California's controversial CARE Court brings mental health care into the courtroom
On any given night, more than 170,000 people are living on California's streets or in its shelters. It is the largest homeless population in the country -- fueled by a lack of affordable housing and the state's failure to provide adequate mental health care.
One-in-four has a serious mental illness.
It's a crisis that's bred fear in communities, as violent crimes rise. And this past week, Sacramento's top prosecutor sued California's capital city for allowing it to quote "collapse into chaos."
That's the landscape Gov. Gavin Newsom says he's trying to change, starting this fall, with a controversial, new plan on track to cost billions.
It's called CARE court because it brings mental health care into the courtroom. Now judges will order people to get help and counties to provide it under a new law that emphasizes accountability and consequences.
We met with Gov Newsom and found him to be fired up and fed up.
Gov. Gavin Newsom: Change has its enemies. I get it. But one thing you cannot argue for, with all due respect to all the critics out there, is the status quo. You can't. And in the absence of alternatives, What the hell are we gonna do to address this crisis?
It is a crisis overwhelming cities across the country, but California has been hit the hardest.
And Gov. Gavin Newsom says it is desperation – born out of scenes like this… that drove the idea for CARE Court.
Cecilia Vega: You've used words like, "You're outraged." "You're disgusted by what's happening on the streets."
Gov. Gavin Newsom: I am. 'Cause I see what everybody else sees. I try to walk my kids to the park and have a difficult time navigating the sidewalk. It's a fail-first system, not a care-first system, which means you have to end up in the criminal justice system before finally someone provides support and a bed and a solution. We've gotta change that. And that's what we're doing.
Here's how it will work: a person referred to CARE Court for a severe mental illness is evaluated. If they have an untreated psychotic disorder, like schizophrenia, a judge can order a mental health treatment plan including medication, therapy and a place to live.
The governor believes the new civil court system will help thousands get off the streets – and make everyone safer by helping people before they become a danger to themselves or others.
Cecilia Vega: You think CARE Court could be the solution that could save someone's life?
Gov. Gavin Newsom: I don't think it. I know it. It's very familiar what we're doing, even though it's novel and new and bold.
Cecilia Vega: Novel, new and bold. So it's an experiment?
Gov. Gavin Newsom: No. It's not. When people get their meds, when people get support, we know we can turn people's lives around. This is imminently solvable
But what if someone ordered by a judge to get help doesn't think they need it?
They'll have access to a public defender and *can* refuse treatment… they won't be sent to jail.
But there is a catch… if someone in CARE Court does refuse -- a judge could refer them for conservatorship -- an extreme outcome that strips them of rights and forces them to comply with treatment.
Anita: This is where he would go…
Anita Fisher hopes CARE Court will be a lifeline for people like her son, Pharoh Degree, who was diagnosed with schizophrenia while serving in the army 22 years ago. He's now 45.
Cecilia Vega: Tell me a little bit about Pharoh.
Anita Fisher: Pharoh is the kindest. He-- even from a little boy. His report card used to say joy to have in my class. And some of the things that we've gone through you couldn't have paid me to believe.
For nearly two decades, Fisher has worked as a mental health advocate in San Diego, running support groups and classes for hundreds of families when their lives are derailed by a loved one's mental illness
Anita Fisher: A lotta times he even can get very agitated. And then he starts to self-medicate. Whether it's alcohol or street drugs and that takes it to a whole different level.
Cecilia Vega: You sometimes feel like your son goes missing in those moments.
Anita Fisher: Yes. We would try to have the conversation with him about, you know, have you stopped your medication? And he said, "Well, they said I don't need this medication." I was like, "OK, who is they?" And I know that it's the voices.
Cecilia Vega: What's this like f-- as a mom, for you?
Anita Fisher: It's devastating.
Supporters back CARE Court because the new law allows families and others — like law enforcement and first responders — to petition a court to help them get someone into treatment.
Until now, Fisher says there has been little recourse… like last year when her son stopped taking his medication.
For seven months, she called for a psychiatric intervention, but without her son's consent, she says her attempts were ignored.
Anita Fisher: When I saw him, I had to call his name. He'd be wrapped in blankets.
