LOS ANGELES—A highly anticipated statewide civil court program aimed at getting more people with severe mental illness into treatment continues to see scant numbers, even as several large California counties are in their sixth month of operations.
The Community Assistance, Recovery and Empowerment (CARE) Act, sailed through the Legislature with bipartisan support in 2022. Seven counties launched in October 2023, followed by Los Angeles in December. The rest of California’s 58 counties must implement their programs by the end of the year.
The act has ushered in what is known as a CARE Court which allows family members and others to refer their loved ones to a judge who can impose treatment and other remedies.
But counties that have invested millions, hired new staff, publicized the program and coordinated a complex rollout with mental health departments and the courts are seeing paltry participation. Many question who the program will ultimately serve—and what impact it can actually have—when it is difficult to enter and easy to abandon.
“It was advertised as being a panacea for homelessness, and the data coming in is showing it’s not,” Orange County Supervisor Doug Chaffee told The Epoch Times.
After months of planning, nearly $10 million and more than five months of operations, only five applications out of 60 have been accepted by the Orange County CARE Court. Fewer than a quarter of those referred to the program were identified as homeless individuals, Mr. Chaffee said.
If that is a sharp drop from the 1,400 the county expected in its first year, it’s not for lack of trying, Mr. Chaffee insisted.
“It’s not like we’ve been out here ignoring it. We’ve been trying to make people aware of it,” he said.
Officials from other counties first to roll out the program also reported low numbers to The Epoch Times. Riverside has received 39 petitions and approved five CARE Plans; San Diego, 90 petitions and approving 16, and San Francisco has received 21 petitions, but did not indicate how many have been accepted. Los Angeles County said the court has accepted all 85 petitions it received since launching Dec. 1.
The state estimated between 7,000 to 12,000 people would be eligible for the program, and has budgeted hundreds of millions of dollars ongoing for it annually.
The bill’s conflicting portrayals in the media have led to confusion around whether the program is voluntary or involuntary—or something in-between.
Meanwhile, advocates envisioned it as a radical revision of the state’s existing law that would finally let family members get court-ordered treatment for their loved ones. A recent editorial by the Orange County Register expressed support for the program as a way to “‘sentence’ offenders with mental health [disorders] and addictions to treatment rather than prison.”
But CARE Courts will do nothing of the sort. They are civil courts that allow family members, mental health workers, first responders, and others to petition on behalf of someone suffering from a severe, narrowly defined psychotic disorder. The goal is to get those suffering approved for a “court-ordered” CARE Plan, which can include medication, counseling, and housing, and hope they accept.
“Respondents” are free to reject such a plan outright or leave the program without penalty. A judge can “order” medications as part of the plan but cannot force participants to take them.
“It has always been a voluntary program, meaning that you cannot be forced into doing it, and very explicitly in the Act, you cannot use this as an on-ramp to conservatorship,” Dr. Veronica Kelley, director of Orange County Behavioral Health Agency, told The Epoch Times. “It has nothing to do with conservatorship.”
After pushback from civil rights groups led to a series of amendments, the program appears to lack any element of compulsion or consequence. Later versions of the bill added clauses specifying there would be no penalties for failure to appear, comply, or take medications.
“The fact that it’s voluntary, that wipes out probably 99.9 percent of the folks that are living on the streets or otherwise disengaged from society and lack the insight or the self-determination to voluntarily participate,” Yolo County District Attorney Jeff Reisig told The Epoch Times.
Yolo, like San Diego County and thousands of others across the U.S., already has mental health and addiction intervention courts that offer mandatory treatment as diversion from criminal prosecution.
Other counties, like Orange, already have robust voluntary mental health programs and serve the same population—nearly half of the county’s 40,000 clients each year have diagnoses of schizophrenia or related psychotic disorders—as well as court-ordered assisted outpatient treatment.
‘A New Hope’
The answer, like the bill language itself, is somewhat ambiguous and open to interpretation.Mr. Newsom expressly framed CARE Court as a solution to the state’s interconnected mental illness, addiction, and homelessness crises, calling it a “new hope” for thousands of Californians with untreated mental health and substance abuse issues.
But as a narrow focus on the severity required for the program and its voluntary nature became clear, high expectations receded.
Qualifying for CARE Court requires proof of previous hospitalization and diagnosis, and respondents must not be receiving treatment elsewhere. And while early versions of the bill specified “adults suffering from mental illness and substance abuse disorder who lack medical decision making capacity,” the final version scraps that language. Those who suffer from an addiction disorder alone do not qualify.
Compared to Orange County’s 25 percent estimated homeless respondents, Riverside reported 5 out of 39 petitions were for homeless individuals, while Los Angeles said around 40 percent of its petitions were.
