A handful of counties in California are getting ready to roll out a new, controversial court program aimed at getting people off the streets and into mental health or drug treatment facilities.
Since CARE court’s unveiling last year, it’s been praised by elected officials struggling to curb the homeless crisis.
But civil liberties groups and some advocates for homeless people warn it puts the Golden State on a path to institutionalization as Orange County Superior Court begins accepting CARE court cases today.
[Read: A Controversial Past Haunts Orange County’s CARE Court Judge]
The program’s capturing a long-brewing debate surrounding homelessness, mental health issues and drug addiction:
How to respect civil liberties while pushing people into programs they haven’t signed themselves up for?
Under the new system, anyone from family members to police officers can file a petition for someone they believe is severely suffering from an untreated psychotic disorder, like schizophrenia, to be put in front of a judge for court-ordered treatment.
Despite the wide range of individuals who can file these petitions – and remarks by state lawmakers who pushed CARE Court as a new approach to the state’s visible poverty and substance abuse crisis – the program is fairly limited in what types of mental health conditions might qualify.
For example, anxiety, stress and depression disorders aren’t covered under the program.
At the same time, CARE Court provides a new path to forcing people into treatment with court-orders– even potential conservatorships – and disability rights advocates say it brings California one step closer to the old days of institutionalization.
Yet, in Orange County, the act of stepping into the process to begin with is totally “voluntary,” says the County of Orange’s Chief of Mental Health and Recovery Services, Dr. Veronica Kelley.
“The respondent does not have to legally show up to court, as this is a voluntary process,” Kelley said in a Wednesday emailed response to questions. “If the respondent does not show up to the court date, the case is dismissed. This is voluntary.”
But it’s unclear what kind of control participants would have once they’re in the program, with a memo from Gov. Gavin Newsom’s office claiming that participants could be forced into a conservatorship.
“The plan focuses on people with schizophrenia spectrum and other psychotic disorders, who may also have substance use challenges, and who lack medical decision-making capacity,” wrote Newsom’s office in a memo explaining the program. “Participants who do not successfully complete Care Plans may, under current law, be hospitalized or referred to conservatorship.”
Disability rights advocates, meanwhile, warn that CARE Court is just one phase of what they’re describing as a legislative effort to scapegoat the disabled for the state’s tent cities, drugs and visible poverty crisis.
“Part of the rhetoric around CARE Court is, it’s going to provide more treatment – people are finally going to get services,” said Samuel Jain, a senior policy attorney for Disability Rights California, in a Wednesday phone interview.
“And I think the issue, currently, is not that these resources are available, and they’re not using them. It’s that these volunteer, community-based services are already under-resourced, and not accessible.”
Jain added:
“We don’t need to force people to be treated, we just need to make voluntary treatment accessible.”
Namely, he and fellow advocates point to three new bills in Sacramento that are sitting on the governor’s desk – Senate Bill 43, Senate Bill 326, and Assembly Bill 531 – which, altogether, they warn could expand institutional care facilities and the types of persons who are eligible for it, and slash funding for more voluntary, community-based mental health services.
“Those are going to make these voluntary community based services less accessible by reducing funding, while we’re then, you know, propping up these forced, more coercive ways of treatment like CARE Court,” Jain said.
It comes amidst a spate of community-based services in Orange County being closed in recent years, as cities like Santa Ana and Orange have moved to crack down on street-level mental health services and soup kitchens through the zoning code, arguing these places drive up blight and public nuisance.
“Important services that provide essential benefits to people, being closed in Orange County,” said fellow DRC attorney Lili Graham.
Others in OC’s advocacy realm await CARE Court more eagerly.
“I’m definitely in total support,” said Paul Leon, CEO of National Healthcare & Housing Advisors (NHHA), and the former CEO of the homelessness nonprofit, Illumination Foundation. “From my point of view, I’m a provider, but it’s really swayed the other way, to where I see clients with their rights actually hurting them.”
He added:
“Most of the people we took care of who were mentally ill were in jail. I keep thinking if it was my son or daughter, I’d much rather have them in CARE Court or in jail, cause they’re inevitably going to do something that will get them in trouble.”
“I’m so for it.”
But how would people being petitioned get notified? Where would these CARE Court hearings take place?
Kelley, of the county’s public health department, said that if a judge believes that the “respondent” meets the criteria, “county behavioral health is ordered to find the individual and serve them.”
If someone isn’t ultimately found to be eligible, Kelley said “we will still offer services to meet their needs.”
Kelley called it a “two-fold” effort.
“First, to try to create rapport and build trust, so that appropriate services being offered can be accepted by the individual. And second, to let the respondent know what CARE is and notify them they may have a court date,” she said.
Kelley added, the hearings could be in courtrooms, though the judge can also remove their robe and meet the person anywhere else “that is deemed appropriate and more comfortable for them.”
“The courtroom and judge in a black robe can be a very triggering environment, especially for people who may be living with untreated mental illness. These are individuals who have not broken the law – they haven’t done anything wrong – they just have a disease and it’s not being treated,” Kelley said.
“We recognize the sensitivity of the situation.”
There’s also open questions on where participants can be sent once they’re hospitalized, as there currently isn’t any facility set aside to receive a wave of mentally ill homeless patients.
Leon pointed out that the recently closed Fairview Center in Costa Mesa would’ve been a strong opportunity for that, given its history as a facility to support the disabled, but it’s currently set to be turned into housing.
[Read: OC Cities Fight Over Bid to Use 100-Acre State Mental Health Campus in Costa Mesa For Housing]
“There’s not enough places for people to really actually stay and be able to receive services,” Leon said. “That’s why that Costa Mesa facility would have been incredible … that was really unique, I’ll be sad if they dismantle that facility.”
Based on his experience, Leon said most homeless people won’t stay on their health plans if they have nowhere to stay.
“It’s really difficult to provide services if they have unstable housing,” he said. “It’s almost impossible.”