Who’s prodding the homeless mentally ill into care under new law?

No, droves of mentally ill people haven’t been yanked off the streets, thrown into padded wagons and medicated against their will.

Actually, the first year of California’s CARE Court action might be described as a deliberate, prudent, cautious foray into a fraught landscape where individual rights and societal responsibility meet, earnestly trying to avoid collision, carefully executing a delicate dance.

The law, championed by Gov. Gavin Newsom and shepherded through the Legislature by Sen. Thomas Umberg, D-Santa Ana, was a philosophical faceoff between those who argued that folks should be free to chart their own course without government intervention, and those who argued that civilized societies don’t allow mentally ill people to live — and die — on public streets.

Newsom and Umberg won. The law started by narrowly targeting severe cases of untreated mental illness (such as schizophrenia) in fewer than 10 guinea pig counties (including Orange, Riverside, San Diego and Los Angeles) more than a year ago. It allowed police, medical personnel, social workers, family members and the like to request intervention for people who may not know they need help, and could expand this year to include folks with bipolar disorder as well.

Some data is in, and one thing is particularly striking: The great majority of petitions aren’t coming from police or doctors or social workers, but rather from family members — the very folks who’ve had to watch, utterly powerless, as their adult (but deeply troubled) children, parents, spouses and siblings descended to dangerous depths.

Because those troubled loved ones were legally adults, there was little heartsick families could do to intervene. Until now.

“Families are eager — as any family would be — to explore all avenues to get help for their loved ones,” said Marcus Cannon, deputy director of behavioral health at Riverside University Health System. “Care Court has been a new avenue, a new tool, for families to not only ask for help from the county behavioral health department, but — because of the formality of the court process — there’s interest in using it to impress upon their loved one the urgency of the situation.

“While it’s still voluntary, involving courts and judges creates sense of urgency and solemnity that families are eager to avail themselves of,” Cannon said.

In a report to the Legislature in November, the state Department of Health Care Services said that Initial results from CARE Court’s early implementation “demonstrate the program is making a significant impact by addressing some of the most severe cases of mental health crises on California’s streets.”

In the nine counties where CARE Court was being implemented, it provided “crucial treatment and housing plans” to hundreds of people with schizophrenia and other psychotic disorders. “This progress reflects a meaningful shift in helping the state’s most vulnerable populations towards long-term recovery and housing stability, showing CARE Court’s ability to reduce the need for crisis services andcreate a path to lasting wellness,” the report said.

More than 900 people connected with county behavioral health departments since the CARE Act’s early implementation, it said. Families were the leading petitioners.

• Statewide over the program’s first nine months, 557 petitions were filed with the courts, and another 362 people engaged with help through county health departments.

• Of those 557 petitions filed, 217 — 39% —were dismissed by judges. That’s not necessarily a bad thing: The person may not have met the specific CARE Act criteria and been directed to other resources.

• The 362 people were connected to help via CARE outreach, directly engaged in services and “diverted” from CARE Court, DHCS said.

Since this data was prepared, CARE Courts have expanded to counties statewide. The number of people engaged is expected to rise as local officials and first responders learn how to use it, and the first full data report on CARE Courts is due to the Legislature by July, DHCS said.

On the front lines

• In Los Angeles County, officials provided a meaty update to the Board of Supervisors last month.

As of Feb. 28, its CARE Court had received 485 referrals and 386 petitions. Family members initiated and filed 305 of those petitions; the L.A. County Department of Mental Health initiated 32; another 25 came from the California Department of State Hospitals; 12 from the Department of Mental Health Provider Network; seven were filed by people seeking help for themselves; and five came from the California Department of Corrections and Rehabilitations.

The court dismissed 130 petitions, most commonly because people were receiving adequate mental health services (43); they needed a higher level of care (29); they didn’t meet the diagnostic criteria (17); or they no longer lived in Los Angeles County (15).

