Overview:
Hopes are high among elected officials as the CARE Court system goes online in Fresno County and beyond. Among those hopes are that CARE Court will be part of California's cure for homelessness.
But health experts across the state are trying to soften some ambitious promises made by elected officials, and some advocates are already levying criticism to how the practice may affect the state’s most vulnerable.
A new California mental health care plan aims to help those with debilitating mental health and substance abuse disorders but experts in Fresno County say politicians, including the governor, have over-promised the plan as part of a solution to the state’s relentless homelessness crisis.
The programs will do a lot of good, they say, but won’t lead to an exodus of homeless encampments.
“The CARE Act and Proposition 1 are intended to strengthen the behavioral health continuum of services,” said Susan Holt, director of the Fresno County Department of Public Health, “but neither of them are, in and of themselves, a solution to homelessness.”
California counties, including Fresno County, launched the CARE Court system on Dec.1 — a new state-wide health plan prominently backed by Gov. Gavin Newsom to help individuals with untreated psychotic disorders, like schizophrenia, connect with community-based mental health services.
Newsom in 2022 signed the bipartisan CARE, or the Community Assistance, Recovery, Empowerment Act, as a part of Senate Bill 1338 — authored by state Sen. Thomas Umberg and former state Sen. Susan Eggman, and others, including Central Valley state Sen. Anna Caballero, D-Merced. The act had near-unanimous support from legislators.
“It’s time that our Golden State stops walking by our greatest moral shame, and faces it head on with clarity and compassion,” said then Oakland Mayor Libby Schaaf at Newsom’s signing ceremony in 2022.
Backed by data from the U.S. Department of Housing and Urban Development, Newsom and other elected officials say an overlap exists between individuals who cannot access mental health services — and who would qualify for CARE Court — and the homeless population.
HUD’s 2023 Point In Time data reports that approximately 38% of the United States’ 653,104 homeless population are either severely mentally ill or suffering from chronic substance abuse.
Data shows California’s unhoused populations have even higher rates of chronic substance abuse and untreated mental health disorders. Within the state’s 181,399 homeless, about 50% fall within one of those two categories.
And locally, that rate jumps to 64% among the Fresno-Madera region’s 4,493 homeless population.
The Fresno-Madera region only has 3,814 year-round beds available, based on the Continuum Of Care’s most recent data.
But health experts told Fresnoland they fear politicians, including Newsom, are creating false expectations with the promise of CARE Court as a solution to the state’s decades-old homeless crisis.
What is CARE Court, and who does it affect?
The CARE Act aims to provide easier access to existing community-based mental health services for individuals with schizophrenia and related disorders through a court-ordered treatment plan.
But it’s designed to be completely voluntary.
Family members, first responders and healthcare professionals related to prospective patients can file a civil petition to the courts to begin the process, but the person in question chooses to participate or reject the treatment plan.
The California Court’s website estimates 8,000 to 12,000 individuals across the state qualify for CARE Court.
Experts who spoke with Fresnoland said the state’s new CARE Court shouldn’t be confused with long-standing drug court, which is a criminal court process.
Compaing CARE Courts and Drug Court
Drug court is a decades-old state program that aims to help certain individuals facing jail time for drug-related criminal offenses to circumvent incarceration by opting into a treatment program.
The City of Fresno installed the Treatment First Program earlier this year. The TFP offers individuals violating the city’s anti-encampment ordinance — typically those who are homeless — with local resources to help them get out off the street, subject to availability.
Though both drug courts and Treatment First have the capacity to find housing for some of Fresno’s most needy, they are also presented to individuals as an alternative to incarceration.
“That goes completely against what the CARE Act is supposed to be,” said Fresno County administrative officer Amina Flores-Becker.
A misconception people like Holt and Flores-Becker have tried to address surrounding CARE Court is the belief that these practices are the same, or that one will replace the other. Flores-Becker said the key distinction is that CARE Court will be a “civil process” unlike drug court, which has historically been for criminal cases.
“CARE Act is a civil process and it is 100% voluntary,” Flores-Becker said. “So even if there is a court-ordered care plan executed, a participant in various scenarios can reject that offer and nothing punitive will happen to them.”
Critics skeptical that program won’t be voluntary
However, CARE Court’s critics have been skeptical on how “voluntary” the court process will be.
Disability Rights California is a nonprofit organization that “defends, advances, and strengthens the rights and opportunities of people with disabilities.” Among the reasons they “strongly oppose” CARE Court is the argument that people with schizophrenia and related disorders may not be in the right mental state to properly advocate for themselves.
