Kern County debuts CARE Court ahead of state deadline

Starting Tuesday, residents can begin making referrals to Kern County health services to enter themselves or a close associate for CARE Court, a new state program aimed at bringing people suffering from mental health disorders into support services.

CARE Courts — enabled by the Community Assistance, Recovery & Empowerment Act of 2022 — are mandated to be set up in all California counties by December but Kern's program will be up and running a bit earlier, said Emily Lyles, program administrator for Kern County Behavioral Health and Recovery Services.

"We've been working diligently with all of our partnering agencies that are involved in this program to be able to launch on Oct. 1," Lyles said.

Referrals can be submitted to the county either by or on behalf of someone suffering from schizophrenia and other psychotic disorders.

CARE Courts are meant to be a softer approach to getting people into mental health services, and though they do involve the court system, advocates say the program is entirely voluntary.

"It's not court ordering the individual themselves the treatment, it's court ordering our department to assess and provide that individual with treatment," Lyles said. "The program is really intended to reach those individuals before they're hospitalized, incarcerated or placed on conservatorship. So we're catching these individuals upstream."

How it works

A range of people from individuals themselves to family members, roommates and first responders can submit a court petition to begin the process of assessing someone's eligibility for the program.

Once a referral is filed, the county takes over as the petitioner, meaning whoever originally made the referral no longer has to be involved. Respondents are then contacted by behavioral health professionals who will work with the individual to determine if a care plan is possible.

Speaking Tuesday to the Bakersfield City Council's Housing and Homelessness Committee, Kern BHRS deputy director of clinical services Jessica Armstrong said the only requirement of the program is an assessment once a referral is received.

"The only non-voluntary piece of this is our department doing an evaluation. We are required to do an evaluation if we receive a petition," Armstrong said. "If they don't want to come to court that day, they do not have to come to court. This is not like diversion programs where there is a criminal component of this."

The county is contracting for behavioral health services with Alameda-based Telecare, which is already running CARE Court programs in other counties, including San Diego, one of the original seven counties to pilot the program.

With the agreement of the respondent, a care plan can then go before a county judge — in Kern County, all CARE Court cases will be heard by Judge Stephanie Childers — who can schedule reviewing hearings to gauge a plan's effectiveness.

The respondent is assigned an attorney to represent them before the court, and participants in the program can choose an advocate to support them through the process.

Care plans will vary from person to person, Lyles said, and will detail what services that person may require to meet their needs. They can include case management, counseling, peer services and even housing.

"It requires a full-service partnership team," Lyles said. "What that means is, it's a multidisciplinary team that will be able to provide a holistic approach to the client's care. This includes a psychiatrist, nurses, therapist, case coordinators that will help them get linked with the housing or other community resources that they may need."

A care plan can involve prescription medications to manage symptoms, but forced medication is not part of the CARE Court program.

County officials stressed that CARE Courts would be supplementary to the range of mental health services already provided by city, county and private organizations.

The CARE Court program is supposed to last for a year, but can be extended for another 12 months if necessary.

"What we're really hoping to see from the individuals who are ready to graduate is that they're able to regain a meaningful role in the community," Lyles said. "That they're on their path to recovery and that they're able to be more independent without the risk of deteriorating or ending up in a more restrictive type of treatment program."

San Diego County graduated its first class of CARE Court participants on Aug. 7.

Program detractors

But the program has its detractors. Civil liberties groups including Disability Rights California sued in an effort to block rollout of the program, but the state Supreme Court sided with the state in 2023.

Civil rights groups have argued CARE Courts will be a pathway to conservatorship, a status that strips people of their rights on the grounds they're not able to care for themselves.

"The 'CARE Court' framework would divert vital resources away from the state's responsibility to expand investments in the housing and care people need to get off the streets," wrote Eve Garrow and Kath Rogers, attorneys with the American Civil Liberties Union California Action.

"It harks back to a dark era when forced treatment of people with serious mental health conditions was the norm. It would unravel decades of hard-won progress by the disability rights movement to secure self-determination, equality and dignity for people with disabilities," Garrow and Rogers wrote.

It is possible that courts can recommend a higher level of care, including involuntary commitment, and non-completion of the CARE Court program can be factored into conservatorship decisions.

"One of the things that the conservators' office looks at when they're evaluating does somebody need to be on conservatorship or not is do they have a history of failing from other types of programming," Armstrong said Tuesday. "So that would be evidence to show that they're not capable of doing voluntary treatment, and that's how care would be used in that scenario."

CARE Courts are being deployed at the same time the state has expanded the conditions under which a person can be involuntarily detained. Senate Bill 43, signed into law last October, expanded the definition of gravely disabled to include mental health and substance abuse disorders.

Forty-five counties, including Kern, have opted to delay implementation of SB 43 until 2026.

Though not necessarily focused on the homeless population, both CARE Courts and SB 43 were passed in the effort to get people off the streets and into treatment.

But one psychologist is skeptical about any program to compel people into treatment.

"I worked within that framework for 40-plus years and I saw and experienced all the ways it cannot work the way people want it to work," said Brik McDill, a retired psychologist who spent several years working as a prison therapist.

Programs like CARE Courts are well-meaning, McDill said, but if a person does not want to accept treatment, there is no way to compel them to receive treatment.

"They're going to spend thousands of hours trying to navigate the judicial process all to be defeated," McDill said. "I've never seen it work, someone who is resistant to treatment will not be amendable to treatment."

"Truly, if you have participated in the process, seeing it fail time and time again one gets the impression that swimming upstream against a current that washes you downstream," McDill said.

State and local officials have emphasized CARE Courts will not solve the homelessness issue, but have touted the program as a way to guide people into voluntary treatment.

"CARE Court is not going to be an end-all, be-all for homelessness in Bakersfield and Kern County," said Lou Groce, public information officer for Kern BHRS. "But this is one of the many ways that we continue to work, and it's going to supplement the work that we're already doing in the community, to get the homeless population the support that they need."