Ideally, the program might bring people into a system that can help them, including with housing and ongoing services, experts say.
There is, Dr. Kelley, the director of Orange County Behavioral Health Agency, points out what she calls the “black robe” effect: Just as we might slow down when we see a CHP officer behind us, people might be more inclined to follow a plan if a judge is watching.
“If a judge is suggesting you do something, and if you have come into proceedings to have those things done, that person might be more willing, right?” she said.
But from a county perspective, she added, what’s hopeful about the program is extending help to people who really need it.
“We serve MediCal. We don’t serve Kaiser or Cigna or Aetna. This, though, brings somebody to our attention that we might not have seen. Of the 3.2 million people in Orange County, I don’t go door to door with my 1,300 staff seeing if somebody here needs help,” Dr. Kelley said. “So, this is another tool to bring people to our attention.”
But critics question the logic of putting that system in the context of a complex judicial bureaucracy—in which respondents are represented by a public defender, and go through the motions of evidentiary hearings, witnesses, and cross-examination.
Mr. Chaffee, the supervisor from Orange County, wonders how it might feel if approached by an unfamiliar mental health worker who is offering a free court program in which you’ll be represented by a public defender.
“Most people don’t want to go to court,” he said. “Already you have some trust issues.”
More Coaxing Than Coercion
Los Angeles County’s December launch involved a “massive investment” in time, infrastructure, and financial resources, according to county officials.“It took a lot to get ourselves into a position where we could roll this out, and it wasn’t just a Department of Mental Health initiative, but a collaboration with the court system,” Anders Corey, health deputy for Los Angeles County Supervisor Kathryn Barger, told The Epoch Times.
The state has allocated $15 million in startup funding for LA County, as well as ongoing funding for administrative and court-related activities. A representative from the county’s mental health department said they will also use other funding sources, like Medi-Cal reimbursement and Mental Health Services Act funding, and expect the state to finalize reimbursement plans for court and administrative activities soon.
While CARE Court is mandatory for counties—they face sanctions of up to $1,000 per day for failing to implement guidelines—the same can’t be said for respondents, who can exit anytime without penalty.
“Our understanding is that CARE Court was never going to touch the Lanterman-Petris-Short Act,” Mr. Corey said, referring to the state’s 1967 conservatorship law, which determines conditions to commit someone involuntarily to mental institutions in California. “It was never going to redefine LPS law, which is the only way that you can get people into involuntary care.”
Dr. Kelley, from Orange County Behavioral Health Agency, pointed out she is a clinician bound by ethical code, and like disability rights advocates, her goal is to ensure people’s rights are protected, with involuntary treatment being only applicable to those who are a danger to themselves or others or if they meet the definition of grave disability.
“So this is not an on-ramp to LPS conservatorship, not at all,” she said. “This is the lower level of care and community-based.”
Many advocates see the program as an intervention designed precisely to prevent institutionalization and coercive treatment.
An individual closely involved with the evolution of the legislation who asked not to be identified as they were not authorized to speak on the matter, told The Epoch Times they had always understood it as a middle ground between voluntary treatment and conservatorship—a way to do something about the homelessness emergency but still appease powerful groups who oppose coercive treatment.
The result, critics say, is a gutted edifice.
For Mr. Reisig, the Yolo County DA, the issue is also personal. He says a family member, who is severely addicted, has been homeless for nearly a decade.
“I think there’s a lot of families, people like me, like my family, who were hoping that CARE Court would provide a meaningful solution, but it doesn’t,” he said.
His relative, he said, is a “great example” of California’s failed policy thus far.
“He needs to be compelled into treatment. He’s so deep into addiction and now mental illness because of the addiction, that he lacks insight into his own illness. Absent compulsion, absent a judge having the authority to detain him in a jail and give him that uncomfortable choice—he’s never going to walk into CARE Court,” Mr. Reisig said.
Existing programs like those in Yolo and San Diego counties that divert people from the criminal justice system with mandatory mental health and addiction treatment are a better approach, he argued.
During fiscal year 2019–20 Yolo County’s Mental Health Court received 86 referrals, enrolling 9 participants, another 13 in Addiction Intervention Court, and 7 in other programs.
The program, which mandates treatment as an alternative to criminal prosecution, reported a 68 percent reduction in arrests, a 47.7 percent reduction in jail bed stays, and a 100 percent reduction in hospital stays.
“Our programs that work have a carrot and they have a stick—and the stick is the felony offenses that are hanging over their head. The carrot is we offer these programs that robustly address their mental illness and addiction through treatment, best practices, with the hope they will complete it and then we can expunge the conviction,” Mr. Reisig said.
