero Plaza in San Francisco on Jan. 23, 2026. \u003ccite>(Tâm Vũ/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But \u003ca href=\"https://www.accountability.ca.gov/county/san-francisco/housing/\">state data shows\u003c/a> that the city has seen just a 1% decline in unsheltered homelessness since 2023, compared to California’s 9% drop. Fifty CARE petitions were filed in 2025. As of last September, about two-thirds of submitted petitions were dismissed, according to an \u003ca href=\"https://calmatters.org/health/mental-health/2025/09/care-court-2025-data/\">investigation by \u003cem>CalMatters\u003c/em>\u003c/a>.\u003c/p>\n\u003cp>The state dashboard notes that the city has increased its number of beds available for unhoused residents by nearly 10% since 2024.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">Clark Harvey said flagging the counties that are performing both well and poorly is important to identify what is and isn’t working, and help bring struggling counties up to speed.\u003c/span>\u003c/p>\n\u003cp>“It’s really now time to drill down and say, ‘Why aren’t things working well for these 10 counties? What can we do to support them? And what can we do to ensure that people aren’t cycling back through the system?’” she said.[aside postID=news_12074462 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2026/02/022426_ALAMEDA-COUNTY-HEALTH-CUTS-_GH_003-KQED.jpg']\u003cspan style=\"font-weight: 400;\">But Monica Porter Gilbert with the advocacy group Disability Rights California said she was concerned about how the governor’s office is measuring a county’s performance on its new accountability dashboard.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\"> “We’re not seeing a ton of rigor in how the governor is defining performance or underperformance,” she told KQED. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">She said she was concerned about the number of petitions a county receives being considered a marker of success. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">“What CARE Court does is it orders people into services without increasing access to them,” she told KQED. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">She said that the program’s first annual report found that more than half of CARE participants were unable to receive at least one mental health service that was part of their treatment plan, such as peer support, medication or therapy. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">The report cited administrative delays like pending applications for services, or a lack of availability of some services in some counties, as well as coordination mishaps that led to these issues.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">“The California Legislature did some analysis this past summer and found CARE Court to be — and this is a quote from them — a very expensive way to coordinate but not directly provide important services,” Gilbert said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">Despite awarding San Francisco \u003c/span>\u003ca href=\"https://www.kqed.org/news/12070144/lurie-newsom-tout-millions-in-homelessness-funding-for-san-francisco-amid-budget-blows\">\u003cspan style=\"font-weight: 400;\">nearly $40 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400;\"> in HHAP funding in January, the governor suggested that money could be diverted from those counties in his May budget revision if they don’t improve implementation.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">“I’m happy to direct every damn penny in these programs to the counties that are getting things done,” Newsom said. “I’m not interested in funding failure.”\u003c/span>\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400;\">KQED’s \u003c/span>\u003c/i>\u003ca href=\"https://www.kqed.org/author/vrancano\">\u003ci>\u003cspan style=\"font-weight: 400;\">Vanessa Rancaño\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400;\"> contributed to this report. \u003c/span>\u003c/i>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Gov. Gavin Newsom announced Monday that California is expanding resources to support its first-of-its-kind \u003ca href=\"https://www.kqed.org/news/12007175/care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going\">mental health court program\u003c/a>, but threatened to divert those funds from counties, including multiple in the Bay Area, where implementation is falling behind.\u003c/p>\n\u003cp>Two years after the launch of the CARE Court program, which aims to connect unhoused Californians suffering from psychosis with housing and treatment plans, Newsom’s office awarded an additional $291 million toward housing and behavioral health services. The governor’s office is also adding accountability measures to speed up the adoption of CARE Court programs for counties like San Francisco, where the programs are struggling to connect people to services.\u003c/p>\n\u003cp>“Through CARE Court, we have seen inspirational stories of recovery and resilience, but many counties continue to lag behind their peers,” Newsom said in a statement. “Local leaders have a moral and legal obligation to deliver this transformational tool for those who need it most. We will not accept failure and excuses when lives are on the line.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In October 2023, counties across the state began rolling out CARE Court programs created by the Community Assistance, Recovery, and Empowerment Act. All 58 counties implemented the programs by the end of 2024. The legislation aims to make it easier for first responders, doctors and family members to petition the court to help people suffering from psychosis due to schizophrenia and other behavioral health challenges.\u003c/p>\n\u003cp>If a case is accepted, a civil court judge presents a voluntary treatment plan, which can include access to housing, mental health counseling, medication and other services. If the person refuses, a judge can compel them into treatment.\u003c/p>\n\u003cp>So far, it’s \u003ca href=\"https://www.kqed.org/news/12073589/californias-care-court-is-falling-short-of-expectations\">failed to keep up with expectations\u003c/a> in some parts of the state. While Newsom’s office predicted CARE could reach \u003ca href=\"https://www.kqed.org/news/12007175/care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going\">7,000 to 12,000 people annually\u003c/a> when it was introduced, only about 3,800 CARE petitions have been submitted to courts. An additional 4,000 cases where people have been considered for CARE have been diverted by connecting them with services without court participation, Newsom’s office said.\u003c/p>\n\u003cfigure id=\"attachment_12047982\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12047982\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Orange County Superior Court will technically house the local CARE Court, though judges say they will more likely hold meetings with patients at a more neutral site, like a conference room at the county health office. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Le Ondra Clark Harvey, the CEO of the advocacy organization California Council of Community Behavioral Health Agencies, said she had “expected more” when the program was initially announced.\u003c/p>\n\u003cp>“I do believe that the trickle [of cases] may represent that there’s not enough thoughtfulness and planning around coordination and tracking,” she told KQED. “We know as providers on the ground that every handoff matters and that people can easily fall through the safety net if that’s not done and crafted very well.”\u003c/p>\n\u003cp>Still, CARE \u003ca href=\"https://www.kqed.org/news/12059464/newsom-expands-care-court-mental-health-law-to-reach-more-californians\">expanded in October\u003c/a> to include people experiencing psychotic symptoms as a result of bipolar disorder. Now, Newsom is throwing additional resources behind the program — and calling out counties, like San Francisco, that are underperforming.\u003c/p>\n\u003cp>Newsom said that his office would direct $131.8 million in Proposition 1 funding to eight Homekey+ affordable housing projects, which provide supportive housing with services for veterans, people who are at-risk or experiencing homelessness, or living with behavioral health challenges.\u003c/p>\n\u003cp>Newsom’s office estimates that the funding will create 443 additional homes across the communities, including in Stockton and Contra Costa County.\u003c/p>\n\u003cp>The other $159 million is in newly awarded Homeless Housing Assistance and Prevention funding, which will go toward 20 regions throughout the state to create permanent housing, sustain interim housing and “accelerate proven local interventions.”\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Among those counties is Alameda, which Newsom called a “shining example” of CARE implementation. The county has one of the highest rates of petitions submitted per capita, and has seen an 11% drop in unsheltered homelessness since 2023.\u003c/p>\n\u003cp>San Francisco and Santa Clara counties, by contrast, are among 10 that have struggled to implement CARE programs. Both had fewer than 100 petitions in 2025, according to a new state dashboard, and San Francisco has seen a significantly lower percentage decrease in unsheltered homelessness than the state average since 2023.\u003c/p>\n\u003cp>“There are counties that haven’t gotten it done, like Santa Clara County,” Newsom said. “We’re calling [San Francisco] out as well.”\u003c/p>\n\u003cp>“They’re the care court ICU,” Newsom said, referring to the term his office has coined for the 10 “bottom” counties in terms of implementation.\u003c/p>\n\u003cp>Santa Clara recorded just 47 CARE petitions in 2025, equaling a rate of about two petitions per 100,000 residents, compared to the state’s six. New state data tracking counties’ progress on reducing unsheltered homelessness says that the county does not have publicly available data. But last year’s point-in-time count in its most populous city, San José — where Mayor Matt Mahan has also cracked down on street homelessness and encampments — reported a 10% drop between 2023 and 2025.\u003c/p>\n\u003cp>“Long before the creation of CARE Court, the County of Santa Clara has been at the forefront of innovative strategies to address the behavioral health crisis facing California,” Santa Clara County Executive James Williams said in a statement. “Our approach is grounded in what works: rapidly connecting people to clinically appropriate treatment and housing, rather than defaulting to lengthy, costly, and often inadequate court-based processes that do not produce better outcomes.”\u003c/p>\n\u003cp>Williams called the CARE program “one tool among many. He said via email that counties need sustained funding and partnership, not “reducing a complex system to a single scorecard.”\u003c/p>\n\u003cp>In a statement, San Francisco Mayor Daniel Lurie’s office, which has been focused on the homelessness crisis since taking office in 2024, said it “has been using every tool in our toolbox to address the crisis on our streets — reimagining street outreach and adding recovery and treatment resources so we can get people off the street and connected to the support they need.”\u003c/p>\n\u003cp>“Today, encampments are at record lows, more people are getting connected to shelter and treatment, and San Franciscans feel safer than they have in years,” a spokesperson for the office said in a statement.\u003c/p>\n\u003cfigure id=\"attachment_12070970\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12070970\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/01/260123-SIGNATUREKICKOFF00606_TV-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2026/01/260123-SIGNATUREKICKOFF00606_TV-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/01/260123-SIGNATUREKICKOFF00606_TV-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2026/01/260123-SIGNATUREKICKOFF00606_TV-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Mayor Daniel Lurie speaks on his support for California Senate Bill 63 at a press conference at Embarcadero Plaza in San Francisco on Jan. 23, 2026. \u003ccite>(Tâm Vũ/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But \u003ca href=\"https://www.accountability.ca.gov/county/san-francisco/housing/\">state data shows\u003c/a> that the city has seen just a 1% decline in unsheltered homelessness since 2023, compared to California’s 9% drop. Fifty CARE petitions were filed in 2025. As of last September, about two-thirds of submitted petitions were dismissed, according to an \u003ca href=\"https://calmatters.org/health/mental-health/2025/09/care-court-2025-data/\">investigation by \u003cem>CalMatters\u003c/em>\u003c/a>.\u003c/p>\n\u003cp>The state dashboard notes that the city has increased its number of beds available for unhoused residents by nearly 10% since 2024.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">Clark Harvey said flagging the counties that are performing both well and poorly is important to identify what is and isn’t working, and help bring struggling counties up to speed.\u003c/span>\u003c/p>\n\u003cp>“It’s really now time to drill down and say, ‘Why aren’t things working well for these 10 counties? What can we do to support them? And what can we do to ensure that people aren’t cycling back through the system?’” she said.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cspan style=\"font-weight: 400;\">But Monica Porter Gilbert with the advocacy group Disability Rights California said she was concerned about how the governor’s office is measuring a county’s performance on its new accountability dashboard.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\"> “We’re not seeing a ton of rigor in how the governor is defining performance or underperformance,” she told KQED. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">She said she was concerned about the number of petitions a county receives being considered a marker of success. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">“What CARE Court does is it orders people into services without increasing access to them,” she told KQED. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">She said that the program’s first annual report found that more than half of CARE participants were unable to receive at least one mental health service that was part of their treatment plan, such as peer support, medication or therapy. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">The report cited administrative delays like pending applications for services, or a lack of availability of some services in some counties, as well as coordination mishaps that led to these issues.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">“The California Legislature did some analysis this past summer and found CARE Court to be — and this is a quote from them — a very expensive way to coordinate but not directly provide important services,” Gilbert said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">Despite awarding San Francisco \u003c/span>\u003ca href=\"https://www.kqed.org/news/12070144/lurie-newsom-tout-millions-in-homelessness-funding-for-san-francisco-amid-budget-blows\">\u003cspan style=\"font-weight: 400;\">nearly $40 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400;\"> in HHAP funding in January, the governor suggested that money could be diverted from those counties in his May budget revision if they don’t improve implementation.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">“I’m happy to direct every damn penny in these programs to the counties that are getting things done,” Newsom said. “I’m not interested in funding failure.”\u003c/span>\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400;\">KQED’s \u003c/span>\u003c/i>\u003ca href=\"https://www.kqed.org/author/vrancano\">\u003ci>\u003cspan style=\"font-weight: 400;\">Vanessa Rancaño\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400;\"> contributed to this report. \u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">When Gov. Gavin Newsom launched CARE Court two years ago, it was envisioned as a new solution to get homeless people with severe mental illness off the streets and into treatment. Newsom’s administration predicted the program could serve 7,000 to 12,000 Californians, but it has failed to meet those projections. Scott and Marisa speak with The San Francisco Chronicle’s politics reporter Sophia Bollag, who recently wrote about a \u003ca href=\"https://www.sfchronicle.com/politics/article/care-court-falling-short-21020708.php\">mother’s urgent effort\u003c/a> to secure a CARE Court treatment plan for her son.\u003c/span>\u003c/p>\n\u003cp>Check out \u003ca href=\"https://www.kqed.org/newsletters/political-breakdown\">Political Breakdown’s weekly newsletter\u003c/a>, delivered straight to your inbox.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">When Gov. Gavin Newsom launched CARE Court two years ago, it was envisioned as a new solution to get homeless people with severe mental illness off the streets and into treatment. Newsom’s administration predicted the program could serve 7,000 to 12,000 Californians, but it has failed to meet those projections. Scott and Marisa speak with The San Francisco Chronicle’s politics reporter Sophia Bollag, who recently wrote about a \u003ca href=\"https://www.sfchronicle.com/politics/article/care-court-falling-short-21020708.php\">mother’s urgent effort\u003c/a> to secure a CARE Court treatment plan for her son.\u003c/span>\u003c/p>\n\u003cp>Check out \u003ca href=\"https://www.kqed.org/newsletters/political-breakdown\">Political Breakdown’s weekly newsletter\u003c/a>, delivered straight to your inbox.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003c!-- Creative Commons Attribution-NonCommercial-NoDerivatives https://creativecommons.org/licenses/by-nc-nd/4.0/ -->\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://calmatters.org/\">CalMatters\u003c/a>. \u003ca href=\"https://calmatters.org/subscribe-to-calmatters/\">Sign up\u003c/a> for their newsletters.\u003c/em>\u003c/p>\n\u003cp>One of Gov. \u003ca href=\"https://www.kqed.org/news/tag/gavin-newsom\">Gavin Newsom\u003c/a>’s marquee mental health programs may broaden its reach despite persistent questions about the number of people it’s helping and whether it’s achieving the goals he set out for it \u003ca href=\"https://www.kqed.org/news/12007175/care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going\">when it launched\u003c/a>.\u003c/p>\n\u003cp>Newsom today signed a law that expands eligibility for CARE Court to include people who experience psychotic symptoms as a result of bipolar disorder. Under the law’s previous constraints, only people with schizophrenia and other limited psychotic disorders were eligible.\u003c/p>\n\u003cp>Newsom, in a written statement, called the law and its expansion an important part of his administration’s efforts to bring people with serious \u003ca href=\"https://www.kqed.org/news/tag/mental-health\">mental illness\u003c/a> into treatment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“California doesn’t sit on the sidelines while people fall through the cracks,” he said. “We don’t stand by while people spiral on our sidewalks or cycle through emergency rooms and jail cells — we step up. We built CARE Court to connect people to treatment, dignity, and accountability — because care and accountability belong at the center of how we serve our communities.”\u003c/p>\n\u003cp>Newsom \u003ca href=\"https://calmatters.org/health/2022/03/newsom-california-mental-illness-treatment/\">introduced CARE Court in 2022\u003c/a>, creating a program that allows family members, first responders, doctors and others to petition the courts on behalf of people with severe psychosis who couldn’t care for themselves.\u003c/p>\n\u003cfigure id=\"attachment_12047982\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12047982\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Orange County Superior Court will technically house the local CARE Court, though judges say they will more likely hold meetings with patients at a more neutral site, like a conference room at the county health office. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Once a petition is accepted, individuals are presented with a voluntary treatment plan, which can include counseling, medication and housing. If they refuse, a judge can, in theory, order them to participate in a treatment plan.\u003c/p>\n\u003cp>Almost two years in, CARE Court has struggled to fulfill Newsom’s initial promises. A recent \u003ca href=\"https://calmatters.org/health/mental-health/2025/09/care-court-2025-data/\">CalMatters investigation\u003c/a> found that the program has so far reached a few hundred people, far short of the thousands originally projected.\u003c/p>\n\u003cp>The new law, by \u003ca href=\"https://calmatters.digitaldemocracy.org/legislators/thomas-umberg-165043\">Sen. Tom Umberg,\u003c/a> a Santa Ana Democrat, sailed through the Legislature with \u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260sb27\">nearly unanimous bipartisan support,\u003c/a> no votes against and just a handful of abstentions.[aside postID=news_12048062 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/Rodriguez_CARE_07_07_2025-1.jpg']“The beauty of CARE Court is that it holds both institutions and individuals accountable, ensures individuals get the care they need and gives judges a clear role in overseeing and guiding the process,” Umberg said in a written statement today. “This bill focuses on implementation by listening to and learning from counties about what’s working and what’s not, in order to meet the goals of the original CARE Court legislation.”\u003c/p>\n\u003cp>But the bill faced plenty of criticism in the community, with counties \u003ca href=\"https://www.abridged.org/news/low-use-program-mental-illness-homelessness/\">questioning how they will implement\u003c/a> an expanded program on a tight timeline and disability rights advocates raising concerns about the effectiveness of a program they consider “unimplementable.”\u003c/p>\n\u003cp>“We have to tell the truth,” said Lex Steppling, a founding member of All People’s Health Collective. “This is not workable. It’s not going to be workable. And I personally believe the cracks in the foundation are getting bigger and bigger and it’s going to collapse.”\u003c/p>\n\u003cp>Steppling saved his harshest criticism for “the state’s self-described ‘liberal and progressive’ politicians,” who he said were too afraid of the Newsom administration to oppose the bill.\u003c/p>\n\u003ch2>Wide estimates on CARE Court expansion\u003c/h2>\n\u003cp>Umberg’s legislation could expand CARE Court enrollment, though it’s unclear by how much. Umberg’s office doesn’t have an estimate of how many more people will be eligible for the program under the new parameters. San Diego County said the new rules could increase its numbers by anywhere from 3.5% to 48.1%.\u003c/p>\n\u003cp>“We’re trying to focus on the right populations,” Umberg said. “I do think it will expand it, but not dramatically.”\u003c/p>\n\u003cfigure id=\"attachment_11983393\" class=\"wp-caption aligncenter\" style=\"max-width: 1980px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11983393\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/GettyImages-1244278587-scaled-e1713477910867.jpg\" alt=\"\" width=\"1980\" height=\"1319\">\u003cfigcaption class=\"wp-caption-text\">California State Sen. Tom Umberg during the opening of Hope Center in Fullerton, California, on Oct. 27, 2022. \u003ccite>(Jeff Gritchen/MediaNews Group/Orange County Register via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Monica Porter Gilbert, a mental health policy advocate with Disability Rights California, said the lack of clear information from the state about how the program has been implemented thus far is a big part of the problem.\u003c/p>\n\u003cp>“It feels concerning to massively open the gates to expand eligibility for the program when we really have no evidence that the program is having a positive impact,” she said.\u003c/p>\n\u003cp>Umberg initially wanted to expand CARE Court in a way that would have made even more people eligible for it. An earlier draft of his legislation would have included all mood disorders with psychotic features. But critics, including the County Behavioral Health Directors Association, warned that “massive expansion” would lead to people flooding into CARE Court faster than counties could provide services. As a concession, Umberg eventually limited his bill to bipolar disorder.\u003c/p>\n\u003ch2>Newsom’s mental health overhaul\u003c/h2>\n\u003cp>In addition to expanding eligibility, Umberg’s bill also eliminates what he said are some “inefficiencies” from the CARE Court process. That includes combining two early court hearings into one, he said, thereby reducing the amount of time participants have to spend in court and saving administrative resources.[aside postID=news_12007420 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-1020x691.jpg']The legislation also allows the criminal justice system to refer someone directly into CARE Court if they are charged with a crime and are deemed incompetent to stand trial.\u003c/p>\n\u003cp>Michelle Doty Cabrera, executive director of the California Behavioral Health Directors Association, said her organization opposed the new law. She worries that counties won’t have the staffing or housing resources necessary to handle an influx of people. And they are still working out kinks in a system that is still relatively new, she said.\u003c/p>\n\u003cp>At the same time, she said, county behavioral health departments are also pivoting to address dozens of other new initiatives, including Newsom’s 2024 \u003ca href=\"https://calmatters.org/health/mental-health/2025/06/prop-1-mental-health-awards/\">mental health housing bond\u003c/a> known as Proposition 1 as well as CalAIM, the governor’s overhaul of \u003ca href=\"https://calmatters.org/housing/homelessness/2024/12/calaim-federal-waivers/\">Medi-Cal for mental health services\u003c/a>.\u003c/p>\n\u003cp>“We need to allow counties to implement the very many things that have been put on the table,” she said.\u003c/p>\n\u003cp>\u003cem>This article was \u003ca href=\"https://calmatters.org/health/mental-health/2025/10/care-court-expansion-new-law/\">originally published on CalMatters\u003c/a> and was republished under the \u003ca href=\"https://creativecommons.org/licenses/by-nc-nd/4.0/\">Creative Commons Attribution-NonCommercial-NoDerivatives\u003c/a> license.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Gov. Newsom introduced CARE Court to bring more people experiencing severe mental illness into treatment. It has helped fewer people than he projected, but a new law will make more people eligible for it.",
