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California's mental health CARE Court aims to help thousands with untreated psychotic disorders

Investigating California’s CARE Court
How California’s CARE Court hopes to tackle severe mental illness | 60 Minutes 13:37

CARE Court, a controversial and costly initiative set to launch in eight California counties by December before going statewide, gives hope to many.

Under the program, judges will be able to order people with untreated psychotic disorders, such as schizophrenia, to get help, with counties required to provide the aid. Anita Fisher sees it as a possible 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 and said living with the illness can be difficult.

"Constant overthinking," he said, describing how difficult experiencing schizophrenia can be when it's untreated. "Your brain is always racing, your inner voice is always talking, racing, racing. No peace. Never any solace and peace."

Why do supporters say CARE Court is needed?

Until now, Fisher says there has been little recourse to make sure her son gets help. Her son stopped taking his medication last year. For seven months, Fisher called for a psychiatric intervention, but without her son's consent, she says her attempts were ignored.

Pharoh became homeless. Fisher spent days searching for him at local spots near their home. She said it was clear he was unwell when she found him.

Anita Fisher works as a mental health advocate. Her son was diagnosed with schizophrenia.  60 Minutes

"He would be, 'I'm fine.' But no, he wouldn't look fine at all," Fisher said.

Last October, he was arrested for vandalism. In custody, he received medication and enrolled in a treatment program. 

Gov. Gavin Newsom, a fierce advocate for CARE Court, describes the current system as a "fail-first system" rather than 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," Newsom said. "We've got to change that. And that's what we're doing."

California already has laws on the books to help many of those with a severe mental illness, but many believe the current laws fall short. Critics have said the Lanterman-Petris-Short Act, which sets rules for involuntary psychiatric treatment, kicks in too late, only helping when someone is already in crisis. Laura's Law, which authorizes assisted outpatient treatment, or court-ordered mental health treatment plans, has also been largely seen as a failure because it is not statewide and was not implemented with significant funding attached. 

On any given night, more than 170,000 people are living on California's streets or in its shelters. About 1 in 4 has a serious mental illness. The Newsom administration believes CARE Court, which is not restricted to those experiencing homelessness, will help an estimated 12,000 people.

While Fisher, who also works as a mental health advocate, hopes her son never needs CARE Court, she said she wouldn't hesitate to initiate proceedings for it. 

"I hope that if it does, that he even sees it as a positive experience where his voice is heard," she said. 

Who is eligible for CARE Court and how does it work?

Only those 18 and older with a diagnosis of schizophrenia or other psychotic disorders are eligible for CARE Court. Other eligibility requirements include the individual's likelihood of surviving safely in the community without supervision or without harming themself or others. Individuals are also only eligible if it is deemed  likely that the person will benefit from being a CARE Court  participant.

A person referred to CARE Court for a severe mental illness is evaluated and a CARE Court judge reviews the petition, which can be filed by a close family member, roommate, hospital director, first responder, police officer or licensed behavioral health professional. 

If the individual is considered likely to meet the required criteria, the judge can order a clinical evaluation. Based on those results, a judge can order a mental health treatment plan including medication, therapy and a place to live. The plan will run for one year, with a one-time option to extend the plan for a second year. 

Those in CARE Court will have access to a public defender and can refuse treatment without being sent to jail, but there's a catch. If someone in CARE Court does refuse treatment, a judge could refer them for conservatorship — an extreme outcome that strips them of rights and forces them to comply with treatment. 

The controversy over CARE Court

Critics say the program, set to launch statewide by the end of next year, is coercive, removing choices and forcing treatment. Eve Garrow, a homelessness policy analyst for the ACLU of Southern California, sees the state plan as a pipeline to conservatorship and the deprivation of civil liberties. Among other things, she worries people would lose the right to determine what medications go into their bodies.

"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," Garrow said. 

Garrow believes the state should provide comprehensive care for all Californians with mental health disabilities, she said. She sees it as a plan that could be a reality if California invests in those services instead of diverting funds to the new court system. 

The Newsom administration invested about $17 billion to fight homelessness and treat mental illness this year. 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.

Some of that money will go toward Los Angeles, a county where 1 in 8 of the nation's homeless people live. Marquesha Babers, 28, was homeless for years, on and off, in the area's notorious Skid Row. When 60 Minutes met Babers, she was living in a shelter and told us she had several serious mental health conditions, including bipolar disorder.

Marquesha Babers has dealt with homelessness. She told 60 Minutes she has several serious mental health conditions, including bipolar disorder. 60 Minutes

"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," Babers said. "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.'"

She does not support CARE Court and said she views it as "medical incarceration" because of the threat of conservatorship, where people can be locked up in psychiatric facilities and treated without their consent.

"I think there just needs to be way more attention to services and prevention rather than the consequences of not having those services," she said.

Last month, Babers was reported missing by her family. 

Many of Babers' concerns about CARE Court have also been voiced by advocacy groups. In all, more than 50 advocacy groups have condemned CARE Court as a "costly mistake" that's "likely to do real harm." 

Newsom counters that conservatorship as a possibility is nothing new. He understands that people don't want to see it happen, but it's a reality already and he believes CARE Court could be key to ensuring that some people experiencing psychotic disorders get the help they need.

"And here's all I ask: prove us wrong," Newsom said. "Don't assume us wrong. Your compassion is not superior to our compassion."

This story was reported by: Cecilia Vega, Natalie Jimenez Peel, Jaime Woods

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