Behavioral health experts identify problems with CARE Court program – State of Reform

A pair of speakers in Health Policy Conference on the State of Reform in Los Angeles in 2022 have identified some challenges they anticipate with the implementation of the recently established CARE Court system. The panelists also discussed how they expect CARE courts to impact the state’s behavioral health system.

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The CARE Court Programestablished through Senate Bill 1338, aims to provide treatment, housing and support services to Californians with complex behavioral health needs. The program provides these individuals with court-ordered care plans that last up to 12 months with the option to extend and focuses on individuals on the schizophrenia spectrum or with other psychotic disorders.

Individuals may be referred to the program by petition to the court from care providers, family members, or other designated individuals. Program participants are required to comply with the court order and participate in all court proceedings.

Connie Draxler, acting chief deputy director of the Los Angeles County Department of Mental Health, said the Los Angeles County Department of Mental Health expects many more people to be eligible for CARE Court than the state originally estimated.

According to Draxler, the state estimates about 7,000 to 12,000 customers in the state are eligible, with about 2,500 to 4,000 potential participants in Los Angeles County. However, a UCLA study of the population of people experiencing homelessness in Los Angeles County alone revealed that 10% of that population falls into this eligibility category (about 4,500 people).

Draxler said that number does not account for justice-involved individuals who may be eligible, as well as other populations of individuals who may be eligible.

“There are elements in the diversion statutes that will allow the court to go directly to the CARE court for anyone who is believed to be diverted, and it doesn’t take into account at all the family members who are supporting their loved ones who might want to file a claim petition in the CARE Court,” she said. “So we think the numbers are higher, and with those numbers, we expected there would be increased strain on the system.”

She added that many of the people coming to the Los Angeles County Department of Mental Health through CARE Court have not yet been brought into the system.

“Maybe we have an engagement with them [through] our homelessness teams, they may have opted out of services,” she said. “One of the arguments we’ve heard is that, ‘That’s your population anyway, just work with it.’ which we have already touched.’

Draxler said they expect the influx of CARE Court clients will strain an already busy system and raise concerns about limited resources.

“We will probably be asked to reallocate services because the legislation really made it clear that CARE Court participants should have priority in our system. I think from a county mental health or rural health perspective, there’s a concern about whether we’re going to have to reallocate services or be more selective about how we choose our services and where our dollars are invested because we have to give priority.”

She added that many of the court processes required with CARE Courts, such as court-ordered evaluations, are not eligible for Medi-Cal reimbursement because the money that has been earmarked is primarily related to court enforcement of this process and not related to the provision of services.

Karen Vicari, acting director of public policy at Mental Health America of California, said she is also concerned that the CARE Courts bill does not put additional money into providing services and does not require housing for CARE Court participants.

Vicari said the forced treatment aspect of CARE courts is also a cause for concern.

“From a peer perspective, mental health recovery is a self-directed, non-linear process,” she said. “When you have an involuntary treatment order and do [them] take medication [and get] services that do not create long-term change. It costs a lot more and takes more time, but we really believe that if we can adequately fund community mental health services [that are] culturally responsive, [and] where people feel comfortable going, that’s where we really need to invest our money and energy.”

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