Fed up with tent cities, officials up and down California have ironed a new approach to the publicly-visible homelessness crisis on their hands:
Putting homeless people in front of judges and potentially into treatment programs.
The newly-approved and highly controversial system is known as CARE Court, and it isn’t exclusive to homeless people or intended for all of them.
Rather, the new law’s authors say it’s for those with mental health and substance abuse issues, who under the current system only get help after they deteriorate or commit crimes, or end up back on the street with no help at all.
The idea’s to court-order such people into a treatment plan for up to two years, with County of Orange officials joining six other counties in committing to an early rollout of the system over the next calendar year.
“The start of this would be October of 2023,” said Dr. Veronica Kelley of the county Health Care Agency. “We have a little bit over a year to stand this up.”
But around this new system are two directly opposing views of how voluntary it really is – and where it stands in California’s long and notorious history of institutionalization.
Gov. Gavin Newsom, state lawmakers and big city mayors have pushed CARE Court as non-coercive and individualized – and as the next step in the state’s move away from institutionalization.
Civil rights groups, on the other hand, say CARE Court is institutionalization’s next chapter, coercive by its very structure, while self-determination — voluntary but supportive treatment — is the best route through which people recover.
The debate played out in California’s deinstitutionalization movement of the 1960s, and in the conservatorship and 72-hour psychiatric hold processes it simultaneously brought about.
The CARE Court legislation invokes the ‘self-determination’ concept twice in its text and in accompanying public policy documents.
Yet the very concept’s loudest advocates have come out swinging against it.
While painted in voluntary terms, critics say CARE Court guarantees no housing in the unaffordable state.
In the long run, they say the plan empowers courts to warehouse people in shelters or place them in conservatorships, the case where a judge appoints someone (the ‘conservator’) to care for another adult deemed to have no self-decisionmaking ability.
“These big city public officials can make what they’ve been trying to do happen at the expense of poor people really easily,” said Lili Graham, a Disability Rights California attorney and one of CARE Court’s chief critics.
“And you can put someone anywhere, regardless of whether it’s the right place for them or not.”
Orange County has stepped to the forefront of the new system in a number of ways.
Local officials and politicians are embracing it.
“They have civil rights, but what about the rest of us? Those of us that have to watch them dying on the streets and tents?” said John Moorlach, a Republican former state senator and county supervisor – and now a Costa Mesa mayoral candidate – in a phone interview.
The county’s home to one of the CARE Court bill’s co-authors, Sen. Tom Umberg (D-Santa Ana), and other proponents who insist CARE Court is voluntary.
It’s a “civil commitment court – it’s a voluntary court,” said Dr. Veronica Kelley, Chief of Mental Health and Recovery Services at the OC Health Care Agency, during a phone interview.
But if you ask Brooke Weitzmann, a high-profile attorney for homeless and disabled people:
“Voluntary does not require the judicial branch.”
And other proponents concede that CARE Court’s not elective, nor does it guarantee housing.
Some say they’re simply tired of listening to civil rights groups.
“It’s exhausting. I’m just — I’m exhausted,” Newsom said in response to a reporter’s questions about the opposition at a news conference earlier this month. “I think their point of view has been well-advanced for a half-century in the State of California. Their point of view is expressed by what you see on the streets and sidewalks.”
“We’re not gonna hear the same excuses of why we can’t do something,” Newsom said.
How Will This Work?
The true nuts and bolts of this new system come down to how Orange County and the six others handle its rollout over the next year.
Here’s how proponents say CARE Court would work:
Anyone from a roommate or family member to a local health agency or even a police officer could petition to put someone through the proceedings.
Once that petition’s filed, the court will review it and order a written report to determine if the person meets, or may meet, the criteria for CARE Court. If one voluntarily agrees to receive services, or if there is insufficient evidence that they meet the criteria, the case is dismissed.
