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LA County Care Court aims to help those on streets with mental illness

Thursday, November 30, 2023

LOS ANGELES (KABC) — Los Angeles County has about 75,000 people living on the streets. Officials estimate about 10% suffer schizophrenia or other disorders.

“There are too many people with severe mental illness who are living on the streets,” LA County Supervisor Janice Hahn says. “We’ve all seen them and so far, we’ve been unable to reach them.”

Los Angeles County officials on Thursday announced a new program called Care Court to help people receive treatment and services.

“We are really committed to helping people get the support they need to improve their mental health and well-being. We are here to change the trajectory of people’s lives,” says Dr. Lisa Wong from the Los Angeles County Department of Mental Health.

With this program a family member or someone else can file a petition asking to determine if someone qualifies.

A judge can then order a care plan for the person.

Samantha Jessner, presiding judge for the Superior Court of Los Angeles County, says “This new tool provides an alternative to the way in which most individuals enter our county’s mental health system, which is usually through the criminal justice system.”

“Initially, LA County wasn’t going to have this program until next year. But we are ground zero for this problem. And so, we moved our start date up an entire year,” adds Hahn.

Not everyone likes this program. The Western Center on Law & Poverty sued to stop the Care law, saying it forces treatment on people.

In an article it claimed, “The law paves the way to eventually institutionalize people who are unhoused and have schizophrenia and other psychotic disorders.”

Ricardo García, the Los Angeles County public defender says, “To those who are concerned that Care court will lead to forced treatments or detention, I want to emphasize participation in Care Court is absolutely voluntary.”

The program officially begins Friday and until then authorities say they’re not sure how many people would qualify for Care Court.

Homeless advocates give list of demands to San Francisco

A coalition of homeless advocates and civil rights attorneys released a list of demands for the City of San Francisco to settle a lawsuit that forbids police from forcing homeless residents off public property.

The letter sent to City Attorney David Chiu on Thursday offers a proposed settlement to resolve the lawsuit, Coalition on Homelessness v. City of San Francisco. A U.S. District Court judge found in favor of the plaintiffs in the underlying lawsuit last year, and the court issued an injunction against San Francisco.

“At its heart, San Francisco’s homelessness crisis is an affordable housing crisis,” said Cynthia Castillo, Policy Advocate of the Western Center on Law and Poverty. “Instead of ensuring that Californians without housing have universal access to a safe, permanent, and affordable place to live, harassment tactics continue to displace and segregate unhoused people. The city’s homelessness problem will never be solved until there is an affordable place for people to live.”

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Federal Housing Voucher Utilization Promoted in Bill by California Assembly Majority Leader Reyes – Tens of Thousands of Federal Housing Choice Vouchers Are Left Unused Each Year

Assemblymember Eloise Gómez Reyes says, “AB 653 will prevent Californians from falling into homelessness, increase oversight and accountability, and invest in proven solutions to house Californians.”

SACRAMENTO – While affordable housing demand remains high, tens of thousands of federal housing choice vouchers are left unused each year. In order to increase use of these vouchers, Assembly Majority Leader Eloise Gómez Reyes has announced legislation, AB 653, which would create the Federal Housing Voucher Acceleration Program.

The program would:

  • Pair voucher recipients with services to find and secure housing,
  • Incentivize landlords to get their units approved to accept vouchers, and
  • Require public housing authorities with the lowest voucher utilization rates to follow evidence-based practices for improvement.

“I hear from people throughout my district and the state whose eligibility for federal vouchers does nothing to house them,” said Reyes. “When someone receives a voucher to make rent affordable, but they cannot find an available unit to accept it, we see federal dollars left on the table and a household who remains housing insecure. We have to do something to make sure we are maximizing the use of federal resources. This bill provides a common sense way to ensure the state is using federal funding to pair individuals and families with places to live.”

“It has been very hard to use my housing voucher in the Inland Empire,” said Traci, an individual who has gone through the process. “It took me forever to get into a place, and the apartment was vacant for three months. I even tried other places while I was waiting, but was constantly declined.”

AB 653 is sponsored by the California Rural Legal Assistance Foundation, Corporation for Supportive Housing, Housing California, National Housing Law Project, United Ways of California and Western Center on Law and Poverty. According to the U.S. Department of Housing and Urban Development, 33% of families in San Bernardino have to return their unused voucher back to the local PHA and only 44.7% of LA County recipients have success finding housing with a voucher.