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"title": "Newsom Expands CARE Court Mental Health Law to Reach More Californians | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c!-- Creative Commons Attribution-NonCommercial-NoDerivatives https://creativecommons.org/licenses/by-nc-nd/4.0/ -->\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://calmatters.org/\">CalMatters\u003c/a>. \u003ca href=\"https://calmatters.org/subscribe-to-calmatters/\">Sign up\u003c/a> for their newsletters.\u003c/em>\u003c/p>\n\u003cp>One of Gov. \u003ca href=\"https://www.kqed.org/news/tag/gavin-newsom\">Gavin Newsom\u003c/a>’s marquee mental health programs may broaden its reach despite persistent questions about the number of people it’s helping and whether it’s achieving the goals he set out for it \u003ca href=\"https://www.kqed.org/news/12007175/care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going\">when it launched\u003c/a>.\u003c/p>\n\u003cp>Newsom today signed a law that expands eligibility for CARE Court to include people who experience psychotic symptoms as a result of bipolar disorder. Under the law’s previous constraints, only people with schizophrenia and other limited psychotic disorders were eligible.\u003c/p>\n\u003cp>Newsom, in a written statement, called the law and its expansion an important part of his administration’s efforts to bring people with serious \u003ca href=\"https://www.kqed.org/news/tag/mental-health\">mental illness\u003c/a> into treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“California doesn’t sit on the sidelines while people fall through the cracks,” he said. “We don’t stand by while people spiral on our sidewalks or cycle through emergency rooms and jail cells — we step up. We built CARE Court to connect people to treatment, dignity, and accountability — because care and accountability belong at the center of how we serve our communities.”\u003c/p>\n\u003cp>Newsom \u003ca href=\"https://calmatters.org/health/2022/03/newsom-california-mental-illness-treatment/\">introduced CARE Court in 2022\u003c/a>, creating a program that allows family members, first responders, doctors and others to petition the courts on behalf of people with severe psychosis who couldn’t care for themselves.\u003c/p>\n\u003cfigure id=\"attachment_12047982\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12047982\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Orange County Superior Court will technically house the local CARE Court, though judges say they will more likely hold meetings with patients at a more neutral site, like a conference room at the county health office. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Once a petition is accepted, individuals are presented with a voluntary treatment plan, which can include counseling, medication and housing. If they refuse, a judge can, in theory, order them to participate in a treatment plan.\u003c/p>\n\u003cp>Almost two years in, CARE Court has struggled to fulfill Newsom’s initial promises. A recent \u003ca href=\"https://calmatters.org/health/mental-health/2025/09/care-court-2025-data/\">CalMatters investigation\u003c/a> found that the program has so far reached a few hundred people, far short of the thousands originally projected.\u003c/p>\n\u003cp>The new law, by \u003ca href=\"https://calmatters.digitaldemocracy.org/legislators/thomas-umberg-165043\">Sen. Tom Umberg,\u003c/a> a Santa Ana Democrat, sailed through the Legislature with \u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260sb27\">nearly unanimous bipartisan support,\u003c/a> no votes against and just a handful of abstentions.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“The beauty of CARE Court is that it holds both institutions and individuals accountable, ensures individuals get the care they need and gives judges a clear role in overseeing and guiding the process,” Umberg said in a written statement today. “This bill focuses on implementation by listening to and learning from counties about what’s working and what’s not, in order to meet the goals of the original CARE Court legislation.”\u003c/p>\n\u003cp>But the bill faced plenty of criticism in the community, with counties \u003ca href=\"https://www.abridged.org/news/low-use-program-mental-illness-homelessness/\">questioning how they will implement\u003c/a> an expanded program on a tight timeline and disability rights advocates raising concerns about the effectiveness of a program they consider “unimplementable.”\u003c/p>\n\u003cp>“We have to tell the truth,” said Lex Steppling, a founding member of All People’s Health Collective. “This is not workable. It’s not going to be workable. And I personally believe the cracks in the foundation are getting bigger and bigger and it’s going to collapse.”\u003c/p>\n\u003cp>Steppling saved his harshest criticism for “the state’s self-described ‘liberal and progressive’ politicians,” who he said were too afraid of the Newsom administration to oppose the bill.\u003c/p>\n\u003ch2>Wide estimates on CARE Court expansion\u003c/h2>\n\u003cp>Umberg’s legislation could expand CARE Court enrollment, though it’s unclear by how much. Umberg’s office doesn’t have an estimate of how many more people will be eligible for the program under the new parameters. San Diego County said the new rules could increase its numbers by anywhere from 3.5% to 48.1%.\u003c/p>\n\u003cp>“We’re trying to focus on the right populations,” Umberg said. “I do think it will expand it, but not dramatically.”\u003c/p>\n\u003cfigure id=\"attachment_11983393\" class=\"wp-caption aligncenter\" style=\"max-width: 1980px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11983393\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/GettyImages-1244278587-scaled-e1713477910867.jpg\" alt=\"\" width=\"1980\" height=\"1319\">\u003cfigcaption class=\"wp-caption-text\">California State Sen. Tom Umberg during the opening of Hope Center in Fullerton, California, on Oct. 27, 2022. \u003ccite>(Jeff Gritchen/MediaNews Group/Orange County Register via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Monica Porter Gilbert, a mental health policy advocate with Disability Rights California, said the lack of clear information from the state about how the program has been implemented thus far is a big part of the problem.\u003c/p>\n\u003cp>“It feels concerning to massively open the gates to expand eligibility for the program when we really have no evidence that the program is having a positive impact,” she said.\u003c/p>\n\u003cp>Umberg initially wanted to expand CARE Court in a way that would have made even more people eligible for it. An earlier draft of his legislation would have included all mood disorders with psychotic features. But critics, including the County Behavioral Health Directors Association, warned that “massive expansion” would lead to people flooding into CARE Court faster than counties could provide services. As a concession, Umberg eventually limited his bill to bipolar disorder.\u003c/p>\n\u003ch2>Newsom’s mental health overhaul\u003c/h2>\n\u003cp>In addition to expanding eligibility, Umberg’s bill also eliminates what he said are some “inefficiencies” from the CARE Court process. That includes combining two early court hearings into one, he said, thereby reducing the amount of time participants have to spend in court and saving administrative resources.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The legislation also allows the criminal justice system to refer someone directly into CARE Court if they are charged with a crime and are deemed incompetent to stand trial.\u003c/p>\n\u003cp>Michelle Doty Cabrera, executive director of the California Behavioral Health Directors Association, said her organization opposed the new law. She worries that counties won’t have the staffing or housing resources necessary to handle an influx of people. And they are still working out kinks in a system that is still relatively new, she said.\u003c/p>\n\u003cp>At the same time, she said, county behavioral health departments are also pivoting to address dozens of other new initiatives, including Newsom’s 2024 \u003ca href=\"https://calmatters.org/health/mental-health/2025/06/prop-1-mental-health-awards/\">mental health housing bond\u003c/a> known as Proposition 1 as well as CalAIM, the governor’s overhaul of \u003ca href=\"https://calmatters.org/housing/homelessness/2024/12/calaim-federal-waivers/\">Medi-Cal for mental health services\u003c/a>.\u003c/p>\n\u003cp>“We need to allow counties to implement the very many things that have been put on the table,” she said.\u003c/p>\n\u003cp>\u003cem>This article was \u003ca href=\"https://calmatters.org/health/mental-health/2025/10/care-court-expansion-new-law/\">originally published on CalMatters\u003c/a> and was republished under the \u003ca href=\"https://creativecommons.org/licenses/by-nc-nd/4.0/\">Creative Commons Attribution-NonCommercial-NoDerivatives\u003c/a> license.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "6-things-to-know-about-how-gov-newsoms-care-court-is-working-so-far",
"title": "6 Things to Know About How Gov. Newsom’s CARE Court Is Working So Far",
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"content": "\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://calmatters.org/\">CalMatters\u003c/a>. \u003ca href=\"https://calmatters.org/subscribe-to-calmatters/\">Sign up\u003c/a> for their newsletters.\u003c/em>\u003c/p>\n\u003cp>Gov. Gavin Newsom’s new \u003ca href=\"https://calmatters.org/health/mental-health/2025/09/care-court-2025-data/\">mental health court made big promises\u003c/a> about how it would help get the sickest Californians off the streets.\u003c/p>\n\u003cp>Launched in 2023, the program allows people to petition a court to order treatment is for someone experiencing psychosis.\u003c/p>\n\u003cp>To see how CARE Court is working so far, CalMatters requested data from every county in the state.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Here’s what we found:\u003c/p>\n\u003ch2>CARE Court is reaching far fewer people than expected\u003c/h2>\n\u003cp>The state initially estimated as many as 12,000 Californians could qualify for the program. Instead, just 2,421 petitions have been filed through July, according to the Judicial Council of California. Only 528 of those have resulted in people getting care through voluntary treatment agreements or court-ordered plans.\u003c/p>\n\u003cp>San Diego County anticipated receiving 1,000 petitions in the first year and establishing court-ordered treatment plans for 250 people. But in nearly two years, the county instead has received just 384 petitions and established 134 voluntary agreements. Los Angeles County saw 511 petitions filed, with 112 resulting in care agreements or plans. In 2023, LA officials predicted to news organizations the county could enroll 4,500 people in the first year.[aside postID=news_12048062 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2025/07/Rodriguez_CARE_07_07_2025-1.jpg']\u003c/p>\n\u003ch2>It can be hard to file in court\u003c/h2>\n\u003cp>Sources we talked to said it ended up being harder than expected to file petitions. Counties thought police, firefighters and other first responders would jump at the chance to file CARE Court petitions on behalf of the sick, unhoused Californians they encounter on the streets every day. But overworked first-responders didn’t have time to navigate the time-consuming process, said Amber Irvine, San Diego County’s behavioral health program coordinator.\u003c/p>\n\u003cp>In some cases, police and firefighters filed petitions when the program first started. But they were often dismissed – which made them reluctant to file more, said Crystal Robbins, who manages a treatment referral program for San Diego Fire-Rescue.\u003c/p>\n\u003cp>“We quickly found out that it wasn’t a useful tool for the people that we see,” she said.\u003c/p>\n\u003ch2>A lot of CARE Court petitions get dismissed\u003c/h2>\n\u003cp>About 45% of petitions filed statewide, although that number includes the handful of cases in which someone has successfully “graduated” from the program. The rate is even higher in some counties, such as San Francisco, where nearly two-thirds of petitions are thrown out.\u003c/p>\n\u003cp>That can be for a variety of reasons. Someone might not meet the narrow criteria to qualify for CARE Court. If the person is homeless, outreach workers might have a hard time finding them. Or, the person might simply refuse services. If that’s the case, CARE Court has few teeth to force them to comply.\u003c/p>\n\u003ch2>Most counties aren’t forcing people to participate\u003c/h2>\n\u003cp>The initial allure of CARE Court for many supporters was the promise of court-ordered treatment plans that would encourage sick people to accept the help they’d been resisting. But most counties are eschewing that aspect of the program, and instead providing treatment only if outreach workers can convince someone to comply. Courts have ordered just 14 people into treatment plans, according to the Judicial Council.\u003c/p>\n\u003cfigure id=\"attachment_11959338\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11959338\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-800x533.jpg\" alt='An office full of people sit at tables looking toward a woman with a purple blouse who speaks from a microphone and holding index cards in her other hand. A flat-screen television hangs above her head displaying \"What is in a CARE Agreement Plan?\"' width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02.jpg 2000w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Annette Mugrditchian, deputy director, speaks to community members about CARE Court in October of 2023, at the Behavioral Health Training Center in Orange County. \u003ccite>(Lauren Justice/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>But counties say numbers don’t tell the whole story\u003c/h2>\n\u003cp>While this data shows how many people engaged in treatment through the official CARE Court program, it doesn’t count all the people who started the process and ended up getting services through another county program instead, said Michelle Doty Cabrera, executive director of the California Behavioral Health Directors Association.\u003c/p>\n\u003cp>“I would say that I think the whole idea of looking at the numbers, it sort of misses the point,” she said.\u003c/p>\n\u003cp>One of CARE Court’s successes, she said, has been in spreading the word about county services to people who might need them. As of December, people were diverted away from CARE Court and into other county services 1,358 times, according to a \u003ca href=\"https://www.chhs.ca.gov/wp-content/uploads/2025/06/CARE-Act-Implementation-Update-July-2025.pdf\">recent report\u003c/a> from the Health and Human Services Agency.\u003c/p>\n\u003ch2>A new bill could boost Care Court’s numbers\u003c/h2>\n\u003cp>Right now, only people with schizophrenia and other limited psychotic disorders qualify. If \u003ca href=\"https://calmatters.digitaldemocracy.org/legislators/thomas-umberg-165043\">Sen. Thomas Umberg’s\u003c/a> \u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260sb27\">Senate Bill 27\u003c/a> passes, the program would expand to include people who experience psychotic symptoms as a result of bipolar disorder.\u003c/p>\n\u003cp>It’s unclear how many more people CARE Court could reach as a result. Umberg’s office has no estimate, and San Diego County says the bill could increase its numbers by anywhere from 3.5% to 48.1%.\u003c/p>\n\u003cp>That’s worrying for people like Irvine. Adding a lot more people into the program would give clinicians less time to spend with each client, Irvine said. And Umberg’s bill doesn’t come with money to hire more staff.\u003c/p>\n\u003cp>\u003cem>This article was \u003ca href=\"https://calmatters.org/health/mental-health/2025/09/care-court-data-takeaways/\">originally published on CalMatters\u003c/a> and was republished under the \u003ca href=\"https://creativecommons.org/licenses/by-nc-nd/4.0/\">Creative Commons Attribution-NonCommercial-NoDerivatives\u003c/a> license.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n",
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"title": "6 Things to Know About How Gov. Newsom’s CARE Court Is Working So Far | KQED",
"description": "This story was originally published by CalMatters. Sign up for their newsletters. Gov. Gavin Newsom’s new mental health court made big promises about how it would help get the sickest Californians off the streets. Launched in 2023, the program allows people to petition a court to order treatment is for someone experiencing psychosis. To see how CARE Court is working so far, CalMatters requested data from every county in the state. Here’s what we found: CARE Court is reaching far fewer people than expected The state initially estimated as many as 12,000 Californians could qualify for the program. Instead, just",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://calmatters.org/\">CalMatters\u003c/a>. \u003ca href=\"https://calmatters.org/subscribe-to-calmatters/\">Sign up\u003c/a> for their newsletters.\u003c/em>\u003c/p>\n\u003cp>Gov. Gavin Newsom’s new \u003ca href=\"https://calmatters.org/health/mental-health/2025/09/care-court-2025-data/\">mental health court made big promises\u003c/a> about how it would help get the sickest Californians off the streets.\u003c/p>\n\u003cp>Launched in 2023, the program allows people to petition a court to order treatment is for someone experiencing psychosis.\u003c/p>\n\u003cp>To see how CARE Court is working so far, CalMatters requested data from every county in the state.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Here’s what we found:\u003c/p>\n\u003ch2>CARE Court is reaching far fewer people than expected\u003c/h2>\n\u003cp>The state initially estimated as many as 12,000 Californians could qualify for the program. Instead, just 2,421 petitions have been filed through July, according to the Judicial Council of California. Only 528 of those have resulted in people getting care through voluntary treatment agreements or court-ordered plans.\u003c/p>\n\u003cp>San Diego County anticipated receiving 1,000 petitions in the first year and establishing court-ordered treatment plans for 250 people. But in nearly two years, the county instead has received just 384 petitions and established 134 voluntary agreements. Los Angeles County saw 511 petitions filed, with 112 resulting in care agreements or plans. In 2023, LA officials predicted to news organizations the county could enroll 4,500 people in the first year.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch2>It can be hard to file in court\u003c/h2>\n\u003cp>Sources we talked to said it ended up being harder than expected to file petitions. Counties thought police, firefighters and other first responders would jump at the chance to file CARE Court petitions on behalf of the sick, unhoused Californians they encounter on the streets every day. But overworked first-responders didn’t have time to navigate the time-consuming process, said Amber Irvine, San Diego County’s behavioral health program coordinator.\u003c/p>\n\u003cp>In some cases, police and firefighters filed petitions when the program first started. But they were often dismissed – which made them reluctant to file more, said Crystal Robbins, who manages a treatment referral program for San Diego Fire-Rescue.\u003c/p>\n\u003cp>“We quickly found out that it wasn’t a useful tool for the people that we see,” she said.\u003c/p>\n\u003ch2>A lot of CARE Court petitions get dismissed\u003c/h2>\n\u003cp>About 45% of petitions filed statewide, although that number includes the handful of cases in which someone has successfully “graduated” from the program. The rate is even higher in some counties, such as San Francisco, where nearly two-thirds of petitions are thrown out.\u003c/p>\n\u003cp>That can be for a variety of reasons. Someone might not meet the narrow criteria to qualify for CARE Court. If the person is homeless, outreach workers might have a hard time finding them. Or, the person might simply refuse services. If that’s the case, CARE Court has few teeth to force them to comply.\u003c/p>\n\u003ch2>Most counties aren’t forcing people to participate\u003c/h2>\n\u003cp>The initial allure of CARE Court for many supporters was the promise of court-ordered treatment plans that would encourage sick people to accept the help they’d been resisting. But most counties are eschewing that aspect of the program, and instead providing treatment only if outreach workers can convince someone to comply. Courts have ordered just 14 people into treatment plans, according to the Judicial Council.\u003c/p>\n\u003cfigure id=\"attachment_11959338\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11959338\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-800x533.jpg\" alt='An office full of people sit at tables looking toward a woman with a purple blouse who speaks from a microphone and holding index cards in her other hand. A flat-screen television hangs above her head displaying \"What is in a CARE Agreement Plan?\"' width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-1920x1280.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02.jpg 2000w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Annette Mugrditchian, deputy director, speaks to community members about CARE Court in October of 2023, at the Behavioral Health Training Center in Orange County. \u003ccite>(Lauren Justice/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>But counties say numbers don’t tell the whole story\u003c/h2>\n\u003cp>While this data shows how many people engaged in treatment through the official CARE Court program, it doesn’t count all the people who started the process and ended up getting services through another county program instead, said Michelle Doty Cabrera, executive director of the California Behavioral Health Directors Association.\u003c/p>\n\u003cp>“I would say that I think the whole idea of looking at the numbers, it sort of misses the point,” she said.\u003c/p>\n\u003cp>One of CARE Court’s successes, she said, has been in spreading the word about county services to people who might need them. As of December, people were diverted away from CARE Court and into other county services 1,358 times, according to a \u003ca href=\"https://www.chhs.ca.gov/wp-content/uploads/2025/06/CARE-Act-Implementation-Update-July-2025.pdf\">recent report\u003c/a> from the Health and Human Services Agency.\u003c/p>\n\u003ch2>A new bill could boost Care Court’s numbers\u003c/h2>\n\u003cp>Right now, only people with schizophrenia and other limited psychotic disorders qualify. If \u003ca href=\"https://calmatters.digitaldemocracy.org/legislators/thomas-umberg-165043\">Sen. Thomas Umberg’s\u003c/a> \u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260sb27\">Senate Bill 27\u003c/a> passes, the program would expand to include people who experience psychotic symptoms as a result of bipolar disorder.\u003c/p>\n\u003cp>It’s unclear how many more people CARE Court could reach as a result. Umberg’s office has no estimate, and San Diego County says the bill could increase its numbers by anywhere from 3.5% to 48.1%.\u003c/p>\n\u003cp>That’s worrying for people like Irvine. Adding a lot more people into the program would give clinicians less time to spend with each client, Irvine said. And Umberg’s bill doesn’t come with money to hire more staff.\u003c/p>\n\u003cp>\u003cem>This article was \u003ca href=\"https://calmatters.org/health/mental-health/2025/09/care-court-data-takeaways/\">originally published on CalMatters\u003c/a> and was republished under the \u003ca href=\"https://creativecommons.org/licenses/by-nc-nd/4.0/\">Creative Commons Attribution-NonCommercial-NoDerivatives\u003c/a> license.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp style=\"text-align: left\">\u003cstrong>Here are today’s headlines:\u003c/strong>\u003c/p>\n\u003cul style=\"text-align: left\">\n\u003cli>California has taken on a grand experiment when it comes to its CARE Courts–a judicial approach to getting people struggling with severe mental health issues into treatment programs. The law, \u003ca href=\"https://newsroom.courts.ca.gov/news/california-courts-implement-care-act-statewide\">which went into effect statewide last December\u003c/a>, empowers judges to mandate that a person with mounting mental health problems undergo treatment, whether the person consents or not. Orange County is taking a different approach, however–with something called “relentless outreach” in getting mental health treatment to those that need it the most.\u003c/li>\n\u003cli>Lawmakers in Sacramento have proposed \u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260sb576\">a bill\u003c/a> that would prohibit online video streaming services, like Netflix and Amazon, from making their advertisements louder than the programs their viewers have subscribed to watch–and it has bipartisan support.\u003c/li>\n\u003c/ul>\n\u003cp>\u003ca href=\"https://www.kqed.org/science/1997759/he-relentlessly-drove-30000-miles-asking-one-question-do-you-want-help\">\u003cstrong>“Relentless Outreach” is Key to Orange County’s CARE Court Strategy\u003c/strong>\u003c/a>\u003c/p>\n\u003cp>Giovanni Figueroa put 30,000 miles on his car last year, roaming the streets of \u003ca href=\"https://www.kqed.org/news/tag/orange-county\">Orange County,\u003c/a> trying to determine who might be one of his missing clients with schizophrenia.\u003c/p>\n\u003cp>Figueroa is among the first to work for California’s \u003ca href=\"https://www.kqed.org/news/12007175/care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going\">brand new CARE Courts\u003c/a>. While the 2022 law gives judges authority to force people into treatment, \u003ca href=\"https://www.kqed.org/news/11955211/californias-new-care-courts-prompt-orange-county-to-weigh-best-practices\">Orange County decided early on\u003c/a> that its program would be utterly voluntary, leaning on the tenets of relentless outreach to coax, rather than coerce, people into care.\u003c/p>\n\u003cp style=\"text-align: left\">\u003cstrong>\u003ca href=\"https://calmatters.org/politics/2025/07/california-streaming-service-ad-volume/\">New Bill Targets Streaming Ads That Ring Out Louder Than Shows\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp style=\"text-align: left\">Ever been streaming a show or a movie and been jolted out of your entertainment reverie by an ad so loud it felt like it rattled the windows?\u003c/p>\n\u003cp style=\"text-align: left\">If California’s lawmakers have their way, those blaring commercials on streaming platforms might soon have the volume turned down.\u003c/p>\n\u003cp style=\"text-align: left\">A\u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260sb576\"> bill sailing through the Legislature with bipartisan support\u003c/a> would prohibit online streaming services like Netflix and Hulu from cranking up the volume during commercials. The proposal would make the platforms comply with the same standards as a 15-year-old federal law that limits how loud traditional television and cable broadcasters can make their advertisements.\u003c/p>\n\u003cp style=\"text-align: left\">Every senator who was present that day voted for the bill when Umberg brought it to the Senate floor in late May.