New California Court for the Mentally Ill Tests a State’s Liberal Values

When LaVonne Collette’s adult daughter, Tamra, needed a place to stay during the pandemic after being evicted, Ms. Collette let her live in a rental property she owns in Los Angeles not far from Venice Beach. That didn’t go well.

Tamra began hoarding, stuffing the house with clothing and other items collected from charities. Ms. Collette saw signs of drug use and growing paranoia, and Tamra said she believed she was living among ghosts.

“She was telling me that my house was haunted and showing me pictures, and I would hear her screaming,” said Ms. Collette, who recounted her daughter’s behavior in documents filed in court.

Sensing in 2022 that the situation would only worsen, Ms. Collette asked her daughter to leave the house and bought her an R.V., in which she lived for a time near a creek on the west side of Los Angeles. That was better, Ms. Collette figured, than her daughter living in a tent or cardboard box. But the troubles continued. Last year, Tamra carjacked her mother outside a convenience store, her mother said in the court documents.

So when Ms. Collette, 68, saw news reports last year about a new state program that allows families to go to court to get treatment for loved ones who may be living in tent encampments and suffering from mental illnesses like schizophrenia, she found herself at the courthouse door as one of the first petitioners in Los Angeles.

“I believe that if she is not helped she’s going to die,” Ms. Colette wrote in the court filing. “And she is only 41 and she has a son who loves her and mom and brother who loves her.”

The new initiative, called CARE Court — for Community Assistance, Recovery and Empowerment — is a cornerstone of California’s latest campaign to address the intertwined crises of mental illness and homelessness on the streets of communities up and down the state.

Another piece of the effort is Proposition 1, a ballot measure championed by Gov. Gavin Newsom and narrowly approved by California voters this month. It authorizes $6.4 billion in bonds to pay for thousands of treatment beds and for more housing for the homeless — resources that could help pay for treatment plans put in place by CARE Court judges.

And Mr. Newsom, a Democrat in his second term, has not only promised more resources for treatment but has pledged to make it easier to compel treatment, arguing that civil liberties concerns have left far too many people without the care they need.

So when Ms. Collette went to court, she was surprised, and disappointed, to learn that the judge would not be able to mandate treatment for Tamra.

Instead, it is the treatment providers who would be under court order — to ensure that medication, therapy and housing are available in a system that has long struggled to reliably provide such services.

“I was hoping it would have a little more punch to it,” Ms. Colette said. “I thought it would have a little more power to order them into some kind of care.”

Yet it seemed like her only option, so she made the petition and hoped.

CARE Court is Mr. Newsom’s bid to balance the very public and very political problem of homelessness with profound questions about individual rights in a country that for generations forced people with severe mental illness into dangerous, dysfunctional institutions.

Under Gov. Ronald Reagan, California led the country in a national movement to end widespread practice of committing the mentally ill to state institutions. But like the rest of the country, the state didn’t ensure that adequate resources were shifted to community services.

Mr. Newsom, in signing the legislation that set up the new courts, nodded to this history, calling it California’s “original sin.”

That failure helped seed the crisis that plays out in city after city.

The states’s growing homeless population — just over 180,000 people, according to federal statistics, more than a quarter of the nation’s homeless — has city parks and spaces underneath freeway overpasses bulging with encampments, and those clearly in mental distress are a common sight in communities up and down the state.

“Continue to do what you’ve done, and you’ll get what you’ve got,” Mr. Newsom said when he signed the CARE Court legislation. “And look what we’ve got. It’s unacceptable.”

But he appears to know that the CARE Court on its own won’t be enough to solve problems that have dogged governors and mayors for decades and that became especially acute and increasingly visible during the pandemic.

So along with launching CARE Court, Mr. Newsom signed a law that makes it easier for courts to appoint guardians, known as conservators, to control vital life decisions, like psychotropic medications.

Yet even with so much public concern over street homelessness and public disorder, the efforts have all faced headwinds, most prominently Proposition 1.

Heading into the vote on Super Tuesday, the ballot proposal drew bipartisan support, reflecting, as a Los Angeles Times headline put it, “a crisis so dire Republicans and Democrats are working together.” But the vote ended up being so close that the count has taken two weeks, and the measure barely passed, The Associated Press said this week in announcing the outcome.

And while the close voted reflected skepticism among some voters, the most pointed concerns have been focused on the governor’s effort to make conservatorship easier. Critics say it is a troubling step backward, and they fear that the CARE Courts will end up being used to make the case for conservatorships when people fail to comply with voluntary treatment.

