California’s controversial experiment to order mental illness and drug treatment for some of its sickest residents is rolling out statewide, but the latest data shows the new initiative is falling far short of early objectives.
The Community Assistance, Recovery and Empowerment Act — known as Care — recently expanded from 11 pilot counties to all 58, and is one of the many ways state and local governments across the nation are trying to grapple with a metastasizing crisis of severe mental illness and substance use.
“There are a lot of people who have had untreated illness for so long, and they’ve cycled out of incarceration and homelessness and hospital emergency departments,” Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness, told me.
First-responders, families and local health officials can all file petitions requesting help for people who are ill.
California’s program empowers civil court judges to order adults into monitored plans that can include housing, social services and treatment for addiction or severe mental illness. Gov. Gavin Newsom, who signed the law in 2022, has called the program a “paradigm shift” that prioritizes Californians who are the most ill and in need. The Democratic governor initially said his administration would serve 2,000 people by the end of 2024.
From its launch at the beginning of October 2023 through the end of September this year, however, only 787 Care petitions were filed, according to the Judicial Council of California. Of those, 150 people were placed in court-approved treatment, with hundreds more pending.
As of the end of June, an additional 362 people had been “diverted” from the Care Court process and provided other services, according to the California Department of Health Care Services.
State officials have said between 7,000 and 12,000 people will ultimately be eligible for Care in a state of more than 39 million residents.
Corrin Buchanan, a deputy secretary for the California Health and Human Services Agency, said she is confident the state can still meet its treatment goal by the end of the year.
Governors in New York and Wisconsin have focused state resources on building community mental health care networks, Wesolowski said, while states such as Oregon and Washington have plowed resources into mental crisis emergency hotlines and mobile response teams.
Although treatment courts are common in other states, Wesolowksi said, California is the first to provide more comprehensive services — known as “wraparound” services, including housing and food support — rather than just prescriptions for medication. But the program is among the most restrictive, applying only to those diagnosed with untreated schizophrenia or a related psychotic disorder.
Such a narrow scope has led to disappointment among family members who have learned that few people qualify for the program, county representatives in California say.
Reaching those who do qualify can take time and treatment is largely voluntary.
Amber Irvine, program manager for San Diego County’s Care Court, said it takes workers there an average of 54 days of casual conversations, which the state doesn’t typically reimburse for, to persuade someone to accept help.
“We need to, as a whole, adjust our expectations of what can be accomplished in a year with such a complicated program and such a complex population,” Irvine said.
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