Newsom plans to overhaul California’s mental health care

In a bold new effort to combat homelessness, Gov. Gavin Newsom’s administration plans to overhaul a behavioral health system that for years has failed thousands of Californians with severe mental illness, leaving many to cycle in and out of jail or hospitals and languish on the streets.

The centerpiece of Newsom’s proposal is a system of court-ordered mental health care for people suffering from psychosis who have lost their ability to care for themselves. It would bring them before a judge, who could place them in a mandated treatment plan that would include psychiatric treatment, medication and housing. Counties would be required to provide the treatment ordered.

The “Care Court” plan is part of Newsom’s broader effort to eliminate homeless encampments across the state. It’s intended to reach the “sickest of the sick” — people living in squalor, sometimes talking to people who don’t exist and potentially self-medicating with narcotics, who may refuse treatment because they don’t understand they’re sick.

“We’re putting everything we can into this,” Newsom said Thursday at Crossroads Village — a San Jose treatment facility run by Momentum for Health. “We recognize what you see every single day. It’s unacceptable. And we recognize our responsibility. Our moral responsibility.”

SAN JOSE, CALIFORNIA – MARCH 3: Employees for Momentum for Health, a mental health treatment center in San Jose, Calif., listens to Governor Gavin Newsom propose his ÒCare CourtÓ program that would target people suffering from psychosis who have lost their ability to care for themselves, Thursday, March 3, 2022. (Karl Mondon/Bay Area News Group) 

The program would need to be passed into law by the state legislature, and a bill has not yet been written or introduced, said Jason Elliott, senior counselor to Newsom. First, the administration wants to hear input from families of people with mental illness, clinicians and others in the community.

“We hope that that bill will be taken up and passed by the legislature very quickly, so we can get that into law,” Elliott said, “because we don’t have any time to waste here.”

Between about 7,000 and 12,000 Californians would be eligible for Care Court, California Health and Human Services Secretary Mark Ghaly told reporters Thursday.

The program would provide a middle-ground alternative to conservatorships, which force people into treatment, often in locked facilities. Because of their restrictive nature and their infringement upon the subject’s civil rights, conservatorships are controversial, difficult to obtain and relatively rare. Care Court would mandate treatment while allowing the subject to continue to live in the community.

The program could have significant implications for the state’s homelessness crisis. In Santa Clara County, 42% of unhoused people surveyed in 2019 reported having psychiatric and emotional conditions. It was 39% in San Francisco. And in Alameda County, 32% of homeless adults reported having a serious mental illness.

Patricia Fontana, a member of Alameda County Families Advocating for the Seriously Mentally Ill, said she was heartened that Newsom appears to accept that some people are so sick they will never voluntarily accept help. Her organization is made up of people who have spent years trying and failing to find treatment for their loved ones.

But for Care Court to work, there must be consequences if participants don’t follow their treatment plan, Fontana said. So far, she said, it’s not clear those consequences are there.

“I think this is just another step toward recognizing that the system is a failure and there has to be a way to get people who don’t recognize that they need help,” she said. “So my reaction is: ‘Let’s see the details.’ ”

SAN JOSE, CALIFORNIA – MARCH 3: Oakland Mayor Libby Schaaf joined Gov. Gavin Newsom at a mental health treatment center in San Jose, Calif., for an announcement of ÒCare Court,Ó a program that would target people suffering from psychosis who have lost their ability to care for themselves, Thursday, March 3, 2022. (Karl Mondon/Bay Area News Group) 

If clients do not follow their Care Court treatment plans, they could be referred into a more restrictive conservatorship or back to jail if they have a criminal case pending, according to Newsom’s administration. If counties fail to provide the services someone needs, the court could order sanctions or appoint an agent to ensure compliance.

Ideally, a person would enter Care Court before their condition deteriorated to the point where a restrictive conservatorship was needed — or before they committed a crime that landed them in jail. Clients could be referred to the new program by a number of stakeholders, including family members, clinicians, outreach workers, the court and first responders.

People admitted into Care Court also would be assigned a “supporter” — a caseworker who would help them develop a care plan. A client’s time in the program would last up to a year and then could be renewed for another 12 months.

Clients also would be matched with housing if needed. Newsom has proposed $1.5 billion in this year’s budget to house people with behavioral health conditions.

The current treatment systems are broken, Newsom said Thursday. That’s why he’s pushing to create a new path, rather than reforming conservatorships or other programs, he said.

In the 2019-2020 fiscal year, 56,800 people were placed on an involuntary 72-hour psychiatric hold in California, according to the governor’s office. But when that hold expires, many of them end up back on the street. During that time, 7,369 people were under conservatorships of between 180 days and one year.