Even before CARE Court began operating, it faced a legal challenge, led by Disability Rights California, which said the program could strip people with disabilities of their rights. The California Supreme Court sided with the state and allowed the new court to start receiving petitions. But the disability rights group and other critics say they are watching the new court closely and could mount a new challenge.

Debra Roth, senior legislative advocate at Disability Rights California, believes CARE Court will end up working hand in hand with the new law making it easier for judges to order conservatorship. “There is a price to pay for people who ‘fail’ in CARE Court: they may be referred for conservatorship with the presumption that there is no less restrictive option available,” she wrote in a column for The Daily Journal, a legal publication.

The pop star Britney Spears was under one such order for 13 years over concerns about her mental health and substance abuse, and the fight to end her conservatorship opened the eyes of many to the enormous power of conservatorships.

In California, people who wind up in CARE Court and don’t comply with a judge’s treatment plan face a similar prospect. A separate court could find a person to be “gravely disabled” from a psychiatric disorder, which would allow confinement to a secure mental health facility for mandatory treatment.

While critics fear that CARE Court will become a new, easier pathway to conservatorship, Dr. Lisa Wong, the director of Los Angeles County’s Department of Mental Health, said those concerns were unfounded. “Our goal for CARE Court is to help people avoid a more restrictive approach to treatment,” said Dr. Wong, who added that her department had hired dozens of new social workers and clinicians to help.

Like Mr. Newsom, leaders of some other largely liberal jurisdictions, like Oregon and New York City, have moved to expand coercive measures to force people into treatment. None of them are urging a return to the days of mass institutionalization, but they are trying to strike a balance between values like freedom and compassion and the pressures they face from the public to clean up the streets.

And despite the enormous political capital and government money Mr. Newsom is investing — the state earmarked $57 million to start up CARE Court and is spending billions of dollars on new housing, treatment beds and behavioral health services — it’s an experiment, and no one knows for certain how much impact it will have.

It is still early, but officials say they have been surprised at how few petitions have been made so far in the eight counties where CARE Courts have been in operation since the fall. Officials have projected that 4,500 petitions could be filed in Los Angeles County in the first year, but only 80 had been filed as of late February — including Ms. Collette’s. (Of those, 20 have been dismissed, and 60 are still active.)

Ricardo Garcia, the Los Angeles County public defender, whose office will represent people appearing in the new court in that county, said his agency would be on guard for any coercion — like a referral for conservatorship — and would fight it if clients were opposed.

Eve Garrow, the homelessness policy analyst for the A.C.L.U. of Southern California, which supported the unsuccessful legal challenge to CARE Court, said she worries about racial disparities, pointing out that Black people are far more likely than others to fall into homelessness. In Los Angeles, Black people represent about 8 percent of the population, but more than 30 percent of the homeless population.

She said the police, who can file petitions themselves to bring homeless people into court, are likely to be heavily involved.

For many family members who have dealt with loved ones’ disease for years, if not decades, the possibility of coercion is what gives the efforts a bit of promise.

“I just really think that any kind of solution you come up with that doesn’t involve some type of involuntary treatment is doomed to failure,” said Harold Turner, who became an advocate in Los Angeles for the National Alliance on Mental Illness while he was dealing with a daughter’s descent into a mental illness.

His daughter stabbed her younger sister and was charged in 2007 with attempted murder. She was found not guilty by reason of insanity and was committed to a state mental health facility. After she was discharged, she went back to school, got a job at a hospital and is doing well.

But Mr. Turner wonders if that trauma could have been avoided with greater intervention. So while he supports the new court, he wishes it were “more coercive.”

After filing her petition, Ms. Collette called and texted her daughter to urge her to go to the court, saying the process could help her regain custody of her 10-year-old son, who has been raised by Ms. Collette for the last five years. But Ms. Colette said Tamra was recalcitrant. “She doesn’t want to know about it,” she said. So she waited while the county’s Department of Mental Health tried to find Tamra to serve her with the court papers.

Ms. Collette didn’t know if they would even able to find her. She said she doesn’t know where her daughter sleeps each night. “She won’t tell us,” Ms. Collette said. (The Times has tried to reach Tamra, through text, phone and social media, but has been unable to.)

A few weeks after filing her petition, Ms. Collette received a letter from the court: petition denied. Clinicians had located Tamra and had found that she was receiving care from a social services agency in Venice. As long as she continued with that treatment, she was not eligible for the new court.

For now, all Ms. Collette can do is hope Tamra stays in treatment. “I’m not going to give up on her,” she said, but she won’t hesitate to try the courts again. “If I see her back on the streets, I’m going back.”