California has launched a pilot program called CARE Court to involuntarily hospitalize people in an effort to confront growing mental health problems in communities.
Senate Bill 1338, also known as the CARE Act, establishes a new civil court process in California to provide community-based behavioral health services to individuals with schizophrenia spectrum or other psychotic disorders.
Since taking effect in January 2024, California’s mental health laws have changed what services are available for individuals in crisis.
However, failure to effectively implement these laws leads many opponents, such as disability advocates, to dismiss Prop. 1 as a step backward.
Every day, thousands of unhoused individuals experience a mental health crisis and risk arrest instead of being linked to specialized treatment to help them stabilize.
Careful consideration is needed to treat individuals with agnosia, a neurological condition preventing a person from recognizing their own illness.
CARE Court’s primary objective is to offer support and treatment before individuals reach a point of crisis, potentially preventing avoidable hospitalizations, incarcerations, and conservatorships.
The intended target population most impacted by Prop. 1 are individuals who are homeless and don’t break the law but have consistent, untreated mental health symptoms affecting their daily functioning.
To grasp the impact of these changes, it is helpful to review the history of mental health laws in the United States to understand how these laws are being implemented and used in the behavioral health care system.
The first major legislation in the United States focused on mental health treatment, including establishing protocol for 5150s (referring to California Welfare and Institutions Code section 5150), was the Lanterman-Petris-Short Act of 1967.
The LPS Act is a California state law enacted in 1967 that regulates involuntary commitment to mental health facilities.
It aimed to end inappropriate, indefinite, and involuntary psychiatric holds, emphasizing due process and establishing rights to prompt evaluation and treatment.
The LPS Act also created a framework for conservatorships for individuals deemed gravely disabled due to mental illness.
It was amended in 2002 to become what is today known as Laura’s Law.
This policy established court-ordered outpatient treatment for six months for patients with a history of noncompliance.
Laura’s Law mandated counties throughout California to provide outpatient treatment but did not have legal teeth, said Dr. Sandra Fitzgerald, associate professor at San Francisco State University in the Department of Counseling.
While Laura’s Law allowed petitioners to be parents, siblings, roommates, counselors, spouses, or police, it was difficult to use as a defense in court because it was hard to prove noncompliance when a patient wasn’t legally mandated to treatment or required to take medication.
The CARE, or Community Assistance, Recovery, and Empowerment Act of 2023, was established as an alternative to existing mental and behavioral health courts.
Its design is meant to provide wraparound support services, including an individualized treatment plan, linkage to a psychiatrist, supportive housing, and case management.
However, disability advocates argue that CARE Court is an ineffective alternative to jail that uses coercion to pressure individuals onto medication and into treatment.
CARE Court is designed to function as a possible two-year court-ordered plan for those deemed unfit by a team of specialists to care for themselves.
There will be supportive services, medication, and housing.
Those who oppose CARE Court argue it subverts the rights protected in the Lanterman-Petris-Short Act, including its behavioral criteria for enforcing coercive treatment.
Critics argue an individual’s involvement in CARE Court is still compulsory, court-ordered treatment.
The CARE Court concept is based on the myth that the solution to treating mental health issues and reducing homelessness is to expand forced treatment.
Gov. Gavin Newsom affirms the CARE Act protects individual rights, calling it a new approach and a paradigm shift.
His administration sees it as a new avenue for individuals living with serious mental or behavioral health challenges to be referred for court-mandated treatment and services.
But, simply put, a court order is forced treatment.
“Indeed, coercive treatment flies in the very face of the concepts of recovery and empowerment,” wrote Eduardo Vega, one of the founders of the California Association of Mental Health Peer Run Organizations.
The power to force compliance with authority using the threat of sanctions—including physical punishment, deprivation of liberty, financial penalty or some other undesirable consequence—has many people guessing whether CARE Courts really care about the individuals they are designed to serve.
Now that it is official, the outcomes of CARE Court locations across the state have yet to be seen.
One of the biggest challenges facing the implementation of CARE Court is resources.
As an alternative to the catch-and-release cycle of emergency psychiatric treatment and temporary 72-hour holds under 5150, counties like San Francisco must race to figure out how to house and treat all the people who need help.
Now in its third year, only time will tell if it is successful.
Victoria Lewis, executive director of HOPICS (Homeless Outreach Program, Integrated care System), a homeless outreach agency in South Central Los Angeles, highlights the need for thinking with an “equity lens that guides and informs the policies, processes, and implementation.”
Thinking with an equity lens is one step closer to reaching a paradigm shift.
It means, metaphorically, that if an agency has $10 and 10 people need help, is it more helpful to give each person $1—or to find out what each individual needs and see who needs $2, who can get by with $1, and who might need a bit extra?
That would be an example of using a racially equitable lens to tackle social problems like housing and healthcare.
“This is not about criminalization,” Lewis said.
“There are pros and cons of forcing people into treatment. There are a lot of people who are not willing or well enough to get the help they need. It’s important for legislators to understand the population of the unhoused in order to help them.”
The future of CARE Court is written with more questions than answers.
It is difficult to measure its effectiveness since the program is meant to support an individual for up to two years and the law only went into effect last year.
So then how should the effectiveness of CARE Court in its first two years be measured?
What will the future of CARE Court look like, and is this the best utilization of resources?
Will the CARE Act ultimately be seen as an effective solution leading to improved quality of life for those trapped in a never-ending cycle of crisis and homelessness?
There is no single solution.
A multi-factor approach and cross-collaborative effort across nonprofits, communities, and local governments is necessary.
Accountability is needed to ensure policies are implemented and services are accessible, especially housing and treatment.
Educational awareness campaigns are needed to raise awareness of changes to California’s mental health laws.
Demanding leaders act transparently in the best interest of society is necessary to ensure new policies are effectively implemented instead of slipping into obscurity.
Rather than pursue their own agendas, elected officials have an obligation to serve their community and a responsibility to listen to their voters, who are directly impacted by laws.
An all-hands-on-deck approach and clear strategy is needed to provide California’s vulnerable population adequate access to housing, healthcare, and the right to live a healthy and fulfilling lifestyle.
Kathryn Barger, an L.A. County supervisor, said, “The concept of Care Court is to put together a program that’s going to facilitate conservatorships for a certain segment of the population. The court plays a major role. There are specific laws surrounding conservatorships. If we don’t do anything, we are failing those that truly are the most vulnerable and in need of our care.”
Categories: Breaking News Everyday Injustice Opinion Tags: CARE Court Dr. Sandra Fitzgerald Gov. Gavin Newsom Kathryn Barger Lanterman-Petris-Short Act of 1967 Laura’s Law Prop 1 Proposition 1 Senator Bill 1338 Victoria Lewis