REGION — While it’s gaining municipal support, foot soldiers on the streets say California’s latest attempt to reach and treat unsheltered people with severe mental illness is, at best, a fluff piece or, at worst, a political game.
However, lawmakers and family members of those suffering from psychotic disorders feel it could be a Hail Mary to push their loved ones into treatment.
The Community Assistance, Recovery and Empowerment (CARE) Court program was introduced in March by Gov. Gavin Newsom to aid people with mental health and substance abuse disorders.
As proposed, the program links a team of providers and adults with diagnosed severe mental illnesses who are not clinically stabilized and may be a risk to themselves or others.
A qualified participant would be enrolled into an agreement — that could upgrade to an involuntary, court-ordered plan — to receive treatment and county behavioral services. If a person cannot meet the standards, they may be hospitalized or put into a mental health conservatorship — different from its probate counterpart.
The CARE Court proposal builds on the preexisting Assisted Outpatient Treatment Demonstration Project Act, or Laura’s Law, and Lanterman-Petris-Short Act, which provides for short-term and longer-term involuntary treatment and conservatorships for people who are determined to be gravely disabled. The CARE program would not override existing law nor redefine the qualifications for those who are gravely disabled or severely mentally ill.
So far, a handful of government bodies in San Diego County — including Del Mar, Carlsbad, Vista, the San Diego Board of Supervisors, Poway, Coronado, Chula Vista, Escondido — have officially supported the CARE Court bill, or Senate Bill 1338.
The Oceanside City Council is still considering the bill but has yet to sign anything in support of the legislation. Others, such as the Encinitas City Council, have not considered a resolution.
The CARE Court bill passed through the California Senate in May and is currently in the judicial and health committees in the state Assembly.
The subject hit particularly close to the Vista community on May 24, as Councilman Joe Green shared his sister’s story during a regular council meeting. Green has witnessed how mental illness takes hold in tragic ways.
The Vista City Council, like other municipalities, still has questions. Governments in San Diego County are seeking additional information on funding, eligibility standards and timelines for the CARE policy framework.
“I didn’t have a CARE Court,” Green said, “I didn’t have anybody that knew how to work the system who could help my sister.
“This is community assistance, recovery and empowerment. This is here to assist our community with recovery and power.”
Joseph De Vico, a former investigator with the San Diego County Public Conservator’s Office and an expert in behavioral health, is not convinced.
Neither are some legal experts who work closely with the unhoused, including one attorney involved in cases against the City of San Diego. Instead, these critics call for more locked shelters, compassionate training on mental disorders that impact the quality of life and following the laws already in place.
However, supporters believe that this precursor to conservatorship will divert individuals on the rotation among jails, hospitals and the streets.
“Humans are and always have been unique in their conscious decision-making abilities regardless of mental disorders,” according to the mental health professionals at Tri-City Medical Center, addressing who should make the decisions for those suffering severe mental illnesses.
“Everyone will have a different opinion about where to draw the line regarding who can make decisions and who cannot.”
Senate Bill 1338
If passed, enrollment in CARE Court must be the least restrictive alternative necessary to ensure the person’s recovery and stability; this point is valid for all involuntary programs for those suffering mental illnesses.
The process would begin with a petition signed by a licensed behavioral health professional that is brought before the court. An adult roommate or family member; a licensed behavioral health professional or a public entity treating the individual; a first responder; a public guardian; and the individual can initiate a CARE petition.
If a court agrees, a case management hearing would be set to determine a settlement agreement or the CARE agreement, which does not include involuntary services. If no deal is made, the person must undergo another hearing to determine if the court-ordered plan is appropriate. The person would receive a clinical evaluation at this time to be used in the determination.
The CARE plan connects the individual with several supportive services (including those for mental health, substance abuse, housing, and a public defender and supporter) for 12 months and subsequent 12-month renewal. At the end of the 24 months, the person either successfully graduates or is referred to a hospital or for a mental health conservatorship under Lanterman-Petris, or LPS.
According to De Vico, the route to conservatorship is inevitable under this plan. The LPS expert now runs his outfit helping the gravely disabled — and their loved ones — work the system so they may get the right help.
De Vico said none of the new rules address that, “by definition,” the severely mentally ill are incapable of “deriving sufficient therapeutic benefit from the levels of treatment and psychosocial support which are available voluntarily, to begin with.”
Critics say the proposed policy framework is just bad lawmaking and positions those in power with good optics. Coleen Cusack, the lead attorney in legal proceedings with the city of San Diego, says the latest bills target a smaller group of the homeless and are being falsely revered as a win for the state.
‘We all know the definition of insanity.’
To lawmakers, the CARE Court bill could be a simplified way to utilize a system that has repeatedly failed an individual.
“I mean, we all know the definition of insanity is trying the same thing repeatedly and expecting a different result,” Deputy Mayor John Franklin said during a council meeting on May 24 discussing CARE Court.