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp style=\"text-align: left\">\u003cstrong>Here are today’s headlines:\u003c/strong>\u003c/p>\n\u003cul style=\"text-align: left\">\n\u003cli>California has taken on a grand experiment when it comes to its CARE Courts–a judicial approach to getting people struggling with severe mental health issues into treatment programs. The law, \u003ca href=\"https://newsroom.courts.ca.gov/news/california-courts-implement-care-act-statewide\">which went into effect statewide last December\u003c/a>, empowers judges to mandate that a person with mounting mental health problems undergo treatment, whether the person consents or not. Orange County is taking a different approach, however–with something called “relentless outreach” in getting mental health treatment to those that need it the most.\u003c/li>\n\u003cli>Lawmakers in Sacramento have proposed \u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260sb576\">a bill\u003c/a> that would prohibit online video streaming services, like Netflix and Amazon, from making their advertisements louder than the programs their viewers have subscribed to watch–and it has bipartisan support.\u003c/li>\n\u003c/ul>\n\u003cp>\u003ca href=\"https://www.kqed.org/science/1997759/he-relentlessly-drove-30000-miles-asking-one-question-do-you-want-help\">\u003cstrong>“Relentless Outreach” is Key to Orange County’s CARE Court Strategy\u003c/strong>\u003c/a>\u003c/p>\n\u003cp>Giovanni Figueroa put 30,000 miles on his car last year, roaming the streets of \u003ca href=\"https://www.kqed.org/news/tag/orange-county\">Orange County,\u003c/a> trying to determine who might be one of his missing clients with schizophrenia.\u003c/p>\n\u003cp>Figueroa is among the first to work for California’s \u003ca href=\"https://www.kqed.org/news/12007175/care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going\">brand new CARE Courts\u003c/a>. While the 2022 law gives judges authority to force people into treatment, \u003ca href=\"https://www.kqed.org/news/11955211/californias-new-care-courts-prompt-orange-county-to-weigh-best-practices\">Orange County decided early on\u003c/a> that its program would be utterly voluntary, leaning on the tenets of relentless outreach to coax, rather than coerce, people into care.\u003c/p>\n\u003cp style=\"text-align: left\">\u003cstrong>\u003ca href=\"https://calmatters.org/politics/2025/07/california-streaming-service-ad-volume/\">New Bill Targets Streaming Ads That Ring Out Louder Than Shows\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp style=\"text-align: left\">Ever been streaming a show or a movie and been jolted out of your entertainment reverie by an ad so loud it felt like it rattled the windows?\u003c/p>\n\u003cp style=\"text-align: left\">If California’s lawmakers have their way, those blaring commercials on streaming platforms might soon have the volume turned down.\u003c/p>\n\u003cp style=\"text-align: left\">A\u003ca href=\"https://calmatters.digitaldemocracy.org/bills/ca_202520260sb576\"> bill sailing through the Legislature with bipartisan support\u003c/a> would prohibit online streaming services like Netflix and Hulu from cranking up the volume during commercials. The proposal would make the platforms comply with the same standards as a 15-year-old federal law that limits how loud traditional television and cable broadcasters can make their advertisements.\u003c/p>\n\u003cp style=\"text-align: left\">Every senator who was present that day voted for the bill when Umberg brought it to the Senate floor in late May.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cb>Here are the morning’s top stories on Wednesday, October 2, 2024…\u003c/b>\u003c/p>\n\u003cul>\n\u003cli style=\"font-weight: 400\">\u003cspan style=\"font-weight: 400\">CARE Court turns one this week. When it rolled out last year in eight California counties, the program took aim at one of the state’s most pressing challenges — how to treat people whose illness often makes them believe they are not sick, particularly those who, left untreated, move between jail, hospitals and homelessness. \u003c/span>\u003ca href=\"https://www.kqed.org/news/12007175/care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going\">\u003cspan style=\"font-weight: 400\">So how’s it going?\u003c/span>\u003c/a>\u003c/li>\n\u003cli style=\"font-weight: 400\">\u003cspan style=\"font-weight: 400\">The Line Fire in the San Bernardino Mountains flared up over the weekend, forcing more evacuations in areas south of Big Bear Lake. On Tuesday, prosecutors \u003c/span>\u003ca href=\"https://www.kvcrnews.org/local-news/2024-10-01/cal-fire-witnesses-allege-suspect-used-paper-coins-to-ignite-line-fire\">\u003cspan style=\"font-weight: 400\">gave details\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> about how they believe the fire was started. \u003c/span>\u003c/li>\n\u003cli>Tuesday is the second day of \u003ca href=\"https://www.npr.org/2024/10/01/nx-s1-5133391/dockworkers-strike-east-gulf-coast-ports-shipping\">a strike by thousands of dockworkers\u003c/a> on the East and Gulf coasts. And so far, there hasn’t been a huge impact at two major ports on the West Coast, the Port of Los Angeles and Port of Oakland.\u003c/li>\n\u003c/ul>\n\u003ch2>\u003ca href=\"https://www.kqed.org/news/12007175/care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going\">\u003cb>CARE Court Was Supposed To Help Those Hardest To Treat. Here’s How It’s Going\u003c/b>\u003c/a>\u003c/h2>\n\u003cp>\u003cspan style=\"font-weight: 400\">When it rolled out last year in eight counties, CARE Court took aim at one of the state’s most vexing challenges: how to treat people whose illness often makes them believe they are not sick and who, if left untreated, can oscillate between jails, hospitals and homelessness.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Using the weight of a judge’s black robe to nudge county health departments’ doctors in white coats to provide an array of services, the program sought to reach the hardest-to-treat cases.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now, a year after the program went live in seven counties — San Francisco, Glenn, Tuolumne, Stanislaus, Orange, Riverside, and San Diego — and ten months after it launched in Los Angeles County, petitions appear to be trickling in slower than expected and treatment plans are taking longer to put in place.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And, while Gov. Gavin Newsom, who first \u003c/span>\u003ca href=\"https://www.gov.ca.gov/2022/03/03/governor-newsom-launches-new-plan-to-help-californians-struggling-with-mental-health-challenges-homelessness/\">\u003cspan style=\"font-weight: 400\">introduced the initiative in March 2022\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, initially said it would target those “living on our streets with severe mental health and substance use disorders,” the number of unhoused people going through the program varies widely from county to county.\u003c/span>\u003c/p>\n\u003ch2>\u003ca href=\"https://www.kvcrnews.org/local-news/2024-10-01/cal-fire-witnesses-allege-suspect-used-paper-coins-to-ignite-line-fire\">\u003cb>CalFire Witnesses Allege Suspect Used Paper, Coins To Ignite Line Fire\u003c/b>\u003c/a>\u003c/h2>\n\u003cp>\u003cspan style=\"font-weight: 400\">Prosecutors revealed new details Tuesday about the cause of \u003c/span>\u003ca href=\"https://www.fire.ca.gov/incidents/2024/9/5/line-fire\">\u003cspan style=\"font-weight: 400\">the Line Fire\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> during a preliminary hearing at the San Bernardino Justice Center.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">CalFire investigators, who are serving as witnesses for the prosecution, testified that suspect 34-year-old Justin Wayne Halstenberg allegedly used paper to ignite the large blaze, which remains active. Several witnesses took the stand, detailing how the fire was started.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Investigators with CalFire say surveillance footage from a city fire station, nearby residents and a passing Tesla captured a white pickup truck owned by Halstenberg at the source of the Line Fire, near Baseline, Alpin and Weaver Streets on the afternoon of September 5.\u003c/span>\u003c/p>\n\u003ch2>\u003cb>West Coast Ports Not Severely Impacted By Strike\u003c/b>\u003c/h2>\n\u003cp>\u003cspan style=\"font-weight: 400\">Union dockworkers along East Coast and Gulf Coast ports are \u003c/span>\u003ca href=\"https://www.npr.org/2024/10/01/nx-s1-5133391/dockworkers-strike-east-gulf-coast-ports-shipping\">\u003cspan style=\"font-weight: 400\">on strike\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, halting the movement of billions of dollars’ worth of goods including furniture, paper, shoes, manufacturing components, farm machinery and much more.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The pickets began just after midnight Tuesday, after talks between the International Longshoremen’s Association (ILA) and the United States Maritime Alliance (USMX), which represents ocean carriers and port operators, failed to yield a new contract.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">So far, officials with the Port of Los Angeles and Port of Oakland say operations are normal and they are not anticipating a significant increase in cargo from the strike.\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cb>Here are the morning’s top stories on Wednesday, October 2, 2024…\u003c/b>\u003c/p>\n\u003cul>\n\u003cli style=\"font-weight: 400\">\u003cspan style=\"font-weight: 400\">CARE Court turns one this week. When it rolled out last year in eight California counties, the program took aim at one of the state’s most pressing challenges — how to treat people whose illness often makes them believe they are not sick, particularly those who, left untreated, move between jail, hospitals and homelessness. \u003c/span>\u003ca href=\"https://www.kqed.org/news/12007175/care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going\">\u003cspan style=\"font-weight: 400\">So how’s it going?\u003c/span>\u003c/a>\u003c/li>\n\u003cli style=\"font-weight: 400\">\u003cspan style=\"font-weight: 400\">The Line Fire in the San Bernardino Mountains flared up over the weekend, forcing more evacuations in areas south of Big Bear Lake. On Tuesday, prosecutors \u003c/span>\u003ca href=\"https://www.kvcrnews.org/local-news/2024-10-01/cal-fire-witnesses-allege-suspect-used-paper-coins-to-ignite-line-fire\">\u003cspan style=\"font-weight: 400\">gave details\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> about how they believe the fire was started. \u003c/span>\u003c/li>\n\u003cli>Tuesday is the second day of \u003ca href=\"https://www.npr.org/2024/10/01/nx-s1-5133391/dockworkers-strike-east-gulf-coast-ports-shipping\">a strike by thousands of dockworkers\u003c/a> on the East and Gulf coasts. And so far, there hasn’t been a huge impact at two major ports on the West Coast, the Port of Los Angeles and Port of Oakland.\u003c/li>\n\u003c/ul>\n\u003ch2>\u003ca href=\"https://www.kqed.org/news/12007175/care-court-was-supposed-to-help-those-hardest-to-treat-heres-how-its-going\">\u003cb>CARE Court Was Supposed To Help Those Hardest To Treat. Here’s How It’s Going\u003c/b>\u003c/a>\u003c/h2>\n\u003cp>\u003cspan style=\"font-weight: 400\">When it rolled out last year in eight counties, CARE Court took aim at one of the state’s most vexing challenges: how to treat people whose illness often makes them believe they are not sick and who, if left untreated, can oscillate between jails, hospitals and homelessness.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Using the weight of a judge’s black robe to nudge county health departments’ doctors in white coats to provide an array of services, the program sought to reach the hardest-to-treat cases.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Now, a year after the program went live in seven counties — San Francisco, Glenn, Tuolumne, Stanislaus, Orange, Riverside, and San Diego — and ten months after it launched in Los Angeles County, petitions appear to be trickling in slower than expected and treatment plans are taking longer to put in place.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And, while Gov. Gavin Newsom, who first \u003c/span>\u003ca href=\"https://www.gov.ca.gov/2022/03/03/governor-newsom-launches-new-plan-to-help-californians-struggling-with-mental-health-challenges-homelessness/\">\u003cspan style=\"font-weight: 400\">introduced the initiative in March 2022\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, initially said it would target those “living on our streets with severe mental health and substance use disorders,” the number of unhoused people going through the program varies widely from county to county.\u003c/span>\u003c/p>\n\u003ch2>\u003ca href=\"https://www.kvcrnews.org/local-news/2024-10-01/cal-fire-witnesses-allege-suspect-used-paper-coins-to-ignite-line-fire\">\u003cb>CalFire Witnesses Allege Suspect Used Paper, Coins To Ignite Line Fire\u003c/b>\u003c/a>\u003c/h2>\n\u003cp>\u003cspan style=\"font-weight: 400\">Prosecutors revealed new details Tuesday about the cause of \u003c/span>\u003ca href=\"https://www.fire.ca.gov/incidents/2024/9/5/line-fire\">\u003cspan style=\"font-weight: 400\">the Line Fire\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> during a preliminary hearing at the San Bernardino Justice Center.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">CalFire investigators, who are serving as witnesses for the prosecution, testified that suspect 34-year-old Justin Wayne Halstenberg allegedly used paper to ignite the large blaze, which remains active. Several witnesses took the stand, detailing how the fire was started.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Investigators with CalFire say surveillance footage from a city fire station, nearby residents and a passing Tesla captured a white pickup truck owned by Halstenberg at the source of the Line Fire, near Baseline, Alpin and Weaver Streets on the afternoon of September 5.\u003c/span>\u003c/p>\n\u003ch2>\u003cb>West Coast Ports Not Severely Impacted By Strike\u003c/b>\u003c/h2>\n\u003cp>\u003cspan style=\"font-weight: 400\">Union dockworkers along East Coast and Gulf Coast ports are \u003c/span>\u003ca href=\"https://www.npr.org/2024/10/01/nx-s1-5133391/dockworkers-strike-east-gulf-coast-ports-shipping\">\u003cspan style=\"font-weight: 400\">on strike\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, halting the movement of billions of dollars’ worth of goods including furniture, paper, shoes, manufacturing components, farm machinery and much more.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The pickets began just after midnight Tuesday, after talks between the International Longshoremen’s Association (ILA) and the United States Maritime Alliance (USMX), which represents ocean carriers and port operators, failed to yield a new contract.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">So far, officials with the Port of Los Angeles and Port of Oakland say operations are normal and they are not anticipating a significant increase in cargo from the strike.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>[dropcap]W[/dropcap]hen it rolled out last year in eight counties, CARE Court took aim at one of the state’s most vexing challenges: how to treat people whose illness often makes them believe they are not sick and who, if left untreated, can oscillate between jails, hospitals and homelessness.\u003c/p>\n\u003cp>Using the weight of a judge’s black robe to nudge county health departments’ doctors in white coats to provide an array of services, the program sought to reach the hardest-to-treat cases.\u003c/p>\n\u003cp>Now, a year after the program went live in seven counties — San Francisco, Glenn, Tuolumne, Stanislaus, Orange, Riverside, and San Diego — and ten months after it launched in Los Angeles County, petitions appear to be trickling in slower than expected and treatment plans are taking longer to put in place.\u003c/p>\n\u003cp>And, while Gov. Gavin Newsom, who first \u003ca href=\"https://www.gov.ca.gov/2022/03/03/governor-newsom-launches-new-plan-to-help-californians-struggling-with-mental-health-challenges-homelessness/\">introduced the initiative in March 2022\u003c/a>, initially said it would target those “living on our streets with severe mental health and substance use disorders,” the number of unhoused people going through the program varies widely from county to county.\u003c/p>\n\u003cfigure id=\"attachment_12005914\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12005914\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05.jpg\" alt=\"A white man wearing a suit stands at a podium with a microphone.\" width=\"2000\" height=\"1355\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-800x542.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-1020x691.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-160x108.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-1536x1041.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-1920x1301.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">California State Senator Thomas Umberg speaks before the Senate Judiciary Committee about SB1338, the Community Assistance, Recovery, and Empowerment (CARE) Court Program, on April 26, 2022, in Sacramento. \u003ccite>(Fred Greaves/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>State Sen. Tom Umberg, who co-authored the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB1338\">legislation\u003c/a> that implemented CARE Court, said the gradual rollout hasn’t come as a complete surprise.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We’re changing the culture here,” he said. “So, that takes a little time.”\u003c/p>\n\u003cp>As of mid-September, at least 692 petitions had been filed across seven of the counties in the first cohort, excluding San Francisco, according to data provided by superior court and county health officials. Of those petitions, a little more than a third, or 245, have been dismissed. And nearly one in five, or 121 petitions, have resulted in a CARE Agreement, an official document that details a voluntary treatment regime. There have been six court-ordered, or involuntary, CARE Plans issued.\u003c/p>\n\u003cp>San Francisco has so far received 42 petitions, said Melanie Kushnir, director of the Collaborative Justice Programs at the San Francisco Superior Courts. Of those, she said roughly half are active, meaning the participant is attending hearings and working toward or enrolled in a CARE Agreement. Citing privacy concerns, Kushnir declined to provide data on the exact number of dismissals or CARE Agreements reached but said there had been no CARE Plans issued.\u003c/p>\n\u003cp>The state had initially estimated that between 7,000 and 12,000 people would qualify for CARE Court each year once the program was fully implemented. But even accounting for the small number of counties that launched last year, court and public health officials agree the number of petitions is far fewer than expected — prompting opponents to argue the program is wasting taxpayers’ dollars.\u003c/p>\n\u003cp>According to the California Department of Finance, the state has already allocated $72 million to counties for start-up costs, along with $12 million for ongoing operations in fiscal year 2024–25, which will increase to $47 million in fiscal year 2026–27.\u003c/p>\n\u003cp>“We feel like the program has already failed,” said Samuel Jain, a senior mental health policy attorney at Disability Rights California, which is among the groups that advocated against CARE Court from the start. “The law doesn’t provide any new services and instead directs the limited resources we have to these expensive court processes.”\u003c/p>\n\u003cp>But supporters say it’s too early to pass judgment on a program that has yet to be fully implemented. The remaining 50 counties are due to open their own programs by Dec. 1.\u003c/p>\n\u003cp>“To really make some grand statement about its efficacy in the first 12 months of it rolling out, I think, is a leap for a state with 40 million people,” Dr. Mark Ghaly, the outgoing Secretary of California’s Health and Human Services Agency, told KQED. “But I do think that’s exactly the question that we have to keep in mind.”\u003c/p>\n\u003ch3>The number of petitions varies widely\u003c/h3>\n\u003cp>In Glenn County, with a population of \u003ca href=\"https://data.census.gov/profile/Glenn_County,_California?g=050XX00US06021\">around 29,000\u003c/a>, just one petition has been filed as of Sept. 12, and it was ultimately dismissed, said Chris Ruhl, executive officer of the Glenn County Superior Court. Ruhl expects one or two more may be submitted soon and that more will follow as word of the program spreads.\u003c/p>\n\u003cp>“We generally anticipate there will be an increase in the number of petitions and filings, but we don’t know that for sure,” he said. “We’ll be watching very closely.”\u003c/p>\n\u003cfigure id=\"attachment_12007228\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12007228\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed.jpg\" alt=\"A white man wearing a blue dress suit leans against a wooden divider in a court room.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Judge Michael Begert, presiding over CARE Court, stands in the San Francisco Superior Court in San Francisco on Sept. 17, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the other end of the spectrum is Los Angeles County, which, with a population of around \u003ca href=\"https://data.census.gov/profile/Los_Angeles_County,_California?g=050XX00US06037\">10 million\u003c/a>, has seen the most petitions: 268 as of Sept. 18. There, the number of petitions has been steadily increasing, Los Angeles Superior Court Judge Scott Herin said.\u003c/p>\n\u003cp>“I don’t think it started off like everybody expected, which was an overwhelming flood of cases,” Herin said, adding that the gradual ramp-up was perhaps “more healthy.”\u003c/p>\n\u003cp>That’s allowed some county behavioral health agencies to reappropriate staff assigned to CARE Court to other needs. In Stanislaus County, which has received 47 petitions, 19 of which have been dismissed, Behavioral Health & Recovery Services Director Tony Vartan said some of his CARE Court staff spent the first four to five months doing outreach with police and sheriff departments, hospital workers and others to build awareness.\u003c/p>\n\u003cp>“But as we saw that trend of those petitions, we pulled back some of our staff, and we assigned them to areas that needed more work,” he said. “Our staff emphasize where the cases are, regardless of what program we manage. That way, we make sure that the staff are working and they’ve got cases.”\u003c/p>\n\u003ch3>Cases dismissed\u003c/h3>\n\u003cp>Despite the lower-than-expected number of petitions, county behavioral health and court staff say they weren’t surprised to see that more than a third have been dismissed. Dismissal rates vary across the counties, from just over 90% in Tuolumne County, where 10 of 11 cases were dismissed, to a low of 26% in both Riverside and Los Angeles counties.\u003c/p>\n\u003cp>To be eligible, San Francisco Superior Court Judge Michael Begert said participants need to not only be diagnosed with schizophrenia or another psychotic disorder, but they also must be likely to benefit from services, can’t already be enrolled in services, and must be unlikely to survive without additional support.\u003c/p>\n\u003cp>“And that’s a small eye in a needle to thread,” Begert said.\u003c/p>\n\u003cp>Algenib Collin is trying to thread that needle as she looks for any program that might help for her daughter.\u003c/p>\n\u003cp>Collin applied for CARE Court the day it opened, she said, “I was so desperate.”\u003c/p>\n\u003cp>For roughly 18 months prior, she had seen her daughter, now 27, rapidly deteriorate on San Francisco’s streets. Collin said she would receive a call from the hospital nearly every other week, reporting her daughter had been placed on a 5150, or a temporary mental health hold, only to be rereleased back into homelessness and addiction.\u003c/p>\n\u003cfigure id=\"attachment_11955160\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11955160\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg\" alt=\"A large multi-story building and a driveway alongside it.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Orange County Superior Court will technically house the local CARE Court, though judges say they will more likely hold meetings with patients at a more neutral site, like a conference room at the county health office. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>High on fentanyl and possibly other drugs, Collin said her daughter would bang her head against the sidewalk or speak to herself in a language only she could understand.\u003c/p>\n\u003cp>“My daughter will die if she doesn’t get help,” Collin said. “Believe me.”\u003c/p>\n\u003cp>However, when it came to determining whether she qualified for CARE Court, the petition was rejected. Collin doesn’t know why, and she may never know. Privacy laws prohibit her from accessing her daughter’s medical records, so she isn’t sure whether her daughter has been formally diagnosed with a psychotic disorder.\u003c/p>\n\u003cp>The legislation doesn’t include any provision that gives petitioners the right to appeal a judge’s denial, though Ghaly said she could potentially refile the case.\u003c/p>\n\u003cp>“It’s frustrating,” Collin said. “I don’t want my daughter to die.”\u003c/p>\n\u003cp>Representatives from the San Francisco Public Health Department declined to be interviewed. Begert said he couldn’t comment on individual cases.\u003c/p>\n\u003cp>Ultimately, it’s up to the judge to hold public health departments accountable for providing appropriate care, Ghaly said, sharing an anecdote about how officials in San Diego frame the program: “They share with clients that CARE is an approach for the individual to … really get the black robe effect to hold the county accountable. And that’s exactly the way that we had hoped.”\u003c/p>\n\u003ch3>Breaking the pattern\u003c/h3>\n\u003cp>Collin’s experience, however, highlights a disconnect between the way the program was initially described — to, in Newsom’s words from 2022, “break the pattern that leaves people without hope and cycling repeatedly through homelessness and incarceration” — and what was actually written into legislation.\u003c/p>\n\u003cp>In the first year of the program’s rollout, success rates of getting people who are also experiencing homelessness into the program have varied. In Stanislaus County, for instance, Vartan said roughly 70% of the participants were unhoused before enrolling.\u003c/p>\n\u003cp>The opposite is true in Los Angeles and Riverside counties, where 30% and 20%–25% of enrollees are experiencing homelessness, respectively, health officials said. In Orange County, the figure is closer to 15%, according to Dr. Veronica Kelley, Director of the Orange County Health Care Agency.