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CARE courts open in a month, promising hope for families. Not everyone is so sure

Nan Ibarra knows what psychosis looks like and wonders if that’s the case with politicians.

Shortly after her older son was convinced she was Satan, he brought a baseball bat to her home in Laguna Hills, smashing windows, framed pictures, and a curio cabinet.

Then his brother started taking spoonfuls of sugar to the backyard because ants told him they were hungry.

Ibarra has observed the effects of schizoaffective disorder on her two sons and knows how unpredictable the symptoms are. In the past three and a half years, her younger son has been hospitalized 45 times, she said; his brother lives in a sober home.

When Ibarra first heard about the Community Assistance, Recovery and Empowerment Act, she wondered why lawmakers were so focused on voluntary compliance.

“I’m open to CARE Court,” she said, “but of course I balk because it’s voluntary.” My sons have never been in a program that gives them choice.”

Ibarra, who now lives in Idaho but attends to the care and treatment of her sons on regular trips to Orange County, says concerns have been raised by some families as details of the legislation have become clearer in recent months.

“Dealing with someone with a serious mental illness is very unpredictable,” said Elaine Tan of Irvine, whose son has been diagnosed with schizoaffective disorder. “How many people with serious mental illness will continue their care voluntarily? It is part of the disease not to do it. It’s part of the lack of brains that they don’t.” (Tan asked to be called by her maiden name to protect her son’s privacy.)

Just weeks before CARE courts in select counties begin accepting cases, a complicated picture is emerging: families who feel the new law does too little to treat people with serious mental illness, and civil rights activists, who fear it will do too much.

A man with a shaved head, wearing a dark suit and red tie, gestures while holding a microphone near a woman seated next to him

Orange County Chief Justice Ebrahim Baytieh speaks during a CARE Court briefing in August 2023.

(Gina Ferazzi / Los Angeles Times)

Although the law does not specifically state what can be done if a person refuses to comply with a court-mandated treatment plan, Clare Cortright, Cal Voices policy director, anticipates coercive action.

“To say that a CARE agreement is voluntary is like saying that a plea agreement goes to jail voluntarily,” said Cortright, whose Sacramento-based nonprofit works to help people with mental illness.

Orange County is among the first

Seven counties, including Orange, will open their CARE courts on October 2. Los Angeles County opens December 1, and the rest of the state has until next year to follow suit.

The families’ disappointment contrasts with their excitement last September when Gov. Gavin Newsom signed into law what was billed as the most significant reform of the state’s behavioral health laws since the Lanterman-Petris Short Act of 1967, known as the LPS.

The CARE Act opened up the possibility for more people, including family members, to apply to the court for treatment for family members with psychosis.

Previous legislation focused on involuntary admission as a means of treatment, and only police, crisis teams and mental health providers could make that request. This resulted in families being left out, unable to receive help and, once help was provided, being barred from the procedure under medical privacy laws.

But now families fear that although they can apply for treatment, they will be turned away. Their loved ones, referred to as respondents in the CARE Act, can refuse to allow families to track their progress and can also refuse treatment.

“What two-year-old would willingly do the things you want them to do?” said Ibarra. “I deal with a 2-year-old all the time. I tell him that’s what’s best for you and he says no and goes back to the streets, to the drugs, and off his meds.”

The law’s harshest critics worry about the judges’ reaction to such opposition. They argue that it is becoming an effective means of involuntarily inducing respondents into treatment.

As an attorney, Cortright said she has represented 2,000 people in involuntary detention and that most of her clients have had a horrible experience. She believes the CARE Act will be just as traumatic.

“Lots of excitement”

“It’s one thing to talk about the program from afar, but what does it look like and how does it feel to the person going through it?” she asked, describing the prospect of someone standing in front of a judge and about need to talk about his state of mind. “It’s humiliating. It robs you of your privacy. It makes your health a crime.”

Cortright also sees no evidence that the CARE Act will work. Her protocols, she said, are not based on data but on society’s desperation over homelessness and mental illness on the streets.

dr Contrary to expectations, Veronica Kelley, Orange County director of behavioral health services and area lead for adoption, is bracing for disappointment.

“There’s a lot of tension throughout the system,” she said before speaking to a gathering of families and carers in Orange.

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Legislation on the treatment of serious mental illnesses in California will always be overshadowed by the past. The Lanterman-Petris-Short Act transformed decades of institutionalized care that often tragically involved coercion.

The CARE Act tries not to repeat this pattern.

Once the application is approved by the judge, the defendant will be contacted and a treatment plan will be drawn up. Once the plan is approved by the judge, the defendant can choose to accept its terms or opt out.

Acceptance establishes a course of treatment for at least one year that includes behavioral health and social services, medication management, and housing. The refusal leads to a call to the judge, who decides how to proceed.

The process relies heavily on ‘supportive decision-making’, where a ‘facilitator’ is appointed – defined in the legislation as someone who will help the respondent ‘understand, make, communicate, communicate, their own life choices during the CARE process implement or act accordingly”.

health management staff, a Michigan-based consulting firm on behalf of the California Department of Health and Human Services, presented the concept this year to a working group helping to implement the legislation. His rationale was described as “a response to decades of suppression of the rights of people with disabilities to make their own decisions.”

A possible exclusion worries parents

The defendant has the option to choose their supporter, who may or may not be a family member or the claimant.

This possible disqualification worries families, who wonder why the CARE Act doesn’t provide a rule for their continued participation even after they have submitted the application.

