Mental Health and the Homeless: Newsom Calls CARE Court Plan ‘New Paradigm’ for Help

When Gov. Gavin Newsom announced his new plan to to get treatment to the homeless with mental health problems and other Californians who need it but either can’t or won’t seek it out, he called his approach “a completely new paradigm, a new approach, a different pathway, and it’s consistent with our values.” The plan was short on the nitty-gritty details. Newsom gave no specific way to pay for it, and he had yet to hammer out specifics with the state legislature, which must still approve the new system.

Under Newsom’s proposal, all 58 California counties would be required to adopt a new system of CARE (Community Assistance Recovery and Empowerment) Courts. Counties would face penalties from the state government if they fail to adopt the system, which would entail a new court attached to each county’s current court system. The CARE Court would be dedicated to cases involving mental health for the homeless and others.

While the CARE Courts are not only for Californians who are homeless and have mental health issues, getting people off the streets and into care is the focus of the proposed program, and Newsom is pitching it that way to the public.

“People have had it. They’re just exhausted,” Newsom said in an interview with KQED radio in San Francisco, a city where the mental health and homeless problems have hit hard, and where he was mayor from 2004 to 2011. “They can’t take what’s happening on the streets and sidewalks. They can’t take what’s happening in encampments and tents.”

Mayors Throw Support Behind CARE Court

The CARE Court concept remains just that—more of a concept than a full-fledged plan for addressing the homeless of mental health. The legislature must still take up the idea, and its specific details, such as the extent of funding the program, and how it will actually be funded. Though it is still in the early stages the plan is nonetheless gathering support from mayors of the state’s largest cities. 

Los Angeles Mayor Eric Garcetti, during an online discussion in early March, said he would “wholeheartedly embrace” the plan to address mental health and the homeless. “We see trauma all around us,” Garcetti said. “This is unacceptable in our world, let alone in our state and our cities."

Oakland Mayor Libby Schaff, another supporter, described the CARE Court proposal as a “system that actually heals and cares for people, and does not just cycle them inhumanely between the streets and a psychiatric hospital.” Sacramento Mayor Darrell Steinberg, San Diego Mayor Todd Gloria, Bakersfield Mayor Karen Goh and San Francisco Mayor London Breed have also all voiced support for Newsom’s proposal.

At the same time, experts who support the plan are trying to lower expectations about how the CARE Courts can alleviate homelessness. Los Angeles County’s mental health director, Dr. Jonathan Sherin, called Newsom’s plan a “move in the right direction,” though he cautioned that it would affect no more than 10 percent of the state’s homeless population.

“This is a very small segment of the population,” added Dr. Margot Kushel, director of the Benioff Homelessness and Housing Initiative at UC San Francisco. “This is not going to end homelessness.”

What Would CARE Courts Do?

Treatment plans ordered by the CARE Court could include not just medication and other therapy, but housing as well. People placed into the CARE Court system would be referred to as “clients” rather than “defendants,” and each would be assigned a support team which includes a public defender as well as clinical care and support staff.

“CARE Court is about meeting people where they are and acting with compassion to support the thousands of Californians living on our streets with severe mental health and substance use disorders,” Newsom said in a press release about the proposal.

An individual would not need to be arrested before going before a judge in CARE Court. But Newsom’s proposal says “we’re going to do it without taking away people’s rights.”

The courts would be authorized to order 12 months of treatment for individuals with severe mental illnesses such as schizophrenia, after a referral from a family member, mental health professional, law enforcement official or someone else approved by the court. The treatment could be extended for a second year, if the court determines that it’s necessary.

The CARE Court program would be, according to Newsom, much tougher than Laura’s Law—legislation passed in 2002 which allows county authorities to compel mental health treatment for people whose illnesses make them dangerous to themselves or others, but who refuse to seek out help on their own.

While the existing law has resulted in treatment for only a couple hundred people per year, the CARE Courts would serve up to 12,000 Californians who need mental health care, but aren’t getting it, according to the governor.

Civil Libertarians Come Out Against Plan

Civil liberties advocates have spoken out against Newsom’s plan. Eve Garrow, of the Southern California American Civil Liberties Union Branch, told the Guardian newspaper that forcing mentally ill people into treatment is “morally wrong,” saying that the CARE Courts would “take us back to the bad old days of confinement, coercive treatment and other deprivations of rights targeting people with disabilities.”

“Anyone who cares about civil rights and disability rights will need to stay at the ready to respond, to stop this new version of the ongoing criminalization of poverty and to defend the rights to due process of unhoused people,” said University of California Riverside historian Catherone Gudis, a scholar-in-residence with the Los Angeles Poverty Department. She added that the plan would lead to “further empowerment of police, lawyers, and courts, rather than people in need.”

The ACLU has its own proposal, called “Supported Decision Making,” in which friends and family of a mentally ill person “agree to help the person with a disability understand, consider, and communicate decisions, giving the person with a disability the tools to make her own, informed, decisions.”

 Newsom, however, has little sympathy for the civil libertarians’ objections.

 “There’s no compassion with people with their clothes off defecating and urinating in the middle of the streets, screaming and talking to themselves,” Newsom told the San Francisco Chronicle. “There’s nothing appropriate about a kid and a mom going down the street trying to get to the park being accosted by people who clearly need help. I’m increasingly outraged by what’s going on in the streets. I’m disgusted with it.”

According to mental health advocate Alison Monroe of the group Alameda County Families Advocating for the Seriously Mentally Ill, the ability of family members to refer patients to the CARE Court system could help prevent civil liberties abuses.

“The history is repellent and horrible things have been done to our kids in institutions. If families could be involved, there would be less of that,” Monroe said. "There has to be some way of getting the very sickest not just off the streets but to where they can thrive. A person shouldn’t have the right to destroy themselves, or commit murder because of a delusion, as some people have.”