Opposition to Newsom's mental health overhaul mounts
Gov. Gavin Newsom is backing a sweeping proposal to overhaul California's mental health care system and end homelessness for the sickest people living on our streets. But his plan to make treatment mandatory faces pushback from opponents who argue it's an inhumane and ineffective solution that will do little to solve the state's homelessness crisis.
Senate Bill 1338, dubbed Community Assistance, Recovery & Empowerment (CARE) Court, would allow California courts to order people with severe, untreated schizophrenia and other psychotic disorders to submit to a care plan.
The goal is to help people who can't help themselves — people wandering in traffic, shouting at no one and bouncing between hospitals, jail and the streets.
The proposal comes at a time when Californians increasingly are fed up with the state's wide-spread homelessness, and Newsom has prioritized eliminating encampments.
But in a system where nearly all available mental health services are voluntary, CARE Court raises a controversial ethical question: should society force treatment on people who are too sick to realize they need help?
Opponents say coerced treatment is unjust and less effective than building trust with someone and convincing them to get help. Court should be a last resort, said Kim Pederson, a senior attorney with Disability Rights California, one of dozens of agencies opposing the idea.
“I can tell you that these folks that the state wants to serve via the CARE Court process have a lot of trauma around courts,” she said, “and do not see courts as a place where they can get help.”
But supporters argue some people will never accept desperately needed assistance without a court's intervention.
“The alternative is to say, `You know what, I'm going to let you live under a bridge because I want to respect your autonomy,'” said the bill's co-author, Sen. Thomas Umberg, D-Santa Ana. “I'm going to let you languish under a bridge in your own feces and I hope you make the right decisions.”
The bill, which cleared its first two legislative committee hearings last week, raises a number of other questions that have yet to be answered. Where would homeless CARE Court participants live, particularly in places such as the Bay Area that are grappling with an extreme shortage of affordable housing? If someone already is refusing help, would a court order really be enough to get them to take their medication and follow a treatment plan? Do counties have the funding, staff and housing to make this sweeping change a success?
“People are fed up and they want something done,” said Mike Herald, director of policy advocacy for the Western Center on Law & Poverty, which opposes the bill. “It's just that what we're proposing to do is highly unlikely to work.”
If SB 1338 is approved, people with severe mental illness could be referred to CARE Court by family members, first responders, county mental health officials, hospitals or clinicians. The court would then order a clinical evaluation of the patient. If a judge decides they are eligible for the program, the patient would be ordered to work with a trained “supporter” to develop a care plan.
Participants, represented by a public defender, would be required to follow a plan for their mental health and substance abuse treatment, medication and housing.
To make this work, the state would have to come up with new funding for the courts, public defenders and “supporters.”
Care plans would last one year, and could be extended for an additional year. If a participant does not comply, they could be placed in a more restrictive conservatorship in a locked facility, or jail if they have a pending criminal case. But participants cannot be forcibly medicated or jailed solely for noncompliance.