“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,” the nonprofit said in a statement last year..
Other opposition groups, like the ACLU of California , Human Rights Watch and the National Homelessness Law Center, say CARE Court can also “perpetuate institutional racism and worsen health disparities.”
These critiques are pointed at two long-standing practices that can revoke an individual’s rights, and that critics feel CARE Court may funnel vulnerable people into — 5150 holds, and conservatorship.
A 5150 is a hold of up to 72 hours by qualified law enforcement and health professionals for individuals who are “a danger to others, or to themselves, or gravely disabled,” due to a mental health disorder. A conservatorship is a court process that allows a judge to appoint somebody to make decisions for a “person who needs help,” which can include individuals with mental health disorders.
The CARE Act does not amend these laws.
Elected leaders like Newsom, however, don’t agree with CARE Court’s critics who see these practices as a reason for concern.
“Those are talking points that have been on rewind for decades and decades, and I’m frankly exhausted by them,” said Newsom in a 2023 interview with 60 Minutes about CARE Court.
“Prove us wrong, don’t assume us wrong,” Newsom later said. “Your compassion is not superior to our compassion.”
Dez Martinez is a formerly homeless Fresnan who founded We Are Not Invisible — a local nonprofit offering resources to Fresno’s Homeless. She also has a son with a substance-use disorder. Martinez is anxious CARE Court can result in people like her son going through forced treatment.
“All they’re looking to do is find my son and throw away the key,” Martinez said.
Martinez also said she believes natural alternatives to court-ordered treatment may be more helpful for people CARE Court stands to benefit, like her son.
“Holistic treatment will fix it,” Martinez said. “Getting back to his culture, getting back to Mother Earth, that’s what will fix it.”
What could CARE Court look like in Fresno?
Eight pilot jurisdictions across the state started CARE Court a year early and their data suggests progress will be slow-going.
Flores-Becker said that in a recent debrief from San Diego County, only about a third of all submitted petitions were for homeless individuals. That data from San Diego County, which more than doubles Fresno in population, doesn’t take into account how many applications have been thrown out for technical or administrative reasons.
In October, a year after San Diego County initiated CARE Courts, 64 CARE agreements were made, with two completed, according to a San Diego County news release.
A spokesperson for the San Diego Health And Human Services Agency told Fresnoland that 32% of submitted CARE petitions indicate a client is homeless, and that 53% of CARE agreements were for clients who were unhoused. However, healthcare workers have found that the data can be unreliable. In a petition, “unhoused” can include individuals who are incarcerated, or in a short-term hotel bed.
Stanislaus County has shown another barrier to getting individuals — homeless or otherwise — the services they need: a lack of understanding for a new system.
The Central Valley Journalism Collaborative reported that in the first month of opening CARE Courts, 36 petitions were submitted, with 10 thrown out due to ineligibility.
Flores-Becker said it’s discussions with these pilot counties that made Fresno aware that “outreach and engagement” play a crucial role in the success of the CARE program.
According to Flores-Becker, San Diego County also reported it took an average of 56 days of engagement to get an individual to voluntarily opt into a treatment plan, with extreme cases taking up to 134 days.
That length of time, Holt said, isn’t out of the ordinary.
“It’s very typical for the population that the CARE Act is intended to reach,” Holt said. “We’re talking about individuals who are, by definition in the CARE Act, not engaged in services, and so the nature of their mental health condition is such that many of those individuals have a condition by which they don’t have an awareness that they have an illness.
“A lot of individuals have had experiences with various systems which have led them to not trust individuals who purport to want to help,” Holt later added, “and so it takes multiple contacts in order to develop a trusting relationship, in order for a person to accept services.”
Flores-Becker told Fresnoland that, though CARE Court can bring a lot of good to the county, the narrative that it can cure homelessness is misguided.
“I don’t mean this as a criticism at all,” Flores-Becker said, “but I do think that in my world people are desperate to find solutions, and so I think it’s very well intentioned to hope that this will do something that it just won’t.
“I constantly feel like I’m just killing everybody’s dreams when, as well intentioned as those dreams were, they were never really the reality,” Flores-Becker added. “It’s fair for them to feel disappointed in that, but I think the biggest misconception is that this is going to solve homelessness, and it’s not, because it impacts a very small percentage of the unhoused, unsheltered population.”
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