Scores of mentally ill people referred for CARE services in program’s first two months

Fears that thousands of homeless Californians would be swiftly swept into unwanted treatment, violating their civil rights, haven’t materialized — yet.

Two months into the Golden State’s “paradigm shift” in how it approaches severe mental illness — where Orange, Riverside and San Diego counties are among the pioneers — there have been more than 100 referrals into the new CARE Act system, said Dr. Mark Ghaly, secretary of the California Health & Human Services Agency.

“We’re seeing promising practices, innovations and ideas in these first two months,” said Ghaly in a call with reporters on Friday, Dec. 1, striking a hopeful tone.

CARE — for Community Assistance, Recovery, and Empowerment — demands that counties provide services like housing, medical treatment, stabilizing drugs, clinical behavioral health care, counseling and more to people with schizophrenia and other serious conditions.

These people often get caught up in systems “that don’t serve them well,” Ghaly said — cycling in and out of jails and locked mental health facilities without getting what they need to stabilize, recover and integrate back into society.

Cautious start

The CARE Act allows concerned folks — such as family members of people who are gravely mentally ill, or doctors, licensed therapists and first responders — to file petitions with the court, asking for housing and other services for those people.

It requires counties, partnered with courts, to ensure that those services are delivered.

But — just 100-or-so referrals in counties that are home to thousands of the severely ill people CARE is meant to help? The sickest of the sick, whose lives are in grave danger, who are most likely to have shunned help?

The early experience in Orange, Riverside, San Diego and the other guinea pig counties affirms what officials already knew: This is an exceedingly difficult population to reach.

“There is no doubt, it’s not easy to do meaningful engagement, and no one expected it would be,” Ghaly said. “I’m convinced the more we do it, the better we get at that engagement. It’s going to pick up ….We see the snowball building little by little.”

Los Angeles joined the first seven pioneer counties on Dec. 1. The rest of the state will follow next year. They’ll have the benefit of lessons learned.

Orange is redefining what courts and courtrooms look like, moving them into the community where people are rather than the other way around  “to support engagement and a more holistic therapeutic environment,” Ghaly said.

In Riverside, workers are taking to the streets to do direct personal engagement with the sickest people and convince them to accept CARE plans that will provide housing, medical care and therapy.

In Tuolumne, officials bought a run-down, vacant assisted living center and transformed it into “high-integrity, dignity-providing housing” for people referred into CARE.

Counties are spending a lot of time trying to engage people, being rebuffed, and then trying again.

“This is new. This is different,” Ghaly said. “We haven’t always been as insistent and as dogged, if you will. These services have to be proactively offered to those who meet the clinical criteria for the pathway. Counties who do a great job for folks who knock on the door — this is a different approach. That experience is going to be really critical and we’re seeing that already.”

Not many referrals are coming in yet from front-line responders who regularly deal with folks in the gravest conditions, such as emergency room personnel, Ghaly said. Officials are working to spread the word among front-line folks to get more people the help they need.

Will take time

Initial funding to get the CARE Act up and running was $57 million.

As of November, Riverside County received 63 referrals for the CARE Act — meaning folks think people might be eligible for services and the county has to check that out —and had 20 formal CARE petitions filed with the court, officials said. Nearly half of Riverside’s referrals came from the county’s CARES line, while 10 came from civil court, four from the county social services department, two from criminal court and one directly from a family member.

In Orange County, there have been 34 filings with the court. Fourteen have moved from the court to County Behavioral Health to start the process of locating and assessing the individual. One case has been dismissed and three have been continued, said Veronica Kelley, Orange County’s chief of mental health and recovery services.

Of the referrals to O.C. Behavioral Health, 10 were filed by relatives (parents, spouse, sibling, adult child), two by hospital personnel, one by a guardian and one by someone seeking services. Nine have been unhoused.

Tallies are not yet official, but the state will release validated numbers on CARE’s initial uptake early next year, Ghaly said.

CARE is not for everyone experiencing homelessness or mental illness. To qualify, people must be at least 18 years old, experiencing severe untreated mental illness (diagnosed as a schizophrenia spectrum disorder or other psychotic disorder), not clinically stabilized or in ongoing voluntary treatment, and in deteriorating condition, unlikely to survive safely without supervision. A CARE plan would have to be the least restrictive alternative to ensure the person’s recovery and stability.

Officials stress that the program is voluntary, but civil libertarians worry that people will be compelled into treatment against their will.

Sen. Tom Umberg, D-Santa Ana, has said that’s not going to happen. Umberg helped shepherd the CARE Act through the legislature, and said that the only mandatory part of the program rests with the public agencies themselves, who are now required to provide resources.

California has about 170,000 people living on the streets — nearly one-third of the nation’s homeless population — and about 10,000 of them are expected to qualify for CARE plans. An initial 100 petitions is not necessarily a slow start to what’s supposed to be a game-changer, Ghaly said.

“I feel like we’re in good shape,” he said. “There’s not a huge influx to be overwhelmed by. I’m pretty pleased with the level of engagement, partnership and optimism …. the pathways implemented county by county are going to be different. It’s going to take time.”