California considering mandatory mental treatment

The Rev. Andy Bales has spent the past 36 years serving the homeless. The current mental health crisis affecting America’s homeless population has left even him amazed.

“The pandemic and the introduction of fentanyl into the drug scene has just wiped out people’s mental health,” said Bales, the president of the Union Rescue Mission homeless shelter in Los Angeles.

In response to the crisis, California Gov. Gavin Newsom proposed a new solution: the Community Assistance, Recovery, and Empowerment (CARE) Court bill. If passed by the California legislature, the bill would establish ways to provide court-ordered behavioral health treatment to people experiencing schizophrenia or other severe psychotic disorders. The California Senate passed the CARE Court bill unanimously on May 25, and it is now making its way through state Assembly committees.

The National Alliance to End Homelessness estimates there are about 580,000 homeless people in the country. About 25 percent of them experience serious mental illness, according to the U.S. Department of Housing and Urban Development. California’s CARE Court bill aims to provide preemptive treatment before an involuntary hospital stay, an arrest, or guardianship, which restricts a person’s right to make decisions such as consenting to medical treatments, owning property, marrying, voting, or choosing where to live.

Under the CARE Court program, a concerned party could ask a county court to order a clinical evaluation of a person struggling with a severe psychotic disorder. Concerned parties might include family members, licensed behavioral health providers, charity workers, or first responders. If the court agreed that the person needed treatment, the county and the participant would establish a one-year care plan for providing medicine and housing with the help of a support person.

Opponents of the proposal do not like that the court could order “involuntary treatment” such as medication for severely ill patients who are resistant to care. Human Rights Watch said the system would “rob individuals of dignity and autonomy” through “a system of involuntary, coerced treatment.”

Bram Begonia, president of the Bay Area Rescue Mission, said he doesn’t believe involuntary treatment will be as effective as his organization’s holistic approach, which emphasizes helping people voluntarily transform their mind, body, and soul. Begonia said recovery has two basic steps: the person struggling with mental health issues must admit there is a problem and want a solution.

“Those two things seem to be very overlooked from a human rights standpoint in this bill,” Begonia said.

But for other Christian homeless shelters working in the state, CARE Court represents a promising shift in direction. Bales said if his organization could refer its most severely ill clients to a CARE Court for involuntary treatment, it would help.

“There’s really been no instrument or tool to save somebody from themselves up to now,” said Bales. “I think the CARE Court would enable somebody like me, who cares about a person struggling on the street who’s a danger to themselves or others, to take them before the court and get relief for them.”

Someone who resisted the CARE Court’s order for mental health treatments could not receive criminal punishments for noncompliance, though they might have to face the consequences that the court was trying to prevent such as arrest or conservatorship. For Stephen Eide, a senior fellow for social policy at the Manhattan Institute, this lack of incentives undermines the progress that he believes involuntary treatments could make.

“I really need to see leverage to have a lot of confidence in the fact that [CARE Court] really would help as advertised,” said Eide. “Not only keeping people from being further sucked into the criminal justice system but also to … incentivize treatment for a population that needs it.”

Local government officials expressed different concerns about the logistics and funding of CARE Court. Anders Corey, the health deputy for Los Angeles County Supervisor Kathryn Barger, said Barger’s office supports CARE Court as a pathway to involuntary treatment. However, it is concerned that the state is not providing additional funding to help the county implement the program.

Regardless of the final version of the bill, Bales and Begonia agree something needs to be done to address California’s worsening homeless crisis. Both of their organizations are expanding to fill the need. Union Rescue Mission finished constructing the 86-unit Angeles House for unsheltered children and their parents in April. The building is nearly full without any advertising. Bay Area Rescue Mission just completed the 114-bed Muriel E. Mayes Center for Women & Children in May. That building is almost at capacity, as well.