California’s mental health system leaves some people on the streets. What Newsom wants to change

Prior to 1967, California treated many of its most mentally ill residents by sending them to live in state hospitals against their will, often for long periods of their lives.

That changed when then-Gov. Ronald Reagan signed the Lanterman-Petris-Short Act, a landmark piece of legislation that sought to end the involuntary commitment of people with mental health disorders and established a conservatorship system, where the court can assign someone to manage a mentally ill person’s assets and legal decisions.

Today, lawmakers say it’s not enough to handle the amount and severity of mental health crises in California.

“We’re talking about a world that no longer exists,” Gov. Gavin Newsom said Thursday as he proposed one of the most significant overhauls to California mental health care in the last 50 years.

Since Reagan’s action, the Golden State has become one of the most unaffordable places to live, with average home prices skyrocketing and contributing to the number of people on the street. California today is home to more than a quarter of the nation’s homeless, many of them mentally ill.

The LPS Act has been tweaked over the years to make it easier to get help to those who need it. Most notably, lawmakers in 2002 passed Laura’s Law, which gave families a legal tool to get treatment for their severely mentally ill relatives.

On Thursday, Newsom proposed letting courts require local governments to provide treatment and services to its most vulnerable citizens.

The goal, Newsom said, is to do more to help the most severely mentally ill residents, who can be so out of touch with reality they don’t know they’re sick and refuse treatment.

The Democratic governor wants the California Legislature to pass a bill establishing “Care Court,” which would serve as mental health arms of county civil courts. Under the plan a judge could decide if an individual who is suffering from psychosis needed a support plan, and could mandate that the county work with the individual to provide services, medication and housing.

To assuage concerns about civil rights and due process, the plan has mechanisms that give mentally ill people a say in their treatment. It would provide a person in need with an advocate, a public defender and peer supporter.

If the person with mental illness didn’t want to participate, they could still be subject to the existing system of temporary 72-hour holds, or in some cases, year-long conservatorships.

Sacramento Mayor Darrell Steinberg, a longtime mental health advocate, said the governor’s plan will finally create a right to treatment in California, something that doesn’t exist under the current system.

“When we shut the state mental hospitals many decades ago, people with severe mental illness were not afforded any kind of a right to treatment,” he said. “Now, when it comes to mental health, care and treatment, especially for people who are the most severely in chronically ill living in our living on our streets, they currently have no entitlement, and in many instances, no expectation, that they’re going to get the help that they need.”

Dr. Mark Ghaly, the state’s health and human services secretary, pointed out that not all counties have to follow Laura’s Law. They can opt in or out, given their preference.

With the Care Court law, all counties would be required to participate, a key factor, Ghaly said. Those who don’t participate could be sanctioned.

“We don’t need to look at the models and tools from decades ago,” Ghaly said. “We’ve modernized many of them, and the innovation is about how do we bring those models that we see in pockets of California and bring those to scale through a program like this.”

State Sen. Susan Eggman, D-Stockton, called the governor’s proposal “bold and much-needed.”

“We have also heard the calls to fix our broken behavioral health system and we must continue to focus on it. Should this proposal be implemented, the current system will still be there to receive folks who may not meet CARE Court criteria or fall out of the system,” Eggman said in a statement.

The senator said she is working on a number of bills to improve the behavioral health system, including refocusing the Mental Health Services Act, a funding mechanism, on achieving treatment outcomes rather than just meeting funding formula requirements. She also is looking at modernizing the conservatorship process.

Compelling local governments to provide services, and individuals to use those services, is only part of the problem, some say.

Michelle Cabrera, executive director of the California County Behavioral Health Directors Association, said the lack of affordability in California has created an “assembly line” of new behavioral health clients for counties to assist.

Not only does the state need to lower housing costs, Cabrera said, it needs to provide more ongoing funding to counties to expand mental health services. State money is often distributed to these programs through one-time grants, she said, which makes it hard to hire staff or plan out services.

“We have built ourselves a patchwork, not even a whole quilt,” she said.

The state’s Mental Health Services Act, championed by Steinberg as a legislator and passed by Proposition 63 in 2004, now generates $3.8 billion a year.

But some advocates say more is needed.

Scarlet Hughes, executive director of the California State Association of Public Administrators, Public Guardians, and Public Conservators, said she and her members look forward to working with lawmakers to strengthen this new proposal and address the “significant impacts it will undoubtedly have on demand” for county programs.

The association is proposing the state dedicate $200 million annually to address critical staffing shortages and prevent greater human suffering for people with severe mental illness, severe cognitive deficits, people who are seriously and persistently mentally ill and homeless, and adults who have been victimized and exploited.

“We share the governor’s goal to provide care and compassion for vulnerable individuals and ensure our guardians and conservators have the resources to meet both current demand and increasing needs,” Hughes wrote in a statement.

This story was originally published March 4, 2022 at 5:00 AM with the headline "California’s mental health system leaves some people on the streets. What Newsom wants to change."