Newsom's “CARE Courts” Would Compel Treatment for the Mentally Ill

Gavin Newsom’s views on mental health and compulsory treatment appear to be evolving. With an intractable homeless and public safety crisis looming over his re-election, the governor has announced a bold new plan to force some unhoused people with severe mental health or substance abuse issues into treatment.

The proposal would establish Community Assistance, Recovery, and Empowerment or “CARE” courts in every single county in California. Counties, relatives or first responders could refer an individual to the civil CARE court for assessment. The individual would be assigned a “Supporter” and a public defender to implement a Shared Decision Making model of treatment. Treatment could include medication, therapy or other services. If necessary, the individual would be mandated to receive court-ordered care for up to 24 months. Those who fail to complete the program could be referred for conservatorship or hospitalization.

As POLITICO’s Jeremy B. White notes, this represents a stark change in tone from just five months ago when the governor vetoed a bill to require substance abuse treatment for convicted drug offenders.

"Coerced treatment for substance use disorder is not the answer...I am concerned that this is a false choice that effectively leads to forced treatment,” Newsom said at the time.

On Friday, however, the governor remarked: "There's no compassion stepping over people in the streets and sidewalks. There's no compassion reading about someone losing their life under [Interstate] 280, in an encampment ... We could hold hands, have a candlelight vigil, talk about the way the world should be, or we could take some damn responsibility to implement our ideals."

The new CARE court system would have to be approved by the Legislature. It’s not clear how much the plan would cost, but every county would have a role to play in its implementation.

“All counties across the state will participate in CARE Court under the proposal,” according to the governor’s office. “If local governments do not meet their specified duties under court-ordered Care Plans, the court will have the ability to order sanctions and, in extreme cases, appoint an agent to ensure services are provided.”

The California State Association Counties (CSAC) says the governor reached out to them to develop the framework.

“Counties need to learn more about the county role and any new mandates, requirements, or sanctions associated with the proposal,” CSAC said in a bulletin. “Requiring county services to engage with an entirely new court model – even if the participant is already a client of county services or eligible for such services – represents new additional workload when county departments are already stretched thin by vacancies and increasing demand for intensive behavioral health services.”

The plan has already received support from many individual city and county leaders, including Los Angeles County Board of Supervisors Chair Holly J. Mitchell, San Francisco Mayor London Breed, Oakland Mayor Libby Schaaf, San Diego Mayor Todd Gloria, and Sacramento Mayor Darrell Steinberg. Bakersfield Mayor Karen Goh also expressed optimism, but says she is awaiting details.

If history is any guide, the governor is likely to receive pushback from civil rights groups that oppose compulsory treatment. Those same groups opposed implementation of a 2002 law that makes it easier for participating counties to force severely mentally ill persons with a history of threats or violence into outpatient treatment.