\u003c/p>\n\u003cfigure id=\"attachment_12007229\" class=\"wp-caption aligncenter\" style=\"max-width: 1024px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12007229\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398.jpg\" alt=\"A man sits next to three women at a table as he points to something.\" width=\"1024\" height=\"694\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398.jpg 1024w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-800x542.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-1020x691.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-160x108.jpg 160w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Veronica Kelley, director of Behavioral Health Services for Orange County, right, listens as Orange County Superior Judge Ebrahim Baytieh speaks during a CARE court information session at Behavioral Health Training Center on Aug. 16, 2023, in Orange. The county’s behavioral health department and a representative from the public defender’s office is meeting with the public to explain what the CARE Act is. \u003ccite>(Gina Ferazzi / Los Angeles Times via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the former two counties, the majority of petitions have come from family members, health officials said. In Orange County, Kelley said the figure is closer to 40%.\u003c/p>\n\u003cp>Rather than view this as a failure to reach people who are living outside, Ghaly said he’s actually pleased to see the higher levels of petitions coming from family members on behalf of people who have housing, emphasizing that the goal was not to solve homelessness but to solve the problem of untreated mental illness “upstream.”\u003c/p>\n\u003cp>“It means that we’re getting to meet them earlier,” he said. “Almost anyone with severe schizophrenia or a psychotic disorder may be at risk of homelessness.”\u003c/p>\n\u003cp>But, Ghaly acknowledged that because eligibility is narrowly tailored, it may also mean, “We might not see the kind of outcomes that we wanted to see.”\u003c/p>\n\u003cp>Under the legislation, people whose primary diagnosis is a psychotic disorder are eligible for CARE Court, but those whose psychosis is primarily the result of using drugs are not. Asked whether the state would consider expanding eligibility to include cases of drug-induced psychosis, Ghaly said the question is a “fraught” one.\u003c/p>\n\u003cp>“If you ask most psychiatrists who take care of patients with these diagnoses and in largely these social circumstances, it’s really hard to tell what came first,” he said. “Was it the substance-use disorder that drove the psychosis? Or, were there underlying psychotic features to some disorder — maybe diagnosed, maybe not — that then drove the substance-use disorder?”\u003c/p>\n\u003cp>He continued, “Where the state lands at the moment is, there may be a very important population of people who have significant substance-use disorders and these other mental health conditions, who could benefit from CARE. And as we engage with our county partners and the practitioners who are in CARE, we’re asking exactly this question.”\u003c/p>\n\u003cp>But, even if someone doesn’t end up in CARE Court, health officials say they’re often referred to other programs within the county. And in Orange County, Kelley said 41 out of 95 petitions were dismissed because the client was already receiving services.\u003c/p>\n\u003cp>“And it would be unethical to remove them from that treatment and stick them over here in court and hope that that works better,” she said.\u003c/p>\n\u003cp>Ultimately, Ghaly said, that is also part of the point.\u003c/p>\n\u003cp>“It really is a group of people who didn’t go all the way down the CARE path, but because the CARE pathway was a potential, they got served and supported,” he said.\u003c/p>\n\u003ch3>Building trust\u003c/h3>\n\u003cp>For those who do qualify for CARE Court, the process to reach a voluntary treatment plan or CARE Agreement can be challenging, judges and health officials said. Just building enough trust to get someone to come into court can itself sometimes take two months, Kelley said.\u003c/p>\n\u003cp>“None of us would be open to a stranger coming up to us and telling us, ‘Come with me to court. I can help you,’” she said. “So, to believe that someone who’s severely impacted by a mental illness would be open to that doesn’t make any sense.” [aside postID=\"news_11955211,news_11952228,news_11924117\" label=\"Related Stories\"]\u003c/p>\n\u003cp>Kaitlyn Willison, an attorney with Legal Assistance to the Elderly in San Francisco who represents CARE Court participants, said the first step might involve combing the streets to search for people, which takes time. Once the person is found, the next hurdle is building trust.\u003c/p>\n\u003cp>“That means I need to see them two, three, four times before they go to court,” Willison said. “And the timelines just aren’t set up in a way that allows us as respondents’ counsel enough time to build that really precious trust that we need to best advocate for our clients.”\u003c/p>\n\u003cp>Umberg said he’s looking into further legislation or possible rule changes within the court system to address the challenges Willison and others have experienced so far.\u003c/p>\n\u003cp>But Jain, with Disability Rights California, is skeptical. One of those challenges is baked into the nature of the program itself, he said: that it has the potential to veer away from voluntary agreements and into coerced care.\u003c/p>\n\u003cp>“The bottom line is that the court is a coercive program,” he said.\u003c/p>\n\u003cfigure id=\"attachment_12007227\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12007227\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed.jpg\" alt=\"A white man wearing a blue dress suit rests his hand on his face with a calendar in the background.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Judge Michael Begert, presiding over CARE Court, sits in the San Francisco Superior Court in San Francisco on Sept. 17, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Judge Begert in San Francisco, coerced treatment is very much “what we’re trying to avoid.” But, he acknowledged that changing the cultures of both the court system and the mental health care system is no easy task.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Getting people to change their mindset in a culture that’s very well-formed and static is a hard thing to do,” he said. “You bring the healthcare system into the criminal justice system — or the justice system in general — it starts to act like the justice system. So, that’s always a challenge.”\u003c/p>\n\n",
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"excerpt": "The California program is marking one year since it first rolled out in seven counties. It was billed as a way to get people with untreated schizophrenia and associated disorders — particularly those experiencing street homelessness — into services and housing.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">W\u003c/span>\u003c/p>\u003cp>hen it rolled out last year in eight counties, CARE Court took aim at one of the state’s most vexing challenges: how to treat people whose illness often makes them believe they are not sick and who, if left untreated, can oscillate between jails, hospitals and homelessness.\u003c/p>\n\u003cp>Using the weight of a judge’s black robe to nudge county health departments’ doctors in white coats to provide an array of services, the program sought to reach the hardest-to-treat cases.\u003c/p>\n\u003cp>Now, a year after the program went live in seven counties — San Francisco, Glenn, Tuolumne, Stanislaus, Orange, Riverside, and San Diego — and ten months after it launched in Los Angeles County, petitions appear to be trickling in slower than expected and treatment plans are taking longer to put in place.\u003c/p>\n\u003cp>And, while Gov. Gavin Newsom, who first \u003ca href=\"https://www.gov.ca.gov/2022/03/03/governor-newsom-launches-new-plan-to-help-californians-struggling-with-mental-health-challenges-homelessness/\">introduced the initiative in March 2022\u003c/a>, initially said it would target those “living on our streets with severe mental health and substance use disorders,” the number of unhoused people going through the program varies widely from county to county.\u003c/p>\n\u003cfigure id=\"attachment_12005914\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12005914\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05.jpg\" alt=\"A white man wearing a suit stands at a podium with a microphone.\" width=\"2000\" height=\"1355\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-800x542.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-1020x691.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-160x108.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-1536x1041.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092024-Senate-Judiciary-FG-05-1920x1301.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">California State Senator Thomas Umberg speaks before the Senate Judiciary Committee about SB1338, the Community Assistance, Recovery, and Empowerment (CARE) Court Program, on April 26, 2022, in Sacramento. \u003ccite>(Fred Greaves/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>State Sen. Tom Umberg, who co-authored the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB1338\">legislation\u003c/a> that implemented CARE Court, said the gradual rollout hasn’t come as a complete surprise.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We’re changing the culture here,” he said. “So, that takes a little time.”\u003c/p>\n\u003cp>As of mid-September, at least 692 petitions had been filed across seven of the counties in the first cohort, excluding San Francisco, according to data provided by superior court and county health officials. Of those petitions, a little more than a third, or 245, have been dismissed. And nearly one in five, or 121 petitions, have resulted in a CARE Agreement, an official document that details a voluntary treatment regime. There have been six court-ordered, or involuntary, CARE Plans issued.\u003c/p>\n\u003cp>San Francisco has so far received 42 petitions, said Melanie Kushnir, director of the Collaborative Justice Programs at the San Francisco Superior Courts. Of those, she said roughly half are active, meaning the participant is attending hearings and working toward or enrolled in a CARE Agreement. Citing privacy concerns, Kushnir declined to provide data on the exact number of dismissals or CARE Agreements reached but said there had been no CARE Plans issued.\u003c/p>\n\u003cp>The state had initially estimated that between 7,000 and 12,000 people would qualify for CARE Court each year once the program was fully implemented. But even accounting for the small number of counties that launched last year, court and public health officials agree the number of petitions is far fewer than expected — prompting opponents to argue the program is wasting taxpayers’ dollars.\u003c/p>\n\u003cp>According to the California Department of Finance, the state has already allocated $72 million to counties for start-up costs, along with $12 million for ongoing operations in fiscal year 2024–25, which will increase to $47 million in fiscal year 2026–27.\u003c/p>\n\u003cp>“We feel like the program has already failed,” said Samuel Jain, a senior mental health policy attorney at Disability Rights California, which is among the groups that advocated against CARE Court from the start. “The law doesn’t provide any new services and instead directs the limited resources we have to these expensive court processes.”\u003c/p>\n\u003cp>But supporters say it’s too early to pass judgment on a program that has yet to be fully implemented. The remaining 50 counties are due to open their own programs by Dec. 1.\u003c/p>\n\u003cp>“To really make some grand statement about its efficacy in the first 12 months of it rolling out, I think, is a leap for a state with 40 million people,” Dr. Mark Ghaly, the outgoing Secretary of California’s Health and Human Services Agency, told KQED. “But I do think that’s exactly the question that we have to keep in mind.”\u003c/p>\n\u003ch3>The number of petitions varies widely\u003c/h3>\n\u003cp>In Glenn County, with a population of \u003ca href=\"https://data.census.gov/profile/Glenn_County,_California?g=050XX00US06021\">around 29,000\u003c/a>, just one petition has been filed as of Sept. 12, and it was ultimately dismissed, said Chris Ruhl, executive officer of the Glenn County Superior Court. Ruhl expects one or two more may be submitted soon and that more will follow as word of the program spreads.\u003c/p>\n\u003cp>“We generally anticipate there will be an increase in the number of petitions and filings, but we don’t know that for sure,” he said. “We’ll be watching very closely.”\u003c/p>\n\u003cfigure id=\"attachment_12007228\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12007228\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed.jpg\" alt=\"A white man wearing a blue dress suit leans against a wooden divider in a court room.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-12-BL_qed-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Judge Michael Begert, presiding over CARE Court, stands in the San Francisco Superior Court in San Francisco on Sept. 17, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the other end of the spectrum is Los Angeles County, which, with a population of around \u003ca href=\"https://data.census.gov/profile/Los_Angeles_County,_California?g=050XX00US06037\">10 million\u003c/a>, has seen the most petitions: 268 as of Sept. 18. There, the number of petitions has been steadily increasing, Los Angeles Superior Court Judge Scott Herin said.\u003c/p>\n\u003cp>“I don’t think it started off like everybody expected, which was an overwhelming flood of cases,” Herin said, adding that the gradual ramp-up was perhaps “more healthy.”\u003c/p>\n\u003cp>That’s allowed some county behavioral health agencies to reappropriate staff assigned to CARE Court to other needs. In Stanislaus County, which has received 47 petitions, 19 of which have been dismissed, Behavioral Health & Recovery Services Director Tony Vartan said some of his CARE Court staff spent the first four to five months doing outreach with police and sheriff departments, hospital workers and others to build awareness.\u003c/p>\n\u003cp>“But as we saw that trend of those petitions, we pulled back some of our staff, and we assigned them to areas that needed more work,” he said. “Our staff emphasize where the cases are, regardless of what program we manage. That way, we make sure that the staff are working and they’ve got cases.”\u003c/p>\n\u003ch3>Cases dismissed\u003c/h3>\n\u003cp>Despite the lower-than-expected number of petitions, county behavioral health and court staff say they weren’t surprised to see that more than a third have been dismissed. Dismissal rates vary across the counties, from just over 90% in Tuolumne County, where 10 of 11 cases were dismissed, to a low of 26% in both Riverside and Los Angeles counties.\u003c/p>\n\u003cp>To be eligible, San Francisco Superior Court Judge Michael Begert said participants need to not only be diagnosed with schizophrenia or another psychotic disorder, but they also must be likely to benefit from services, can’t already be enrolled in services, and must be unlikely to survive without additional support.\u003c/p>\n\u003cp>“And that’s a small eye in a needle to thread,” Begert said.\u003c/p>\n\u003cp>Algenib Collin is trying to thread that needle as she looks for any program that might help for her daughter.\u003c/p>\n\u003cp>Collin applied for CARE Court the day it opened, she said, “I was so desperate.”\u003c/p>\n\u003cp>For roughly 18 months prior, she had seen her daughter, now 27, rapidly deteriorate on San Francisco’s streets. Collin said she would receive a call from the hospital nearly every other week, reporting her daughter had been placed on a 5150, or a temporary mental health hold, only to be rereleased back into homelessness and addiction.\u003c/p>\n\u003cfigure id=\"attachment_11955160\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11955160\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg\" alt=\"A large multi-story building and a driveway alongside it.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Orange County Superior Court will technically house the local CARE Court, though judges say they will more likely hold meetings with patients at a more neutral site, like a conference room at the county health office. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>High on fentanyl and possibly other drugs, Collin said her daughter would bang her head against the sidewalk or speak to herself in a language only she could understand.\u003c/p>\n\u003cp>“My daughter will die if she doesn’t get help,” Collin said. “Believe me.”\u003c/p>\n\u003cp>However, when it came to determining whether she qualified for CARE Court, the petition was rejected. Collin doesn’t know why, and she may never know. Privacy laws prohibit her from accessing her daughter’s medical records, so she isn’t sure whether her daughter has been formally diagnosed with a psychotic disorder.\u003c/p>\n\u003cp>The legislation doesn’t include any provision that gives petitioners the right to appeal a judge’s denial, though Ghaly said she could potentially refile the case.\u003c/p>\n\u003cp>“It’s frustrating,” Collin said. “I don’t want my daughter to die.”\u003c/p>\n\u003cp>Representatives from the San Francisco Public Health Department declined to be interviewed. Begert said he couldn’t comment on individual cases.\u003c/p>\n\u003cp>Ultimately, it’s up to the judge to hold public health departments accountable for providing appropriate care, Ghaly said, sharing an anecdote about how officials in San Diego frame the program: “They share with clients that CARE is an approach for the individual to … really get the black robe effect to hold the county accountable. And that’s exactly the way that we had hoped.”\u003c/p>\n\u003ch3>Breaking the pattern\u003c/h3>\n\u003cp>Collin’s experience, however, highlights a disconnect between the way the program was initially described — to, in Newsom’s words from 2022, “break the pattern that leaves people without hope and cycling repeatedly through homelessness and incarceration” — and what was actually written into legislation.\u003c/p>\n\u003cp>In the first year of the program’s rollout, success rates of getting people who are also experiencing homelessness into the program have varied. In Stanislaus County, for instance, Vartan said roughly 70% of the participants were unhoused before enrolling.\u003c/p>\n\u003cp>The opposite is true in Los Angeles and Riverside counties, where 30% and 20%–25% of enrollees are experiencing homelessness, respectively, health officials said. In Orange County, the figure is closer to 15%, according to Dr. Veronica Kelley, Director of the Orange County Health Care Agency.\u003c/p>\n\u003cfigure id=\"attachment_12007229\" class=\"wp-caption aligncenter\" style=\"max-width: 1024px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12007229\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398.jpg\" alt=\"A man sits next to three women at a table as he points to something.\" width=\"1024\" height=\"694\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398.jpg 1024w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-800x542.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-1020x691.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/GettyImages-1612098398-160x108.jpg 160w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Veronica Kelley, director of Behavioral Health Services for Orange County, right, listens as Orange County Superior Judge Ebrahim Baytieh speaks during a CARE court information session at Behavioral Health Training Center on Aug. 16, 2023, in Orange. The county’s behavioral health department and a representative from the public defender’s office is meeting with the public to explain what the CARE Act is. \u003ccite>(Gina Ferazzi / Los Angeles Times via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the former two counties, the majority of petitions have come from family members, health officials said. In Orange County, Kelley said the figure is closer to 40%.\u003c/p>\n\u003cp>Rather than view this as a failure to reach people who are living outside, Ghaly said he’s actually pleased to see the higher levels of petitions coming from family members on behalf of people who have housing, emphasizing that the goal was not to solve homelessness but to solve the problem of untreated mental illness “upstream.”\u003c/p>\n\u003cp>“It means that we’re getting to meet them earlier,” he said. “Almost anyone with severe schizophrenia or a psychotic disorder may be at risk of homelessness.”\u003c/p>\n\u003cp>But, Ghaly acknowledged that because eligibility is narrowly tailored, it may also mean, “We might not see the kind of outcomes that we wanted to see.”\u003c/p>\n\u003cp>Under the legislation, people whose primary diagnosis is a psychotic disorder are eligible for CARE Court, but those whose psychosis is primarily the result of using drugs are not. Asked whether the state would consider expanding eligibility to include cases of drug-induced psychosis, Ghaly said the question is a “fraught” one.\u003c/p>\n\u003cp>“If you ask most psychiatrists who take care of patients with these diagnoses and in largely these social circumstances, it’s really hard to tell what came first,” he said. “Was it the substance-use disorder that drove the psychosis? Or, were there underlying psychotic features to some disorder — maybe diagnosed, maybe not — that then drove the substance-use disorder?”\u003c/p>\n\u003cp>He continued, “Where the state lands at the moment is, there may be a very important population of people who have significant substance-use disorders and these other mental health conditions, who could benefit from CARE. And as we engage with our county partners and the practitioners who are in CARE, we’re asking exactly this question.”\u003c/p>\n\u003cp>But, even if someone doesn’t end up in CARE Court, health officials say they’re often referred to other programs within the county. And in Orange County, Kelley said 41 out of 95 petitions were dismissed because the client was already receiving services.\u003c/p>\n\u003cp>“And it would be unethical to remove them from that treatment and stick them over here in court and hope that that works better,” she said.\u003c/p>\n\u003cp>Ultimately, Ghaly said, that is also part of the point.\u003c/p>\n\u003cp>“It really is a group of people who didn’t go all the way down the CARE path, but because the CARE pathway was a potential, they got served and supported,” he said.\u003c/p>\n\u003ch3>Building trust\u003c/h3>\n\u003cp>For those who do qualify for CARE Court, the process to reach a voluntary treatment plan or CARE Agreement can be challenging, judges and health officials said. Just building enough trust to get someone to come into court can itself sometimes take two months, Kelley said.\u003c/p>\n\u003cp>“None of us would be open to a stranger coming up to us and telling us, ‘Come with me to court. I can help you,’” she said. “So, to believe that someone who’s severely impacted by a mental illness would be open to that doesn’t make any sense.” \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Kaitlyn Willison, an attorney with Legal Assistance to the Elderly in San Francisco who represents CARE Court participants, said the first step might involve combing the streets to search for people, which takes time. Once the person is found, the next hurdle is building trust.\u003c/p>\n\u003cp>“That means I need to see them two, three, four times before they go to court,” Willison said. “And the timelines just aren’t set up in a way that allows us as respondents’ counsel enough time to build that really precious trust that we need to best advocate for our clients.”\u003c/p>\n\u003cp>Umberg said he’s looking into further legislation or possible rule changes within the court system to address the challenges Willison and others have experienced so far.\u003c/p>\n\u003cp>But Jain, with Disability Rights California, is skeptical. One of those challenges is baked into the nature of the program itself, he said: that it has the potential to veer away from voluntary agreements and into coerced care.\u003c/p>\n\u003cp>“The bottom line is that the court is a coercive program,” he said.\u003c/p>\n\u003cfigure id=\"attachment_12007227\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12007227\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed.jpg\" alt=\"A white man wearing a blue dress suit rests his hand on his face with a calendar in the background.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/10/240917-CARECourt-04-BL_qed-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Judge Michael Begert, presiding over CARE Court, sits in the San Francisco Superior Court in San Francisco on Sept. 17, 2024. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Judge Begert in San Francisco, coerced treatment is very much “what we’re trying to avoid.” But, he acknowledged that changing the cultures of both the court system and the mental health care system is no easy task.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Getting people to change their mindset in a culture that’s very well-formed and static is a hard thing to do,” he said. “You bring the healthcare system into the criminal justice system — or the justice system in general — it starts to act like the justice system. So, that’s always a challenge.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "how-shots-instead-of-pills-could-change-californias-homeless-crisis",
"title": "How Shots Instead of Pills Could Change California's Homeless Crisis",
