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Has Mental Health Flown the Cuckoo's Nest? California Psychiatric Detention Centers Are Back

In this commentary, we'll explore the potential risks associated with court-ordered mental health treatment for unwilling homeless individuals, extending for up to two years in locked psychiatric detention centers.

photo by shutter stock

This approach is called 'Care Courts,' drawing parallels to a fusion of 'One Flew Over the Cuckoo's Nest,' meets monetized care, and societal sanitation efforts, all rolled into one. We will also examine how our state's policy might exacerbate the challenges faced by California's already beleaguered behavioral health system, despite the substantial funding it has received.

California's SB 1338, also known as the Community Assistance, Recovery, and Empowerment (CARE) Court program, is a new law that expands the use of involuntary treatment for people with serious mental illness. The law allows judges to order people into treatment for up to 24 months, even if they do not want it.

Proponents of the law argue that it is necessary to help people with serious mental illness who are unable to care for themselves and are a danger to themselves or others. They also argue that it will help to reduce homelessness and crime among people with mental illness.

Let's Talk Turkey

How does locking-up homeless people with mental health challenges in psychiatric detention centers reduce homelessness, if it fails to address the underlying core issues related to homelessness? Which, begs the question: Are these psych-facilities destined to become revolving doors that cost tax payers billions of dollars, only to end up being overhauled in 10 to 15 years, because they've failed?

Some would argue that the state already spent 17.5 billion on decreasing homelessness. Did that happen? Nope. Homelessness has increased in California. Others argue that forced long-term mental health detention will be a literal gold mine for lawyers and clog up our court system.

Prior to Care Court

Did you know that the "5150" code in California was in place long before the introduction of Care courts? This code allowed individuals to be involuntarily placed on a psychiatric hold if they were determined to pose a threat to themselves or others due to a mental illness, or if they were considered "gravely disabled" and unable to provide for their basic needs of food, clothing, or shelter.

The average Californian absolutely wants more services and more housing for those who need it most, but they don’t want to be duped into funding the legal system and criminalization of communities of color and more involuntary institutionalization,” said Carolina Valle, senior policy director with the California Pan Ethnic Health Network.

Forced Institutionalization

Critics of the law also argue that it is a form of forced institutionalization that could have devastating consequences for people with mental illness and addiction challenges. They also argue that it will erode public trust in behavioral health services and make it more difficult to reach and serve people who need help the most.

It's also concerning that SB 1338 has created a significant influx of power, billing opportunities, and substantial grants for mental health providers, which raises apprehensions for this writer.

California Wants More Psychiatric Detentions

As psychiatric detentions increase, and officials clamor for more, it’s not at all clear that they help people more than they harm.

As summarized by a 2019 review of scientific literature on coercive care: “there is little evidence [coercive interventions] confer any clinical benefits,” making it “paradoxical” that these interventions “continue to be used extensively.” Worse, the authors wrote, forced interventions are “often associated with negative outcomes” and experienced as “highly distressing and even traumatic.”

Concerns About the Impact of the CARE Court Program

One of the biggest concerns about the CARE Court program is that it could disproportionately harm marginalized communities. People of color, people who are homeless, and people with disabilities are already more likely to be incarcerated and criminalized. The CARE Court program could further marginalize these populations by making it easier to force them into treatment against their will.

The Need for a More Humane and Compassionate Approach

There is a better way to help people with mental illness issues. Instead of forcing them into treatment against their will, California should focus on investing in voluntary mental health services and supports. These services should be accessible and affordable for everyone, regardless of income, insurance status, or housing status.

We need housing not mental health jails

The CARE Court Program is a Recipe for Trauma and Abuse

Forced involuntary treatment is a serious infringement on a person's civil liberties. It is also a recipe for trauma and abuse. People who are forced into treatment against their will are more likely to experience negative outcomes, such as worsening mental health symptoms, increased aggression, and self-harm.

The CARE Court program is a flawed solution to the problem of homelessness and mental illness. It is more likely to harm than help the people it is intended to serve. California should instead focus on investing in voluntary mental health services and supports and on reducing the stigma associated with mental illness.

What California Can Do Instead

Here are some specific things that California can do instead of the CARE Court program:

  • Invest in voluntary mental health services and supports, such as crisis intervention teams, mobile mental health teams, and supported housing.

  • Reduce the stigma associated with mental illness by promoting public awareness and education.

  • Address the root causes of homelessness, such as poverty and lack of affordable housing.

By taking these steps, California can create a more supportive and humane system for helping people with mental illness.

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Article Research Links:

Urgent Legislative Alert: Stop SB-1338 in California!

Human Rights Watch’s Opposition to CARE Court (CA SB 1338)

Tell the California Assembly Appropriations to Reject CARE Court!

Disability Rights California Disappointed with Governor Newsom’s Signing of SB 1338 (Umberg) CARE COURT into Law



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