When California Governor Gavin Newsom signed the Community Assistance, Recovery, and Empowerment Act law in September 2022, showcasing the concept called CARE Courts, he pitched it as a “transformative” tool for helping homeless people struggling with schizophrenia get the help they need
But that hasn’t panned out in Orange County.
After nearly two years, the program has only placed one person on a mandated plan and another dozen on voluntary agreements.
So far, only one person has graduated from the program.
In all, the County of Orange has spent at least $9.3 million on the program since its launch.
There are growing questions around whether the program is costing too much for too few results.
Some of the toughest questions come from those trying to manage it, including Orange County Healthcare Agency Director Veronica Kelley.
“The idea about maybe we can address homelessness through this didn’t land very well,” Kelley said in a June 9 interview. “The unfortunate part is I have to do CARE. But there are a lot of other programs that do great work that I have to cut because I have to do CARE.”
What is CARE Court?
The Community Assistance, Recovery and Empowerment Act created a new court program designed to open the door for social workers, first responders and family members of people with schizophrenia to connect them with treatment without having to enter a conservatorship.
Under that program, a judge can direct county healthcare workers to create a treatment plan for people struggling with schizophrenia, known as a CARE plan, that lays out what medical treatment they must receive from the county.
“Each plan is managed by a care team in the community and can include clinically prescribed, individualized interventions with several supportive services, medication, and a housing plan,” reads an outline from Newsom’s office. “Participants who do not successfully complete CARE Plans may, under current law, be hospitalized or referred to conservatorship.”
The law was designed to give people another option to help their loved ones seek treatment according to state Senator Tom Umberg, one of the authors of the law who represents much of north Orange County.
While the results aren’t perfect, Umberg said it’s a start and making a difference for some of the most vulnerable.
“Historically the alternative for those 13 people (in the program) is to leave them in this state of both despair and in most cases homelessness so that both they and their families are living a life of incredible pain and trepidation, fear, all those things,” Umberg said in a June interview. “My impression is that we are headed in the right direction.”
Umberg also said the program is meant to put responsibility on the county to work with these people and have a concrete goal.
“There are so many different government initiatives with no one in charge,” Umberg said. “In Orange County, we have a judge that is in charge.”
Opaque Process Protects Participants, Limits Engagement
When the program launched, Newsom billed it as a major tool to help fix homelessness and offer care before people ended up in prison allowing local governments to address the problem.
“When people get their meds, when people get support, we know we can turn people’s lives around. This is eminently solvable,” Newsom said in a 60 Minutes interview in 2023. “Foundationally, what CARE Court is about is accountability at all levels.”
But the program hasn’t proven to be the revelation in healthcare that many thought it would be.
There aren’t many details on what happens in the actual CARE Courtroom – case records are sealed, conferences are not open to the public.
Under the law, participants are guaranteed access to a public defender and the judge is required to order the county healthcare agency to review their care.
Kostas Kalaitzidis, spokesperson for the county courts, did not respond to multiple requests to interview Ebrahim Baytieh, the judge who oversees the program, but said Baytieh “is responsible for the application of the laws of the State of California and the oversight of the process consistent with the CARE Act.”
Baytieh is a former prosecutor who was fired after a federal Department of Justice investigation found he ran a program that systematically violated prisoner’s civil rights. He later ran a successful campaign for superior court judge.
[Read: A Controversial Past Haunts Orange County’s CARE Court Judge]
How Many People Has CARE Court Helped?
So far, only one person in the entire county has been placed on a court mandated CARE plan.
Another dozen are currently on CARE agreements, which means participants voluntarily agreed to mental health treatment without being taken to court, something they were already able to do before the program was created.
Part of the program’s small size is its limit to schizophrenia disorders according to Director Kelley, who said there are only around 12,000 people in the state who are even eligible for the program.
“We just see it as an additional tool, it’s a specific set of people with treatment resistant schizophrenia,” Kelley said.
Another struggle is that even under CARE plans, the treatment people receive is voluntary, meaning they can opt out or choose not to show up at any time.
“Our goal is to have people voluntarily be in treatment,” said Ian Kemmer, Orange County’s head of behavioral health programs in a May 23 interview. “Saying here’s a court process that seems like we’re criminalizing mental health a little bit to get folks in, that’s not the ideal way.”
Kemmer also noted that the program isn’t offering services that weren’t already available to people.
“If they’re our clients we’re going to see them anyway. This just gives us an opportunity to maybe see some folks we wouldn’t have seen otherwise,” Kemmer said. “Did we need to have this whole infrastructure set up in the way that it’s set up in this very narrow, rigid way to do that? No, probably not.”
Another 60 people have been referred to the program, but haven’t formally entered CARE agreements or plans for a variety of reasons according to Frank Congine, the county’s Health Services Assistant Deputy Director who oversees the CARE program.
Congine also said it’s often hard to find many of the people referred to the program out on the street.
“We might have nothing beyond the name Joe and a park in Newport Beach,” Congine said in a June 13 interview.
Congine also noted that some of those people were still receiving care from the county while waiting on their case to move through CARE Court.
So far, only one person has graduated from the CARE Court program, which means they stayed in the program for a year without any missed appointments or relapses.
It’s unclear where that person is or what they’re doing now because that information is kept confidential.
Is the Program Serving Its Purpose?
When CARE Court was first launched, many homeless advocacy groups raised concerns that it was the first step toward institutionalizing people who wouldn’t seek treatment.
Eve Garrow, a senior policy analyst with the southern California branch of the ACLU, called the entire program a “fool’s errand,” and said that it’s designed for a class of people that don’t exist.
“The person this program is meant to serve, the person who could receive mental health treatment if they were willing or able to receive it and have a dire need for such a treatment, is just a unicorn that doesn’t really exist,” Garrow said. “I agree 100% that the program is just a monumental failure.”
Kelley said she’s been a long time opponent of the program because she feels it isn’t clinically appropriate, emphasizing again that none of the offerings are forced on participants.
“We don’t force them to do services, it’s not forced like that,” Kelley said. “We offer them services. If you didn’t show up, we’re going to go out and see if there’s another way to engage you.”
Umberg said he never pitched the program as a “silver bullet,” but that many others thought it would be.
“One of the things that happens with families is they’ve tried so many things and they’re desperate for something that will help make a positive difference,” Umberg said. “When they see anything out there, they have tremendous expectations that this is somehow going to be the silver bullet.”
“I never thought it was going to be the silver bullet,” he continued. “I did think it was going to change the paradigm in that we were going to focus on those with schizophrenia and we were going to put somebody in charge.”
Noah Biesiada is a Voice of OC reporter. Contact him at nbiesiada@voiceofoc.org.