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"content": "\u003cp>As Dr. Rishi Patel’s street medicine van bounces over dirt roads and empty fields in rural Kern County, he’s looking for a particular patient he knows is overdue for her shot.\u003c/p>\n\u003cp>The woman, who has schizophrenia and has been living outside for five years, has several goals for herself: Start thinking more clearly, stop using meth and get an ID so she can visit her son in jail. Patel hopes the shot — a long-acting antipsychotic — will help her meet all of them.\u003c/p>\n\u003cp>Patel, medical director of Akido Street Medicine, is one of many street doctors throughout California using these injections as an increasingly common tool to help combat the state’s intertwined homelessness and mental health crises. Typically administered into a patient’s shoulder muscle, the medication slowly releases into the bloodstream over time, providing relief from symptoms of psychosis for a month or longer. The shots replace a patient’s oral medication — no more taking a pill every day. For people who are homeless and routinely have their pills stolen, can’t make it to a pharmacy for a refill or simply forget to take them, the shots can mean the difference between staying on their medication, or not.\u003c/p>\n\u003cp>“They’ve been an absolute game-changer,” Patel said.\u003c/p>\n\u003cp>Street medicine teams bring the shots directly to their patients wherever they are — whether it’s in a tent along Skid Row in Los Angeles, in a dugout in the middle of a field in the Central Valley, or along the bank of a stream in Shasta County. Doctors can diagnose someone, prescribe the medication, get their consent and give the shot within a matter of days — or sometimes even more quickly — and with minimal paperwork and red tape. They don’t need a psychiatrist’s sign-off.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It’s estimated that California is home to more than 180,000 homeless residents. \u003ca href=\"https://calmatters.org/housing/2023/08/care-court-california-start/\">How to help\u003c/a> the sickest of them — people with severe, untreated psychosis who might wander into traffic or otherwise put themselves in danger — has become a \u003ca href=\"https://calmatters.org/health/mental-health/2023/12/mental-health-conservatorship-newsom/\">hot-button issue\u003c/a>, with Gov. Gavin Newsom and state lawmakers creating new and sometimes controversial ways to get people into treatment. In a recent \u003ca href=\"https://homelessness.ucsf.edu/sites/default/files/2023-06/CASPEH_Report_62023.pdf\">UCSF survey (PDF)\u003c/a> of homeless Californians, 12% reported experiencing hallucinations in the past 30 days, and more than a quarter said they’d ever been hospitalized for a mental health condition.\u003c/p>\n\u003cp>Doctors say the goal of giving an antipsychotic shot to someone living in an encampment is to get them thinking clearly, so that they can start engaging with social workers, sign up for benefits and get on housing waitlists. While Newsom’s new CARE Court allows judges to order people into mental health treatment, and other recent legislation makes it easier to put people with a serious mental illness into conservatorships, doctors administering street injections take a different approach. The treatment is voluntary, and people can get help where they are, instead of in a locked facility.[aside label=\"Related Stories\" tag=\"homelessness\"]Some success stories are dramatic. Doctors talk about patients who one day are babbling incoherently, and a week after a shot, are having conversations.\u003c/p>\n\u003cp>“It’s been pretty common that that’s the initiation of, ‘We’re going indoors,’” said Dr. Coley King, director of homeless health care for the Venice Family Clinic in Los Angeles. He said he’s seen dozens of patients get off the street after taking these shots.\u003c/p>\n\u003cp>As with any medication, the shots can have side effects. And while a patient can stop taking a pill and generally put a stop to a negative reaction, once they’ve been given a shot, they have no choice but to wait a month for the drug to wear off.\u003c/p>\n\u003cp>Despite some street doctors’ rave reviews, injectable antipsychotics still aren’t reaching everyone who experts say they could help. Street medicine teams report having just a handful of patients on these medications at any one time (King’s team in Los Angeles has about two dozen). Some patients don’t want the shots, balking at the idea of having a drug in their system for an entire month, especially if they have feelings of paranoia related to health care.\u003c/p>\n\u003cp>And street doctors complain that hospitals still seem to prefer discharging patients from temporary psychiatric holds with a bottle of pills they may or may not take — instead of giving them a long-acting shot.\u003c/p>\n\u003ch2 id=\"h-losing-track-of-patients\" class=\"wp-block-heading\">Losing track of patients\u003c/h2>\n\u003cp>One of the biggest challenges street doctors face in administering these shots is following up with patients.\u003c/p>\n\u003cp>In Kern County, Patel hasn’t seen the woman he’s looking for since his team gave her first antipsychotic shot almost two months ago. Now she’s past due for another dose.\u003c/p>\n\u003cp>It’s worrying, Patel said, “because I don’t know how she did on it.”\u003c/p>\n\u003cp>The last place they saw her was at an encampment known as “The Sump” in the Central Valley farming community of Lamont, where she lived in a plywood shack along a muddy ditch behind a farm. But code enforcement recently cleared everyone out of that area, and Patel’s team doesn’t have a phone number or any other way to contact her.\u003c/p>\n\u003cfigure id=\"attachment_11989533\" class=\"wp-caption aligncenter\" style=\"max-width: 1568px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11989533\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_15-ezgif.com-webp-to-jpg-converter.jpg\" alt=\"\" width=\"1568\" height=\"1045\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_15-ezgif.com-webp-to-jpg-converter.jpg 1568w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_15-ezgif.com-webp-to-jpg-converter-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_15-ezgif.com-webp-to-jpg-converter-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_15-ezgif.com-webp-to-jpg-converter-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_15-ezgif.com-webp-to-jpg-converter-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1568px) 100vw, 1568px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Rishi Patel from the Akido street medicine team checks on several unhoused people on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments. \u003ccite>(Larry Valenzuela/CalMatters/CatchLight Local)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The first place they look is another encampment known as “the Shrine,” because it once held a shrine to Santa Muerte, a Mexican saint of death often prayed to by drug dealers. The team drives the van through an empty field of dead, yellow grass. Several people are living in room-sized pits they’ve dug into the dirt and covered with tarps and sheets of metal. Next to the vacant land is a vineyard, with rows of vines dotted with small, green grapes.\u003c/p>\n\u003cp>She’s not there, so the team hands out sack lunches and bottles of water, then gets back in the van and leaves.\u003c/p>\n\u003cp>“We’ve seen results,” said Kirk McGowan, a street medicine nurse with Akido. “But we’ve seen more failures than successes. That’s just kind of the nature of the situation.”\u003c/p>\n\u003ch2>Who should prescribe antipsychotic injections?\u003c/h2>\n\u003cp>In most cases, the people prescribing and administering antipsychotic shots in homeless encampments are general practice doctors — not specially trained psychiatrists. That’s because despite the growing prevalence of street medicine, street psychiatrists are still rare, according to a recent \u003ca href=\"https://www.chcf.org/wp-content/uploads/2023/03/CAStreetMedLandscapeSurveyReport.pdf\">USC report (PDF)\u003c/a>.\u003c/p>\n\u003cp>“You look over your shoulder and there’s not a psychiatrist there helping you out,” King said. “And we want to meet the need. We want to take care of these patients. They’re really, really ill, they’re really disorganized, and suffering and dying on the streets.”\u003c/p>\n\u003cp>There are no legal restrictions preventing a general practice doctor from administering these injections. But some practitioners think the responsibility should be reserved for psychiatric providers.\u003c/p>\n\u003cfigure id=\"attachment_11989539\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11989539\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Rishi Patel from the Akido street medicine team checks on an unhoused man living in a vineyard in Arvin on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments. \u003ccite>(Larry Valenzuela/CalMatters/CatchLight Local)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“These medications are in there for an extended period of time,” said Keri Weinstock, a psychiatric nurse practitioner who practices street medicine in Shasta County. “They do come with risks. There are specialty things that come along with some of these specialty meds, and it’s a lot to learn when you have to know everything else, too.”\u003c/p>\n\u003cp>Some street doctors who give these shots seek out additional psychiatric training, while others learn on the job — often with a psychiatrist on speed dial, just in case.\u003c/p>\n\u003cp>“I don’t think it’s rocket science to diagnose schizophrenia, as long as we’ve done it with some thoughtfulness,” King said.\u003c/p>\n\u003cp>In-the-field diagnoses aren’t always clear-cut, Patel said. Sometimes, people do such a good job of hiding their symptoms that it’s hard to tell they’re dealing with psychosis. Or, instead of experiencing obvious hallucinations or other symptoms commonly associated with schizophrenia, patients experience “negative symptoms,” such as extreme social withdrawal.\u003c/p>\n\u003cp>When those types of cases arise, Patel calls a psychologist for a second opinion.\u003c/p>\n\u003cp>While these drugs are generally considered safe, they do come with a risk of side effects that can include dizziness, sedation, stiffness and decreased mobility. Those symptoms might be no big deal for someone living in a house, but for someone on the street, could be catastrophic, said Dr. Shayan Rab, a street psychiatrist with Los Angeles County’s Homeless Outreach and Mobile Engagement team. It could make someone more vulnerable to being attacked or robbed, or prevent them from accessing food or shelter.\u003c/p>\n\u003cp>“It’s a very serious kind of action that’s being taken and a lot of time needs to be spent before you say, ‘Hey, this individual is safe for a long-acting injection,’” he said.\u003c/p>\n\u003cp>To make sure a patient doesn’t have an adverse reaction, doctors typically give them an oral dose of the same medication for a few days before administering the shot.\u003c/p>\n\u003cfigure id=\"attachment_11989540\" class=\"wp-caption aligncenter\" style=\"max-width: 1568px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11989540\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_20-ezgif.com-webp-to-jpg-converter.jpg\" alt=\"\" width=\"1568\" height=\"1045\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_20-ezgif.com-webp-to-jpg-converter.jpg 1568w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_20-ezgif.com-webp-to-jpg-converter-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_20-ezgif.com-webp-to-jpg-converter-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_20-ezgif.com-webp-to-jpg-converter-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_20-ezgif.com-webp-to-jpg-converter-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1568px) 100vw, 1568px\">\u003cfigcaption class=\"wp-caption-text\">An Abilify Maintena shot being prepared by the Akido street medicine team at their main office in Bakersfield on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments. \u003ccite>(Larry Valenzuela/CalMatters/CatchLight Local)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There’s also a risk that after a street doctor gives someone a shot, that patient could later get sent to the hospital on a temporary psychiatric hold. Doctors there might not know the patient already has a long-acting dose of antipsychotic medication in their body, and might give them another dose.\u003c/p>\n\u003cp>Before giving someone a shot, Dr. Aislinn Bird wants to be 100% sure their symptoms are actually caused by psychotic disorder, such as schizophrenia, and not complex PTSD, major depressive disorder, methamphetamine use, or something else. Overdiagnosis of psychotic disorders is rampant, especially in the African American community, Bird said.\u003c/p>\n\u003cp>“You have to be sure you really know the correct diagnosis,” said Bird, who serves as director of Integrated Care at Health Care for the Homeless in Alameda County.\u003c/p>\n\u003cp>But Dr. Susan Partovi, who practices street medicine on Skid Row in Los Angeles, said that’s an “antiquated way of thinking.” When someone is experiencing psychosis, it’s an emergency that needs to be treated as soon as possible, no matter the cause, she said. Her preference is to treat the symptoms first, and then see if the patient wants to work on other issues, such as substance use.\u003c/p>\n\u003cp>Antipsychotic injectables, such as Abilify and Invega, tend to be most prevalent in street medicine practices. But street doctors also administer long-acting injectable HIV medication, as well as medication for addiction such as Vivitrol — an injectable, long-acting medication that can help reduce cravings for opioids and alcohol, and protect against overdose.\u003c/p>\n\u003ch2 id=\"h-silencing-the-voices-in-his-head\" class=\"wp-block-heading\">Silencing the voices in his head\u003c/h2>\n\u003cp>Ricardo Fonseca Jr., who goes by “Ricky,” has been homeless for two years, living in a tent behind a Dollar Tree, then in a park in rural Kern County. The 31-year-old said he was working as a welder until he had a sudden mental breakdown and started hearing voices.\u003c/p>\n\u003cp>The voices said horrible things to him. Sometimes they yelled, and he yelled back, scaring those around him. He used methamphetamine to cope.\u003c/p>\n\u003cp>“It was getting to the point where I just felt like killing myself,” Fonseca said.\u003c/p>\n\u003cp>Two months ago, Fonseca started taking a monthly shot of the antipsychotic drug Abilify. Since then, “everything’s changed,” he said.\u003c/p>\n\u003cp>Now, Fonseca is staying at a friend’s house and considering going to school. He says he’s stopped using meth.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I can finally hear the birds and the crickets,” he said. “I couldn’t hear them before.”\u003c/p>\n\n",
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"title": "How Shots Instead of Pills Could Change California's Homeless Crisis | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As Dr. Rishi Patel’s street medicine van bounces over dirt roads and empty fields in rural Kern County, he’s looking for a particular patient he knows is overdue for her shot.\u003c/p>\n\u003cp>The woman, who has schizophrenia and has been living outside for five years, has several goals for herself: Start thinking more clearly, stop using meth and get an ID so she can visit her son in jail. Patel hopes the shot — a long-acting antipsychotic — will help her meet all of them.\u003c/p>\n\u003cp>Patel, medical director of Akido Street Medicine, is one of many street doctors throughout California using these injections as an increasingly common tool to help combat the state’s intertwined homelessness and mental health crises. Typically administered into a patient’s shoulder muscle, the medication slowly releases into the bloodstream over time, providing relief from symptoms of psychosis for a month or longer. The shots replace a patient’s oral medication — no more taking a pill every day. For people who are homeless and routinely have their pills stolen, can’t make it to a pharmacy for a refill or simply forget to take them, the shots can mean the difference between staying on their medication, or not.\u003c/p>\n\u003cp>“They’ve been an absolute game-changer,” Patel said.\u003c/p>\n\u003cp>Street medicine teams bring the shots directly to their patients wherever they are — whether it’s in a tent along Skid Row in Los Angeles, in a dugout in the middle of a field in the Central Valley, or along the bank of a stream in Shasta County. Doctors can diagnose someone, prescribe the medication, get their consent and give the shot within a matter of days — or sometimes even more quickly — and with minimal paperwork and red tape. They don’t need a psychiatrist’s sign-off.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It’s estimated that California is home to more than 180,000 homeless residents. \u003ca href=\"https://calmatters.org/housing/2023/08/care-court-california-start/\">How to help\u003c/a> the sickest of them — people with severe, untreated psychosis who might wander into traffic or otherwise put themselves in danger — has become a \u003ca href=\"https://calmatters.org/health/mental-health/2023/12/mental-health-conservatorship-newsom/\">hot-button issue\u003c/a>, with Gov. Gavin Newsom and state lawmakers creating new and sometimes controversial ways to get people into treatment. In a recent \u003ca href=\"https://homelessness.ucsf.edu/sites/default/files/2023-06/CASPEH_Report_62023.pdf\">UCSF survey (PDF)\u003c/a> of homeless Californians, 12% reported experiencing hallucinations in the past 30 days, and more than a quarter said they’d ever been hospitalized for a mental health condition.\u003c/p>\n\u003cp>Doctors say the goal of giving an antipsychotic shot to someone living in an encampment is to get them thinking clearly, so that they can start engaging with social workers, sign up for benefits and get on housing waitlists. While Newsom’s new CARE Court allows judges to order people into mental health treatment, and other recent legislation makes it easier to put people with a serious mental illness into conservatorships, doctors administering street injections take a different approach. The treatment is voluntary, and people can get help where they are, instead of in a locked facility.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Some success stories are dramatic. Doctors talk about patients who one day are babbling incoherently, and a week after a shot, are having conversations.\u003c/p>\n\u003cp>“It’s been pretty common that that’s the initiation of, ‘We’re going indoors,’” said Dr. Coley King, director of homeless health care for the Venice Family Clinic in Los Angeles. He said he’s seen dozens of patients get off the street after taking these shots.\u003c/p>\n\u003cp>As with any medication, the shots can have side effects. And while a patient can stop taking a pill and generally put a stop to a negative reaction, once they’ve been given a shot, they have no choice but to wait a month for the drug to wear off.\u003c/p>\n\u003cp>Despite some street doctors’ rave reviews, injectable antipsychotics still aren’t reaching everyone who experts say they could help. Street medicine teams report having just a handful of patients on these medications at any one time (King’s team in Los Angeles has about two dozen). Some patients don’t want the shots, balking at the idea of having a drug in their system for an entire month, especially if they have feelings of paranoia related to health care.\u003c/p>\n\u003cp>And street doctors complain that hospitals still seem to prefer discharging patients from temporary psychiatric holds with a bottle of pills they may or may not take — instead of giving them a long-acting shot.\u003c/p>\n\u003ch2 id=\"h-losing-track-of-patients\" class=\"wp-block-heading\">Losing track of patients\u003c/h2>\n\u003cp>One of the biggest challenges street doctors face in administering these shots is following up with patients.\u003c/p>\n\u003cp>In Kern County, Patel hasn’t seen the woman he’s looking for since his team gave her first antipsychotic shot almost two months ago. Now she’s past due for another dose.\u003c/p>\n\u003cp>It’s worrying, Patel said, “because I don’t know how she did on it.”\u003c/p>\n\u003cp>The last place they saw her was at an encampment known as “The Sump” in the Central Valley farming community of Lamont, where she lived in a plywood shack along a muddy ditch behind a farm. But code enforcement recently cleared everyone out of that area, and Patel’s team doesn’t have a phone number or any other way to contact her.\u003c/p>\n\u003cfigure id=\"attachment_11989533\" class=\"wp-caption aligncenter\" style=\"max-width: 1568px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11989533\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_15-ezgif.com-webp-to-jpg-converter.jpg\" alt=\"\" width=\"1568\" height=\"1045\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_15-ezgif.com-webp-to-jpg-converter.jpg 1568w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_15-ezgif.com-webp-to-jpg-converter-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_15-ezgif.com-webp-to-jpg-converter-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_15-ezgif.com-webp-to-jpg-converter-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_15-ezgif.com-webp-to-jpg-converter-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1568px) 100vw, 1568px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Rishi Patel from the Akido street medicine team checks on several unhoused people on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments. \u003ccite>(Larry Valenzuela/CalMatters/CatchLight Local)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The first place they look is another encampment known as “the Shrine,” because it once held a shrine to Santa Muerte, a Mexican saint of death often prayed to by drug dealers. The team drives the van through an empty field of dead, yellow grass. Several people are living in room-sized pits they’ve dug into the dirt and covered with tarps and sheets of metal. Next to the vacant land is a vineyard, with rows of vines dotted with small, green grapes.\u003c/p>\n\u003cp>She’s not there, so the team hands out sack lunches and bottles of water, then gets back in the van and leaves.\u003c/p>\n\u003cp>“We’ve seen results,” said Kirk McGowan, a street medicine nurse with Akido. “But we’ve seen more failures than successes. That’s just kind of the nature of the situation.”\u003c/p>\n\u003ch2>Who should prescribe antipsychotic injections?\u003c/h2>\n\u003cp>In most cases, the people prescribing and administering antipsychotic shots in homeless encampments are general practice doctors — not specially trained psychiatrists. That’s because despite the growing prevalence of street medicine, street psychiatrists are still rare, according to a recent \u003ca href=\"https://www.chcf.org/wp-content/uploads/2023/03/CAStreetMedLandscapeSurveyReport.pdf\">USC report (PDF)\u003c/a>.\u003c/p>\n\u003cp>“You look over your shoulder and there’s not a psychiatrist there helping you out,” King said. “And we want to meet the need. We want to take care of these patients. They’re really, really ill, they’re really disorganized, and suffering and dying on the streets.”\u003c/p>\n\u003cp>There are no legal restrictions preventing a general practice doctor from administering these injections. But some practitioners think the responsibility should be reserved for psychiatric providers.\u003c/p>\n\u003cfigure id=\"attachment_11989539\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11989539\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_11-ezgif.com-webp-to-jpg-converter-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Rishi Patel from the Akido street medicine team checks on an unhoused man living in a vineyard in Arvin on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments. \u003ccite>(Larry Valenzuela/CalMatters/CatchLight Local)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“These medications are in there for an extended period of time,” said Keri Weinstock, a psychiatric nurse practitioner who practices street medicine in Shasta County. “They do come with risks. There are specialty things that come along with some of these specialty meds, and it’s a lot to learn when you have to know everything else, too.”\u003c/p>\n\u003cp>Some street doctors who give these shots seek out additional psychiatric training, while others learn on the job — often with a psychiatrist on speed dial, just in case.\u003c/p>\n\u003cp>“I don’t think it’s rocket science to diagnose schizophrenia, as long as we’ve done it with some thoughtfulness,” King said.\u003c/p>\n\u003cp>In-the-field diagnoses aren’t always clear-cut, Patel said. Sometimes, people do such a good job of hiding their symptoms that it’s hard to tell they’re dealing with psychosis. Or, instead of experiencing obvious hallucinations or other symptoms commonly associated with schizophrenia, patients experience “negative symptoms,” such as extreme social withdrawal.\u003c/p>\n\u003cp>When those types of cases arise, Patel calls a psychologist for a second opinion.\u003c/p>\n\u003cp>While these drugs are generally considered safe, they do come with a risk of side effects that can include dizziness, sedation, stiffness and decreased mobility. Those symptoms might be no big deal for someone living in a house, but for someone on the street, could be catastrophic, said Dr. Shayan Rab, a street psychiatrist with Los Angeles County’s Homeless Outreach and Mobile Engagement team. It could make someone more vulnerable to being attacked or robbed, or prevent them from accessing food or shelter.\u003c/p>\n\u003cp>“It’s a very serious kind of action that’s being taken and a lot of time needs to be spent before you say, ‘Hey, this individual is safe for a long-acting injection,’” he said.\u003c/p>\n\u003cp>To make sure a patient doesn’t have an adverse reaction, doctors typically give them an oral dose of the same medication for a few days before administering the shot.\u003c/p>\n\u003cfigure id=\"attachment_11989540\" class=\"wp-caption aligncenter\" style=\"max-width: 1568px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11989540\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_20-ezgif.com-webp-to-jpg-converter.jpg\" alt=\"\" width=\"1568\" height=\"1045\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_20-ezgif.com-webp-to-jpg-converter.jpg 1568w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_20-ezgif.com-webp-to-jpg-converter-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_20-ezgif.com-webp-to-jpg-converter-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_20-ezgif.com-webp-to-jpg-converter-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/06/053124-Bakersfield-Injectable-LV_20-ezgif.com-webp-to-jpg-converter-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1568px) 100vw, 1568px\">\u003cfigcaption class=\"wp-caption-text\">An Abilify Maintena shot being prepared by the Akido street medicine team at their main office in Bakersfield on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments. \u003ccite>(Larry Valenzuela/CalMatters/CatchLight Local)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There’s also a risk that after a street doctor gives someone a shot, that patient could later get sent to the hospital on a temporary psychiatric hold. Doctors there might not know the patient already has a long-acting dose of antipsychotic medication in their body, and might give them another dose.\u003c/p>\n\u003cp>Before giving someone a shot, Dr. Aislinn Bird wants to be 100% sure their symptoms are actually caused by psychotic disorder, such as schizophrenia, and not complex PTSD, major depressive disorder, methamphetamine use, or something else. Overdiagnosis of psychotic disorders is rampant, especially in the African American community, Bird said.\u003c/p>\n\u003cp>“You have to be sure you really know the correct diagnosis,” said Bird, who serves as director of Integrated Care at Health Care for the Homeless in Alameda County.\u003c/p>\n\u003cp>But Dr. Susan Partovi, who practices street medicine on Skid Row in Los Angeles, said that’s an “antiquated way of thinking.” When someone is experiencing psychosis, it’s an emergency that needs to be treated as soon as possible, no matter the cause, she said. Her preference is to treat the symptoms first, and then see if the patient wants to work on other issues, such as substance use.\u003c/p>\n\u003cp>Antipsychotic injectables, such as Abilify and Invega, tend to be most prevalent in street medicine practices. But street doctors also administer long-acting injectable HIV medication, as well as medication for addiction such as Vivitrol — an injectable, long-acting medication that can help reduce cravings for opioids and alcohol, and protect against overdose.\u003c/p>\n\u003ch2 id=\"h-silencing-the-voices-in-his-head\" class=\"wp-block-heading\">Silencing the voices in his head\u003c/h2>\n\u003cp>Ricardo Fonseca Jr., who goes by “Ricky,” has been homeless for two years, living in a tent behind a Dollar Tree, then in a park in rural Kern County. The 31-year-old said he was working as a welder until he had a sudden mental breakdown and started hearing voices.\u003c/p>\n\u003cp>The voices said horrible things to him. Sometimes they yelled, and he yelled back, scaring those around him. He used methamphetamine to cope.\u003c/p>\n\u003cp>“It was getting to the point where I just felt like killing myself,” Fonseca said.\u003c/p>\n\u003cp>Two months ago, Fonseca started taking a monthly shot of the antipsychotic drug Abilify. Since then, “everything’s changed,” he said.\u003c/p>\n\u003cp>Now, Fonseca is staying at a friend’s house and considering going to school. He says he’s stopped using meth.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I can finally hear the birds and the crickets,” he said. “I couldn’t hear them before.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "California's 'CARE Court' Program Starts Amid Concerns Over Effectiveness",
