Sunday Commentary: CARE Court Likely to Pass, but Many Experts Disagree with Compelled Treatment

Newsom’s March Announcement, image from YouTube

By David M. Greenwald
Executive Editor

Sacramento, CA – You don’t see many bills pass the State Senate 38-0, but CARE Court did this week.  Under the terms of CARE Court, introduced in March by Governor Newsom, the governor created a framework that would *force* people living with mental health conditions to undergo treatment under court order.

The governor sees this as a way to deal with the chronic homeless problem.  And the governor has gained the backing of key business organizations—including the California Chamber of Commerce, the California Downtown Association and 21 local chambers of commerce from throughout the state.

“With broad support from California’s state Senate, CARE Court is one step closer to becoming a reality in California,” said Governor Newsom, “I am also grateful to have the California Chamber of Commerce, the California Downtown Association, and 21 local chambers of commerce join our ever-expanding CARE Court coalition, which includes a diverse group of supporters focused on tackling the challenge of severe mental illness that too often leaves individuals on our streets without hope.”

“The California Chamber of Commerce and our colleagues from throughout the state are pleased to support Governor Newsom and his vision to provide support for those suffering from severe mental illness and substance use disorders through the newly proposed CARE Court plan,” said Jennifer Barrera, President and CEO of the California Chamber of Commerce.

Barrera added, “CARE Court is a thoughtful, measured response to the tragedy of untreated mental illness impacting thousands of individuals. California employers have a clear stake in seeing the success of CARE Court as many business owners and their employees experience, first-hand, the impacts of inadequate policies that fail to address the needs of those individuals suffering on our streets and in our communities.”

“The establishment of CARE Court represents a new approach to early intervention and will help people get the support they deserve by addressing their underlying needs,” said Rena Leddy, President of the California Downtown Association. “We appreciate the Governor’s leadership on this important issue, and we are pleased to support this legislation.”

But these accolades aside, many of the same concerns that have been presented against Jeff Reisig’s compulsive drug treatment exist here as well.

Recently Olivia Ensign and John Raphling of Human Rights Watch published an op-ed in the LA Times that underscored these concerns.

They criticize the bill for having “highly subjective criteria” but perhaps more importantly taking resources from voluntary treatment that the state desperately needs for people with mental health conditions.

They write, “The state urgently needs more readily available voluntary treatment for all Californians with mental health conditions, and there is a desperate shortage of affordable supportive housing. But CARE Court will not provide either resource. Instead, it reshuffles existing funding for housing and healthcare, while building an expensive system of state control over fundamental life decisions.”

As parents of a troubled teen a few years ago, my wife and I were stunned about how hard it was to get the treatment our child needed and the overall lack of resources and support that the system provides.  Waiting for the person to encounter a judge to get treatment seems the wrong approach.

Moreover, as the Human Rights Watch warned with respect to the drug treatment program, “the proposed system is not voluntary.”

They write, “A person enters the court’s jurisdiction because someone else — such as an adult family member, roommate, police officer or behavioral health worker — files a petition to the court. If the judge finds that the petition adequately asserts that the person meets vaguely defined CARE Court criteria, then that person is forced into a convoluted process in which they must negotiate the terms of their required treatment with the county behavioral health agency.”

Moreover, the person who is, in effect, committed does not have much resource.

“If the person disagrees with the agency, then the court orders that same agency to evaluate the individual, absent an agreement to use an existing evaluation made in the past 30 days,” they write.  “This process gives the agency control over the evaluation. The judge considers the evaluation, alongside other evidence, and can then order the creation of a treatment plan that the person either accepts or is ordered by the court to accept. The plan can last up to one year, and the judge can extend it for another year if they determine the person failed to comply.”

They warn that officials “are using tragic stories of families who struggled to get mental health treatment for their loved ones, many of whom are unhoused,” but they also warn “the proposal does not invest new money into making treatment or other community-based responses more widely available. It does not add resources to develop permanent safe and supportive housing, critical to helping unhoused people with mental health conditions get off the streets.

Instead, they argue that “it relies on existing, largely inadequate housing programs and funding already allocated for voluntary mental health services.”

Moreover, the new funding, which is “about $65 million in the governor’s revised budget — will pay for new court infrastructure, including hiring personnel and training judges.”

State officials have misleadingly promoted CARE Court as “diversion to prevent more restrictive conservatorships or incarceration.”

But, in fact, people can be committed without being accused of a crime or qualifying for a conservatorship.

“The CARE plans are enforceable court orders, which can include coerced medication as well as submission to treatment modes not chosen by the person who must comply,” they write.

Ensign and Raphling add, “Under international human rights standards, treatment should be based on the will and preferences of the person concerned. Housing or disability status does not rob a person of their legal capacity or right to personal autonomy. The expansive, involuntary CARE Court process denies these rights.”

And they warn, “The potential for abuse in this program is astounding.”

Studies repeatedly show that “involuntary treatment is ineffective and can further traumatize and harm vulnerable people while hampering their recovery efforts. Studies of court-ordered drug treatment have linked coerced treatment with increased overdoses and relapses compared to voluntary treatment.”

No one seems to pay attention to these studies.  Not when it comes to mental health treatment.  Not when it comes to drug treatment.

I agree that what we are doing is not working, but a major component of why it is not working is that we are failing to put the resources in to get people the treatment they actually need.  And what is alarming here is that there is no new money added to the already inadequate system—it is simply adding money for administration at the court end.

About The Author

David Greenwald is the founder, editor, and executive director of the Davis Vanguard. He founded the Vanguard in 2006. David Greenwald moved to Davis in 1996 to attend Graduate School at UC Davis in Political Science. He lives in South Davis with his wife Cecilia Escamilla Greenwald and three children.

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