Introduction

California’s ongoing homelessness crisis has spurred the creation of an alternative mental health court program known as “CARE Court.” This program aims to expedite treatment and support for individuals with untreated schizophrenia and related disorders, potentially without their consent. Governor Gavin Newsom initiated this initiative to tackle the pressing issue of homelessness and provide assistance to those suffering from apparent psychotic breaks. While the program has received both praise and criticism, its effectiveness and impact remain uncertain.

Understanding CARE Court

CARE Court, short for Coordinated, Assertive, and Resilient Engagement, is a civil court process designed to intervene before individuals’ mental health conditions worsen. The program allows family members and first responders to file a petition on behalf of adults who they believe are at risk without supervision or support. To be eligible for CARE Court, individuals must have a diagnosis on the schizophrenia spectrum or related disorders. Severe depression, bipolar disorder, and addiction by themselves do not qualify.

The eligibility assessment is conducted by a specialized civil court in each county, in collaboration with the county behavioral health agency. Once deemed eligible, individuals are appointed a lawyer and a support person of their choice. They are then encouraged to work with the county on a voluntary plan that includes housing, medication, counseling, and other necessary social services. The agreement remains in effect for up to a year, with the possibility of extension.

Consent and Participation

One major concern raised by civil rights advocates is the potential for coercion and involuntary treatment. However, the court process allows individuals to decline participation or refuse to follow the agreement. Judge Michael Begert, overseeing CARE Court in San Francisco, acknowledges that he cannot compel someone to engage but emphasizes the importance of building a trusting relationship with participants. In Orange County, judges have granted extra time to reach voluntary agreements, recognizing the need for rapport-building.

Resource Availability and Challenges

While CARE Court holds promise, there are challenges associated with resource availability. Emergency shelters have received funding, but critics argue that the shortage of case managers, suitable in-patient treatment facilities, and supportive housing remains a significant issue. According to San Francisco officials, only around 10% of available beds are open for new individuals seeking treatment and care. The under-resourcing and limited accessibility of voluntary community-based services further exacerbate the challenges faced by the program.

Eligibility and Beyond

CARE Court’s eligibility criteria focus primarily on individuals with untreated schizophrenia and related disorders, which has drawn attention from mental health advocacy groups. The National Alliance on Mental Illness in California has been a driving force behind the program, advocating for better treatment options for individuals with mental illness. While not everyone may qualify for CARE Court, alternative resources and support may still be available to those in need.

Implementation in Selected Counties

CARE Court was launched in seven California counties, including San Francisco, Orange, San Diego, Riverside, Stanislaus, Tuolumne, and Glenn. These counties have begun accepting petitions and anticipate approximately 1,800 to 3,100 eligible individuals. Los Angeles County will follow suit on December 1st, estimating a higher number of eligible participants, potentially ranging from 3,600 to 6,200 individuals. The remaining counties across the state have until December 2024 to establish their own mental health courts.

Conclusion

The introduction of CARE Court in California reflects a significant step forward in addressing the mental health challenges faced by individuals experiencing homelessness and apparent psychotic breaks. While the program has generated both hope and skepticism, its effectiveness remains uncertain due to limited eligibility criteria and resource availability. As the court process unfolds, it is imperative to monitor its impact, address challenges, and explore additional avenues for support to ensure the well-being and recovery of individuals with severe mental illnesses.