"headTitle": "California’s ‘CARE Court’ Program Starts Amid Concerns Over Effectiveness | KQED",
"content": "\u003cp>An alternative mental health court program designed to fast-track people with untreated schizophrenia and other psychotic disorders into housing and medical care — potentially without their consent — kicked off in seven California counties, including San Francisco, on Monday.\u003c/p>\n\u003cp>Democratic Gov. Gavin Newsom created the new civil court process, \u003ca href=\"https://www.kqed.org/news/tag/care-court\">called CARE Court,\u003c/a> as part of a massive push to address the homelessness crisis in California. Lawmakers approved it despite \u003ca href=\"https://apnews.com/article/health-california-legislature-san-francisco-gavin-newsom-245e23bf1c02ea4b900649c6c54ba139\">deep misgivings over\u003c/a> insufficient housing and services, saying they needed to try something new to help those suffering in public from apparent psychotic breaks.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"San Francisco Superior Court Judge Michael Begert\"]‘It’s hopefully going to help some people who need some help, and it is probably not going to make a huge dent in what you observe in the community.’[/pullquote]Families of people diagnosed with severe mental illness rejoiced because the new law allows them to petition the court for treatment for their loved ones. Residents dismayed by the estimated 171,000 people experiencing homelessness in California cheered at the possibility of getting them help and off the streets.\u003c/p>\n\u003cp>Critics blasted the new program as ineffective and punitive, given that it could coerce people into treatment.\u003c/p>\n\u003cp>But as petitions roll in Monday, it’s not clear who the program might help nor how effective it will be. That’s because the eligibility criteria is narrow and limited largely to people with \u003ca href=\"https://www.courts.ca.gov/documents/CARE-Act-Eligibility-Criteria.pdf\">untreated schizophrenia and related disorders (PDF)\u003c/a>. Severe depression, bipolar disorder and addiction by itself do not qualify.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s hopefully going to help some people who need some help, and it is probably not going to make a huge dent in what you observe in the community,” said San Francisco Superior Court Judge Michael Begert, who will supervise the court.\u003c/p>\n\u003cp>Here are things to know about the new system:\u003c/p>\n\u003ch2>What is ‘CARE Court’ and who is eligible?\u003c/h2>\n\u003cp>Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, said in a news briefing last week that the program is aimed at catching people before their condition worsens.\u003c/p>\n\u003cp>Family members and first responders are among those who can now file a petition on behalf of an adult they believe “is unlikely to survive safely” without supervision and whose condition is rapidly deteriorating. They also can file if an adult needs services and support to prevent relapse or deterioration that would likely result in “grave disability or serious harm” to themselves or others.\u003c/p>\n\u003cp>[aside postID=\"news_11959302,news_11955211,news_11958561\" label=\"Related Stories\"]To be eligible, the person needs a diagnosis on the \u003ca href=\"https://www.courts.ca.gov/documents/CARE-Act-Eligibility-Criteria.pdf\">schizophrenia spectrum or other qualifying disorders (PDF)\u003c/a>. People with severe depression or bipolar disorder do not qualify. A person does not have to be homeless to be eligible.\u003c/p>\n\u003cp>A special civil court in each county will review each petition with the county behavioral health agency evaluating eligibility. The individual will be appointed a lawyer and a support person of their choice.\u003c/p>\n\u003cp>If the court determines the individual meets eligibility criteria, they will be asked to work with the county on a voluntary plan that includes housing, medication, counseling and other social services. The agreement would be in effect for up to a year with the possibility of extending it for another year.\u003c/p>\n\u003cp>If all parties cannot agree to a voluntary plan, the statute says the court will order they work on a plan.\u003c/p>\n\u003ch2>What happens if the person does not want to participate?\u003c/h2>\n\u003cp>Civil rights advocates have raised fears that the new process will result in vulnerable people being forced into treatment.\u003c/p>\n\u003cp>A person who does not successfully complete a plan could be subject to conservatorship and involuntary treatment, said Tal Klement, a deputy public defender in San Francisco who is among critics of the new process.\u003c/p>\n\u003cp>But the statute also allows the court to dismiss the proceedings if the individual declines to participate or to follow the agreement. Judge Begert, in San Francisco, said he cannot compel someone to engage; the best he can do is start building a relationship with the person.\u003c/p>\n\u003cp>Veronica Kelley, Orange County behavioral health director, said the county’s judges understand building rapport with eligible candidates takes time and have agreed to grant her team extra time to reach voluntary agreements, despite the statute’s deadlines.\u003c/p>\n\u003ch2>Are there enough homes, treatment beds and support?\u003c/h2>\n\u003cp>The state has allocated money for emergency shelters — but critics say there is a constant shortage of case managers, appropriate in-patient treatment facilities and supportive housing.\u003c/p>\n\u003cp>San Francisco officials said in a statement that about 10% of more than 2,500 beds are open for new people. The treatment beds range from detox to step-down care for people leaving long-term care.\u003c/p>\n\u003cp>Opponents of the program say the state should have invested in more housing and existing services rather than establishing a new court system.\u003c/p>\n\u003cp>“The issue is not that these resources are available and people aren’t using them,” said Samuel Jain, senior policy attorney at Disability Rights California. “It’s that these voluntary community-based services are under-resourced and not accessible.”\u003c/p>\n\u003ch2>What happens if the person is not eligible for care?\u003c/h2>\n\u003cp>The National Alliance on Mental Illness in California, a grassroots organization supporting people with a mental illness and their families, pushed for the new mental health program. Some family members have long wanted a way to order their loved ones into treatment, the organization said.\u003c/p>\n\u003cp>Jessica Cruz, the group’s CEO, encourages people not to give up if their family member does not qualify because other resources may be available.\u003c/p>\n\u003cp>“For us, it is just really about making sure that our loved ones have the best life that they could possibly have,” she said. “Living on the streets and dying on the streets is not the way for anybody to live.”\u003c/p>\n\u003ch2>Which counties are accepting petitions?\u003c/h2>\n\u003cp>San Francisco, Orange, San Diego, Riverside, Stanislaus, Tuolumne and Glenn counties launched the new program Monday. Los Angeles County will begin its program Dec. 1.\u003c/p>\n\u003cp>The state estimates roughly 1,800 to 3,100 people could be eligible in the first seven counties. Los Angeles could bump up estimates to 3,600 to 6,200, although uptake could take time.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The rest of the state has until December 2024 to establish mental health courts.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>An alternative mental health court program designed to fast-track people with untreated schizophrenia and other psychotic disorders into housing and medical care — potentially without their consent — kicked off in seven California counties, including San Francisco, on Monday.\u003c/p>\n\u003cp>Democratic Gov. Gavin Newsom created the new civil court process, \u003ca href=\"https://www.kqed.org/news/tag/care-court\">called CARE Court,\u003c/a> as part of a massive push to address the homelessness crisis in California. Lawmakers approved it despite \u003ca href=\"https://apnews.com/article/health-california-legislature-san-francisco-gavin-newsom-245e23bf1c02ea4b900649c6c54ba139\">deep misgivings over\u003c/a> insufficient housing and services, saying they needed to try something new to help those suffering in public from apparent psychotic breaks.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Families of people diagnosed with severe mental illness rejoiced because the new law allows them to petition the court for treatment for their loved ones. Residents dismayed by the estimated 171,000 people experiencing homelessness in California cheered at the possibility of getting them help and off the streets.\u003c/p>\n\u003cp>Critics blasted the new program as ineffective and punitive, given that it could coerce people into treatment.\u003c/p>\n\u003cp>But as petitions roll in Monday, it’s not clear who the program might help nor how effective it will be. That’s because the eligibility criteria is narrow and limited largely to people with \u003ca href=\"https://www.courts.ca.gov/documents/CARE-Act-Eligibility-Criteria.pdf\">untreated schizophrenia and related disorders (PDF)\u003c/a>. Severe depression, bipolar disorder and addiction by itself do not qualify.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>To be eligible, the person needs a diagnosis on the \u003ca href=\"https://www.courts.ca.gov/documents/CARE-Act-Eligibility-Criteria.pdf\">schizophrenia spectrum or other qualifying disorders (PDF)\u003c/a>. People with severe depression or bipolar disorder do not qualify. A person does not have to be homeless to be eligible.\u003c/p>\n\u003cp>A special civil court in each county will review each petition with the county behavioral health agency evaluating eligibility. The individual will be appointed a lawyer and a support person of their choice.\u003c/p>\n\u003cp>If the court determines the individual meets eligibility criteria, they will be asked to work with the county on a voluntary plan that includes housing, medication, counseling and other social services. The agreement would be in effect for up to a year with the possibility of extending it for another year.\u003c/p>\n\u003cp>If all parties cannot agree to a voluntary plan, the statute says the court will order they work on a plan.\u003c/p>\n\u003ch2>What happens if the person does not want to participate?\u003c/h2>\n\u003cp>Civil rights advocates have raised fears that the new process will result in vulnerable people being forced into treatment.\u003c/p>\n\u003cp>A person who does not successfully complete a plan could be subject to conservatorship and involuntary treatment, said Tal Klement, a deputy public defender in San Francisco who is among critics of the new process.\u003c/p>\n\u003cp>But the statute also allows the court to dismiss the proceedings if the individual declines to participate or to follow the agreement. Judge Begert, in San Francisco, said he cannot compel someone to engage; the best he can do is start building a relationship with the person.\u003c/p>\n\u003cp>Veronica Kelley, Orange County behavioral health director, said the county’s judges understand building rapport with eligible candidates takes time and have agreed to grant her team extra time to reach voluntary agreements, despite the statute’s deadlines.\u003c/p>\n\u003ch2>Are there enough homes, treatment beds and support?\u003c/h2>\n\u003cp>The state has allocated money for emergency shelters — but critics say there is a constant shortage of case managers, appropriate in-patient treatment facilities and supportive housing.\u003c/p>\n\u003cp>San Francisco officials said in a statement that about 10% of more than 2,500 beds are open for new people. The treatment beds range from detox to step-down care for people leaving long-term care.\u003c/p>\n\u003cp>Opponents of the program say the state should have invested in more housing and existing services rather than establishing a new court system.\u003c/p>\n\u003cp>“The issue is not that these resources are available and people aren’t using them,” said Samuel Jain, senior policy attorney at Disability Rights California. “It’s that these voluntary community-based services are under-resourced and not accessible.”\u003c/p>\n\u003ch2>What happens if the person is not eligible for care?\u003c/h2>\n\u003cp>The National Alliance on Mental Illness in California, a grassroots organization supporting people with a mental illness and their families, pushed for the new mental health program. Some family members have long wanted a way to order their loved ones into treatment, the organization said.\u003c/p>\n\u003cp>Jessica Cruz, the group’s CEO, encourages people not to give up if their family member does not qualify because other resources may be available.\u003c/p>\n\u003cp>“For us, it is just really about making sure that our loved ones have the best life that they could possibly have,” she said. “Living on the streets and dying on the streets is not the way for anybody to live.”\u003c/p>\n\u003ch2>Which counties are accepting petitions?\u003c/h2>\n\u003cp>San Francisco, Orange, San Diego, Riverside, Stanislaus, Tuolumne and Glenn counties launched the new program Monday. Los Angeles County will begin its program Dec. 1.\u003c/p>\n\u003cp>The state estimates roughly 1,800 to 3,100 people could be eligible in the first seven counties. Los Angeles could bump up estimates to 3,600 to 6,200, although uptake could take time.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The rest of the state has until December 2024 to establish mental health courts.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "California Families Can Expect Eligibility Limits in CARE Courts Rollout",
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"headTitle": "California Families Can Expect Eligibility Limits in CARE Courts Rollout | KQED",
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"content": "\u003cp>Under the low hum of cold fluorescent lights in a nondescript office park in Orange County, dozens of Californians gathered to find out if they could get help for their loved ones under the state’s new \u003ca href=\"https://www.kqed.org/news/tag/care-court\">CARE Court\u003c/a> system.\u003c/p>\n\u003cp>Unless that loved one has a medical diagnosis specific to schizophrenia or some other psychotic disorders, the answer is probably not.\u003c/p>\n\u003cp>The mid-August meeting was a series held by a mental health advocacy group in Orange County with the officials in charge of implementing CARE Court, which starts in October, about what the new system can and cannot do.\u003c/p>\n\u003cp>“What we’re here to do is share the facts to help manage expectations,” said Veronica Kelley, Orange County’s chief of mental health and recovery services.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Community Assistance, Recovery, and Empowerment (CARE) Court was Gov. Gavin Newsom’s \u003ca href=\"https://calmatters.org/housing/2022/09/california-lawmakers-approved-care-court-what-comes-next/\">biggest legislative priority\u003c/a> last year — what state lawmakers and local politicians hoped would be one answer to California’s dual, overlapping homelessness and mental health crises.\u003c/p>\n\u003cp>The new program allows family members and others to petition someone with untreated mental illness into civil courts, where a judge would order a treatment plan and require county mental health departments to provide it.\u003c/p>\n\u003cp>Backed by millions in new state funds, it’s a mandate for those departments at a time when Californians have become increasingly frustrated with one of the most visible consequences of the state’s trenchant homelessness crisis — people with the most severe mental illnesses languishing on the streets. [pullquote size=\"medium\" align=\"right\" citation=\"Luke Bergmann, director, San Diego County Behavioral Health Services\"]‘[CARE Court’s] not going to be this thing that dramatically changes homelessness.’[/pullquote] Counties will be judged on how well they’re able to get people, who may be resistant to help, inside and into treatment, even though CARE Court is not exclusively a program targeting homelessness. Local mental health officials are warning it won’t be a panacea.\u003c/p>\n\u003cp>“There’s been a presumption — and this is, to be clear, driven by how the administration talked about CARE Court at the outset — a broad presumption that CARE Court is going to fix homelessness or have a broad impact on the nexus of homelessness and behavioral health,” said Luke Bergmann, director of the San Diego County Behavioral Health Services department.\u003c/p>\n\u003cp>In reality, he said, it’s “actually going to be a pretty small program. It’s not going to be this thing that dramatically changes homelessness.”\u003c/p>\n\u003cp>The program aims to walk the line between forced treatment and completely voluntary treatment for those with the gravest needs. Disability rights groups decry it as a violation of a person’s civil liberties, and a potential path \u003ca href=\"https://calmatters.org/justice/2021/07/britney-spears-conservatorship/\">toward conservatorship\u003c/a> and the loss of legal rights for those who repeatedly decline care.\u003c/p>\n\u003cfigure id=\"attachment_11959338\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11959338\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/08/CMCareCourts02.jpg\" alt='An office full of people sit at tables looking toward a woman with a purple blouse who speaks from a microphone and holding index cards in her other hand. A flat-screen television hangs above her head displaying \"What is in a CARE Agreement Plan?\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Annette Mugrditchian, deputy director, speaks to community members about CARE Court at the Behavioral Health Training Center in Orange County. \u003ccite>(Lauren Justice/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>CARE Court \u003ca href=\"https://www.latimes.com/california/story/2023-01-26/disability-advocates-lawsuit-care-court-newsom-mental-illness-addiction-homeless\">survived a legal challenge\u003c/a> from Disability Rights California and other civil rights groups earlier this year. The group sat on a state working group for the program’s implementation and will monitor its rollout.\u003c/p>\n\u003cp>The program was welcomed by some family members of those with severe mental illness, who have complained that the state’s privacy and patients’ rights laws only allow their loved ones to \u003ca href=\"https://calmatters.org/projects/mentally-ill-forced-treatment-conservatorship-california-debate/\">be compelled into treatment \u003c/a>when in crisis, trapping them in a revolving door of short-term hospital stays and homelessness.\u003c/p>\n\u003cp>The first courts will open across the state in about a month. Seven counties, urban and rural, have been deep in preparation to be the first to roll out the program in October.\u003c/p>\n\u003cp>Los Angeles County, whose roughly 75,000-person unhoused population is the state’s largest, will start the program in December; the rest of the state will follow next year.\u003c/p>\n\u003cp>Those in the first group — San Francisco, Orange, San Diego, Riverside, Stanislaus, Glenn and Tuolumne counties — have had numerous questions to address, such as:\u003c/p>\n\u003cul>\n\u003cli>Who will find and serve respondents with their CARE Court petition if the respondent is unhoused?\u003c/li>\n\u003cli>How can county courts make the paperwork-heavy petition process easy for family members?\u003c/li>\n\u003cli>How many mental health treatment beds will counties need to add?\u003c/li>\n\u003cli>Where will people live after completing the court-ordered plans?\u003c/li>\n\u003c/ul>\n\u003cp>The state estimates between 7,000 and 12,000 people will qualify. They needn’t be homeless to receive the services, though many who qualify are likely to be unhoused. The state’s homeless population on any given night last year topped 171,000. [aside postID=news_11955211 hero='https://ww2.kqed.org/app/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-02-KQED-1020x680.jpg'] A UC San Francisco \u003ca href=\"https://homelessness.ucsf.edu/sites/default/files/2023-06/CASPEH_Report_62023.pdf\">study of homelessness statewide (PDF)\u003c/a> this year found that more than a quarter of unhoused people had been hospitalized at some point in their lives for a mental health problem; the homeless services authority in Los Angeles \u003ca href=\"https://www.lahsa.org/documents?id=3422-2019-greater-los-angeles-homeless-count-los-angeles-continuum-of-care.pdf\">has estimated (PDF)\u003c/a> a quarter of the city’s homeless adults has a severe mental illness. But CARE Court is targeted at an even narrower set of diagnoses and circumstances.\u003c/p>\n\u003cp>So counties are also playing a careful game of “level-setting,” Bergman said, “about what this thing will actually be.”\u003c/p>\n\u003cp>Still, local officials see the program as an opportunity to get more people into mental health care who haven’t been treated, before their condition deteriorates to the point of being put in conservatorships.\u003c/p>\n\u003cp>And the state’s Department of Health Care Services says it will be looking out for whether the program reduces emergency room visits, police encounters, short-term hospital stays and involuntary psychiatric holds — and whether it helps people find stable housing.\u003c/p>\n\u003ch2>Managing expectations\u003c/h2>\n\u003cp>One major uncertainty counties face, officials say, is even knowing how many cases they’ll get.\u003c/p>\n\u003cp>That’s in part because the law allows a wide range of people to petition for someone to be in CARE Court, including family members, roommates, health care providers, paramedics, hospital officials or homeless outreach workers.\u003c/p>\n\u003cp>But the list of actual conditions the program targets is narrow. It’s limited to schizophrenia and related illnesses. [pullquote size=\"medium\" align=\"right\" citation=\"Michelle Doty Cabrera, director, County Behavioral Health Directors Association\"]‘What the public thinks CARE Court is and what it is are definitely two very different things.’[/pullquote] That could disappoint those whose loved ones have other diagnoses — and create an unknown amount of work for counties if a flood of those family members file petitions. Behavioral health departments must evaluate each person if it’s not clear whether they qualify for the program.\u003c/p>\n\u003cp>San Diego County estimates it will get 1,000 petitions in the first year and establish court-ordered treatment plans for 250 people; the remainder likely will either not qualify or will agree to services voluntarily, Bergmann said. Orange County expects about 1,400 petitions and anywhere from 400 to 600 treatment plans.\u003c/p>\n\u003cp>Officials in Riverside County don’t even have an estimate, citing varying data there on the prevalence of schizophrenia in the unhoused population.\u003c/p>\n\u003cp>“We really think it’s unknowable,” said Marcus Cannon, the county’s deputy behavioral health director.\u003c/p>\n\u003cp>Counties want the state to help them manage public expectations. Both Kelley and Cannon said they’ve heard from local leaders who have floated having city workers file petitions for a wide swath of unhoused residents, to get them indoors.\u003c/p>\n\u003cp>“What the public thinks CARE Court is and what it is are definitely two very different things,” said Michelle Doty Cabrera, director of \u003ca href=\"https://www.cbhda.org/\">the County Behavioral Health Directors Association\u003c/a>.\u003c/p>\n\u003cp>In an emailed statement, state Department of Health Care Services spokesperson Sami Gallegos said that counties “are managing public relations among local elected officials and others” to spread the message about who the program is and isn’t for.\u003c/p>\n\u003cp>After learning of the narrow eligibility criteria at a community meeting in August, Nancy Beltran considered her options.\u003c/p>\n\u003cp>Beltran, of Anaheim, said she lives with a family member whose psychotic condition caused him to hit another relative in 2020, landing him in the hospital against his will. She said he’s refused treatment and doesn’t believe he’s sick. Another psychotic episode earlier this year didn’t qualify him for hospitalization, she said, because the symptoms weren’t as severe.\u003c/p>\n\u003cp>“I didn’t want it to get to that point,” she said. “I don’t want him to be incarcerated. I want it to be the least restrictive, least traumatic experience.”\u003c/p>\n\u003cp>She’s still not sure whether the program is for her family member, because they haven’t gotten a clear diagnosis, she said.\u003c/p>\n\u003cp>Beltran said she also wishes the program could help a friend, who is already enrolled in therapy sessions for diagnosed schizophrenia, find a place to live. Her friend’s condition, she said, deteriorates because he is unhoused, but he remains on waiting lists for housing. But CARE Court, she was disappointed to learn at the meetings, is only for those with untreated schizophrenia.