CARE Courts

Yesterday, Governor Newsom proposed that California implement a system of “CARE Courts” in all of California’s 58 counties. The Governor held not one but two separate news conferences on this. In one of the news conferences (in Santa Clara) the Governor was joined by several mayors (Steinberg – Sacramento; Schaaf – Oakland; Gloria – San Diego), Judge Steven Manley (Santa Clara) and Los Angeles County Supervisor Holly Mitchell. In addition to the Governor’s press conferences, Secretary Ghaly also held a call with stakeholders to walk through the proposal and respond to questions.

Governor’s Press Release 
Care Courts Fact Sheet
Press Conference in Santa Clara – SYASL Staff Notes
Youtube / Facebook – Livestream of Press Conference 
CalHHS Secretary Dr. Ghaly Stakeholder Call – SYASL Staff Notes

This morning, even more mayors from across California came together to discuss the Governor’s proposal and how it can help confront the mental health and homelessness crises. You may view SYASL staff notes from their discussion here. 

Here is, as of today, a synopsis of the proposal put together by our advocates at SYASL: 

1. The Care Court will be a new court in each county (no provision to opt-out) that will accept petitions requesting an evaluation order be issued for any individual for whom the petitioner believes needs mental health treatment and isn’t getting it.
   1. There are many entities who can file the petition:
      1. Family members
      2. Clinicians (physicians/therapists, etc.
      3. First Responders
      4. Public Guardians / Public Conservators (PG/PCs)
      5. Behavioral Health
2. The Care Court will order an “independent evaluation” of the client. Who would be responsible for developing this evaluation system, including who pays for it is not known at this time.
3. If the client meets criteria (which has not been established yet), for the program they will be assigned a “Supportive Decision-Making Supporter”. The “Supportive Decision-Making Supporter” will help the client create a Mental Health Advanced Directive and help with monitoring the client’s progress with the program.
4. Who these Supporters are or where they will come from is not known at this time. It appears that they will be county employees.
5. Who will coordinate, supervise and train these “Supporters” is not yet known. Again, where the funding will come from for this new function within the system is unknown at this time. The suggestion was made that PG/PCs be responsible for the training, but currently they don’t do this and believe they don’t currently have the expertise to do trainings.
6. The Care Court will order a care plan be created with the client’s participation. Unclear who would be responsible for creating and monitoring the care plan, maybe county mental health departments.
7. The goal of the client’s participation in Care Court is to avoid Conservatorship, avoid locked placements and to provide “stabilizing medication” (verses crisis medication), housing and voluntary mental health treatment to help the client live well in the community.
8. The client will have a court hearing 60 days after entering the program and then every 180 days. The program is for 12 months with an option to renew for an additional 12 months.
9. If the client doesn’t succeed, the consequence will most likely be a 5150 and conservatorship.
10. Initial funding for the housing piece of this program will come from the $1.5 billion the Governor put into his January budget to address the homelessness crisis. It is possible that other funding for the initial year(s) may be proposed in the Governor’s May Revision to the State Budget. It is also possible that the Newsom Administration may seek to amend Proposition 63 to clarify that counties may use these monies, at least in part, to provide a stable and ongoing funding stream.

Although in the Newsom Administration’s rollout there was mention of possible scope changes to help implement this proposal, please know that the Governor’s staff later clarified that scope changes are NOT being proposed as part of CARE Courts. 

Also, the San Francisco Chronicle initially got one piece of the proposal incorrect. The “supporters / advocates” are not going to be like In-Home Supportive Services (IHSS) or family members – the Newsome Administration envisions these individuals to be more like a conservator, someone who understands due process and the clinical treatment process. They see this type of professional having dozens of clients at any one time – but they also know there is currently a shortage of conservators.

Will CSAP be in the room as the proposal is discussed further – you can count on it.

Some additional flavor from Politico:

“Few problems in California are as visible and intractable as the number of people with no homes with severe mental illnesses or substance use disorders. There are unmistakably many people who need help, but the solution is less clear. Those who believe California needs the means to compel people into treatment have collided with civil libertarians wary of incarcerating and medicating people against their will or of effectively criminalizing homelessness.

Those concerns have so far halted legislation to fortify existing tools. Five months ago, Newsom vetoed a pilot project bill to let people convicted of drug offenses choose between incarceration and treatment, warning that “coerced treatment for substance use disorder is not the answer” — a topic that, though distinct from the question of how best to help those in mental health crises, shares a similar weighing of choice and compulsion.

The political calculus for mental health reform may be shifting. Despite the billions of dollars California and its cities and counties have channeled toward homelessness services, the crisis has not abated — by many measures, it has worsened. That has led Newsom and other Democratic policymakers, from the state Capitol to city halls, to consider more stringent approaches for compelling people who have severe mental illness and are unhoused into treatment, including creating more legal avenues to treat or hold people. “What’s happening in this state is unacceptable,” the governor said yesterday. “There’s no compassion stepping over people sleeping on the streets and sidewalks.”

Now Newsom wants to create a new constellation of civil mental health courts that still carry the clout of obligation. Counties would be required to provide services via this new court arm. Judges could order people brought before a “Care Court” to either a) participate in treatment programs or b) go through the criminal process (if they’ve been charged with a crime) or face involuntary hospitalization or conservatorship. Newsom and allies said this is about avoiding the criminal justice system by giving people a route to treatment — with some consequences behind that choice. “This is not just cops going out there arresting folks and throwing away the key,” Newsom said.

One election cycle ago, Democratic former Assemblymember Mike Gatto pursued a ballot initiative to achieve essentially the same thing. It never qualified. Gatto faced backlash from liberals who accused him of seeking to penalize rather than aid the most vulnerable. “There were a lot of people in my own party who called me a whole bunch of names for even proposing it,” Gatto said. But he argued that the status quo had failed: “We were offering treatments purely voluntarily, and that does not work.” 

Now that same idea has the governor’s imprimatur and is gaining traction, including with big-city mayors who have grappled with spiraling homelessness. San Diego Mayor Todd Gloria said that despite the amount of money thrown at the issue, “the public doesn’t see progress on these streets” as people shuffle “between jails and emergency rooms.” Oakland Mayor Libby Schaaf said the response can’t be voluntary. “Care for our most vulnerable should not be optional,” she said. “It should be a legal mandate.”

What will this proposal mean for Senator Eggman’s nine bill legislative package on conservatorship / LPS reform? She has been in close communication with the Big City Mayors as well as the Newsom Administration. While this may obviate the need for so many bills all at one time there is no doubt she will continue to be integral to this discussion also by virtue of her subcommittee chairpersonship and also her campaign committee to possibly put a measure on the 2024 statewide ballot if legislative reform efforts are derailed. 

There are so many conservatorship / LPS reform bills that we’ve put them into a separate matrix, which you may view here.