If someone’s likely to meet the criteria, the court will set an initial appearance on the petition within 14 days and appoint the person’s legal counsel, according to the law’s framework documents.
A case management hearing will then determine if the parties have entered into a CARE agreement. If so, the court will approve or modify the terms of the agreement and set a progress hearing for 60 days.
If an agreement isn’t reached, the court would order a clinical evaluation of the respondent.
During the clinical evaluation hearing, the county will present its findings and the person put through the proceedings will have an opportunity to respond.
If the court finds that the respondent meets the criteria, the court will order a jointly-submitted CARE plan within two weeks.
Once the court approves the CARE plan, the timeline goes up to one year. The court will have status review hearings every 60 days to hear treatment progress, which services were provided, which weren’t, and any issues. At the end of the first year the patient has the option of another.
Medication can be court-ordered, but not forcibly administered.
Failure to complete treatment could still land the person in state hospitalization or conservatorship, though proponent lawmakers say this process is meant to be checkpoint where people on that path can be diverted.
“We have fought really hard to ensure that that CARE court was not a direct line to conservatorship,” said Kelley of the OC Health Care Agency.
CARE Court Rings Alarms for Civil Rights Groups
The bill’s loudest opponents are scores of civil rights organizations, more than 40 of them, from Disability Rights California to the American Civil Liberties Union to Human Rights Watch.
Throughout this year they’ve argued that CARE Court is compulsory by the very fact it puts people through the judicial system, where they can’t exactly refuse to comply with a judge or the CARE Court process if found to be eligible — lest they end up in a conservatorship.
In fact, civil rights advocates argue local governments and judges get more choices under the new law than the patients compelled into court themselves. A judge doesn’t have to order every component of the system the bill provides for.
The court can also decide where the person lives with conservatorship as a prospect.
The CARE Court provisions also prioritize patients for “any appropriate bridge housing” where there’s funding – meaning they’re prioritized for spots in shelter, not housing.
What’s “really terrifying” about CARE court, Graham said, is that “you’re just stripping away a really basic fundamental right.”
Weitzmann, meanwhile, has this question: “Why would we want to redirect money that could be going toward the actual resources and toward the people’s needs, into the administration of a court system?”
“We already have a great voluntary system,” Weitzmann said. “It’s called the Health Care Agency. And if they had enough employees, to help people come up with voluntary plans and execute them, if they had enough internal staff, and enough contractors, we could be meeting the needs.”
In a written emailed statement responding to questions on Sept. 19, Umberg said “Housing is a vital component to the CARE Court process – but finding stability and staying up to date with treatment is virtually impossible for the unhoused. One of the upsides to this new process is that the court will be able to issue orders that are specific to the needs of each individual (i.e. bridge housing, a licensed adult care facility, supportive housing, etc.).”
Some Like the New Approach
Arguing for CARE Court had local officials at times drawing from their own deeply personal stories of tragedy and loss.
“I’m a social worker,” Kelley said. “But before being a social worker, I was a conservator of a family member who ended up on the streets, who was not amenable to treatment and had no services offered to her from another county, and she actually perished on the streets. I’m raising her son as my own.”
It’s been 16 years since Umberg’s family stopped looking for a relative, as a plan like CARE Court in his family’s case came “too late,” he said at Newsom’s bill-signing news conference earlier this month.
Moorlach said those stories are affecting families all over OC.
“I have a very close friend who told me that he was driving down Tustin Avenue. And he said, ‘I pulled over and saw my daughter for the first time in two years,’” Moorlach said in a phone interview.
Orange County in many ways has poised itself for a system like CARE Court, long before it came about.
Moorlach was the co-author of what could be considered CARE Court’s precursor, Laura’s Law, which provides assisted outpatient treatment to a small population of individuals who meet strict legal criteria and who can’t voluntarily access community mental health service.
Yet the opposition remains, and murmurs of lawsuits by civil rights groups over the new system are now filling the air.
“This goes against every core principle of why we exist,” Graham said.
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