Governor Gavin Newsom of California has proposed a court program that would force unhoused people with severe mental illnesses and addiction disorders into treatment. The moves comes in response to a worsening humanitarian crisis of people living on the streets, but has raised concerns from disability rights and civil liberties advocates.
The plan would create a “care court” requiring people with serious mental health challenges, such as schizophrenia, to accept treatment while also mandating that counties provide services, Newsom said on Thursday when announcing the program.
If people don’t follow through with forced treatment, they could be placed into conservatorships, a form of court-appointed guardianship that strips people of their rights to make basic decisions about their lives and care.
The homelessness crisis has become the top issue in political races across the state, as there are growing encampments and more visible signs of people struggling with mental illness on the streets. Some officials have responded with sweeps of tent communities and new policies prohibiting camping in certain locations individuals from sleeping outside. The announcement also follows intense scrutiny of California’s conservatorship system surrounding the case of the pop star Britney Spears, who spent nearly 14 years under a court-appointed guardianship that she said was abusive and controlling.
Depending on legislation – the court program would create a mental health branch in counties’ civil courtrooms and counties could face sanctions if they don’t provide services. The California health and human services (HHS) secretary, Mark Ghaly, called it a new “framework” to respond to “one of the most heartbreaking, heart-wrenching and yet curable challenges that we face in our communities and on our streets”.
Ghaly estimated that 7,000 to 12,000 people in California could be eligible. People who are arrested or facing charges could be diverted from the criminal justice system into the care court, officials said. Relatives, first responders and others could also refer people to the program, which would not just be for the unhoused.
“The really important part of the care court model is that the court has responsibility not just to oversee and ensure that the individual is participating in the treatment plan, but that government partners, counties and others, are prioritizing this population.”
As of January 2020, more than 150,000 people are considered to be homeless in California.
‘This is morally wrong’
Officials have not unveiled details about the timeline or funding. But the announcement quickly raised alarms among advocates for the unhoused and people with disabilities, who have long opposed involuntary care. Some argue it is ineffective and can violate people’s constitutional rights. Others said it was counterproductive to use the courts as the response to the homelessness crisis.
“Subjecting unhoused people to forced treatment is extremely draconian, and it would take us back to the bad old days of confinement, coercive treatment and other deprivations of rights targeting people with disabilities,” said Eve Garrow, policy analyst and advocate at the ACLU of Southern California. “It’s morally wrong.”
The problem, Garrow said, was that existing voluntary programs were not adequately accessible or effective for “people living on the streets where they have to endure extreme deprivation, exposure to violence and the daily trauma of law enforcement harassment, all of which contribute to and exacerbate mental health disabilities”.
Conservatorships are meant for elderly people and those with grave disabilities who the courts deem unable to take care of themselves, but the Spears case shone a light on how guardianships can erode individuals’ most basic rights – and how hard it can be to terminate the arrangements.
Jasmine E Harris, a University of Pennsylvania law professor and disability rights expert, said Newsom’s announcement mirrored trends across the country, including a growing movement of families who have pushed for involuntary treatment in response to the opioid crisis.
But studies have suggested that coercive treatment is often ineffective and that housing and other services are the most appropriate response to unhoused people in crisis, Harris said. She also noted that federal disability rights regulations dictate that services should be delivered in the “least restrictive environment” possible.
“Community-based services and treatment, when they are meaningful, will almost always be superior to a restrictive setting where the individual loses all agency,” Harris said. “If you expand the authority for individuals to be hauled into court or to be stripped of their rights, it’s a really slippery slope.”
Garrow noted a 2011 study on involuntary treatment and homelessness, which found that forced care had no significant difference in outcomes compared with standard care. A 2014 psychiatric epidemiology review also concluded that empirical evidence did not support coercive treatment.
‘I’m disgusted by our streets’
Asked whether the care court program would expand the use of conservatorships for unhoused people, an HHS spokesperson, Sami Gallegos, said in an email that the program would seek to “divert individuals in need away from the pathway to conservatorships” by focusing on “community-based placements with robust services, including housing”. Individuals would be referred to conservatorships if the court process fails and “if no suitable alternatives to conservatorship are available”.
Harris said the lack of investment in community-based alternatives often created a catch-22: “Even if you say conservatorship is ‘the nuclear option’, if you don’t have any other options available, the nuclear option becomes the only option.”
Newsom told the San Francisco Chronicle that there was no more time to debate people’s civil rights when communities were faced with “people with their clothes off defecating and urinating in the middle of the streets, screaming and talking to themselves”.
“I’m increasingly outraged by what’s going on in the streets,” he said. “I’m disgusted with it.”
While there are growing concerns about escalating gun violence and homicide rates, advocates argue that the unhoused are themselves victimized at disproportionately high rates.
Ananya Roy, director of the UCLA Luskin Institute on Inequality and Democracy, said the court proposal was concerning and was part of a trend in California of criminalizing the unhoused.
“There is seemingly a lot of compassion for the unhoused,” Roy said, “but that is coupled with a deliberate and enforced state of stripping the unhoused of rights in the name of saving them and doing good.”