Gov. Gavin Newsom wants to take more aggressive action to address the needs of Californians suffering from debilitating mental illness.
On Thursday, the governor unveiled a plan to overhaul the state’s mental health system by creating a mental-health-focused arm of civil courts in every California county, dubbed Care Court.
Under the plan, which still needs legislative approval, the state would require counties to provide comprehensive treatment to those suffering from psychosis, and risk sanctions if they don’t.
Speaking at a press conference on Thursday, Newsom said rather than reforming the system in the margins, the state is offering a new approach. It’s the largest overhaul of the system since the 1960s, when then-Gov. Ronald Reagan dismantled state mental health institutions, he said.
“There’s no compassion stepping over people in the streets and sidewalks,” Newsom said. “No compassion reading about someone losing their life under (Interstate) 280 in an encampment. There’s no compassion in that. I mean, we could hold hands, have a candlelight vigil, talk about the way the world should be. Or we can take some damn responsibility to implement our ideals, and that’s what we’re doing differently here.”
Newsom is taking aim at one of the state’s most pervasive problems. As homelessness and mental illness has become more visible on California streets, some have called for the state to do more to compel people into treatment.
Those calls have run into opposition from mental health advocates, who worry about returning to an age of institutionalization, when mentally ill Californians could be sentenced to a lifetime in a state mental hospital with little due process.
Newsom said the current system, however, often results in incarceration for the mentally ill.
“The largest mental institution in the United States is the LA County jail,” he said.
Under the governor’s plan, people who are suffering from psychosis, described as a condition with a loss of contact with reality, could appear before a Superior Court judge under three scenarios: they are suspected of a crime, an involuntary hold in a psychiatric emergency room is ending, or a family member believes they can’t care for themselves.
In those three scenarios, if the judge ordered so, the county would be required create a care plan with input from the person and a county case manager. The plan could include clinical services such as visits with a psychiatrist, prescriptions for medications, and housing. The plan would be time-limited for 12 months, and renewable for another 12 months, according to Kimberly McCoy Wade, the governor’s senior adviser on aging, disability, and Alzheimer’s.
Newsom said the hope is to give mental health crisis teams, homeless outreach workers, and family members the capacity to save someone’s life. He emphasized that this will not be about rounding people up and throwing them into jail without due process.
“The mayor of Oakland herself could say, ‘this individual, I now have the ability to help this individual who clearly can’t help herself and get her off the streets so she doesn’t become a statistic. To give her a chance,’” Newsom said.
If the person refused to participate, they would go back to the Superior Court for criminal proceedings. If no crime was committed, they could be subject to the existing state process, where those who are a danger to themselves could face involuntary holds or conservatorship, a long-term program where someone else takes control of the person’s assets and decisions, usually requiring a yearly renewal.
Each year, about 56,000 people in California end up in 72-hour holds, often called 5150s, which are used in some cases for people with severe mental health issues. After those holds, people are typically sent back to the streets. With the Care Court program, however, Newsom said the courts will be able to catch people and connect them with long-term services instead.
Last year, Newsom and the Legislature approved $12 billion in funding for homelessness and housing. This year, the governor is seeking another $2 billion, focused on cleaning up street encampments and getting people into immediate housing. If the budget is approved, it will mean 33,000 new beds or placements for the homeless, Newsom said Thursday.
County behavioral health staff have said they still lack the resources to care for those who need it. State officials said there is enough money through state programs to pay for the Care Court system in counties.
Of the $14 billion total that has been invested over the past two years, $4.5 billion is targeted for mental health programs. Counties can also get funding through the Mental Health Care Services Act, said Jason Elliott, senior counselor to the governor and director of intergovernmental affairs. Elliott said there will likely be a need for more resources to the courts.
Much of the Care Court plan centers around compelling mentally ill people and local governments to participate in services. But Michelle Cabrera, executive director of the California County Behavioral Health Directors Association, said counties are already willing to provide help and individuals are already taking advantage of it.
She appreciates the state’s efforts to expand immediate housing and is willing to discuss how the courts can connect people with services, but said the underlying problem is housing affordability and funding at the country level.
One-time grants and block funding do come from the state, but it’s not enough to provide the level of care needed, she said. The problem, she said, is a lack of permanent and ongoing funding source for county behavioral health staff.
“Were the additional resources put on the table, there is nothing that could stop us from providing this care,” she said. “I’ve got buildings, I’ve got bricks and mortar. I don’t necessarily have extra money in the bank to fund expanded services.”
Cabrera also said affordability is one of the key drivers of homelessness in California, which can in turn lead people to develop severe mental health problems. By failing to adequately address affordability, California has created “an assembly line of new behavioral health clients,” she said.
The affordability problem also often means county behavioral health offices are critically understaffed in California, Cabrera said.
“How are we going to hire staff? In a very competitive job market where McDonald’s is struggling to hire people, we’ve lost board care operators to the gig economy. We’ve lost housing to AirBnb,” she said. “Even our own staff are asking for help with housing. This isn’t a matter of a lack of will on our part.”
Much of modern mental health treatment in California is built on a 1967 law signed by then-Gov. Ronald Reagan called the Lanterman-Petris-Short, or LPS, Act. That law allows for short temporary holds and conservatorship.
Care Court isn’t a replacement for conservatorship, Elliott said, but the scale of encampments across the state makes it clear that a new approach is needed.
“The Care Court model and care plans really are the other side of the coin on everything that the governor and the Legislature have done in the last couple of years to invest in the homelessness continuum,” Elliott said. “We need to make sure that people get into this treatment, people get into these beds that we’re prioritizing… And that’s really what Care Court is.”
The program has the potential to help between 7,000 and 12,000 Californians, California Health and Human Services Secretary Dr. Mark Ghaly said.
Elliott, with the governor’s office, said they would like to move the Care Court legislation through the budget process, which means it could take effect as early as July 1. But at this time there is just a framework, Elliott said, and the administration will need to work with the legislature on the final outcome.
The Sacramento Bee Capitol Bureau’s Lindsey Holden contributed to this story.
This story was originally published March 3, 2022 10:58 AM.