Mark Gale, Greater Los Angeles County Criminal Justice Chair of the National Alliance on Mental Illness, sees a strong anti-family bias in the legislation.

“Some stakeholders worry that families may put undue pressure on respondents,” he said. “What they don’t understand is that families would be thrilled if their loved ones volunteered for treatment, but we all know that doesn’t happen as often as we’d like.”

“We want to be partners in care,” said Teresa Pasquini, who has been helping her son, who suffers from schizophrenia, for 20 years. She feels families have been disregarded and despised at every meeting.

Pasquini is concerned that the implementation of the CARE Act focuses on “conversations focused on equality, race and culture” while avoiding important conversations about families and the role those relationships play in the dynamics of mental illness.

“The culture of families like mine, who have endured multiple traumas while being blamed and shamed for the no-fault brain disorders of our loved ones, cannot be disregarded or glossed over,” she said.

The CARE Act’s author, State Senator Tom Umberg (D-Orange), hopes to bring families back into the process with what he calls a “cleansing bill,” Senate Bill 35. This would allow the court Assign “ongoing rights” to the original requestor but only if the court and the defendant agree. (The bill also waives the $433 fee for filing a petition.)

The exclusion of families, say Gale and Pasquini, is a mistake and an example of how the CARE Act does not adequately balance effective treatment with respondents’ autonomy.

“There is too much emphasis on making them feel good, with the assumption that they should think clearly and their rights should be protected,” Ibarra said.

While Ibarra supports the legislation’s requirement for supportive decision-making, she doubts it will result in a more consensual treatment plan. She describes how some days a son is perfectly clear and rational and other days claims she is not his mother but a clone.

“Everything is suspicious in his head,” she said. “It doesn’t matter if he’s in a room with flowers.”

Ibarra believes that effective treatment should be both compassionate and vigorous, and the respondent should be held accountable.

When her older son was arrested for DUI and tried in community court on a mental illness charge, the judge ordered two shackles and random drug and alcohol tests. Three years later, he is sober and medication compliant.

But when his brother developed symptoms, Ibarra saw that the authorities were treating him more sensitively and, in their opinion, were less effective.

“They said they didn’t want to bother him and make him nervous and anxious,” she said, “not considering that his thoughts and feelings change like the wind.”

Supportive decision-making, said Rod Shaner, former medical director of the Los Angeles County Department of Mental Health, is a “pivot of the CARE Act” but does not directly affect a person’s ability or inability to think rationally based on their illness.”

Families can help because they have experience of the respondent’s illness, delusions and paranoia, Gale and Pasquini say, and at the very least families should be allowed to disclose the medical history of their loved ones.

Cortright is concerned about such arguments, and particularly the influence families can have on lawmakers.

“Family members say, ‘I’m at my wits end about how to deal with my loved one,’ but we can’t make politics based on anecdotes. We write laws that affect millions of people forever; “You make laws that benefit most people the most,” Cortright said.

“Let’s stop walking on eggshells”

But she is particularly concerned that a bad experience with CARE Court will discourage respondents from using the system.

“Eventually, once your finger is off the scale, they’ll say go to hell and walk away if what you’re doing is harming them and keeping them out of the psychiatric system,” Cortright said.

Instead, it takes a trusting relationship, and that takes time, she said. “You have to balance treatment with quality of life. If you go that far in search of treatment and a decrease in quality of life, people will resist you.”

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A woman holds a microphone and documents, stands in front of a projector screen and looks at an audience

Sara Nakada, a senior assistant public defender for Orange County, speaks to a group during a CARE Court informational session.

(Gina Ferazzi / Los Angeles Times)

The CARE Act, said Dr. Susan Partovi, medical director of Homeless Health Care Los Angeles, a nonprofit that provides health care to homeless Los Angeles residents, said she was “strongly opposed to coercion.” There’s a lot of “We don’t want to force anyone to do what they don’t want to do.”

“Let’s stop walking on eggshells to make sure we don’t upset the ACLU or Disability Rights California and let’s take this opportunity to get people the help they need.”

Getting someone into treatment requires patience and special skills to present resources to someone who is suspicious and paranoid, Partovi said. The involvement of a judge and court is likely to upset many people who need help.

“I hope that the actual outreach staff – or people who are petitioning the courts – have the tools to know that over time there will be a discussion and just because the first time they’ Saying no’ doesn’t mean you’re “done again,” she said.

When she met the 35 people who had gathered in Orange to learn more about the crime, Kelley described the efforts Orange County will make to get someone into treatment. She understands that some respondents may require numerous interactions with staff and the volunteer.

“Our job is to work with them so they can feel safe enough to trust us,” she said.

The goal – and hope – of the CARE Act is that the defendant’s decision be consistent with that of the court, thereby avoiding the potentially traumatic experience of facing a judge.

“The best achievement is no one has to see me,” said Ebrahim Baytieh, the Orange County Superior Court Justice who will oversee the county’s CARE court.

Although the CARE Act is not “an advancement to conservatory service,” he added, “If someone goes through the CARE Act process and is unsuccessful, there is a presumption that they are entitled to involuntary conservatory service,” as defined in the Lanterman-Petris-Short Act.

The overlap between the CARE Act and other existing LPS codes — where voluntary treatment becomes an involuntary obligation — remains a gray area that likely needs coloring, Shaner said.

Although the CARE Act tries to maintain less restrictive treatment, there needs to be clarity about what happens next if the respondent is deemed to need help, he added.

“There has to be a backing so they don’t just disappear back down the street and die,” Shaner said.

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