The CARE Courts false promise
Lawmakers seem committed to this flawed program. They should at least add some guardrails.
IT’S ONLY natural to scour Gov. Gavin Newsom’s proposed CARE Courts plan for enough redeeming features to make it worthwhile. Californians are desperate for solutions to help people struggling with debilitating mental illness because the state has failed utterly to provide sufficient mental health care. Cities have tried criminalizing the homelessness that can be a result of severe mental illness, and some lawmakers have tried to more easily compel mentally ill people into treatment — anything but make the necessary investment in housing, treatment and care.
But the Community Assistance Recovery and Empowerment Court, and the accompanying Senate Bill 1338, merely create a new legal framework for the same failed approach, making mental illness tantamount to a crime. A veneer of voluntariness — civil courts instead of criminal, “supported decision-making” before outright compulsion — is meant to make the program more palatable. But the only real step forward is Newsom’s separate but related commitment to fund thousands of affordable housing units, some of which counties could use to bolster their slim stock of supportive housing. California needs much more of that — plus many more dedicated permanent supportive housing units — and fewer policy mirages.
Under the CARE Court proposal, a person with specified serious mental disorders such as schizophrenia could petition a court for entry into a county care program. But it is presumed that few patients will choose to act on their own behalf and that most entries will be initiated by people the new law would authorize to act, supposedly on their behalf. Those people include police officers, regardless of whether the subjects of their petitions are suspected of committing any crime (counties, care providers and family members are also among those who could petition).
Police participation in mental health petitions is deeply alarming. There is a growing movement nationwide to remove police from dealing with mental health challenges because they are particularly unsuited to the task. It’s estimated that 25% of police shootings involve mentally ill people, according to multiple studies, including a 2015 Washington Post investigation. Earlier this month, the nation launched the 988 crisis number as an alternative to 911, and although the new number is best known as a suicide hotline, the broader vision is to use it as a dispatch line to send trained mental health clinicians and counselors to respond to patients whose problems are best handled outside the criminal system.
The CARE Courts program pushes in the opposite direction, centering police as frontline mental health responders.
The program makes additional funding available to state superior courts to take on the new tasks. Judges would consider each petition and determine whether the person’s condition meets the legal criteria. If so, the court would order the county to provide a care program which could last up to two years. Failure to improve in that time could result in the court imposing conservatorships, although one purpose of the program is ostensibly to avoid conservatorships.
The person would be asked to volunteer to participate in the CARE program, but if he or she declines, the judge could compel participation. That’s reminiscent of a famous line from “Casablanca,” after a couple asks the prefect of police whether he is ordering them to appear at the station the next morning. “Let us say that it is my request,” the prefect, Captain Renault, answers. “That is a much more pleasant word.”
Disabled people and their caregivers are beginning to embrace a practice known as supported decision-making, in which a person who recognizes that his or her capacity for making key decisions about care is compromised and selects one or more trusted family members, friends or agents to discuss options and make recommendations. The patient ultimately retains final decisionmaking power. The CARE Courts program includes a feature that uses the term “supported decision-making” while undermining the concept by depriving patients of the power to choose their own support system and ultimately make their own decisions.
That’s an important flaw, because experience demonstrates that people battling mental illness do better, for longer, when they retain as much of their personal autonomy as their situation allows.
There are times when compulsion in mental health care may be necessary, as existing law recognizes. But our failure in California is not that we don’t compel treatment often enough, but that we don’t have enough places for people who want and need treatment to go. The CARE Courts program would be like adding an additional door to a building that is too small to hold the people already inside.
Federal law dating to 1963 was meant to provide a network of community mental health clinics, but it was never completed. Instead of keeping our promises and following through on innovative proposals such as an L.A. County plan to create a mental health community in Hollywood, modeled on a program in Trieste, Italy, California just keeps coming up with new ways to apply crime-and-punishment features to a health problem.
Supporters of CARE Courts argue that numerous county and state programs to provide comprehensive care, housing and services to mentally ill Californians failed because they were only pilots that ran their course, collected their data and vanished because funding and interest ran out. They have a point. We don’t need more pilots that won’t be renewed even if they helped patients. But neither do we need a big, expensive program that continues indefinitely without actually making things better.
Lawmakers appear adamant about moving forward with the CARE Courts program despite its flaws, though, so they should add a five-year sunset with mandatory evaluation and an option to renew. Otherwise, the program could wind up being a boondoggle that funds the courts without making much headway against the mental health crisis.