Pharoh became homeless… and Anita spent days searching for him at local spots near their home.
Cecilia Vega: When you would find Pharoh on these days, what kind of condition was he in?
Anita Fisher: He was just very psychiatrically ill. He would be, "I'm fine." But, no. He wouldn't look fine at all.
Cecilia Vega: Your son would be convinced that he was fine mentally, that he didn't need his meds. How do you convince him otherwise? What has to happen?
Anita Fisher: He ends up arrested. It's-- it's almost we have to wait for that to happen.
And, last October, he was arrested for vandalism. In custody, he received medication and enrolled in a treatment program.
Pharoh declined to be interviewed on-camera, but he described to us on the phone how difficult it can be to live with his illness.
Pharoh Degree, on the phone: Constant overthinking, your brain is always racing, your inner voice is always talking. Racing, racing. No peace. Never any solace and peace.
Cecilia Vega: What do you think would have happened to him had he not had that treatment?
Anita Fisher: Every single time I have to start, in my mind, preparing a funeral. I have to get my heart and myself and my family ready, you know, the-- will he make it this time? It's not-- it's not easy.
With California voters overwhelmingly ranking homelessness as a top concern, last year, the CARE Act sailed through the state legislature with near-unanimous and bipartisan support.
Assemblymember Jim Cooper: It's the humane thing to do.
But opponents point to the threat of conservatorship - where people can be locked up and treated without their consent.
And more than 50 advocacy groups condemn CARE Court as a "costly mistake" "likely to do real harm."
Cecilia Vega: Some of the words that have been used to describe CARE Court: coercive, backwards, harmful. Are any of those fair? You laugh.
Gov. Gavin Newsom: I laugh. I mean-- I don't laugh dismissively. Those are talking points that have been on rewind for decades and decades. And I'm frankly exhausted by them.
Cecilia Vega: Someone could end up in conservatorship. And that is a very big deal. Isn't CARE Court saying, "Comply or else?"
Gov. Gavin Newsom: We have-- we have people end up in conservatorship all the time. And I get why people don't want to see more of those. But we have that system already.
Gov. Gavin Newsom: And here's all I ask. Prove us wrong. Don't assume us wrong. Your compassion is not superior to our compassion.
Cecilia Vega: But that's a big gamble when you're talking about conservatorships, people's lives. Prove us wrong.
Gov. Gavin Newsom: Exact opposite.
Cecilia Vega: Wait and see.
Gov. Gavin Newsom: The gamble is allowing more people to die under our watch. The gamble is more families struggling, suffering. How dare we?
Eve Garrow: We see it as a pipeline to conservatorship the greatest deprivation of civil liberties short of the death penalty.
Eve Garrow is a homelessness policy analyst for the ACLU of Southern California.
Cecilia Vega: What are the individual rights that you think someone would be stripped of under CARE Court?
Eve Garrow: The right to determine, for example, what medications go into your body--
Cecilia Vega: There's no forced medication in CARE Court.
Eve Garrow: There's no forced medication. But when there's pressure and coercion you're more likely to potentially comply with treatment that actually isn't meeting your needs.
Cecilia Vega: Governor Newsom says that you're defending the status quo.
Eve Garrow: The administration likes to propose this false dichotomy, that either we force people into treatment, or we let them die on the streets.
Cecilia Vega: You don't feel like that's what's at stake here?
Eve Garrow: I don't feel like that's what's at stake, because obviously there's a third alternative.
Garrow says that alternative is for the state to provide comprehensive care for all Californians with mental health disabilities.
Cecilia Vega: Is that realistic?
Eve Garrow: Yes. It is. If we invest in those services, instead of investing in a new court system. Of course it is.
Cecilia Vega: A lot of people will hear you, and say, "Eve, clearly the current situation is not working. Aren't we at the point where we have to try something else?"
Eve Garrow: I agree completely with that. But the something else we need to try is not a civil court system.
We went with Garrow to the notorious Skid Row in Los Angeles, a county where 1-in-8 of the nation's homeless people live.
For years, on and off, that included Marquesha Babers; a 28-year-old who told us she has several serious mental health conditions including bipolar disorder.