Franklin later added, “What will we do when the approach that has been tried for a long time for decades fails?”
In a previous article, The Coast News interviewed Deborah, an Oceanside mother struggling together with her son as he’s fallen into homelessness, been diagnosed with schizophrenia, and taken to drug use. Jake’s been to jail a few times and county behavioral health facilities just the same.
However, Deborah said he’s learned his way out of the court-ordered help — or learned how to avoid voluntary services.
According to Tri-City, symptoms of psychotic disorders include social withdrawal, decreased motivation, and decreased a sense of purpose, and individuals tend to self-medicate due to these negative impacts.
Those with schizophrenia and schizoaffective disorders also experience varying levels of paranoia and delusional beliefs – which affect their ability to take care of themselves at times logically.
“Clients often need a collaborative approach that includes medication management, group and individual therapy, and psychoeducation related to nutrition, substance use and management of symptoms,” Tri-City names outpatient programs, which are generally covered by the state, as suitable alternatives.
Deborah, whose son accesses county services through state insurance, couldn’t quite find the words for the ineffectiveness and overburden she saw in these facilities. There are just not enough resources to provide adequate help.
“Every time [my son] is set up for failure because he’s not getting the treatment he truly needs,” Deborah said.
Last year, Jake was diverted by the courts and placed into treatment with the understanding that he would be receiving psychiatric treatment. That didn’t happen because there was no directive from the judge, or so Deborah was told.
After ping-ponging between her son’s public defender and probation officer, she found out her son was, in fact, able to access psychiatric treatment – with or without direction from the court.
“[The probation officer] says, ‘Well, we didn’t want to put too much pressure on your son,’” according to Deborah.
“My son’s treatment program was four hours a week of lessons; the rest of the time was freedom at a sober living house… all he did was play video games,” she explained. “He didn’t even have weekly therapy. He didn’t even meet with a psychologist or therapist.”
Finally, after some encouragement, Deborah got her son to volunteer to get psychiatric help — which he had to wait behind 35 people to benefit.
“Then, he relapsed,” Deborah said. “After four months, he never got that spot, and he relapsed into drug use.”
Jake is possibly a candidate for CARE Court.
No ‘Punk Rock’
New policy frameworks, conservatorships, and county-wide behavioral health initiatives all have the same goal: Ensuring — by either voluntary or involuntary means — that a specific population is getting treatment and has a safe place to live.
The terms of note in these conversations are “gravely disabled” and “severely mentally ill,” both are defined by the state with varied dictations on the level of intervention legislative bodies are allowed to impose.
The CARE Court proposal inherently means that an individual is subject to a locked placement — such as a 5150 or a 5250 or eventually conservatorship. However, these individuals must be in the least restrictive, most clinically appropriate level of care at any given time.
“This is all over the LPS Act,” De Vico said, “The way you prove to the court that an individual needs a higher level of care is to show that the existing level is insufficient.”
To some, the need for more access to locked treatment facilities and clinically-sufficient supportive step-down services that promote that individual’s success is inarguable.
However, a boney policy initiative is a focus rather than employing the tools already laid out in behavioral health programs.
According to De Vico: “When we expand access to these programs, what we’re really saying to everybody out there who would already be using this program is, ‘We just want to let you know that you’re still eligible, but those of you who cannot make use of a voluntary resource or who need to receive stuff on an involuntary basis in a closed setting for a while, we’ve done nothing to increase your odds of getting treatment.”
Law enforcement has the discretion to transport an individual to an Emergency Psychiatric Unit to be evaluated and possibly placed on hold. The public also has access to a petition for court-ordered evaluation if they believe someone has been hiding in the blind spots of county professionals and law enforcement.
“The CARE court initiative does not have a single provision anywhere in it… that increases resources for the gravely disabled,” he said.
The bill should include more oversight, in De Vico’s perspective.
“For all of the oversight or redundancy that it creates, none of that has anything to do with ensuring that the people who decide who’s going to go to the ER, who’s going to go to the hospital, who’s going to end up possibly on a 14-day hold will be reviewed, supervised to see if they are operating in good faith,” he said.
This is a major red flag to Cusack, representing 30 people suffering homelessness for various infractions. She doesn’t trust putting the lives of the unsheltered, particularly those with severe mental illnesses, in the hand of those who treat them carelessly.
Cusack thinks the bill is another wrong decision in a string of those harming the homeless population.
“The mental health trauma that people is suffered at the hands of the state,” Cusack, who named the five threats homeless people face: Service providers, other homeless, the public, the police, “the act of just being homeless is an act of systemic violence imposed by the state.”
Read The Coast News’ profiles on homeless residents in North County San Diego:
“Homeless in North County: Joseph’s Story”
“Homeless in North County: Luke’s Story”
“Homeless in North County: Jake’s Story“
CORRECTION: The article misstated that Oceanside officials had supported the CARE Court bill. The Oceanside City Council is still considering the bill but has yet to sign anything in support of the legislation.