LA, Riverside And Orange Counties Will Be Among The First In California To Implement Judge-Ordered Mental Health Care

On a recent afternoon Diana and Lorrin Burdick share pictures and swap stories with three other parents over a lunch of chicken curry sandwiches and fruit salad. They’re hosting an informal but semi-regular support group at their home in suburban Rancho Cordova east of Sacramento.

“Yeah, she loves having family dinners. Sunday is family dinner day now,” says Elizabeth Kaino Hopper as she and husband, Marvin, show a recent picture of their 37-year-old daughter, Christine.

This ordinary lunch with friends is also a vital one: Every parent here has an adult child with a severe mental illness; a son or daughter who’s also struggled with homelessness, substance abuse and arrests. The gatherings give them the chance to share stories, strategies and challenges of having a child with a serious and untreated mental disorder.

“That’s pretty much what he looks like now,” says Diana Burdick as she shows the others a phone shot of her son, Michael, 49, who has lived on the streets for a nearly a decade.

“Aww, see, anybody looking at him would say, he’s not right, he doesn’t feel good,” Elizabeth Hopper says, shaking her head in between lunch bites.

Eight California counties are going first in a planned statewide, controversial experiment to try to fix a seemingly intractable problem every parent around the table is grappling with: How to get treatment and support for loved ones with serious mental health challenges, mostly schizophrenia and other psychotic disorders.

Some of these people end up cycling in and out of police holds, jails, emergency rooms and homeless shelters and encampments. The nationwide problem is particularly acute in California, which accounts for nearly one third of all people in the United States experiencing homelessness.

Some cities including Los Angeles estimate that 10% to 17% of individuals who are unsheltered have been diagnosed with a serious mental illness. But the fact that so many go without a formal diagnosis, experts say the true percentage is likely far higher.

Housing Search With a Voucher Is Difficult in Los Angeles County. A Homeless Student Received Aid for an Apartment. Then Came the Hard Part.

LOS ANGELES — Many of the apartment listings were outdated or offered scant details. Sometimes the rent was a few hundred dollars higher than advertised.

If she managed to get someone on the phone, Jacqueline Benitez would inquire about square footage, about parking, about whether the landlord might accept a rescue tabby named Kiwi.

But when she brought up her housing voucher, the tone would usually shift.

“They would say, ‘No, we do not accept Section 8, sorry.’ Or, ‘We tried Section 8 in the past, and it didn’t work for us,’” Ms. Benitez said, referring to the commonly used term for the vouchers. At 21 years old, she had found herself stuck in a loop of hope and rejection.

Landing an apartment in Los Angeles County can be an arduous journey in a region struggling with a housing shortage and homelessness crisis, where even those with steady middle-class salaries have found themselves in a rat race for a home.

For the impoverished, the search can feel ultimately impossible.

“Are you going to interrupt your search to fight every landlord who says, ‘I’m not going to rent to you because you have Section 8?’” said Nisha Vyas, an attorney with the Western Center on Law and Poverty. “It’s more likely you’re going to keep trying to find someone who’s going to say yes.”

Why We Sued to End CARE Court

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.

Groups sue to block Newsom’s CARE Courts program for severe mental illness

SACRAMENTO, Calif. — Civil rights groups are challenging Gov. Gavin Newsom’s new court program for people with severe mental illness.

Three groups — Disability Rights California, Western Center on Law & Poverty, and The Public Interest Law Project — filed a petition to the California Supreme Court on Thursday challenging the constitutionality of the CARE Courts program, which Newsom designed, championed, and signed into law last year.

Western Center’s Analysis of Governor Newsom’s 2022-23 May Budget Revision

The Newsom Administration released its 2022-23 May Revise budget, which includes a massive three year budget surplus of over $90 billion. While the budget includes many noteworthy proposals, overall it fails to provide robust help to those who need it most. Rather than target the surplus on increased tax credits and emergency relief for people with low incomes, the budget proposal provides more than $11 billion in tax credits to car owners, including households with incomes up to $250,000.

Paradoxically, the state has so much extra revenue that General Fund spending is limited since the increased revenue exceeds the State Appropriations Limit (aka the Gann limit). As such, the May Revise proposes large infrastructure spending that is not counted towards the Gann limit. While those proposals are not without merit, the Revise fails on fundamental anti-poverty measures, like backfilling the lost federal child tax credits proven to reduce child poverty, leaving hundreds of thousands of children at risk of unnecessarily falling back into poverty. The Revise also fails to fully eliminate civil assessment fees that disproportionately punish people experiencing poverty who cannot afford to pay a traffic ticket or take time to appear in court.

