California mental health court launches with high expectations and uncertainty

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A mental health court diversion program designed to expedite access to housing and health care for people with untreated schizophrenia and other psychotic disorders, potentially without their consent, began Monday in seven California counties, including San Francisco.

Democratic Gov. Gavin Newsom created the new civil court process, called “CARE Court,” as part of a massive effort to address the homelessness crisis in California. Lawmakers approved it despite deep misgivings about insufficient housing and services, saying they needed to try something new to help those publicly suffering apparent psychotic breaks.

Families of people diagnosed with serious mental illnesses rejoiced because the new law allows them to petition the court for treatment for their loved ones. Residents, dismayed by the estimated 171,000 homeless people in California, applauded the possibility of getting them help and getting them off the streets.

Critics criticized the new program as ineffective and punitive, since it could force people into treatment.

But as requests come in Monday, it's unclear who the program could help or how effective it will be. This is because the eligibility criteria are narrow and largely limited to people with untreated schizophrenia and related disorders. Major depression, bipolar disorder, and addiction alone do not qualify.

"Hopefully it will help some people who need help, and it probably won't affect much of what you see in the community," said San Francisco Superior Court Judge Michael Begert, who will oversee the court.

Here are things to know about the new system:

Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, said at a news conference last week that the program aims to catch people before their condition worsens.

Family members and first responders are among those who can now file a petition on behalf of an adult who they believe is “unlikely to survive safely” without supervision and whose condition is rapidly deteriorating. They can also apply if an adult needs services and supports to prevent a relapse or deterioration that is likely to result in “serious disability or serious harm” to themselves or others.

To be eligible, the person needs a diagnosis on the schizophrenia spectrum or other qualifying disorders. People with severe depression or bipolar disorder do not qualify. A person does not have to be homeless to be eligible.

A special civil court in each county will review each petition with the county behavioral health agency that evaluates eligibility. The person will be appointed an attorney and a support person of their choice.

If the court determines that the person meets the eligibility criteria, they will be required to work with the county on a voluntary plan that includes housing, medications, counseling and other social services. The agreement would be valid for up to one year with the possibility of extending it for another year.

If all parties cannot agree on a voluntary plan, the statute says the court will order them to work on a plan.


Civil rights advocates have expressed fears that the new process will result in vulnerable people being forced into treatment.

A person who does not successfully complete a plan could be subject to involuntary guardianship and treatment, said Tal Klement, a deputy public defender in San Francisco who is among critics of the new process.

But the statute also allows the court to dismiss the proceeding if the individual refuses to participate or abide by the agreement. Judge Begert, in San Francisco, said he cannot force anyone to participate; The best thing he can do is start building a relationship with the person.

Veronica Kelley, Orange County's behavioral health director, said county judges understand that building rapport with eligible candidates takes time and have agreed to give her team additional time to reach voluntary agreements, despite the deadlines. established by statute.

The state has allocated money for emergency shelters, but critics say there is an ongoing shortage of case managers, appropriate inpatient treatment facilities and supportive housing.

San Francisco officials said in a statement that about 10% of the more than 2,500 beds are open to new people. Treatment beds range from detoxification to graduated care for people leaving long-term care.

Opponents of the program say the state should have invested in more existing housing and services instead of establishing a new court system.

"The problem is not that these resources are available and people are not using them," said Samuel Jain, senior policy attorney at Disability Rights California. "These voluntary community services do not have sufficient resources and are not accessible."

The National Alliance on Mental Illness in California, a grassroots organization that supports people with mental illness and their families, spearheaded the new mental health program. Some family members have long wanted a way to arrange for their loved ones to receive treatment, the organization said.

Jessica Cruz, the group's executive director, encourages people not to give up if their family member doesn't qualify because other resources may be available.

“For us, it's just about making sure our loved ones have the best life possible,” he said. "Living on the streets and dying on the streets is no one's way to live."

San Francisco, Orange, San Diego, Riverside, Stanislaus, Tuolumne and Glenn counties launched the new program on Monday. Los Angeles County will begin its program on December 1.

The state estimates that approximately 1,800 to 3,100 people could be eligible in the first seven counties. Los Angeles could raise estimates to between 3,600 and 6,200, although acceptance could take time.

The rest of the state has until December 2024 to establish mental health courts.

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