\u003c/p>\n\u003ch2>Threading a needle\u003c/h2>\n\u003cp>Everyone involved in CARE Court in Orange County — from the judge who would ultimately order treatment to the public defender who will represent respondents to the behavioral health officials responsible for finding, diagnosing and treating them — had the same message for the public: The program will be voluntary.\u003c/p>\n\u003cp>Critics, however,\u003cstrong> \u003c/strong>contend that there’s no way a court process can be voluntary, since at some point there is a judge’s order. By law, counties must try at least twice to persuade a respondent to accept treatment before a judge orders it. Even then, the treatment plan, which can include therapy, medication and housing, doesn’t come with much enforcement. Medication can be ordered, but not forcibly administered.\u003c/p>\n\u003cfigure id=\"attachment_11959344\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11959344\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/08/CMCareCourts03.jpg\" alt=\"A bald man in a business suit speaks to a crowd as he sits at a table holding a microphone in his hand.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts03.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts03-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts03-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts03-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts03-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts03-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Judge Ebrahim Baytieh speaks to community members about CARE Court, a new program that will be implemented in the fall. \u003ccite>(Lauren Justice/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Over the course of a year, respondents will attend court hearings to see whether they’re adhering to the treatment and whether the county is providing it. Counties can be fined as much as $1,000 a day for not providing the care; if the person fails to complete treatment they could be considered for conservatorship.\u003c/p>\n\u003cp>But county officials stressed that’s not the goal.\u003c/p>\n\u003cp>“We have tried for 40 years in this wonderful country of ours to force people with mental illness” to be treated, Orange County Superior Court Judge Ebrahim Baytieh told family members at another community meeting, in a church in Cypress. “Study after study has found it doesn’t work. We all know there’s no magical answer. But we will be patient, and we will be persistent.”\u003c/p>\n\u003cp>Kelley’s department is training its workers and peer supporters — people who also have mental illness or have recovered who can help guide a respondent through CARE Court — in a well-regarded communication method \u003ca href=\"https://leapinstitute.org/about/#:~:text=LEAP%20(Listen%2DEmpathize%2DAgree,and%20the%20treatment%20they%20need.\">called LEAP\u003c/a> to persuade respondents to accept care. It will offer services to those in CARE Court under a “whatever it takes” approach, whether it’s a ride to the doctor’s office, help to enroll in food stamps, addiction treatment, or temporary housing.\u003c/p>\n\u003cp>The task will take time.\u003c/p>\n\u003cp>At the community meetings, Kelley and her colleagues repeatedly described a pilot program she ran as behavioral health director in San Bernardino County. The program took referrals from family, police or other community members who wanted to prod those who were resistant to mental health treatment. [pullquote size=\"medium\" align=\"right\" citation=\"Orange County Superior Court Judge Ebrahim Baytieh\"]‘We have tried for 40 years in this wonderful country of ours to force people with mental illness” [to be treated]. … We all know there’s no magical answer. But we will be patient, and we will be persistent.’[/pullquote] The time it took for county workers using the LEAP method to persuade respondents to enter treatment varied, Kelley said. But on average, she said it took 20 visits if a respondent was housed — and 40 visits if they were unhoused. Visit times varied, from a few minutes to a whole day so that the whole process could take weeks or months, Kelley said.\u003c/p>\n\u003cp>The timetables set by law for CARE Court are much tighter.\u003c/p>\n\u003cp>If counties initially determine a client won’t agree to treatment, they get 14 days to try again before the next court hearing. Kelley said the judges in her county are sympathetic toward those concerns, but not all counties will get such flexibility.\u003c/p>\n\u003cp>“I can’t do 40 face-to-face visits in 14 days,” she said.\u003c/p>\n\u003cp>Civil rights advocates balked at the counties’ suggestion that any program involving the pressure of the judicial system, even a non-criminal court, could be voluntary.\u003c/p>\n\u003cp>“If you’re trying to engage somebody, and there’s a petition that involves a court,” there’s less hope of building genuine trust, said Keris Myrick, a mental health advocate who lives with schizophrenia and a board member of Disability Rights California.\u003c/p>\n\u003cp>The group is particularly concerned the court process could be ineffective or harmful among Black residents, who are overrepresented both in California’s homeless population and among people diagnosed with schizophrenia.\u003c/p>\n\u003cp>Myrick, who is Black, said she has been subject to involuntary treatment and described harrowing experiences during which she was handcuffed in the back of a police car or strapped down to a gurney for hours before a doctor visited. She said one thing that actually helped her recover was having a peer supporter who was also African American and related to her experiences, eventually persuading her to get treatment on her own terms.\u003c/p>\n\u003cp>She later ran a peer support program in Los Angeles County and trained workers in the county mental health department. Myrick says the state needs to expand those services, as well as housing and social supports to help people live stable lives, without the threat of a judicial order.\u003c/p>\n\u003cp>Alex Barnard, a sociologist at New York University who has studied involuntary mental health treatment in California, is skeptical about whether the state can appease both civil libertarians and those who want more aggressive treatment. But he said the program’s mandate of a year of persistent engagement is promising.\u003c/p>\n\u003cp>“If CARE Courts work, it will probably be because of that,” he said. “It creates some accountability on the provider to keep trying to work with somebody who might be very challenging, and elsewhere in the system would just have their file closed out.”\u003c/p>\n\u003ch2>Long-term resources\u003c/h2>\n\u003cp>Those implementation questions are among a list of other practical hurdles counties face for the program to be successful.\u003c/p>\n\u003cp>There’s long-term funding. The first seven counties were given $26 million in one-time state grants to start the programs; some have estimated annual costs of the services themselves will \u003ca href=\"https://sfstandard.com/2023/04/20/newsoms-care-court-faces-50-million-hurdle-in-san-francisco-as-key-deadline-approaches/\">far exceed\u003c/a> those allotments.\u003c/p>\n\u003cp>The state says most services will be covered by Medi-Cal or private insurance, and expects counties to submit reimbursement requests, including the costs of going to court or finding respondents.\u003c/p>\n\u003cp>But the \u003ca href=\"https://www.kqed.org/news/11923034/were-drowning-why-kaiser-mental-health-workers-are-striking#:~:text=Kaiser%20administrators%20point%20to%20what,15%20statement.\">nationwide shortage of behavioral health workers\u003c/a> has made it a challenge for some departments to hire. In San Diego County, Bergmann’s department plans to add 55 new staff, including 10 clinicians, for CARE Court. Only 35% have been hired so far, a spokesperson said. [aside label='More on Public Health' tag='public-health'] And there’s housing and beds, which all agree are crucial to making treatment a success.\u003c/p>\n\u003cp>Health officials believe most people who qualify for CARE Court will need a more intensive treatment placement in the beginning, while some may be able to be placed in residential facilities or their own apartments after being stabilized.\u003c/p>\n\u003cp>But there are shortages across that spectrum. A \u003ca href=\"https://www.rand.org/pubs/research_reports/RRA1824-1-v2.html\">2021 Rand analysis\u003c/a> found the state is short more than 4,700 psychiatric inpatient treatment beds and nearly 3,000 residential facility beds such as \u003ca href=\"https://calmatters.org/projects/board-and-care-homes-closing-in-california-mental-health-crisis/\">board-and-cares\u003c/a>—long-term housing for people with severe mental illness and one option for respondents to live after they complete CARE Court.\u003c/p>\n\u003cp>Included in last year’s state budget was \u003ca href=\"https://bridgehousing.buildingcalhhs.com/county-behavioral-health-agencies/\">nearly $1 billion\u003c/a> in new funding for counties to expand temporary housing placements for those with mental illness, with priority given to people in CARE Court.\u003c/p>\n\u003cp>Orange County and some others are using the grants to open new treatment beds. In San Diego, Bergmann’s department will use the money to pay for board-and-care placements. Significant new infrastructure, however, will take years to complete. Over the past five years, Bergmann said, the county has lost a fifth of those residential facilities.\u003c/p>\n\u003cp>“In the near term, those funds will help us help people with the fewest resources to compete more” for placements, he said. “It’s not going to all of a sudden create a net increase in infrastructure.”\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://calmatters.org/author/marisa-kendall/\">Marisa Kendall\u003c/a> contributed to this reporting.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Gov. Gavin Newsom’s plan to encourage people with mental illnesses to accept treatment starts this fall. Counties responsible say it may be more modest than advertised.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Under the low hum of cold fluorescent lights in a nondescript office park in Orange County, dozens of Californians gathered to find out if they could get help for their loved ones under the state’s new \u003ca href=\"https://www.kqed.org/news/tag/care-court\">CARE Court\u003c/a> system.\u003c/p>\n\u003cp>Unless that loved one has a medical diagnosis specific to schizophrenia or some other psychotic disorders, the answer is probably not.\u003c/p>\n\u003cp>The mid-August meeting was a series held by a mental health advocacy group in Orange County with the officials in charge of implementing CARE Court, which starts in October, about what the new system can and cannot do.\u003c/p>\n\u003cp>“What we’re here to do is share the facts to help manage expectations,” said Veronica Kelley, Orange County’s chief of mental health and recovery services.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Community Assistance, Recovery, and Empowerment (CARE) Court was Gov. Gavin Newsom’s \u003ca href=\"https://calmatters.org/housing/2022/09/california-lawmakers-approved-care-court-what-comes-next/\">biggest legislative priority\u003c/a> last year — what state lawmakers and local politicians hoped would be one answer to California’s dual, overlapping homelessness and mental health crises.\u003c/p>\n\u003cp>The new program allows family members and others to petition someone with untreated mental illness into civil courts, where a judge would order a treatment plan and require county mental health departments to provide it.\u003c/p>\n\u003cp>Backed by millions in new state funds, it’s a mandate for those departments at a time when Californians have become increasingly frustrated with one of the most visible consequences of the state’s trenchant homelessness crisis — people with the most severe mental illnesses languishing on the streets. \u003c/p>\u003c/div>",
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"content": "‘[CARE Court’s] not going to be this thing that dramatically changes homelessness.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp> Counties will be judged on how well they’re able to get people, who may be resistant to help, inside and into treatment, even though CARE Court is not exclusively a program targeting homelessness. Local mental health officials are warning it won’t be a panacea.\u003c/p>\n\u003cp>“There’s been a presumption — and this is, to be clear, driven by how the administration talked about CARE Court at the outset — a broad presumption that CARE Court is going to fix homelessness or have a broad impact on the nexus of homelessness and behavioral health,” said Luke Bergmann, director of the San Diego County Behavioral Health Services department.\u003c/p>\n\u003cp>In reality, he said, it’s “actually going to be a pretty small program. It’s not going to be this thing that dramatically changes homelessness.”\u003c/p>\n\u003cp>The program aims to walk the line between forced treatment and completely voluntary treatment for those with the gravest needs. Disability rights groups decry it as a violation of a person’s civil liberties, and a potential path \u003ca href=\"https://calmatters.org/justice/2021/07/britney-spears-conservatorship/\">toward conservatorship\u003c/a> and the loss of legal rights for those who repeatedly decline care.\u003c/p>\n\u003cfigure id=\"attachment_11959338\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11959338\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/08/CMCareCourts02.jpg\" alt='An office full of people sit at tables looking toward a woman with a purple blouse who speaks from a microphone and holding index cards in her other hand. A flat-screen television hangs above her head displaying \"What is in a CARE Agreement Plan?\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts02-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Annette Mugrditchian, deputy director, speaks to community members about CARE Court at the Behavioral Health Training Center in Orange County. \u003ccite>(Lauren Justice/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>CARE Court \u003ca href=\"https://www.latimes.com/california/story/2023-01-26/disability-advocates-lawsuit-care-court-newsom-mental-illness-addiction-homeless\">survived a legal challenge\u003c/a> from Disability Rights California and other civil rights groups earlier this year. The group sat on a state working group for the program’s implementation and will monitor its rollout.\u003c/p>\n\u003cp>The program was welcomed by some family members of those with severe mental illness, who have complained that the state’s privacy and patients’ rights laws only allow their loved ones to \u003ca href=\"https://calmatters.org/projects/mentally-ill-forced-treatment-conservatorship-california-debate/\">be compelled into treatment \u003c/a>when in crisis, trapping them in a revolving door of short-term hospital stays and homelessness.\u003c/p>\n\u003cp>The first courts will open across the state in about a month. Seven counties, urban and rural, have been deep in preparation to be the first to roll out the program in October.\u003c/p>\n\u003cp>Los Angeles County, whose roughly 75,000-person unhoused population is the state’s largest, will start the program in December; the rest of the state will follow next year.\u003c/p>\n\u003cp>Those in the first group — San Francisco, Orange, San Diego, Riverside, Stanislaus, Glenn and Tuolumne counties — have had numerous questions to address, such as:\u003c/p>\n\u003cul>\n\u003cli>Who will find and serve respondents with their CARE Court petition if the respondent is unhoused?\u003c/li>\n\u003cli>How can county courts make the paperwork-heavy petition process easy for family members?\u003c/li>\n\u003cli>How many mental health treatment beds will counties need to add?\u003c/li>\n\u003cli>Where will people live after completing the court-ordered plans?\u003c/li>\n\u003c/ul>\n\u003cp>The state estimates between 7,000 and 12,000 people will qualify. They needn’t be homeless to receive the services, though many who qualify are likely to be unhoused. The state’s homeless population on any given night last year topped 171,000. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp> A UC San Francisco \u003ca href=\"https://homelessness.ucsf.edu/sites/default/files/2023-06/CASPEH_Report_62023.pdf\">study of homelessness statewide (PDF)\u003c/a> this year found that more than a quarter of unhoused people had been hospitalized at some point in their lives for a mental health problem; the homeless services authority in Los Angeles \u003ca href=\"https://www.lahsa.org/documents?id=3422-2019-greater-los-angeles-homeless-count-los-angeles-continuum-of-care.pdf\">has estimated (PDF)\u003c/a> a quarter of the city’s homeless adults has a severe mental illness. But CARE Court is targeted at an even narrower set of diagnoses and circumstances.\u003c/p>\n\u003cp>So counties are also playing a careful game of “level-setting,” Bergman said, “about what this thing will actually be.”\u003c/p>\n\u003cp>Still, local officials see the program as an opportunity to get more people into mental health care who haven’t been treated, before their condition deteriorates to the point of being put in conservatorships.\u003c/p>\n\u003cp>And the state’s Department of Health Care Services says it will be looking out for whether the program reduces emergency room visits, police encounters, short-term hospital stays and involuntary psychiatric holds — and whether it helps people find stable housing.\u003c/p>\n\u003ch2>Managing expectations\u003c/h2>\n\u003cp>One major uncertainty counties face, officials say, is even knowing how many cases they’ll get.\u003c/p>\n\u003cp>That’s in part because the law allows a wide range of people to petition for someone to be in CARE Court, including family members, roommates, health care providers, paramedics, hospital officials or homeless outreach workers.\u003c/p>\n\u003cp>But the list of actual conditions the program targets is narrow. It’s limited to schizophrenia and related illnesses. \u003c/p>\u003c/div>",
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"content": "‘What the public thinks CARE Court is and what it is are definitely two very different things.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp> That could disappoint those whose loved ones have other diagnoses — and create an unknown amount of work for counties if a flood of those family members file petitions. Behavioral health departments must evaluate each person if it’s not clear whether they qualify for the program.\u003c/p>\n\u003cp>San Diego County estimates it will get 1,000 petitions in the first year and establish court-ordered treatment plans for 250 people; the remainder likely will either not qualify or will agree to services voluntarily, Bergmann said. Orange County expects about 1,400 petitions and anywhere from 400 to 600 treatment plans.\u003c/p>\n\u003cp>Officials in Riverside County don’t even have an estimate, citing varying data there on the prevalence of schizophrenia in the unhoused population.\u003c/p>\n\u003cp>“We really think it’s unknowable,” said Marcus Cannon, the county’s deputy behavioral health director.\u003c/p>\n\u003cp>Counties want the state to help them manage public expectations. Both Kelley and Cannon said they’ve heard from local leaders who have floated having city workers file petitions for a wide swath of unhoused residents, to get them indoors.\u003c/p>\n\u003cp>“What the public thinks CARE Court is and what it is are definitely two very different things,” said Michelle Doty Cabrera, director of \u003ca href=\"https://www.cbhda.org/\">the County Behavioral Health Directors Association\u003c/a>.\u003c/p>\n\u003cp>In an emailed statement, state Department of Health Care Services spokesperson Sami Gallegos said that counties “are managing public relations among local elected officials and others” to spread the message about who the program is and isn’t for.\u003c/p>\n\u003cp>After learning of the narrow eligibility criteria at a community meeting in August, Nancy Beltran considered her options.\u003c/p>\n\u003cp>Beltran, of Anaheim, said she lives with a family member whose psychotic condition caused him to hit another relative in 2020, landing him in the hospital against his will. She said he’s refused treatment and doesn’t believe he’s sick. Another psychotic episode earlier this year didn’t qualify him for hospitalization, she said, because the symptoms weren’t as severe.\u003c/p>\n\u003cp>“I didn’t want it to get to that point,” she said. “I don’t want him to be incarcerated. I want it to be the least restrictive, least traumatic experience.”\u003c/p>\n\u003cp>She’s still not sure whether the program is for her family member, because they haven’t gotten a clear diagnosis, she said.\u003c/p>\n\u003cp>Beltran said she also wishes the program could help a friend, who is already enrolled in therapy sessions for diagnosed schizophrenia, find a place to live. Her friend’s condition, she said, deteriorates because he is unhoused, but he remains on waiting lists for housing. But CARE Court, she was disappointed to learn at the meetings, is only for those with untreated schizophrenia.\u003c/p>\n\u003ch2>Threading a needle\u003c/h2>\n\u003cp>Everyone involved in CARE Court in Orange County — from the judge who would ultimately order treatment to the public defender who will represent respondents to the behavioral health officials responsible for finding, diagnosing and treating them — had the same message for the public: The program will be voluntary.\u003c/p>\n\u003cp>Critics, however,\u003cstrong> \u003c/strong>contend that there’s no way a court process can be voluntary, since at some point there is a judge’s order. By law, counties must try at least twice to persuade a respondent to accept treatment before a judge orders it. Even then, the treatment plan, which can include therapy, medication and housing, doesn’t come with much enforcement. Medication can be ordered, but not forcibly administered.\u003c/p>\n\u003cfigure id=\"attachment_11959344\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11959344\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/08/CMCareCourts03.jpg\" alt=\"A bald man in a business suit speaks to a crowd as he sits at a table holding a microphone in his hand.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts03.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts03-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts03-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts03-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts03-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/08/CMCareCourts03-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Judge Ebrahim Baytieh speaks to community members about CARE Court, a new program that will be implemented in the fall. \u003ccite>(Lauren Justice/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Over the course of a year, respondents will attend court hearings to see whether they’re adhering to the treatment and whether the county is providing it. Counties can be fined as much as $1,000 a day for not providing the care; if the person fails to complete treatment they could be considered for conservatorship.\u003c/p>\n\u003cp>But county officials stressed that’s not the goal.\u003c/p>\n\u003cp>“We have tried for 40 years in this wonderful country of ours to force people with mental illness” to be treated, Orange County Superior Court Judge Ebrahim Baytieh told family members at another community meeting, in a church in Cypress. “Study after study has found it doesn’t work. We all know there’s no magical answer. But we will be patient, and we will be persistent.”\u003c/p>\n\u003cp>Kelley’s department is training its workers and peer supporters — people who also have mental illness or have recovered who can help guide a respondent through CARE Court — in a well-regarded communication method \u003ca href=\"https://leapinstitute.org/about/#:~:text=LEAP%20(Listen%2DEmpathize%2DAgree,and%20the%20treatment%20they%20need.\">called LEAP\u003c/a> to persuade respondents to accept care. It will offer services to those in CARE Court under a “whatever it takes” approach, whether it’s a ride to the doctor’s office, help to enroll in food stamps, addiction treatment, or temporary housing.\u003c/p>\n\u003cp>The task will take time.\u003c/p>\n\u003cp>At the community meetings, Kelley and her colleagues repeatedly described a pilot program she ran as behavioral health director in San Bernardino County. The program took referrals from family, police or other community members who wanted to prod those who were resistant to mental health treatment. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp> The time it took for county workers using the LEAP method to persuade respondents to enter treatment varied, Kelley said. But on average, she said it took 20 visits if a respondent was housed — and 40 visits if they were unhoused. Visit times varied, from a few minutes to a whole day so that the whole process could take weeks or months, Kelley said.\u003c/p>\n\u003cp>The timetables set by law for CARE Court are much tighter.\u003c/p>\n\u003cp>If counties initially determine a client won’t agree to treatment, they get 14 days to try again before the next court hearing. Kelley said the judges in her county are sympathetic toward those concerns, but not all counties will get such flexibility.\u003c/p>\n\u003cp>“I can’t do 40 face-to-face visits in 14 days,” she said.\u003c/p>\n\u003cp>Civil rights advocates balked at the counties’ suggestion that any program involving the pressure of the judicial system, even a non-criminal court, could be voluntary.\u003c/p>\n\u003cp>“If you’re trying to engage somebody, and there’s a petition that involves a court,” there’s less hope of building genuine trust, said Keris Myrick, a mental health advocate who lives with schizophrenia and a board member of Disability Rights California.\u003c/p>\n\u003cp>The group is particularly concerned the court process could be ineffective or harmful among Black residents, who are overrepresented both in California’s homeless population and among people diagnosed with schizophrenia.\u003c/p>\n\u003cp>Myrick, who is Black, said she has been subject to involuntary treatment and described harrowing experiences during which she was handcuffed in the back of a police car or strapped down to a gurney for hours before a doctor visited. She said one thing that actually helped her recover was having a peer supporter who was also African American and related to her experiences, eventually persuading her to get treatment on her own terms.\u003c/p>\n\u003cp>She later ran a peer support program in Los Angeles County and trained workers in the county mental health department. Myrick says the state needs to expand those services, as well as housing and social supports to help people live stable lives, without the threat of a judicial order.\u003c/p>\n\u003cp>Alex Barnard, a sociologist at New York University who has studied involuntary mental health treatment in California, is skeptical about whether the state can appease both civil libertarians and those who want more aggressive treatment. But he said the program’s mandate of a year of persistent engagement is promising.