Care Court

The governor proposes $65 million to fund a new court process called Care Court, which would force unhoused individuals with schizophrenia and other psychotic disorders into a court ordered treatment plan. Western Center has been tracking the proposal and vocal about our opposition since the governor revealed it in March, as it touches on each of our issue areas.

The Revise provides $39 million to the Judicial Council to run the court process, $10 million to finance a supporter program within the state Department of Aging, and $15 million to counties for training and technical assistance.

With its lack of necessary interventions, like a clear budget strategy and mechanisms for creating housing, we believe the framework of the proposal is fundamentally flawed. If implemented, it is likely CARE Court will lead to unnecessary institutionalization of people with disabilities and unhoused people and likely create a chilling effect that will prevent people from seeking services for fear of being institutionalized. Additionally, by involving the court system the proposal will perpetuate institutionalized racism and exacerbate existing disparities in health care delivery since Black, Indigenous and other people of color are significantly more likely to be diagnosed with psychotic disorders than white people. All evidence shows that adequately-resourced, intensive, voluntary outpatient treatment – not court-ordered treatment – is most effective for treating the population CARE Court seeks to serve.

HOUSING & HOMELESSNESS

The governor’s May Revise proposes a $2.5 billion dollar increase for housing and homelessness programs from last year for multi-year investments to build housing and behavioral health housing. The Revise includes an additional $150 million to fund Homekey projects, $50 million to build interim housing and $500 million to accelerate affordable housing production and conversions of retail space in downtown corridors.

Even with the economic fallout of the pandemic raging on, the proposal does not include additional funding for tenants at the brink of eviction for their inability to pay rent. To confuse matters, the governor announced a $2.7 billion budget allocation for rental assistance, but it is not a new commitment. Rather, it’s part of the commitment the legislature made in February via Senate Bill 115, designed to ensure full coverage for rental assistance applications submitted before March 31. However, because of the burdensome application process, tenants accrue debt while they wait for approval and still face the threat of eviction for the months their application was being processed.

The governor’s proposal fails to comply with the legal requirement for the state to fully fund rental assistance applications submitted before March 31 by paying those tenants 100% of their accrued debt at the time they are approved. To keep tenants housed and fulfill the promise of the rental assistance program, the massive budget surplus must be used to fully fund tenants’ rental debt and ensure that vulnerable Californians remain housed.

Western Center will continue to advocate for other sponsored proposals missing in the May Revise, including $500 million in the Community Anti-Displacement and Preservation Program (CAPP) to acquire unsubsidized affordable housing and make them permanently affordable, $200 million in the Reentry Housing and Workforce Development Program to provide stable housing and supportive services to formerly incarcerated people as outlined in AB 1816 (Bryan), and $150 million for eviction defense funding and community education and outreach.

PUBLIC BENEFITS & ACCESS TO JUSTICE

CalWORKs

The May Revise proposes an 11.1 percent increase in CalWORKs, the largest one-year increase in the grant levels in recent memory. The funding for this comes from the Child Poverty subaccount which has seen a significant increase along with the overall budget. Even with this increase, CalWORKs grants for most families are still not out above deep poverty (50 percent of the federal poverty level). That is because most families have an excluded adult. We are calling on the legislature to fulfill the commitment made four years ago to fund CalWORKs grants at the assistance unit plus one level. See the chart below for what the gap will remain at:

Child Support Pass Through

The May Revise makes no change in the administration’s proposal to pass through all child support to former CalWORKs families. While advocates support the proposal, we seek to have it extended to current CalWORKs cases where families have lower incomes and could use the child support assistance immediately.

Food Assistance

The May Revise makes no change to the governor’s January proposal seeking to expand the California Food Assistance Program to Californians regardless of immigration status for those 55 years of age and older. Western Center stands with our partners advocating for the expansion of the program to include Californians of all ages. Many immigrant families were excluded from pandemic relief and continue to be left behind as we rebuild the state’s safety nets.

SSI/SSP

The governor’s May Revise budget makes no proposal to increase grants for blind, aged and disabled Californians. There is a provisional agreement to restore the remainder of the 2009 SSP grant cuts beginning in January 2024 but the governor did not include CA4SSI’s request to accelerate the grant increase to January 2023. By delaying the second restoration, the value of the grant will decline when compared to the federal poverty level.

