CARE Court or Scare Court?

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It is estimated that more than 170,000 individuals are homeless in California and that one in four of them has a serious mental illness. This is due to a lack of affordable housing and the state’s failure to provide necessary mental health care. Governor Newsom is hoping to change these statistics with his 14-billion-dollar investment in a system that will bring mental health into the courtroom. Judges will be able to order people to get help and counties to provide it under the Community Assistance Recovery and Empowerment (CARE) Court initiative. Newsom believes that the new civil court design will help thousands of people get off the streets and begin to live their lives with the mental health support they need.

Indeed, the CARE Court philosophy seems like a no-brainer. What is there to dispute about finally providing overdue clinical services to this widely ignored and vulnerable population? For starters, the CARE Court program is mandated for those who fall under its purview. Disability rights groups argue the CARE Court system violates the fundamental rights of individuals being forced into involuntary treatment. Further, the efficacy of mandated treatment is questionable.

What Is CARE Court?

Newsom has implemented CARE Court to address people with mental health and substance use disorders. This new court protocol is evidence-based and predicated on the ideology that people can stabilize, begin healing, and exit homelessness in less restrictive, community-based care settings. The CARE Court is designed to aid people who have become homeless, incarcerated, or worse due to mental illness by getting them into treatment, including therapy, medications, and housing. Specifically, Newsom proclaims the CARE Court system steps in and connects a person struggling with mental health and often co-occurring substance abuse with a court-ordered care plan for up to 12 months, which can be renewed for an additional year. Each treatment plan is managed by a care team in the community and is individualized with supportive services that are supposed to be culturally and linguistically competent.

How Does CARE Court Work?

The first step is a petition to the court by a family member, behavioral health provider, first responder, or other approved party to provide care and prevent institutionalization of an individual. Those who are exiting a short-term involuntary hospital hold or an arrest may be particularly good candidates for CARE Court. However, it is not available for every individual experiencing homelessness or mental illness. CARE Court only applies to those people on the schizophrenia spectrum and other psychotic disorders who may also have substance use issues and who lack medical decision-making capacity. Mental illnesses such as anxiety, depression, and posttraumatic stress disorder are not included, and the participant must be 18 years or older. The civil court then orders a clinical assessment after a reasonable likelihood of meeting the CARE Court criteria is held. The court appoints a public defender and a CARE supporter to represent the individual to ensure their rights are being protected.

The court reviews the clinical evaluation, and if the person meets the criteria, the development of a CARE plan is ordered, which will include therapy, medications, and housing as part of its objective. As housing is an important component of this system, persons under a CARE Court plan will have access to clinically enhanced interim or bridge housing, licensed adult and senior care settings, and other supportive housing options. The CARE plan is then reviewed and adopted by the court with both the individual and county behavioral health as parties to the court order for up to 24 months. If an individual refuses to participate in their CARE Court-ordered plan, including stabilization medications, they may be subject to an additional court hearing and can be referred by the court for a conservatorship.

Civil Rights Groups Against CARE Court

Not everyone is praising Newsom’s CARE Court system. Helen Tran, senior attorney at the Western Center on Law and Poverty stated: “The CARE Act unnecessarily involves our court systems to force medical care and social services on people.” Additionally, Disability Rights California and The Public Interest Law Project have challenged the constitutionality of the CARE Courts program-mandated treatment agenda. Specifically, they argue that the CARE Court violates constitutional guarantees of due process and equal protection while burdening fundamental rights to privacy, autonomy, and liberty. Moreover, enabling the state to force severely mentally ill individuals into court-ordered treatment and housing programs is unconscionable. Disability activists contend that the CARE Court is a coercive, involuntary system period. Further, there are consequences for not following through with a CARE plan including that the court will refer the person for a conservatorship, which equates to the loss of controlling their own medical care, finances, and housing preferences. Finally, they indicate that there is no proven research that mandated treatment works.

Efficacy of Involuntary Treatment

The CARE Court system is predicated on self-determination for the individual involved. However, at its core, the CARE Act was devised to essentially force people into a court-mandated design of treatment. Taking people off the streets and requiring them to subject themselves to treatment or face conservatorship does not scream self-determination. Moreover, there is evidence that forced treatment doesn’t work. According to Corrado Barbui, the efficacy of mental health treatment when coercive is vastly reduced. Barbui contends that shared decision-making interventions and integrated care to reduce forced treatment in mental health services should be considered in the development of policy and clinical practice. Moreover, Christopher Maylea argues that social workers should reject the compulsion for involuntary treatment as the research does not support this paradigm. Instead, he states that inclusive participatory mental health approaches offer the individual the greatest chance for change.

Conclusion

Advocates of the CARE Court argue that this model of intervention will help thousands of mentally disabled persons. The CARE Court’s inception is brand new, and time will reveal if involuntary treatment offers hope for California’s most vulnerable population. While it was created as a “CARE” Court, its focus on mandated treatment scares many.