California's CARE courts: Licensed clinical psychologist weighs in
Dr. Chloe Carmichael, a licensed clinical psychologist practicing in New York City, tells FOX News Digital her thoughts about California's new CARE court system.
California's plan to stem mental health crises and homelessness is coming to several cities soon and is expected to go statewide next year.
The Golden State's Community Assistance, Recovery and Empowerment (CARE) Act, allows family members, mental health providers, first responders and others to ask a judge to create a care plan for those suffering from uncontrolled mental illness – including schizophrenia – and substance use disorders before they are either incarcerated and committed to state hospitals or placed under a conservatorship.
"CARE Court means new hope for thousands of Californians with untreated mental health and substance abuse issues," Democratic California Gov. Gavin Newsom said of the plan last year. "Today, our work begins to turn promise into practice. While we watch other places in America move swiftly towards more involuntary hospitalization, in California, we’re doing it the right way – community based care, a focus on housing, and accountability for everyone involved."
Despite some controversy stirred by disability rights groups, support appeared otherwise unanimous, even among the state's Democratic and Republican assembly members.
GOV. GAVIN NEWSOM APPROVES COURT-ORDERED MENTAL TREATMENT FOR HOMELESS
Some disability groups are concerned that California's CARE Act will violate the civil rights of those referred for court-ordered treatment. (iStock)
However, some, including James Gallagher, the Republican leader of the state Assembly, believe it doesn't go far enough.
"It’s not the groundbreaking policy change we need. It will help some severely mentally ill people get treatment, but will not stop the explosion of homeless camps in our communities," he said.
Gallagher, in a statement responding to the law last year, called for reforms to the state's conservatorship laws by, in his words, "changing the definition of 'gravely disabled' to get people the mental health and drug treatment they need."
He, along with a majority of his Republican colleagues, voted in favor of the bill authored by two Democratic state senators and endorsed by Newsom.
Both Sens. Tom Umberg and Susan Talamantes Eggman and the governor's office were contacted for comment.
Newsom's office responded, directing FOX News Digital to a presser about CARE courts, but did not provide further comment. The other offices did not provide a statement.
The CARE Act received bipartisan support in California, including from Democratic Gov. Gavin Newsom. (Justin Sullivan/Getty Images)
Dr. Chloe Carmichael, a clinical psychologist practicing in New York City, told FOX News Digital Tuesday that, with the caveat that she isn't fully informed about the ins and outs of the state's new mental health court strategy, she believes society needs to change the way mental health rights and responsibilities go together.
"As a clinical psychologist, I can certainly understand looking at different levels of mandating treatment or responsibility for actions on people that have a history of harm to self or others if that harm has been in some way excused because of a mental illness. However, I also have a great deal of caution about exercising any type of level of control or mandating on people who have no history of harm to self or others, where it's just merely the suspicion or concern of a psychologist without any actual behavioral evidence," she said.
According to a state-issued fact sheet, the plan extends beyond those on the schizophrenia spectrum to people with other psychotic disorders "who may also have substance use challenges, and who lack medical decision-making capacity" to avoid more extreme measures in the future.
"What usually happens now in the mental health system [when family members/others are concerned about someone], which I think makes perfect sense, is that what's called a mobile crisis unit would typically go to the scene of wherever this person [struggling with mental illness] is and do a wellness check on them. And if indeed that person is saying or exhibiting that they are causing physical harm to self or others, then, for their own safety and for the safety of society, we might take them to a psychiatric or emergency room or to an inpatient facility," Carmichael said.
While treatment is not reserved for homeless Californians, many of the homeless suffering from mental illnesses may be eligible. (Tayfun Coskun/Anadolu Agency via Getty Images)
According to the California Department of Health and Human Services (CHHS) webpage, "family members, behavioral health providers and first responders with a history of engagement with the individual" may refer them to the court to order treatment plans that local mental health providers if they have an undiagnosed or uncontrolled mental illness.
Following the referral, if the potential patient is unable to voluntarily "engage in services," courts will review the petition for evidence to see if the would-be patient meet's CARE's criteria and "appoints legal counsel and a voluntary supporter selected by the individual if desired."
The court can additionally, according to CHHS, order a clinical evaluation on someone who has been referred to determine if they meet the criteria of someone in need of care. Carmichael finds psychological evaluation an essential part of the process instead of simply forcing people into treatment without sufficient assessment.
Treatment can be ordered for up to 12 months "with periodic review hearings and subsequent renewal for up to another 12 months," the state's fact sheet says.
Those who fail to complete their court-ordered treatment are subjected to hospitalization or conservatorship.
Those who do successfully complete treatment are, according to CHHS, eligible to receive ongoing treatment and "may elect to execute a Psychiatric Advance Directive, allowing them to document their preferences for treatment in advance of potential future mental health crisis."
Despite overwhelming support, the plan isn't without controversy. Some disability rights groups allege the measure eliminates another important factor – autonomy for those struggling with disabilities.
"[We are] firm in [our] commitment to stop any policy that takes away the rights of people with disabilities, including the CARE Court framework…. DRC strongly opposes CARE Court because it is based on stigma and stereotypes of people living with mental health disabilities and experiencing homelessness…" Disability Rights California, a group at the center of a failed legal challenge against the law, wrote in opposition.
The group further alleged the policy would disproportionately affect Black Californians. FOX News Digital also reached out to DRC for comment, but did not receive a response.
Carmichael, when asked about civil rights in relation to mental health, said, "Obviously, I'm not a lawyer or an expert on the subject of civil rights, but as a clinical psychologist, I certainly do have experience and understanding about mandating treatment or, in many cases what's called ‘Baker Acting’ somebody where, against their will, we take them, and we stabilize them in a mental health facility for their own safety."
"One could say perhaps that that's a violation of civil rights. I'm not sure if I think it's [involuntarily institutionalizing someone] passed the test of being a violation of civil rights, I would think, because it's legal, and I think all 50 states on some level," Carmichael continued.
Seven counties -- Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus and Tuolumne -- are piloting the program, launching CARE courts by Oct. 1. All other California counties will be required to do so by December 2024.
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The Associated Press contributed to this report.
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