How California’s CARE Court Will Treat Mental Illness

California has a new statewide approach to treating people with serious mental illness: the court of care.

The program connects people in crisis to a court-ordered treatment plan for up to two years, while diverting them from possible incarceration, homelessness or court-ordered restrictive guardianship.

Governor Gavin Newsom signed the measure (Senate Bill 1338) into law on Wednesday. Because it doesn’t take effect immediately, however, most California counties won’t see implementation of the program until 2024.

The law takes a phased approach, with Glenn, Orange, Riverside, San Diego, Stanislaus, Tuolumne and San Francisco counties implementing the program by October 2023. The remaining counties are required to start the program no later than December of the following year. .

How will CARE Court work?

To initiate a treatment plan, a family member, behavioral health care provider, or first responder asks a judge to order an evaluation of an adult with an untreated psychotic disorder (such as schizophrenia) who is in urgent need of treatment and, in some cases, housing. . A court can also initiate the program by referring a person from assisted outpatient treatment, guardianship proceedings, or misdemeanor proceedings to a CARE treatment plan.

The judge then orders a clinical assessment and appoints a lawyer and a volunteer support person from CARE. The support would help a CARE beneficiary understand the options available in the program so that the beneficiary can make decisions with as much autonomy as possible.

If the person meets the criteria, the judge then orders a series of hearings and the development of an individualized, culturally and linguistically appropriate CARE plan.

The plan – developed by county behavioral health professionals, the individual and volunteer support – may include behavioral health treatment, medication, substance abuse treatment, social services and housing specific to the needs of the patient. ‘individual.

If necessary, the court can make orders necessary to help the CARE recipient access housing and services, including imposing penalties on providers and local government agencies if they fail to provide court-ordered services or treatment .

Throughout this process, the court will hold status hearings as needed to check in with the recipient and review progress made, services provided, any issues the person may have with the program, and recommendations to make the plan more efficient.

Graduates of the program will remain eligible for ongoing treatment, support services and community housing to support long-term recovery.

Who is eligible for this program?

The CARE Court program is for people diagnosed with schizophrenia spectrum disorder or other psychotic conditions of this class, as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders.

A person with these mental health issues must also be 18 years of age or older and not currently stabilized with treatment. Additionally, the person must be significantly deteriorating and “unlikely to survive safely in the community without supervision” or at risk of a relapse or deterioration that would result in “serious disability or serious harm to the person or other people “.

This program may be an appropriate step for someone who has suffered a short-term involuntary hospitalization (either 72 hours or 14 days) or who can be safely diverted from certain criminal charges.

Is this program voluntary?

Although participation in CARE plans is voluntary, a court can establish a plan for a qualified person without that person’s consent, and a judge can order housing and other services for that person. Some critics of the program, including the ACLU and Human Rights Watch, argue that it is coercive to force people to appear in court as a means of providing treatment.

No penal sanction can be pronounced if the person refuses or omits to participate. Individuals who do not successfully complete their treatment plan will be disqualified from the plan, although they will still be entitled to all services and supports for which they are eligible.

In such cases, a court can use the existing authority under the Lanterman-Petris-Short Act to ensure a person’s safety by notifying the county behavioral health agency and the Office of the Conservator and Public Guardian.

If all appropriate CARE plan services have been made available but the person has not participated, this will affect any hearings held for that person under the Lanterman-Petris-Short Act within the following six months, creating a presumption that the person needs additional intervention beyond what CARE can provide.

Times editor Anita Chabria contributed to this report.

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