California governor proposes plan to force homeless people with mental illnesses into treatment

In an effort to address his state’s mental health and homeless crises, California governor Gavin Newsom has proposed a new plan to increase the availability of mental health care and compel those who are suffering from debilitating psychosis to accept it.

Mr Newsom is calling his proposal Care Court. It would require that counties across the state provide comprehensive treatment for psychosis and sanction counties that fail to meet that standard. It would also, at the same time, require people to enroll in treatment programs.

Mr Newsom, the former mayor of San Francisco, told the San Francisco Chronicle that conditions on the street of his hometown drove him to make the proposal.

“I’m increasingly outraged by what’s going on in the streets,” he said. “I’m disgusted with it.”

But while there is broad agreement that the state is struggling with a housing crisis driven in large part by exorbitant housing prices and a lacking social safety net, Mr Newsom’s plan may well face fierce opposition from homeless people and allies who see the proposal as a de facto violation of civil liberties.

Under Mr Newsom’s proposal, California residents who suffering from psychosis – whether due to an underlying mental illness or addiction – could be brought before a Superior Court judge if they are suspected of a crime, if their involuntary hold in a psychiatric emergency room is ending, or if a family member or social worker believes them to be unable to care for themselves.

The person would then be enrolled in a treatment plan under the supervision of a case manager that could include psychiatry, medication, and temporary housing. If at any point the person decided they were unwilling to proceed with treatment, the state could move to either proceed with a criminal case or hold them involuntarily and eventually place them in a conservatorship if it determined them to be a threat.

Mr Newsom on Thursday seemed unconcerned about the potential civil rights concerns with the proposal, arguing that the state needs to act quickly and decisively to get people out of homelessness and into treatment programs.

“There’s no compassion with people with their clothes off defecating and urinating in the middle of the streets, screaming and talking to themselves,” the governor told the Chronicle. “There’s nothing appropriate about a kid and a mom going down the street trying to get to the park being accosted by people who clearly need help.

As part of the law, counties would be required to pay for and provide all of the elements included in the treatment plan – a potentially significant investment in the state’s mental health care infrastructure.

Whether the state has the capacity needed to handle a surge of people seeking treatment for mental illness and addiction, however, remains to be seen. The state legislature last year approved $12bn in spending on homelessness and mental health, and the state’s one percent income tax on the ultra-wealthy will provide nearly $4bn more to work with. Mr Newsom is seeking $2bn more in funding in this year’s budget.

But that level of financing may not be enough, especially given that the plan does not address root causes of the homelessness crisis in California like stagnant working class wages, income and wealth inequality, and a slow rate of housing production.

Mr Newsom’s proposal requires legislative approval, which he plans to seek in June. If it passes, the plan could be implemented next year.

Dr Mark Ghaly, secretary of the California Health and Human Services Agency, said at a news conference that he expects the program, should it take effect, to apply to between 7,000 and 12,000 people in the state.