A New Approach for People With Severe Mental Illness

Policymakers in California have been trying for years to change longstanding laws and bring people with severe mental illness in from the streets.

Roughly a third of the nation’s homeless population is in California, and a substantial proportion suffers from schizophrenia or other serious psychotic disorders. Getting them treatment and medication, the authorities have long maintained, would make a significant dent in the state’s homelessness crisis.

But some of them resist care, and laws have been on the books for decades that make it difficult to force people into treatment, because of past abuses in state mental health institutions and coercion of mentally ill people.

Now, the state is trying a course correction, and one of the most closely watched measures will start next week.

A new program known as CARE Court — the acronym stands for Community Assistance, Recovery and Empowerment — will give relatives, health care providers and homeless outreach workers standing to ask state courts to compel certain people with severe mental illness to accept treatment, to be provided by county government. The measure will apply only to untreated people who have diagnoses of schizophrenia or certain other psychotic disorders.

The approach is aimed at adults who resist care and often end up in crisis, cycling through emergency rooms, jail cells or homeless shelters. It authorizes judges to order evaluations and, if necessary, to order up to two years of treatment by a team that can also prescribe medication and help the patient find housing. If a person refuses to enter treatment voluntarily, the court can order them hospitalized or refer them to conservatorship, in which a conservator would be appointed who could make medical and financial decisions for them.

The new program is part of a surge of proposals to change behavioral health policy. Next year, voters will decide whether to increase state funding for mental health and to channel more of it into programs that house homeless people.

CARE Court will be phased in, starting Monday in seven of the state’s 58 counties: San Francisco, Orange, San Diego, Riverside, Stanislaus, Glenn and Tuolumne.

State health officials say the initial enrollment will probably be small. Only about 1,800 to 3,100 people are expected to be eligible for the program in the first rollout, increasing to about 6,200 when Los Angeles County starts CARE Court in December. The program will not expand to the rest of the state until next year.

Nonetheless, the program has been controversial, with some critics saying it goes too far and others — particularly relatives of mentally ill people — worried that it will be insufficiently coercive. Already, the law has withstood a court challenge from advocates for people with disabilities and civil rights groups, who said it violated due process and equal protection rights and asked the California Supreme Court to strike it down as unconstitutional.

Time will tell how well the program works, health officials in Gov. Gavin Newsom’s administration said this week.

“I certainly respect and understand the concern and opposition to change,” said Dr. Mark Ghaly, secretary of the California Health and Human Services Agency. But the existing approaches to addressing homelessness “don’t work very well for many, many Californians,” he said, “and if you are among those with severe behavioral health conditions, they can often hardly work at all.”

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Where we’re traveling

Today’s tip comes from Karen Wessen:

“My daughter and I, along with her dog, recently visited Mammoth Lakes. One reason we went there was because it was dog friendly. There are many hikes and sites to explore. Our first was to see Devil’s Postpile and Rainbow Falls. We caught the bus from the Mammoth ski area that took us to the trailhead. Even though we went in September, the falls were amazing and sure enough we saw the rainbow.

There are many other lakes you can easily walk around. One favorite was Convict Lake. Be sure to go counterclockwise around the lake to take in the beautiful mountain scene. There are a couple of hot springs, really out in the middle of nowhere, that you can visit for free. The best was Wild Willy’s Hot Springs. You can soak in the shallow pleasantly warm water; best to wear your swimsuit as there are no changing rooms. A delightful trip with varied landscapes and lots to do.”

Tell us about your favorite places to visit in California. Email your suggestions to [email protected]. We’ll be sharing more in upcoming editions of the newsletter.

And before you go, some good news

An ever-expanding network of horology clubs are offering watch aficionados around the world a chance to find community, collecting advice and above all friendship.

The groups have cropped up in cities around the world with a new ferocity since the pandemic, when many home-ridden enthusiasts connected on social media. With hundreds of chapters globally, the watch-curious can now reliably find meet-ups monthly, whether in Seattle or Sydney.

The meetings, open to fans of all backgrounds and interest levels, have become an important source of community for watch enthusiasts looking to make friends, seek advice on vintage purchases or simply enjoy the intricate devices in a judgment-free zone. Unlike online forums that proliferated in the late 1990s, many of which were exclusive or dedicated to specific name brands, today’s watch clubs were created with a specific focus on inclusivity.

“No matter who you are or what you own or don’t own, everybody’s welcome,” Jarrod Cooper, a watch enthusiast who founded the horology club Neighborhood Watch Club, based in Los Angeles, said in a recent interview with The New York Times. “No one really cares if you’ve got the latest Rolex.”

Thanks for reading. We’ll be back tomorrow.

P.S. Here’s today’s Mini Crossword.

Soumya Karlamangla, Maia Coleman and Briana Scalia contributed to California Today. You can reach the team at [email protected].

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