When we met her, she lived in a shelter.
Marquesha Babers: I go almost every day to ask if I could speak to a therapist or if I can, you know, get some mental health services or help. And there are really none. Or if you do find one it's like, "Oh, well, the waiting list is six months before you can actually talk to a therapist," or–
Cecilia Vega: Six months?
Marquesha Babers: Oh yeah. Yeah, absolutely.
Cecilia Vega: Do you feel like you're getting medication that you need?
Marquesha Babers: Absolutely not.
Cecilia Vega: What has to happen in order for you to get that?
Marquesha Babers: Honestly, I would have to be committed into a mental health hospital because going into places that offer, like, volunteer services are-- they're backed up, or they don't have enough space, or my insurance doesn't cover some of the stuff that I need.
Cecilia Vega: When I say the word CARE Court to you, what comes to your mind?
Marquesha Babers: Medical incarceration. It's just another way to mass incarcerate people, and instead of it just being, like, criminal, it's medical now.
Cecilia Vega: What would you like to be done?
Marquesha Babers: I think there just needs to be way more attention to services and prevention rather than the consequences of not having those services.
This year, the Newsom administration invested about $17 billion to fight homelessness and treat mental illness. But leaders in many counties say money earmarked for CARE Court is nowhere near enough for the thousands of people expected to land in the system.
Gov. Gavin Newsom: Spare me. Honestly, I'm a little indignant by this rhetoric. The only thing limiting people is an unwillingness to be accountable. And I'm just done with that.
Cecilia Vega: But are you overly optimistic on this one? This is a very taxed system. And you're expecting it to take on a lot more.
Gov. Gavin Newsom: I'm done with the excuses. You should be done as a taxpayer. Everyone watching should be sick and tired of the excuses. There's plenty of money in this space.
Yet even with California facing the highest debt in the nation, Gov. Newsom is asking voters to approve billions more for housing, and he admits that without enough, CARE Court will not work.
Cecilia Vega: You're promising here that anybody who goes into CARE Court will have some kind of housing attached to them--
Gov. Gavin Newsom: Well, I'm not promising anything here. I'm promoting a promise where there's accountability at the local level. I'm not the mayor of California. I'm the governor.
Cecilia Vega: And those local governments, if they don't comply--
Gov. Gavin Newsom: There are sanctions--
Cecilia Vega: --will be held accountable.
Gov. Gavin Newsom: They are – Absolutely. Foundationally what CARE Court is about, is about accountability at all levels.
Cecilia Vega: Worth the billions of dollars that you're gonna end up spending on this--
Gov. Gavin Newsom: We're spending more on the back end. We can save taxpayers billions of dollars and save lives.
By December, CARE Court will launch in eight California counties, including Los Angeles and San Diego, where Anita and Pharoh live. By the end of next year, it will be statewide.
Cecilia Vega: what does a successful CARE Court look like for Pharoh?
Anita Fisher: I hope he will never have to use it. And I hope that if it does, that he even sees it as a positive experience where his voice is heard.
Cecilia Vega: If you have to, will you initiate CARE Court proceedings?
Anita Fisher: Absolutely. I have no hesitation. It is trauma for the family to keep going through that with their loved one.
Cecilia Vega: Is part of this that voters are so fed up with what they see on the streets of their cities that as a politician, you've gotta clean up those streets?
Gov. Gavin Newsom: Well, that's generally the case. But that's not the inspiration for CARE Court.
Cecilia Vega: But is there a political factor in this for you?
Gov. Gavin Newsom: As an electoral strategy, I'm termed out.
Gov. Gavin Newsom: That's not the issue. The politics here is compassion. The politics is purpose.
Cecilia Vega: What happens if CARE Court doesn't work?
Gov. Gavin Newsom: Then we learn from it. Biggest risk is that we don't take one.
Last month, Marquesha Babers, the woman who was living in a Los Angeles shelter and told us she struggles with mental illness, was reported missing by her family.
Produced by Natalie Jimenez Peel. Associate producer, Jaime Woods. Broadcast associate, Eliza Costas. Edited by Peter M. Berman.