Los Angeles County is on track to establish CARE Court this year

Los Angeles County is on track to join the first wave of counties this year by rolling out a sweeping new plan backed by Gov. Gavin Newsom to address severe mental illness with compelling cures for people who are in severe crisis.

The governor’s office announced Friday that Los Angeles County would begin the new program known as CARE Court (for Community Assistance, Recovery and Empowerment) by Dec. 1, a year ahead of schedule.

“CARE Court brings real progress and accountability at all levels to repair the broken system that is failing too many Californians in crisis,” Newsom said in a statement. “I applaud Los Angeles County leaders, the courts, and all local government partners and stakeholders across the state who are taking urgent action to make this life-saving initiative a reality for thousands of Californians in need.”

However, a key question remained unanswered Friday afternoon: whether the Los Angeles County Board of Supervisors should vote on the plan for the county to join the program. A voting majority of supervisors – Hilda Solis, Janice Hahn, Kathryn Barger – expressed support for launching CARE Court this year in a public statement.

When signed, the CARE Act identified seven counties for initial implementation on October 1: Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus and Tuolumne. The rest of the state, including Los Angeles County, has until December 2024.

Los Angeles County planned to join that later rollout, said Lisa Wong, acting director of the county’s Department of Mental Health, who will be the CARE Court program administrator.

“This year was going to be a very busy year for us,” he said, citing a number of initiatives that were already planned for 2023, including Hollywood 2.0, a pilot program to provide services and assistance in a part of the city where homelessness and mental illness are particularly acute.

Though her agency didn’t know “for sure” that Los Angeles County would be added to the first cohort before this week, Wong understands the urgency.

“Whether we were in the first or second cohort, there will always be challenges,” she said. “The fact is that people who need this help are on the streets, suffering and not getting the care they need. There’s never a convenient time to roll out this kind of program at scale, but the level of need out there is so great that we can’t put it off any longer.”

The addition of Los Angeles County, the state’s most populous county, to the first phase of the new program could have ramifications for Newsom’s ambitions to address one of California’s most vexing problems: the sheer number of people on the streets struggling against addiction and mental illness.

By some estimates, nearly 40 percent of people living on the streets suffer from a serious mental illness, a substance abuse disorder, or both. More to the point, UCLA’s California Policy Lab determined that just over 4,500 people living on the streets in the county have a psychotic disorder such as schizophrenia, and that number includes only those who have received outreach services.

Los Angeles County’s sudden inclusion is a measure of the urgency of the state’s homeless crisis, particularly in Los Angeles, and it carries some risk. While the other seven counties have been formulating their CARE Court plans for nearly four months, Los Angeles County is on track, and any difficulties in implementing the program invite further criticism.

Supervisor Lindsey Horvath told the Times she was “concerned about the hasty decision to join the program,” which requires robust infrastructure and services to be successful.

“Without proper investment and clear direction, this system will run the risk of breaking the promises we made to Los Angeles County voters to bring about real and meaningful progress and change,” Horvath said.

Similarly, supervisor Holly Mitchell urged caution not to rush to a deal this year, instead calling for a “thorough discussion” of the decision at a board meeting next week.

“It is imperative that we have clarity on how the courts and the county will implement this program with enough funding to be successful,” Mitchell said in a statement.

The county mental health department has been assured it will receive adequate funding from the state to move into the first cohort, Wong said.

“We all want this to be successful,” he said. “We are concerned about this highly vulnerable patient population and know that something needs to be done.”

Newsom’s announcement represents the latest in a series of actions taken in both the City and County of Los Angeles in recent weeks to address the mental illness and homelessness crisis that has hit the city.

On December 12, Los Angeles Mayor Karen Bass declared a state of emergency in the city, and county supervisors followed suit nearly a month later. The statements will help speed up services for the tens of thousands of homeless people in the region.

“I support the introduction of the CARE Court in our county. It allows us to be on the ground floor of a new program where many processes and implementation details still need to be worked out,” Barger said in a statement. “Our county needs to have a seat at the table so we can effectively bring healing. to the people living with debilitating mental illness on our streets.

“We need a coordinated and consistent approach to helping these people and CARE Court is ready to help us achieve this mission. Serious mental illness doesn’t go away on its own.

When Newsom introduced the CARE Act in March, his proposal met with initial resistance.

The legislation was initially intended to address the state’s homelessness crisis through the auspices of California Health and Human Services and administered by county agencies. But requiring these agencies to address homelessness — with penalties if court-ordered housing isn’t provided — has been a tough sell, said Dr. Veronica Kelley, director of behavioral health services for Orange County.

Then the CARE Act evolved, and when the legislation was signed in September, it focused not so much on homelessness but on helping people with schizophrenia and associated disorders. Many behavioral health departments therefore decided it would be in their best interest to be in the first set of counties to implement the program.

When a funding measure for the CARE Act passed in the fall, it committed $88 million in new funding for the implementation of the judicial system.

In his January budget proposal introduced Tuesday, Newsom set aside an additional $52 million to continue helping counties and courts implement the new program, with plans to increase funding to nearly $215 million within the year. fiscal year 2025-2026.

Those numbers don’t yet account for Los Angeles County, said Jason Elliott, Newsom’s deputy chief of staff and top counsel on housing and homelessness. Instead, the governor plans to increase funding in a revised budget plan due out in May. Billions more dollars are available to fund CARE Court through existing housing, homelessness, behavioral and mental health programs, according to the administration.

The legislature has until June 15 to approve the budget.

The administration estimates that currently 7,000 to 12,000 people would qualify for CARE Court, though not all are expected to be homeless. Newsom’s administration argues that the CARE courthouse was not created to solve the problems of homelessness, but rather to help some of the state’s most vulnerable and mentally ill find needed treatment and behavioral health services, and for many, this could include accommodation.

Proponents have hailed it as an innovative approach that will help stem the flow of people with serious mental health problems into hospitals and prisons, while critics have called it an infringement on personal freedoms. Organizations like Disability Rights California and the American Civil Liberties Union spent much of the 2022 legislative session trying to prevent the CARE Court from passing it.

Given the challenge of implementing the CARE Act, initially excluding counties like Los Angeles made sense, said Rod Shaner, who was medical director for the Los Angeles County Department of Mental Health from 1996 to 2018.

“This is a common way to start a large program like this,” said Shaner. “If there are major unforeseen problems with the immediate wide-scale implementation of the CARE Court, then it could cause dire consequences across the state. A more gradual phasing in allows you to identify potential problems when they are small enough to be more easily managed and corrected.

Elliott said the inclusion of Los Angeles County will help other counties that have until 2024 to implement it.

“What we’re doing now isn’t working,” Elliott said. “CARE Court is big and bold, and we assume and plan for success. We will be optimistic. I think Los Angeles County’s early entry into this program is an indication that there is a lot of trust locally.”

Among the most obvious challenges counties face as they implement CARE Court is uncertainty about the financial responsibility of insurers, who are required to pay for court-ordered treatment in cases where the individual has coverage.

“Guidelines for insurers on compliance have not yet been issued,” Shaner said.

Despite widespread interest in ending homelessness, Newsom faced intense opposition from some local governments that CARE Court was the best solution.

During his press briefing on the budget on Tuesday, Newsom renewed his engagement with CARE Court.

“This is life and death. People are dying on the streets in the name of compassion and these stale arguments,” she said. “Unprecedented support. I want to see unprecedented progress.”

Reporter Rebecca Ellis contributed to this story.

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