CEO of California Council of Community Behavioral Health Agencies discusses CARE Court initiative

As part of California’s work to address serious mental illness and substance use disorder, which sometimes leads to individuals becoming unhoused, the CARE Court initiative, which stands for Community Assistance, Recovery, and Empowerment, connects individuals with a court-ordered care plan and supporter for up to 24 months. 

CEO of the California Council of Community Behavioral Health Agencies, Le Ondra Clark Harvey, PhD, received a call from the governor’s administration prior to the announcement of the initiative in 2022. Clark Harvey said the administration was interested in working with associations to identify a location to provide services. 

 

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“We were happy to provide a member agency location,” Clark Harvey told State of Reform. “The reason we decided to really step up on faith and participate with the administration is because we know that this population isn’t getting what they need.”

The initiative focuses on individuals who fall on the schizophrenia spectrum, in addition to other psychotic disorders, who may also have substance use disorders and who may be unable to make medical decisions. One goal of this program is to divert away from incarceration, or more restrictive conservatorships. 

The court-ordered response can be initiated by a family member, county or community-based social services providers, behavioral health providers, or first responders. Individuals who are exiting short-term involuntary hospital holds, or an arrest, may be especially good candidates for the initiative, according to the California Health and Human Services Agency (CalHHS). 

“My understanding is that you can be referred to CARE Court, you need to agree to CARE Court in terms of clients entering this new proposed setup, and that if so, what you’re agreeing to is to fully participate in the programs,” Clark Harvey said. “I think the mandatory part of anything is the referral—like if you’re referred then you’re asked to come. Obviously, people don’t have to do it, you’re not going to go to jail if you didn’t show up for your CARE Court appointment, but it will be noted that you didn’t follow through.” 

A care plan can be ordered for up to 12 months, with periodic review hearings, and can potentially be renewed for up to another 12 months. CalHHS states that individuals who don’t successfully complete the care plan may be hospitalized or referred to a conservator, with the presumption that no alternatives to conservatorship are available. Under conservatorship, the court appoints an individual to manage financial and personal affairs of a minor, or an incapacitated individual. 

Disability Rights California (DRC) has repeatedly advocated against Senate Bill 1338, the legal framework for the CARE Court initiative, which was approved by Gov. Gavin Newsom in September. 

“CARE Court is a coerced, court-ordered treatment system that strips people with mental health disabilities of their right to make their own decisions about their lives,” DRC stated. “It will do more harm because studies show forced treatment lessens the likelihood of people seeking voluntary treatment in the future.” 

DRC said the initiative creates additional stigma and stereotypes against individuals living with mental health disabilities or who are experiencing homelessness, which disproportionately impacts Black individuals, who make up 40% of the state’s unhoused population.

“They will be more likely to be subject to a CARE Court petition, and the court system does not have the appropriate care for people with mental health disabilities, especially Black and brown people,” DRC stated. 

DRC also noted how domestic violence is the third leading cause of homelessness in this country, and that housing is one of the main needs of survivors. DRC finds it concerning that a broad scope of individuals, including family members who may be perpetrators of domestic violence, can file a court referral, which creates a cycle of abuse. 

On Jan. 26th, DRC, the Public Interest Law Project, and the Western Center on Law & Poverty (WCLP) sued Newsom to put an end to CARE Court. In a statement, WCLP said CARE Court does not mandate counties to provide housing or behavioral health treatment, and it does not create new rights or benefits for people with schizophrenia or other psychotic disorders who are referred to CARE Court. 

“A person who, for any reason, does not follow through their court order, would more easily be conserved and lose their rights to control their own medical care, finances, and housing preferences,” WCLP stated. “No matter how Gov. Newsom and his proponents want to spin CARE Court, the law speaks for itself.”

Clark Harvey said the administration’s goal is to get 7,000 to 12,000 individuals the care they need through the CARE Court initiative, adding that the current system is not effectively working for this population. 

“The general concept makes sense and is something we support,” Clark Harvey said. “The treatment plan and the participation of the individual in that, I think, is critical.” 

As part of the court-ordered treatment program, participants can choose a supporter who assists the participant with understanding, considering, and communicating decisions. The care plan identifies services and supports, and offers a coordinated focus on the individual needs of the participant. In addition to the supporter, a public defender and a full clinical team will be made available.

“I think the care plan, which allows a person to really sit down with providers to figure out what their treatment plan is, including some housing supports and other supportive services, is very important,” Clark Harvey said. 

Clark Harvey is excited to be a part of an integrated system that assists individuals on their journeys to wholeness, and that the initiative reflects the idea of whole-person care. 

“I think a lot of the details of CARE Court are still being put together, and right now they’ve assembled a working group—we have two provider members that are on that working group—so I think a lot of the details and the logistics … are going to be informed by the work of that group,” Clark Harvey said.

She hopes to continue partnering and holding difficult conversations about the initiative, and hopes the working group can flush out crucial details around how the court is constructed and how it’s implemented. 

Clark Harvey will be a panelist for the 2023 Northern California State of Reform Health Policy Conference, coming up on May 23rd in Sacramento, where she will be speaking further on the CARE Court initiative. You can register here if you haven’t already!