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Newsom signs law creating mental health courts in California. How it could help homelessness

Sacramento Bee - 9/14/2022

Gov. Gavin Newsom signed into law Wednesday the centerpiece of his latest push to address California’s escalating homeless crisis, a program to compel residents struggling with mental health and addiction into court-ordered treatment.

Surrounded by elected officials and behavioral health providers in San Jose, Newsom signed legislation to create a new civil court system — the Community Assistance, Recovery and Empowerment Court, or CARE Court — intended to provide treatment and housing for people who are suffering from severe forms of mental illness and are unable to care for themselves.

Senate Bill 1338 gives family members, first responders and medical professionals, among others, a new pathway to get treatment for those with mental illness. The policy will not only require people to participate in treatment programs but also mandate counties to make services available to them.

Although CARE Court is also open to those who have housing, Newsom has repeatedly framed it as an innovative tool to treat unhoused residents in the most critical need of assistance — those living in sordid conditions who often cycle between the streets, hospitals and jails.

“This is a new paradigm,” Newsom said during a news conference at the headquarters of Momentum for Health, a mental health provider in Santa Clara County. “Continue to do what you’ve done and you’ll get what you got. And look what we got. It’s unacceptable.

“We have the power to turn this around.”

Although legislators almost unanimously supported the plan and some initial critics came around to the idea, disability rights groups and criminal justice advocates remain staunchly opposed, arguing that it disregards the civil rights of individuals by forcing them into treatment.

Eve Garrow, a policy analyst and advocate at the ACLU of Southern California, said Wednesday that she was devastated and concerned that the new legislation would “roll back the clock” on progress made by the disability rights movement.

“From our perspective, its just one more non-solution to the houselessness and mental health crises affecting our state,” Garrow said in an interview. “California desperately needs more housing and healthcare — that’s the answer. California does not need an expansive, adversarial court system.”

Newsom and local elected officials across California are facing mounting pressure to show progress in curbing homelessness, a pervasive problem that polls indicate is a top concern of residents.

The Golden State is pouring more money than ever into tackling homelessness and mental illness. Over the last two years, the governor earmarked $14 billion in his budget for homeless initiatives.

In Sacramento County, 34% of unhoused residents surveyed in 2022 reported having psychological issues. In San Francisco, it was 36%. In the greater Los Angeles area, a quarter of its unhoused population are dealing with serious mental illness, according to 2022 surveys.

Jessica Cruz, CEO of NAMI California, thanked the governor at Wednesday’s news conference for seeing that “there is a new path forward” to treat those individuals.

“We can treat people who live with severe mental illness or substance use in a very humane way,” Cruz said, “but sometimes also in a way that gives them a little nudge to let them know that they need help.”

Under the new legislation, California’s 58 counties must set up mental health courts and provide treatment to those diagnosed with schizophrenia or other psychotic disorders.

For an individual to be referred to CARE Court, family members, first responders, behavioral health providers and others can petition a civil judge who will be tasked with ordering a clinical evaluation to assess whether the person meets the criteria to qualify. Participants must be age 18 or older, experiencing severe mental illness and either be “unlikely to survive safely in the community without supervision” or at risk of causing serious harm to themselves or others if their conditions go untreated.

The governor’s office has estimated that 10,000 to 12,000 people would qualify for the program, but county offices believe that number could reach as high as 50,000, according to an Assembly floor analysis.

If admitted into the program, individuals will be provided with a plan that includes treatment, medication and social services. Through the program, which could last up to two years, participants will paired with an attorney and personal advocate to help them navigate the situation.

Counties are required to provide housing, healthcare and other services mandated by a court order. Failure to deliver on the orders could result in fines of up to $1,000 a day and potentially appointment of outside oversight.

Despite Wednesday’s fanfare over the bill signing, major questions about the program have yet to be answered, including whether there will be enough housing and staffing to go around.

“Our work is not done,” said Sen. Susan Talamantes Eggman, an author of the bill. “We still need to implement this and much more needs to be happen. But I think we have broken the paradigm of just trying to fix the same broken system by creating a whole new way of being able to deal with this.”

State officials hope that a staggered approach and an influx of cash will help counties navigate the uncharted waters.

“This is unprecedented support that we are committing to over the next few years to make this program work,” Newsom said.

In response to intitial concerns from local officials over the bill’s expedited timeline for implementation, the program will be rolled out in two phases. The first batch of counties — Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne — are required to establish courts by Oct. 1, 2023, while the remainder of counties have until Dec. 1, 2024 to comply.

The state’s 2022 budget allocates $39.5 million for CARE Court start-up costs and $37.7 million in ongoing support, according to a legislative floor analysis. The Judicial Council of California estimates courts would need $40 million to $50 million to conduct additional hearings, expand self-help systems and update court management systems.

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