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Newsom signs bill to create courts to oversee mental health, homelessness treatment

State leaders hope to tackle mental health and homelessness crises by compelling civil courts to require treatment plans.

SAN JOSE, Calif. (CN) — Making good on policy he advanced this year, California Governor Gavin Newsom signed a bill Wednesday to create courts that will handle mental health and homelessness.

Gathering outside the treatment center Momentum Health in San Jose on Wednesday, Newsom said the bill affirms his goal to directly handle mental health and homelessness in special courts overseen by civil courts.

Senate Bill 1338 gives California judges the power to compel people suffering from illnesses like schizophrenia to accept medical treatment. Officials estimate the plan, which counties would be required to administer under the threat of court sanctions, could bring complete care to over 10,000 desperate residents.

The bill received bipartisan and near-unanimous approval in the Legislature and is supported by the state’s $15.3 billion investment in homelessness — including $1.5 billion for behavioral bridge housing, more than $11.6 billion annually for mental health programs and more than $1.4 billion for the health and human services workforce. An additional $88.3 million will go to counties, courts, self-help and legal aid.

In recent decades, California lawmakers and voters have approved billions of dollars toward fighting homelessness, yet the issue continues to plague the nation’s most populous state. Despite the influx of money — including $12 billion included in the current state budget — the number of people experiencing homelessness in the Golden State continues to grow. According to the most recent federal data, California’s homeless population grew nearly 7% to 161,000 between 2019-2020.

Under the plan, parents, first responders and doctors would be authorized to refer someone to the new mental-health judicial arm. Once referred to the court, an individual would be assigned a public defender and judges — in coordination with mental health professionals — would determine whether a treatment plan is necessary. If a plan is ordered, the individual would be required to accept treatment administered by the county or local government. Counties declining to provide care would face court-ordered fines and individuals who refuse help would be referred to their previous situation, such as a criminal court, a hospital or conservatorship.

Officials say the idea is to get treatment to desperate people before they end up on the street, the emergency room or jail. SB 1338's co-author Senator Susan Talamantes Eggman, a Democrat from Stockton, said Wednesday the bill is also designed to hold institutions accountable and work with people in the greatest need, rather than waiting until crises which leave emergency responders and hospital emergency rooms strained.

“We don’t like to talk about people as a problem, but it’s a problem that we have created by our own policies,” Eggman said. “We have reached a crisis where it is not working anymore. Often these people are the most difficult to treat, and they’re at the back of the line.”

State Health and Human Services Secretary Mark Ghaly said the law prioritizes both self-determination and accountability.

“The CARE Act recognizes that to serve those with the most complex behavioral health conditions, we must do the hard work of prioritizing those who need help the most, providing a comprehensive CARE plan that honors self-determination to the greatest extent possible, and holding ourselves accountable to delivering services and housing that are key to long term stability and recovery,” Ghaly said in a statement. 

Newsom has argued the plan isn’t a return to institutionalization and large-scale involuntary treatments, noting CARE Court orders can't last more than two years and won’t call for forced medication. Instead, he called it a “rare” occurrence of a policy moving from collaborations and agreement across the board to becoming state law, particularly a policy directly tackling issues he called “vexing” for state leaders.

Newsom’s choice of venue for the press conference, which is affiliated with Kaiser Permanente, irritated National Union of Healthcare Workers union spokesperson Matt Artz. The union has called for Kaiser to be investigated for its handling of mental health care treatment. 

“Kaiser has so far faced no repercussions for illegally canceling thousands of mental health appointments and severely reducing services, putting lives at risk, during a strike by Kaiser therapists that is now in its 31st day,” Artz said, referring to the union’s ongoing, open-ended mental health care worker strike. “If Governor Newsom is serious about improving mental health care for Californians, he must take immediate action to enforce state law and get Kaiser to address the mental health needs of its members.”

Robert Field, a professor of law and health management policy at Thomas R. Kline School of Law and Dornsife School of Public Health, said in an interview Wednesday the concept of CARE Court has been formulating for decades as “therapeutic jurisprudence — that the justice system can be used therapeutically rather than punitively.”

“Incarcerating people with mental illness is very expensive for the taxpayers, and there’s really no chance of rehabilitating or treating them or reducing the chances they’ll revert to homelessness or forms of antisocial behavior,” Field said. 

Some homeless advocates argue that the policy is problematic by focusing on compelling people to get treatment rather than creating more accessible housing. 

Marybeth Shinn, a professor of human and organizational development at Vanderbilt University, said the core problem is a lack of housing.

“Supportive housing, where people get housing first and then choose the services they want, succeeds in getting people off the street,” Shinn said in an email. “Services work a lot better when people choose them freely than when they are foisted on folks, and mandatory services without housing are unlikely to be of much help.”

Scott Burris, professor of law at Temple University, agreed. Ordering people to seek treatment may have mixed results because the state's homelessness issue is not caused by mental illness, but by "too little public investment in affordable housing, and way too much NIMBYism," he said.

"Similarly, the problem of untreated mental illness is not driven by a lack of coerced treatment, but by the extreme shortage of opportunities for voluntary treatment in appropriate settings," Burris said. 

But Field said he thinks the state has to weigh costs and benefits.

“Yes, there is risk of compelling treatment, but on the other hand, is that worse than incarceration?” Field said. 

And the policy could alter public behavioral health approaches in California, as agencies work closely with local law enforcement. Field said CARE Court is an attempt to recognize behavioral health issues that are not “a matter of criminal culpability” and reduce incidents where innocent people are injured or killed in confrontations with law enforcement. 

“If it’s successful, California should see a reduction of homelessness over the coming months and years,” Field said.  

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