A few years ago, Allen, an old friend, called me from a hospital where he was confined under a 72-hour psychiatric hold. Exhausted by the grind of life on the streets, he had threatened to step into the path of an oncoming car. Orange County–a place where immense wealth co-mingles with staggering poverty–had taken its toll on him, he said, and it had seemed like the only escape from an existence marked by relentless deprivation.
Laguna Beach, where I first met Allen, was his home. Remarkably, he navigated life outdoors while managing several mental health conditions. Allen had an encyclopedic knowledge of every bus route in the southland and was connected to all of the healthcare, mental health, and housing programs the county offered. But waiting lists for subsidized affordable housing in Orange County are years long, and the scant mental health care he received from our severely underfunded system could not protect him from the stressors of the streets.
When I found Allen, he was laid up in the brightly lit emergency room of a large, busy hospital, and was feeling agitated. He had been confined to a gurney for two days, he said, and the nurses had not allowed him to shower. Nor had he seen a doctor or therapist. The next day, after a perfunctory meeting with a psychiatrist, the hospital released him back onto the streets, armed only with a bus pass and a referral to the nearest shelter.
Enter CARE Court, a new state initiative that rolls out in a handful of California counties this month, including Orange County, with plans to expand to all 58 counties next year.
Supporters argue that CARE Court will alleviate the neglect and suffering people like Allen endure. In reality, it is court-ordered outpatient mental health treatment, a regression to an era when coercion of people with serious mental health conditions was the norm. Non-compliance with a treatment plan can result in conservatorship, which strips people of almost all of their rights to self-determination and bodily autonomy.
Concerningly, there is no evidence that CARE Court will work. Studies show that adding a court order to high-quality outpatient care does not improve the effectiveness of treatment. And a court order will not magically conjure desperately needed affordable housing and services into existence.
Yet, in a recent 60 Minutes segment, Governor Newsom displayed little tolerance for California counties that raised the alarm about the dire shortage of housing and mental health resources for CARE Court participants. “The only thing limiting people is an unwillingness to be accountable,” he said, “and I’m just done with it.”
It is people with serious mental health conditions, many of them unhoused, who stand to bear the brunt of this initiative. They face the prospect of being ensnared in a new civil court and the looming threat of conservatorship should the system fail them.
This year marks the 60th anniversary of the Community Mental Health Act–a policy that presented a very different image of what our communities could look like. John F. Kennedy, who signed the Act into law, envisioned a society in which people with disabilities–people like his sister, Rosemary, who had undergone a lobotomy and spent her life confined to an institution–would have access to the voluntary care they require to live fully and equally in their communities, free from coercion, deprivation, and fear.
CARE Court is a step backwards, and a distraction. But it needn’t blind us to the vision embodied by the Community Mental Health Act. Counties are well-positioned to provide the state with feedback on the shortcomings of the new civil court system. And they should continue to advocate for the state and federal dollars necessary to fund what works: meeting the affordable housing and voluntary mental health care needs of their community members. They can also allocate more county funds to meeting these urgent needs.
In this regard, Orange County stands at a crossroads. The County Board of Supervisors has consistently failed to commit any portion of their discretionary budget—amounting to around a billion dollars— to subsidized affordable housing. Armed with this substantial resource, the supervisors have the opportunity to make a meaningful impact on the lives of unhoused people with disabilities.
Allen eventually reached the top of the waiting list for permanent affordable housing. Today, he lives independently and is on the path to regaining his health. But for years, our community failed to meet his basic survival needs. He should never have become unhoused in the first place. Allen, like everyone else, deserves the opportunity to live a full and free life and to be an equal member of his community. It’s time to reaffirm our commitment to this vision.
Eve Garrow is a Senior Policy Analyst and Advocate at the ACLU of Southern California. Her office is in the City of Orange.
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