By contrast, CARE Courts cannot issue a bench warrant to go get the person, focusing rather on trying to encourage people to go to court and be influenced by a judge, he said.
“Everybody’s engaged in this process of spending millions and millions and millions of dollars trying to coax people into treatment, when everybody in the room knows that they need it except the person standing there, you know, who is sick,” Mr. Reisig said. “And that’s where CARE Court is not delivering. It’s not going to deliver.”
Dr. Kelly noted Orange County already has, since 2014, successfully implemented its court-ordered Assisted Outpatient Treatment program, known as “Laura’s Law.”
But she thinks the metric for success for the state’s new program can be reframed.
“I think the problem is people look at the end, they look at how many people are in [an assisted outpatient treatment program and], how many people are in CARE. What we want to be looking at is how many people were brought to our attention and voluntarily agreed. … They made a treatment decision for themselves,” she said.
Of the 6,000 referrals the county has received for its assisted outpatient treatment program since 2014, around a third went into treatment before they even hit the court system, she said.
“That’s the success. Not the 12 people I have in the current system. … We aren’t trying to get more people into court. We’re trying to get more people into treatment,” she said.
Given the importance of outreach and building relationships in a program like CARE Court, Dr. Kelley said, her office is struggling with the 14-day window they’re allotted to find respondents to serve them with paperwork to come to court to start the process.
“We’re managing it, but we are trying to see if we can get some cleanup bill language that would allow us to extend that… We just need a little bit longer so we can really do what I think the act was intended to do, which is to get care to people,” she said.
Mr. Corey, from LA County Supervisor Kathryn Barger’s office, also defended the program as a compliment to existing programs, saying the supervisor supports “multiple mechanisms” to get new individuals into treatment, including more urgent care, prevention, and Lanterman-Petris-Short reform that will allow “more flexibility” for involuntary care.
“There is definitely a need for a referral process that is voluntary,” he said, suggesting such community programs can provide stability for people with severe mental illness.
Budgetary Concerns
The governor’s budget allocates $128.9 million in fiscal year 2023–24, $234 million in 2024–25, and $290.8 million in 2026–27 for all counties “and annually thereafter” for mental health and judicial branches to implement the CARE Act.Some counties say funding came in higher than expected, so they are trying to ramp up operations and hiring quickly to maximize impact.
But others say they are unsure what state funding will look like after this year, and whether counties will have to pick up the slack, especially as the state is facing a projected $73 billion budget deficit, according to the state’s Legislative Analyst’s Office.
The passage of Proposition 1 and CARE Courts, funded by the Mental Health Services Act, could result in counties having to cut back existing programming, said Dr. Kelley, Orange County’s director of mental health.
“Our funding stream for [the] Mental Health Services Act has gone down significantly. And so that’s a budgetary concern I have. [CARE Court] costs us $5 million a year to run, and then I have to look at what other programs I have that might be more economically feasible and might serve a broader flock of people,” she said. “But CARE is in statute, I have to do it, I have to fund it. And so we’re doing it.”
The state is also providing funding to county public defenders and superior courts for the program. In addition to $6.6 million for its mental health department, Riverside’s Public Defender is getting $4.98 million. In Los Angeles that office has received a little more than $10 million for the first year, and will hire five administrative staff, a representative said. And in Orange, the state allocated $2.8 million to its public defender’s office, in addition to the $7 million or so that went to its mental health department.
The Orange County team has three attorneys, all with experience representing clients with mental illness in collaborative courts or the Lanterman-Petris-Short system, as well as three social workers, a clerical employee, and a paralegal—and hopes to add two more attorneys, two investigators, another social worker and paralegal, according to county officials. The investigators, they noted, would be “particularly helpful” as teams try to locate homeless clients.
The LA Department of Mental Health has approved 117 positions to support the program, more than half of which have been filled, and will continue to evaluate whether more hiring is necessary, according to a representative. Riverside Department of Mental Health has hired 10 people so far and plans on recruiting additional staff, while Orange County has hired 11.
Mr. Chaffee, the Orange County supervisor, said the program may yet bear results, but stressed each county has distinctive needs, and will already be facing funding constraints as a result of Mental Health Services Act reforms.
“I don’t particularly like the one-size-fits-all, which is what the state is trying to do,” he said. “Each county is a little different. I would think the state would be better off instead of using a punitive hand,” for not having the program implemented, “to encourage the programs that are successful and reward them. So other counties that don’t have the program might emulate it,” he said. “I think statewide that would be a much better match than what I see coming out of Sacramento.”