Updated figures from L.A. County show that 413 petitions have now been filed, and that the overwhelming majority — 320, or more than 77% — came from family members. They’ve resulted in 77 CARE agreements (entered into with the person’s consent) and four CARE plans (to help people regain competency).

• In Orange County, 128 petitions have been filed, resulting in 10 active care agreements, with 65 in progress.

About 30% of petitions have come from family members, another 30% from the O.C. Health Care Agency, 13% from clients themselves, 10% from hospitals, 6% from the Public Guardian and 11% from others, such as first responders and behavioral health clinicians.

• In Riverside County, 154 petitions have been filed, resulting in 42 CARE agreements, but no CARE plans to date.Again, the majority of petitions came from family members, followed by the county behavioral health department.

• In San Bernardino County, which just started the program on Dec. 1, there have been 11 petitions filed. They’ve come from state prisons, state hospitals, transfers from other counties (petitions filed elsewhere, though the person resides in San Bernardino County), and, of course, family members.

One petition is heading toward a voluntary CARE agreement, while another was dismissed because the person couldn’t be located (and was believed to be living, unsheltered, in another county).

Takes time

Umberg’s Senate Bill 1338 passed in 2022 and established the Community Assistance, Recovery and Empowerment (CARE) Act, providing community-based behavioral health services and supports to Californians living with untreated schizophrenia or other psychotic disorders who meet certain health and safety conditions — through a civil court process.

It certainly hasn’t been easy. Much of the initial work involved recruiting staff, designing workflows and figuring out how to manage the myriad data collection requirements. It requires collaboration between courts, county lawyers, mental health experts and families.

Staffing has been an issue. In Los Angeles, for example, just 64 of 104 positions have been filled, with most of the vacancies involving psychologists, psychiatrists and nurses — professionals in short supply nationwide. Officials are trying to overcome that by bolstering recruiting, forming partnerships with colleges and universities, increasing internship opportunities and participating in loan forgiveness and repayment programs, state officials said.

They also issue warnings about tempering expectations.

“The CARE Act process can take time — like all mental health and substance use disorder care — to build the trust and to develop the self-directed plans needed for long-term recovery and stability,” DHCS said. “While the CARE Act is still in its early stages, the program is showing promise — and the state’s ongoing investment in treatment capacity, housing and workforce development through initiatives like Proposition 1 and the Behavioral Health Services Act reforms will help ensure that more people will access the care they need.”

Take heart: The very first “CARE graduation” happened Aug. 7 in San Diego County.

The woman struck a CARE agreement early on, as a step-down from living in a locked setting subject to conservatorship, DHCS said. She received wrap-around services — case management, peer support, therapy, medication evaluation and management, social service benefits and vocational help. After several months, she and her family felt she had achieved her treatment goals and was ready to move to a new community.

Graduation ceremonies are exciting and festive affairs, said Riverside County’s Cannon, with balloons and flowers and certificates and photos. Riverside County has had three of them. The graduates and their families gather in court with the judge, public defender and treatment team to celebrate success and go over the graduation plan that spells out what will happen going forward.

“Those are really exciting days,” Cannon said. “We’ve had a graduate return to work, and another who had been estranged from family move back in with family.”

Change may be hard, but it can happen.

“California’s transformation of the larger behavioral health system is underway, with a focus on the most seriously ill and homeless,” DHCS said. “Thousands of new treatment sites and permanent supportive housing units are opening, under construction, and in the process of applying for new Prop 1 funding. New statewide workforce investments from Prop 1 will begin in July 2025 and continue annually. Ongoing funding to counties for treatment and housing is available through Prop 1’s reform of the Behavioral Health Services Act and other existing funding totaling around $11 billion annually.”

Here’s hoping that buys peace and stability for the people who need it most.

Have you filed a CARE Act petition? Email us at tsforza@scng.com. For more information on the CARE Act, see https://www.chhs.ca.gov/care-act/. For details on how and where to file a petition, see https://www.chhs.ca.gov/care-act-petitioners/