An unprecedented number of Californians live on the streets and face severe mental illness. It is gut wrenching to see. The CARE Act accurately describes this humanitarian crisis but prescribes a wrong, inhumane solution. Not only is creating this new court system to round up individuals unconstitutional, it is bad policy subject to pervasive societal biases and disproven methods of treating mental illness. That is why on January 26, Disability Rights California, Western Center on Law & Poverty, and the Public Interest Law Project sued Governor Newsom to put an end to CARE Court.
Contrary to some strong opinions that CARE Court is “California’s only real plan for helping our most vulnerable and seriously mentally ill,” Governor Newsom never planned to truly provide behavioral health treatment and housing through this bill. The CARE Act does not mandate counties to provide behavioral health treatment or housing; it creates no new rights or benefits for people with schizophrenia and other psychotic disorders who are summoned to court to join the CARE process. Rather, all CARE Court-ordered services are “subject to available funding and all applicable federal and state statute and regulations, contractual provisions, and policy guidance governing initial and ongoing program eligibility” (Welf. & Inst. Code § 5982(d)). In other words, services will only be provided as they are available.
Here’s a reality check for Sacramento: behavioral health and housing services are not available to all Californians. A person who needs treatment and housing usually cannot receive either in a timely manner because there are not enough mental health providers, facilities, and affordable housing units to access.
A UCSF study projected that if nothing significant changes by 2028, California will have 50% fewer psychiatrists to meet demand for behavioral health services, and 28% fewer psychologists, therapists, and social workers combined to meet the demand. We see this play out daily with stark disparities based on income and race. For example, in Compton, there are only five licensed psychologists compared to Santa Monica, which has 361.
Compounding CARE Court’s false promises is the affordable housing shortage. There is a shortage of 1 million affordable rental homes for extremely low income renters. And the CARE Act does not appropriate one single penny for housing.
The CARE Act pretends this backlog of services and housing does not exist, despite advocates’ cries to increase funding for our behavioral health systems and affordable housing instead of funding new courts. If we invested in behavioral health and housing to their full level of need, and give some time for the workforce to catch up, we would already have a better plan than CARE Court.
So, if not guaranteeing behavioral health or housing services, what does the CARE Act provide? The law paves the way to eventually institutionalize people who are unhoused and have schizophrenia and other psychotic disorders, out of sight from the very people who support CARE Court.
The biggest lie about CARE Court is that it is not involuntary treatment. CARE Court is an involuntary, coercive system. There are consequences for not following through with a CARE plan. When a person does not comply with the exact terms of a CARE plan, the court must refer the person for conservatorship with “a presumption . . . the [person] needs additional intervention beyond the supports and services provided by the CARE plan” (Welf. & Inst. Code § 5979(a)(3)). A person who, for any reason, does not follow through their court order, would more easily be conserved and lose their rights to control their own medical care, finances, and housing preferences. No matter how Governor Newsom and his proponents want to spin CARE Court, the law speaks for itself.
Existing laws already provide for involuntary treatment of persons found dangerous to themselves or others. But the CARE Act takes this a giant step further by permitting a judge to impose restrictions on persons deemed “likely” to become dangerous. Little guidance is offered for judges to make that speculative determination.
The CARE Act was enacted despite any evidence that it would be effective. As Disability Rights California wrote in May 2022 on behalf of our coalition opposing the CARE Act, voluntary treatment works and involuntary treatment does not:
[N]o studies exist to prove that a court order for outpatient treatment in and of itself has any independent effect on client outcomes. Studies show that any positive effects that result from outpatient commitment are due to the provision of intensive services, and whether court orders have any effect at all in the absence of intensive treatment is an unanswered question.
In determining how we provide medical care and housing for Californians, our civil rights and social policies can co-exist. The state should house people first, then let people decide their course of treatment. The Legislature has not explained why it cannot appropriate resources to fund all medically necessary care and permanent affordable housing for individuals and also protect their dignity and privacy interests at the same time. What is clear is that faced at a moral crossroads, Governor Newsom and the Legislature chose a more politically expedient route instead of a benevolent and effective one.