People with severe mental illness and those with substance use disorders could be compelled into treatment under a plan unveiled Thursday by Gov. Gavin Newsom.
The program, called “CARE Court,” is meant to address the worsening homelessness crisis, but members of Newsom’s administration say it would also be open to people who have shelter but need treatment. The administration estimates between 7,000 and 12,000 people would qualify.
“What's happening in this state … is unacceptable. There's no compassion stepping over people in the streets and sidewalks,” Newsom said at a press conference in San Jose announcing the proposal.
“We could hold hands, have a candlelight vigil, talk about the way the world should be, or we could take some damn responsibility to implement our ideals, and that’s what we’re doing differently here,” he said.
The governor and his advisors described the proposal as a “paradigm shift” that would get people into treatment before their mental state deteriorates to the point where they are a danger to themselves and others.
They say existing policies — like Laura’s Law, which allows for court-ordered treatment, and the Lanterman-Petris-Short Act, which reformed mental health and institutional treatments in the 1960s — are outdated and not helping enough people. Just 218 people were referred to court-order treatment under Laura’s Law in the 2018-19 fiscal year, according to the state Department of Health Care Services.
Advocates for unsheltered people have opposed policies that would compel people into treatment, arguing it violates their civil rights.
“We need to treat brain health early before we punish it later,” Newsom said. “This is not just cops going out there, arresting folks and then throwing away the key.”
The plan must be approved by the Legislature. Newsom said he hopes lawmakers will approve the plan through the budget process, which would allow it to take effect as soon as July.
The governor said court-ordered treatment plans would be tailored to the individual and provided through community-based care teams.
First responders, families, clinical providers and others could refer people to the court system. Treatment programs would last anywhere from three to 12 months and could be renewed for another 12 months as an alternative to prison if the person was arrested for a crime. Otherwise, those who refuse to participate could be ordered into a conservatorship under the legal presumption that there are no suitable treatment alternatives.
Counties would be required to participate in the program and provide comprehensive treatment with financial help from the state.
“The money is there. The beds are coming online,” said Jason Elliot, Newsom’s senior adviser on homelessness. “Now we need to make sure we can get the sickest people into treatment.”
Newsom said in addition to $12 billion earmarked for homelessness last year, the state’s Mental Health Services Tax ballooned from $2.1 billion a few years ago to $3.7 billion last year. That money comes from a 1% tax on income over $1 million and helps fund behavioral health services.
Counties that do not participate or provide treatment would be subject to sanctions from the courts, the governor’s office said. In extreme cases, an independent agent could be appointed to ensure the services are provided.
The California State Association of Counties warned that after decades of being underfunded, the behavioral health system may not be adequate to help thousands of new patients. It also bristled at the “punitive” approach.
“Counties are all in to do our part to solve homelessness and rebuild behavioral health infrastructure. Sanctions are not the way to do it,” said executive director Graham Knaus.
County behavioral health directors echoed concerns about existing mental health and addiction treatment systems.
“Penalizing the county safety net system when certain housing resources, workforce, or funding don’t exist in the first place is counterproductive and won’t expand connections to life-saving treatment and services,” said Michelle Doty, executive director of the County Behavioral Health Directors Association of California.
Several mayors, including Sacramento Mayor Darrell Steinberg, have offered support for the proposal.
San Diego Mayor Todd Gloria said despite “tremendous investment” from the state for more housing, shelter beds and services, “the public doesn’t see progress on these streets. In fact, some would say that it looks worse than it has ever looked, and I agree.”
Assembly Republican Leader James Gallagher (R–Yuba City) said he was skeptical of the proposal.
“There is nothing compassionate about Newsom’s status quo homeless agenda of letting people suffer and die on the streets. And nothing in today’s flashy announcement gives me confidence that Capitol Democrats are going to suddenly change their ways,” he said in a statement.
Last month Gallagher introduced a bill that would allow people unable to care for themselves or make “informed decisions” about their wellbeing to be forced into treatment under the Lanterman-Petris-Short Act.