\u003c/p>\n\u003cp>“If CARE Courts work, it will probably be because of that,” he said. “It creates some accountability on the provider to keep trying to work with somebody who might be very challenging, and elsewhere in the system would just have their file closed out.”\u003c/p>\n\u003ch2>Long-term resources\u003c/h2>\n\u003cp>Those implementation questions are among a list of other practical hurdles counties face for the program to be successful.\u003c/p>\n\u003cp>There’s long-term funding. The first seven counties were given $26 million in one-time state grants to start the programs; some have estimated annual costs of the services themselves will \u003ca href=\"https://sfstandard.com/2023/04/20/newsoms-care-court-faces-50-million-hurdle-in-san-francisco-as-key-deadline-approaches/\">far exceed\u003c/a> those allotments.\u003c/p>\n\u003cp>The state says most services will be covered by Medi-Cal or private insurance, and expects counties to submit reimbursement requests, including the costs of going to court or finding respondents.\u003c/p>\n\u003cp>But the \u003ca href=\"https://www.kqed.org/news/11923034/were-drowning-why-kaiser-mental-health-workers-are-striking#:~:text=Kaiser%20administrators%20point%20to%20what,15%20statement.\">nationwide shortage of behavioral health workers\u003c/a> has made it a challenge for some departments to hire. In San Diego County, Bergmann’s department plans to add 55 new staff, including 10 clinicians, for CARE Court. Only 35% have been hired so far, a spokesperson said. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp> And there’s housing and beds, which all agree are crucial to making treatment a success.\u003c/p>\n\u003cp>Health officials believe most people who qualify for CARE Court will need a more intensive treatment placement in the beginning, while some may be able to be placed in residential facilities or their own apartments after being stabilized.\u003c/p>\n\u003cp>But there are shortages across that spectrum. A \u003ca href=\"https://www.rand.org/pubs/research_reports/RRA1824-1-v2.html\">2021 Rand analysis\u003c/a> found the state is short more than 4,700 psychiatric inpatient treatment beds and nearly 3,000 residential facility beds such as \u003ca href=\"https://calmatters.org/projects/board-and-care-homes-closing-in-california-mental-health-crisis/\">board-and-cares\u003c/a>—long-term housing for people with severe mental illness and one option for respondents to live after they complete CARE Court.\u003c/p>\n\u003cp>Included in last year’s state budget was \u003ca href=\"https://bridgehousing.buildingcalhhs.com/county-behavioral-health-agencies/\">nearly $1 billion\u003c/a> in new funding for counties to expand temporary housing placements for those with mental illness, with priority given to people in CARE Court.\u003c/p>\n\u003cp>Orange County and some others are using the grants to open new treatment beds. In San Diego, Bergmann’s department will use the money to pay for board-and-care placements. Significant new infrastructure, however, will take years to complete. Over the past five years, Bergmann said, the county has lost a fifth of those residential facilities.\u003c/p>\n\u003cp>“In the near term, those funds will help us help people with the fewest resources to compete more” for placements, he said. “It’s not going to all of a sudden create a net increase in infrastructure.”\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://calmatters.org/author/marisa-kendall/\">Marisa Kendall\u003c/a> contributed to this reporting.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cstrong>\u003cem>Editor’s note:\u003c/em>\u003c/strong>\u003cem> This story is part of an occasional series examining the rollout of CARE Courts across the state. \u003c/em>\u003ca href=\"https://www.kqed.org/news/11952228/san-francisco-to-implement-newsoms-care-court-plan-to-treat-severe-mental-illness\">\u003cem>Read or listen to KQED’s reporting on San Francisco County here.\u003c/em>\u003c/a>\u003c/p>\n\u003cp>When Heidi Sweeney first began hallucinating, the voices in her head told her Orange County’s Huntington Beach was where she would be safe. There, behind the bikini-clad crowds playing volleyball and riding beach cruisers, she slept in homeless encampments, then beside a bush outside a liquor store, drinking vodka to drown out the din only she could hear.\u003c/p>\n\u003cp>For years, she refused help, insisting to all who offered, “I’m not sick,” until police arrested her for petty theft and public drunkenness. A judge gave her an ultimatum: jail, or treatment. She chose treatment.\u003c/p>\n\u003cp>“I’m so thankful that they did that,” said Sweeney, now 52. “I needed that. I think there’s others out there that need it, too.”\u003c/p>\n\u003cp>If she hadn’t been compelled to get care, Sweeney said she wouldn’t be alive today, back at work and reunited with her husband. It’s why she supports California’s new civil CARE Courts, which will launch this fall in eight counties, including \u003ca href=\"https://www.kqed.org/news/11952228/san-francisco-to-implement-newsoms-care-court-plan-to-treat-severe-mental-illness\">San Francisco\u003c/a>, \u003ca href=\"https://www.kcrw.com/news/shows/greater-la/psych-treatment/care-court\">Los Angeles\u003c/a> and Orange, followed by the rest of the state in 2024.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Under the new system, family members and first responders can ask county judges to order people with psychotic illness into treatment, even if they are not unhoused or haven’t committed a crime.\u003c/p>\n\u003cp>The bill creating the program sailed through the state Legislature with near unanimous support last year amid growing frustration from voters over the state’s increasing population of unhoused residents, even as it drew vehement opposition from disability rights groups, who argued CARE Courts’ hallmark — compelling people who have done nothing wrong into mental health care — is a violation of civil rights.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Maria Hernandez, presiding judge, Orange County Superior Court\"]‘We don’t want to punish people. We want them to maintain their dignity.’[/pullquote]\u003c/p>\n\u003cp>In Orange County, that tension — between those who advocate for voluntary treatment and those who say the status quo allows people to die in the streets “\u003ca href=\"https://www.kqed.org/news/11944448/a-war-of-compassion-debate-over-forced-treatment-of-mental-illness-splits-california-liberals\">with their rights on\u003c/a>” — is playing out in the implementation of the program.\u003c/p>\n\u003cp>Its officials are threading a delicate needle: particularly, how to convince people to accept care without coercion, when their illness causes them to believe they are not ill.\u003c/p>\n\u003cp>“We don’t want to punish people,” said Maria Hernandez, the presiding judge for Orange County Superior Court. “We want them to maintain their dignity.”\u003c/p>\n\u003cfigure id=\"attachment_11955163\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11955163 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED.jpg\" alt=\"A light-skinned middle-aged woman with long brown hair and wearing black judge's robes smiles at the camera from behind a desk.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Orange County Superior Court Presiding Judge Maria Hernandez says CARE Court will resemble the county’s other collaborative courts, like her young adult diversion court, where compassion and science drive her decisions. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Orange County is expecting that between 900 and 1,500 residents will be eligible for CARE Court in any given year, according to the county public defender’s office. Local lawyers, judges and health officials all have aligned in designing their program with a distinct patient focus, endeavoring to make the process as benign and nonthreatening as possible.\u003c/p>\n\u003cp>[aside label='More Stories on CARE Court' tag='care-court']\u003c/p>\n\u003cp>Hernandez said that means modeling the new civil court after the county’s other collaborative courts, where judges often lose the black robe and come down off the bench to work \u003cem>with \u003c/em>people, eye to eye.\u003c/p>\n\u003cp>One prototype, she said, is her \u003ca href=\"https://www.occourts.org/directory/collaborative-courts/YAC_Pamphlet.pdf\">Young Adult Court (PDF)\u003c/a>, where, on a day in June, the mood was downright jovial. Defendants and their family members were chatting and laughing, munching on snacks laid out on a table in the back as three young men “graduated” from the diversion program.\u003c/p>\n\u003cp>“Judge Hernandez is so awesome,” said Abraham, 25, a former graduate, who asked to be identified only by his first name because he was charged with a felony that has since been expunged from his record. “I don’t even look at her as the judge. She’s just like a mom figure. She’s only trying to push you to be the better you.”\u003c/p>\n\u003cp>A minute later, Hernandez walked through the aisle of the courtroom and gave Abraham a hug.\u003c/p>\n\u003ch2>‘Disaster preparedness’\u003c/h2>\n\u003cp>Even if CARE Court is ruled by the likes of Mary Poppins, Orlando Vera, who lives with bipolar disorder, said helping a vulnerable person heal from mental illness shouldn’t involve dragging them into a courtroom.\u003c/p>\n\u003cfigure id=\"attachment_11955161\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11955161 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED.jpg\" alt=\"A very fair-skinned bald man wearing glasses sits in an office setting, smiling and wearing a short-sleeved blue collared polo shirt.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Orlando Vera, co-founder of Peer Voices of Orange County, says he and other people with lived experience of mental illness will attend CARE Court proceedings on behalf of patients. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“It’s not a place [where] you resolve your emotions. It is a very business-oriented environment. So I do feel that this is not the place for it,” Vera said, adding, “Can we stop it? I would say we can’t.”\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Orlando Vera, founder, Peer Voices of Orange County\"]‘Our focus is how do we support those that are going through the system. We need to be their voice.’[/pullquote]\u003c/p>\n\u003cp>After advocates \u003ca href=\"https://www.sacbee.com/news/politics-government/capitol-alert/article274547296.html\">failed to convince the state Supreme Court\u003c/a> to block the program on constitutional grounds, some started referring to the rollout of CARE Court as “disaster preparedness.”\u003c/p>\n\u003cp>\u003ca href=\"https://peervoices.org/\">Peer Voices of Orange County\u003c/a>, a group Vera co-founded and runs, plans to install patient advocates at the courthouse to attend any and all CARE Court hearings.\u003c/p>\n\u003cp>“Our focus is how do we support those that are going through the system,” he said. “We need to be their voice.”\u003c/p>\n\u003ch2>‘CARE’ without coercion\u003c/h2>\n\u003cp>Orange County behavioral health director Veronica Kelley is sympathetic to advocates’ concerns. She said CARE Court is not the program she would have created to improve the state’s mental health system. But she serves at the will of the governor and other elected officials who control her budget.\u003c/p>\n\u003cp>“So we end up building the Winchester Mystery House,” she said. “It is a structure that was OK, but then it just started adding hallways to nowhere and basements that are on top of the building. That’s what our system looks like.”\u003c/p>\n\u003cfigure id=\"attachment_11955162\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11955162 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED.jpg\" alt=\"A white woman with long blond hair and long earrings sits in front of a bookshelf filled with books. She is unsmiling.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Veronica Kelley, behavioral health director for Orange County, will oversee mental health outreach and care provided through the local CARE Court, launching Oct. 1. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But Kelley is committed to making sure CARE Court is not a hallway to nowhere.\u003c/p>\n\u003cp>“It is a hallway that I’m going to, at the end, construct a door that opens out to a bunch of different options,” she said.\u003c/p>\n\u003cp>Kelley is shaping the new court process into something its critics can accept. This is why she wanted Orange County to go first.\u003c/p>\n\u003cp>“So we can help craft it into something that’s not another colossal waste of time and funds, and that we don’t destroy the people we’re trying to serve at the same time,” she told a roomful of patient advocates during a meeting of the state \u003ca href=\"https://www.dhcs.ca.gov/services/MH/Pages/PatientsRights.aspx#:~:text=California%20Office%20of%20Patients'%20Rights,training%20and%20technical%20assistance%20to\">Patient Rights’ Committee\u003c/a>, held in Santa Ana.\u003c/p>\n\u003cp>This means social workers from her \u003ca href=\"https://www.ochealthinfo.com/services-programs/mental-health-crisis-recovery/mental-health\">behavioral health department\u003c/a> or the \u003ca href=\"https://www.pubdef.ocgov.com/\">public defender’s office\u003c/a> might visit people 20, 30 or 40 times to build trust, listen and set goals.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Veronica Kelley, behavioral health director, Orange County\"]‘If someone agrees to do something of their own accord, it is far more probable that there will be long-term success and long-term commitment to the services being provided.’[/pullquote]\u003c/p>\n\u003cp>“If they can’t be convinced, CARE Court isn’t for them. But we’re not going to give up on folks because they say no the first time,” said Martin Schwarz, Orange County’s public defender, who plans to devote eight full-time staff to represent the interests of patients referred into the program.\u003c/p>\n\u003cp>Under the CARE legislation, the court is allowed to fine behavioral health agencies $1,000 per day if they can’t find a patient and enroll them in treatment by certain deadlines.\u003c/p>\n\u003cp>Kelley said her county’s judges have agreed to give her staff the time and extensions they need to do their jobs right. She also vowed that no one who declines services in her county would be institutionalized, as the legislation allows.\u003c/p>\n\u003cp>“If someone agrees to do something of their own accord, it is far more probable that there will be long-term success and long-term commitment to the services being provided,” she said.\u003c/p>\n\u003cp>Kelley and Schwarz pointed to their success with another civil court process established by Laura’s Law in 2002, where for each individual involved in court-ordered outpatient care, there were another 20 who accepted treatment willingly.\u003c/p>\n\u003cp>They say they have the same goal for CARE Court, where the focus will be on finding a treatment plan people accept voluntarily — before a judge has to order it.\u003c/p>\n\u003cp>“Success is measured by who we keep out of the court system,” Schwarz said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>\u003cem>Editor’s note:\u003c/em>\u003c/strong>\u003cem> This story is part of an occasional series examining the rollout of CARE Courts across the state. \u003c/em>\u003ca href=\"https://www.kqed.org/news/11952228/san-francisco-to-implement-newsoms-care-court-plan-to-treat-severe-mental-illness\">\u003cem>Read or listen to KQED’s reporting on San Francisco County here.\u003c/em>\u003c/a>\u003c/p>\n\u003cp>When Heidi Sweeney first began hallucinating, the voices in her head told her Orange County’s Huntington Beach was where she would be safe. There, behind the bikini-clad crowds playing volleyball and riding beach cruisers, she slept in homeless encampments, then beside a bush outside a liquor store, drinking vodka to drown out the din only she could hear.\u003c/p>\n\u003cp>For years, she refused help, insisting to all who offered, “I’m not sick,” until police arrested her for petty theft and public drunkenness. A judge gave her an ultimatum: jail, or treatment. She chose treatment.\u003c/p>\n\u003cp>“I’m so thankful that they did that,” said Sweeney, now 52. “I needed that. I think there’s others out there that need it, too.”\u003c/p>\n\u003cp>If she hadn’t been compelled to get care, Sweeney said she wouldn’t be alive today, back at work and reunited with her husband. It’s why she supports California’s new civil CARE Courts, which will launch this fall in eight counties, including \u003ca href=\"https://www.kqed.org/news/11952228/san-francisco-to-implement-newsoms-care-court-plan-to-treat-severe-mental-illness\">San Francisco\u003c/a>, \u003ca href=\"https://www.kcrw.com/news/shows/greater-la/psych-treatment/care-court\">Los Angeles\u003c/a> and Orange, followed by the rest of the state in 2024.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Under the new system, family members and first responders can ask county judges to order people with psychotic illness into treatment, even if they are not unhoused or haven’t committed a crime.\u003c/p>\n\u003cp>The bill creating the program sailed through the state Legislature with near unanimous support last year amid growing frustration from voters over the state’s increasing population of unhoused residents, even as it drew vehement opposition from disability rights groups, who argued CARE Courts’ hallmark — compelling people who have done nothing wrong into mental health care — is a violation of civil rights.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In Orange County, that tension — between those who advocate for voluntary treatment and those who say the status quo allows people to die in the streets “\u003ca href=\"https://www.kqed.org/news/11944448/a-war-of-compassion-debate-over-forced-treatment-of-mental-illness-splits-california-liberals\">with their rights on\u003c/a>” — is playing out in the implementation of the program.\u003c/p>\n\u003cp>Its officials are threading a delicate needle: particularly, how to convince people to accept care without coercion, when their illness causes them to believe they are not ill.\u003c/p>\n\u003cp>“We don’t want to punish people,” said Maria Hernandez, the presiding judge for Orange County Superior Court. “We want them to maintain their dignity.”\u003c/p>\n\u003cfigure id=\"attachment_11955163\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11955163 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED.jpg\" alt=\"A light-skinned middle-aged woman with long brown hair and wearing black judge's robes smiles at the camera from behind a desk.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-05-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Orange County Superior Court Presiding Judge Maria Hernandez says CARE Court will resemble the county’s other collaborative courts, like her young adult diversion court, where compassion and science drive her decisions. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Orange County is expecting that between 900 and 1,500 residents will be eligible for CARE Court in any given year, according to the county public defender’s office. Local lawyers, judges and health officials all have aligned in designing their program with a distinct patient focus, endeavoring to make the process as benign and nonthreatening as possible.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Hernandez said that means modeling the new civil court after the county’s other collaborative courts, where judges often lose the black robe and come down off the bench to work \u003cem>with \u003c/em>people, eye to eye.\u003c/p>\n\u003cp>One prototype, she said, is her \u003ca href=\"https://www.occourts.org/directory/collaborative-courts/YAC_Pamphlet.pdf\">Young Adult Court (PDF)\u003c/a>, where, on a day in June, the mood was downright jovial. Defendants and their family members were chatting and laughing, munching on snacks laid out on a table in the back as three young men “graduated” from the diversion program.\u003c/p>\n\u003cp>“Judge Hernandez is so awesome,” said Abraham, 25, a former graduate, who asked to be identified only by his first name because he was charged with a felony that has since been expunged from his record. “I don’t even look at her as the judge. She’s just like a mom figure. She’s only trying to push you to be the better you.”\u003c/p>\n\u003cp>A minute later, Hernandez walked through the aisle of the courtroom and gave Abraham a hug.\u003c/p>\n\u003ch2>‘Disaster preparedness’\u003c/h2>\n\u003cp>Even if CARE Court is ruled by the likes of Mary Poppins, Orlando Vera, who lives with bipolar disorder, said helping a vulnerable person heal from mental illness shouldn’t involve dragging them into a courtroom.\u003c/p>\n\u003cfigure id=\"attachment_11955161\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11955161 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED.jpg\" alt=\"A very fair-skinned bald man wearing glasses sits in an office setting, smiling and wearing a short-sleeved blue collared polo shirt.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-03-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Orlando Vera, co-founder of Peer Voices of Orange County, says he and other people with lived experience of mental illness will attend CARE Court proceedings on behalf of patients. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“It’s not a place [where] you resolve your emotions. It is a very business-oriented environment. So I do feel that this is not the place for it,” Vera said, adding, “Can we stop it? I would say we can’t.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>After advocates \u003ca href=\"https://www.sacbee.com/news/politics-government/capitol-alert/article274547296.html\">failed to convince the state Supreme Court\u003c/a> to block the program on constitutional grounds, some started referring to the rollout of CARE Court as “disaster preparedness.”\u003c/p>\n\u003cp>\u003ca href=\"https://peervoices.org/\">Peer Voices of Orange County\u003c/a>, a group Vera co-founded and runs, plans to install patient advocates at the courthouse to attend any and all CARE Court hearings.\u003c/p>\n\u003cp>“Our focus is how do we support those that are going through the system,” he said. “We need to be their voice.”\u003c/p>\n\u003ch2>‘CARE’ without coercion\u003c/h2>\n\u003cp>Orange County behavioral health director Veronica Kelley is sympathetic to advocates’ concerns. She said CARE Court is not the program she would have created to improve the state’s mental health system. But she serves at the will of the governor and other elected officials who control her budget.\u003c/p>\n\u003cp>“So we end up building the Winchester Mystery House,” she said. “It is a structure that was OK, but then it just started adding hallways to nowhere and basements that are on top of the building. That’s what our system looks like.”\u003c/p>\n\u003cfigure id=\"attachment_11955162\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11955162 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED.jpg\" alt=\"A white woman with long blond hair and long earrings sits in front of a bookshelf filled with books. She is unsmiling.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/07/230707-ORANGE-COUNTY-CARE-COURT-AD-04-KQED-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Veronica Kelley, behavioral health director for Orange County, will oversee mental health outreach and care provided through the local CARE Court, launching Oct. 1. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But Kelley is committed to making sure CARE Court is not a hallway to nowhere.\u003c/p>\n\u003cp>“It is a hallway that I’m going to, at the end, construct a door that opens out to a bunch of different options,” she said.\u003c/p>\n\u003cp>Kelley is shaping the new court process into something its critics can accept. This is why she wanted Orange County to go first.\u003c/p>\n\u003cp>“So we can help craft it into something that’s not another colossal waste of time and funds, and that we don’t destroy the people we’re trying to serve at the same time,” she told a roomful of patient advocates during a meeting of the state \u003ca href=\"https://www.dhcs.ca.gov/services/MH/Pages/PatientsRights.aspx#:~:text=California%20Office%20of%20Patients'%20Rights,training%20and%20technical%20assistance%20to\">Patient Rights’ Committee\u003c/a>, held in Santa Ana.\u003c/p>\n\u003cp>This means social workers from her \u003ca href=\"https://www.ochealthinfo.com/services-programs/mental-health-crisis-recovery/mental-health\">behavioral health department\u003c/a> or the \u003ca href=\"https://www.pubdef.ocgov.com/\">public defender’s office\u003c/a> might visit people 20, 30 or 40 times to build trust, listen and set goals.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If they can’t be convinced, CARE Court isn’t for them. But we’re not going to give up on folks because they say no the first time,” said Martin Schwarz, Orange County’s public defender, who plans to devote eight full-time staff to represent the interests of patients referred into the program.\u003c/p>\n\u003cp>Under the CARE legislation, the court is allowed to fine behavioral health agencies $1,000 per day if they can’t find a patient and enroll them in treatment by certain deadlines.\u003c/p>\n\u003cp>Kelley said her county’s judges have agreed to give her staff the time and extensions they need to do their jobs right. She also vowed that no one who declines services in her county would be institutionalized, as the legislation allows.\u003c/p>\n\u003cp>“If someone agrees to do something of their own accord, it is far more probable that there will be long-term success and long-term commitment to the services being provided,” she said.\u003c/p>\n\u003cp>Kelley and Schwarz pointed to their success with another civil court process established by Laura’s Law in 2002, where for each individual involved in court-ordered outpatient care, there were another 20 who accepted treatment willingly.\u003c/p>\n\u003cp>They say they have the same goal for CARE Court, where the focus will be on finding a treatment plan people accept voluntarily — before a judge has to order it.\u003c/p>\n\u003cp>“Success is measured by who we keep out of the court system,” Schwarz said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"perspectives": {
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"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
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},
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},
"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
"airtime": "SAT 4pm-5pm",
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"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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},
"link": "/radio/program/reveal",
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