Gov. Gavin Newsom announced a program last week that would shift how counties like Alameda are required to address mental health crises. Credit: Governor Gavin Newsom/Youtube

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Gov. Gavin Newsom wants to overhaul how residents with serious mental illnesses, many unhoused, are treated in Alameda County and across the state.

Newsom announced his “care court” proposal in San Jose last week, alongside Oakland Mayor Libby Schaaf and other supporters. The new civil court wing would allow family members, clinicians, first responders, and county staff to refer people experiencing a mental health crisis. A judge could require a 12-24 month treatment plan for the individual, including behavioral health services, medication, and housing.

Anyone referred to care court—an acronym for “community assistance, recovery, and empowerment”—would be represented by a public defender and would be provided a case manager, called a “supporter,” to help craft their specific care plan. 

At another press event with several other California mayors, Schaaf praised what she called a “system that actually heals and cares for people, and does not just cycle them inhumanely between the streets and a psychiatric hospital.”

Proponents of care court, which will need approval from the state legislature, say it would provide a more effective and compassionate response to mental illness and substance abuse than funneling people through the criminal justice system, where some end up. However, care court is not always a diversion program; people can be referred to it even if they haven’t been arrested for a crime. The court could impose sanctions on counties that don’t carry out the care plans.

Alameda County’s treatment of people with mental illnesses was recently the target of a U.S. Department of Justice investigation that found the county violated residents’ civil rights, failing to provide adequate treatment and jailing them for lack of hospital space or other more appropriate facilities and resources. And despite serving as the mental health treatment center for so many people, Santa Rita Jail lacks effective services and safe conditions, the federal government found. A recently settled class-action lawsuit will also require a massive restructuring of the mental health system at the jail.

But the “care court” alternative has drawn criticism from civil- and disability-rights groups opposed to mandatory treatment programs. If someone does not comply with the court-mandated care plan, they could be referred for conservatorship, a controversial process where a court appoints a guardian to make decisions for the individual.

“Anything that involves a court order is coercive, because there are consequences if someone is unable to follow a court order,” said Kim Pederson, senior attorney with Disability Rights California. “That could be jail or conservatorship, exactly the bad consequences the governor is saying he’s trying to address.”

Pederson said many of her clients who have serious mental illnesses or are unhoused have been mistreated by the court system in the past and are distrustful of it.

“There’s a history of court orders and state control over people with disabilities who are deemed to not be able to make decisions for themselves,” she said. Care court is “not a new tool—it’s involving a court system to control the lives of persons with disabilities.”

When he announced the program last week, Newsom pushed back on criticism that the care court is inhumane.

“There’s no compassion in stepping over people on the sidewalk,” he said. “The mayor of Oakland can say: I now have the ability to help this individual who clearly can’t help herself, and get her off the streets so she doesn’t become a statistic.” 

Schaaf said the program would also empower first responders and other city workers to better serve people in crisis. According to the mayor, over one recent year in Oakland, there were more than 4,000 ambulance transports to John George Psychiatric Hospital, and there were more than 100 people who were transported at least six times during that period. 

In recent years, Alameda County has had the highest rate of emergency psychiatric hospital admissions of any county in California.

“Our police officers, firefighters, and paramedics will welcome this because it is demoralizing to try to help someone and bring them into safety only to see them back on the streets 72 hours later,” Schaaf said.

Alison Monroe, of Alameda County Families Advocating for the Seriously Mentally Ill, or FASMI, said she appreciated that relatives would be able to refer their loved ones to care court. Monroe, who has struggled to get her daughter the help she needs, said the new role for families could actually make the system less coercive.

“The history is repellent and horrible things have been done to our kids in institutions,” Monroe said. “If families could be involved, there would be less of that.”

Recently Monroe’s daughter left the board-and-care facility where she was living and was found wandering the streets, using meth.

“There has to be some way of getting the very sickest not just off the streets but to where they can thrive,” Monroe said. “At a certain point, a person shouldn’t have the right to destroy themselves, or commit murder because of a delusion, as some people have.”

FASMI has long pushed Alameda County to build a new mental health hospital and more housing facilities for people with serious mental health needs.

Newsom said new infrastructure is a critical component of the care court plan. He said the program will draw on $14 billion, $12 billion of which is already budgeted, for supportive housing and treatment. That includes $3 billion that would support 33,000 new beds across the state. 

“People are understandably concerned about all this support that’s expected but doesn’t exist,” said Newsom. “Fourteen billion dollars will back up this approach.”

At the press conference, others brought up concerns around staffing new and existing facilities. 

Pederson, the disability rights attorney, told The Oaklandside that housing should be the primary element of any homelessness and mental health program, not a piece that’s contingent on accepting a court-ordered treatment plan. 

“Our position is housing solves homelessness,” she said. “And once you get people into housing, then you can engage them in services.”

One thing that many proponents and skeptics of care court agree on is that details about how it will work are scarce. No bill has been written yet, and Newsom’s administration has put out a call for input from groups working in the mental health, homelessness, and disability fields, said Pederson.

“I think it’s politically advantageous to be waffley about this,” said Monroe.

Natalie Orenstein covers housing and homelessness for The Oaklandside. She was previously on staff at Berkeleyside, where her extensive reporting on the legacy of school desegregation received recognition from the Society of Professional Journalists NorCal and the Education Writers Association. Natalie’s reporting has also appeared in The J Weekly, The San Francisco Chronicle and elsewhere, and she’s written about public policy for a number of research institutes and think tanks. Natalie lives in Oakland, grew up in Berkeley, and has only left her beloved East Bay once, to attend Pomona College.