HEALTH CARE

The governor’s May Revision maintains the expansions proposed in the January proposal, including expanding Medi-Cal to all adults regardless of immigration status (Health4All), zeroing out premiums and copayments for Medi-Cal, and expanding Medi-Cal coverage of custom crowns for back teeth. In addition, the May Revision makes new investments to increase the Medi-Cal doula reimbursement rate, provides navigator funding, and permanently extends presumptive eligibility for older adults and individuals with disabilities. Unfortunately, the May Revision does not update the Medi-Cal share of cost, fully fund SB 65, or implement Health4All sooner than January 2024.

Below is summary of health proposals in the May Revision, which still needs to be negotiated with the legislature by the budget deadline of June 15th.

Medi-Cal

  • Increased Doula Reimbursement Rate: The May Revision proposes to increase the average doula service reimbursement rate from $450 to $1,094, which includes antepartum visits, delivery, and postpartum visits. The implementation date for the doula benefit will be shifted from July 2022 to January 2023 resulting in $974,000 total funds ($377,000 General Fund) in 2022-23 for this benefit.
  • $60M One-time Navigator Funding: The May Revision proposes to add $60 million total funds ($30 million General Fund) to the Health Enrollment Navigators available over four years through fiscal year 2025-26 to assist in outreach, application assistance, enrollment, and retention for difficult-to-reach populations, including the implementation of Health4All.
  • Presumptive Eligibility for Individuals 65 +, Blind, or Disabled: The May Revision includes $73 million total funds ($37 million General Fund) to continue Medi-Cal presumptive eligibility for older adults and individuals who are blind or disabled. Already permanent for other populations, this gives eligible older adults and individuals who are blind or disabled instant Medi-Cal eligibility for a limited time. Advocates are working to ensure this means two Presumptive Eligibility periods per year, as is currently available during COVID.
  • Equity and Practice Transformation Payments: To close health equity gaps in preventative, maternity, and behavioral health care measures, and to address gaps in care, the May Revision proposes an additional $300 million ($150 million General Fund) to the $400 million proposed in January for a combined $700 million in total funds.
  • Transitions to Managed Care: Under CalAIM, various populations are shifting to mandatory managed care effective January 2022 and January 2023. The May Revision proposes to delay the transition of ICF/DDs and Subacute Care Facilities into managed care from January 1, 2023 to July 1, 2023 to prepare for the transition. The administration also identified additional individuals subject to mandatory managed care that were assumed to already be included and will provide details on specific populations once determined.
  • LA Care Sanctions: The May Revision proposes budget bill language to use monetary sanctions collected from LA Care in the budget year to award grants to qualifying non-profit legal aid programs and organizations that serve Medi-Cal managed care enrollees in Los Angeles County or other impacted counties, for purposes of improving access to care in the Medi-Cal program.
  • Medi-Cal Media and Outreach Campaign: In an April budget change proposal prior to the May Revision, the Department of Health Care Services (DHCS) requested $25 million ($12.5 million General Fund) for a media and outreach campaign to encourage members to update their contact information with their counties, and to educate members of potential Medi-Cal termination if requested information is not submitted.
  • Additional AB 97 Provider Payment Reductions Elimination: In addition to elimination of AB 97 payment reductions in the January proposal, the May Revision proposes to include doula services, community health worker services, asthma prevention services, health care services delivered via remote patient monitoring, dyadic services, Medication Therapy Management, and continuous glucose monitoring system, supplies and accessories.

Other Health Proposals

  • Covered California: The May Revision proposes $304 million to extend California’s premium subsidy program for middle income Californians with incomes between 400 and 600% FPL. This represents a fraction of potential loss if federal relief is not extended.
  • Children and Youth Behavioral Health Initiative Grants: The May Revision includes $85 million General Fund for Children and Youth Behavioral Health Initiative (CYBHI) grants to schools, cities, counties, tribes, and/or community-based organizations. This includes grants to wellness and mindfulness programs as well as parent support and training programs.
  • Reproductive Health: The May Revision includes $57 million one-time General Fund to support safe and accessible reproductive health care, for a total of $125 million including investments in the January budget. Specifically, $40 million to DHCS for uncompensated reproductive health care, $15 million for the California Reproductive Justice and Freedom Fund at the Department of Public Health (DPH); $1 million to DPH for the Comprehensive Reproductive Rights Website, and $1 million to DPH for research on unmet needs for reproductive health care.

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PDF of this document available here.

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