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Parts of California to have Care Court for those with untreated severe mental illness

JUANA SUMMERS, HOST:

Eight counties in California will launch an experiment this fall aiming to fix a seemingly intractable problem - how to get treatment for people with the most serious mental health challenges, many of whom wind up homeless and with drug or alcohol use disorders. Too often, they end up cycling in and out of police holds, jail or emergency rooms and don't get help. But under these Care Courts, a judge will be able to order mental health treatments and other support under a care plan that counties have to fund. As NPR's Eric Westervelt reports, the rollout is being met with both praise and fierce opposition.

UNIDENTIFIED PERSON #1: That is so supportive, Essie.

(CROSSTALK)

ERIC WESTERVELT, BYLINE: In Diana and Lorrin Burdick's home in suburban Rancho Cordova, east of Sacramento, five parents are talking about their kids over a lunch of curried chicken, potato chips and fruit salad.

UNIDENTIFIED PERSON #1: Her hair is finally growing out.

UNIDENTIFIED PERSON #2: Oh.

UNIDENTIFIED PERSON #3: Oh.

UNIDENTIFIED PERSON #2: Yeah, that's better than the last time I saw her.

WESTERVELT: This ordinary lunch with friends is also a vital support group. Every parent here has an adult child with a severe mental illness, a son or daughter who's also struggled with homelessness, substance abuse and arrests. Using her phone, Diana shows a picture of her son, Michael, who's lived on the streets since 2014.

DIANA BURDICK: That's pretty much what he looks like, right?

ELIZABETH: Oh, yeah. Gosh. See; anybody looking at him would say, that's not right. He doesn't feel good.

D BURDICK: Yeah. This is a couple days ago.

WESTERVELT: Diana says her son, now 49, used to play guitar in a band, loved to draw elaborate pen-and-ink landscapes and worked for a time as an electrician's apprentice. But for a very long time now, her son's been gripped by delusions and paranoia, she says, and frequently self-medicates with street narcotics, mostly methamphetamine. Diana was recently turned down when she tried to get Michael into the county's assisted outpatient treatment program because he's never been diagnosed. He doesn't want any help, Diana says, because Michael refuses to think of himself as ill at all.

D BURDICK: In fact, he thinks that he owns IKEA and that I have a trust fund with Bill Clinton and that I should be giving him monthly checks. And that's why he refuses to get care - because he does not believe anything's wrong with him and that if I would just give him that money, he would be fine.

WESTERVELT: Diana has no idea where he sleeps. Most every day, though, she drops off food for him at a nearby store. We're just kind of waiting for him to get arrested again for something, she says, that might push him into care. As Michael's stepdad Lorrin puts it, unless they can put pressure on him, Michael is very likely to stay on the streets ill, drug-addled and lost.

LORRIN BURDICK: Well, you can kind of look at it - he's in that dark hole right now. And if you could force treatment on him, there's a chance he could possibly crawl out of it. But without some way to force him to do something, he won't do it.

WESTERVELT: It's exactly this mix that California's Care Courts, which launch in eight counties this fall, aim to address - people suffering with untreated severe mental illness, mostly schizophrenia and other psychotic disorders, the kind of folks who too often also end up homeless, addicted and incarcerated. Under Care Court, a wide range of people - parents, friends, clinicians and first responders - can petition the court that a person needs help. If the judge agrees, he or she can order a care plan that counties must fund. The plans would be individualized but would likely include clinical treatment, bridge housing and other support. As the state's Health and Human Services Department puts it, the goal is to give the ill person the tools they need to make self-directed choices to the greatest extent possible. But it's that kind of language that some advocates say shows the program is really coercion masquerading as care.

CHRISTIAN ABASTO: Care Court, as it's written right now, is unconstitutionally vague, and it violates the civil rights of our clients with mental health disabilities who are homeless.

WESTERVELT: Christian Abasto is legal director of Disability Rights California. They're part of a coalition that has sued to stop the program and to get clarity, especially about what will happen to people who fail to follow through on their court-ordered treatment plans. Californians are so fed up with homelessness - it's home to nearly one-third of the nation's homeless - that Abasto worries the program will end up pushing many people into involuntary treatment, what he sees as a backdoor attempt to expand conservatorship where ill people risk losing self-determination.

ABASTO: It empowers parents, police, school persons to basically make an accusation and invoke the court system with potential confinement and potential infringement of the civil rights of people with mental health disabilities when they have done nothing wrong.

WESTERVELT: Instead of funding new courts, the coalition wants the state to dramatically boost funding for existing treatment and housing for homeless persons with severe mental illness. Proponents, including the governor, counter that any potential penalties for not complying with a care plan are being wildly exaggerated. The program hasn't even gotten off the ground.

LISA WONG: I think it's terribly frustrating and heartbreaking for a lot of these families.

WESTERVELT: Dr. Lisa Wong is director of Los Angeles County's Department of Mental Health, the largest county launching a Care Court pilot. LA and other counties going first stress that outreach by social workers will be key to getting people to participate voluntarily so they don't end up in court. But even if a case does, Dr. Wong says, it's still a voluntary service.

WONG: You know, we're not holding people against their will. There's no involuntary medication order or anything like that. So people still have the ability to say no.

WESTERVELT: And many parents, including Diana Burdick, say the Care Court experiment will surely be better than watching their loved ones cycle endlessly between crisis police holds, emergency rooms, jails and homeless shelters.

D BURDICK: What we're doing now is telling my son it's OK to kill himself. He can stay on the streets, and he can die there, but he's going to die with his rights. The only rights I have as a mother is to go claim him in the morgue.

ADRIAN FLORIDO, HOST:

Diana says sometimes when she drops off food or clothes to Michael, a light seems to turn on, and he calls her Mom. But much of the time, she says, she's just Diana, who controls that imaginary trust fund with Bill Clinton, and she has to just drive away.

D BURDICK: So after a while, you kind of have to laugh about it. But then you cry about it because it's such a sad waste of our emotions, our time and his life. He doesn't - what kind of a life does he have, you know? And when you put yourself in those shoes, then it's very hard to function and to - well, to sleep.

WESTERVELT: Maybe with Care Court, her son will finally get a diagnosis and the medical help she's been trying to get for him for so long.

D BURDICK: There isn't anything that I've been able to do. I mean, I've got a book here on all - and all these notes that I have taken and time that I have taken to try to help him. And this is the first time that now I feel like I'm hopeful.

WESTERVELT: Hopeful for her own son and that there's a chance, she says, to save other families from going through some of the pain we have. Eric Westervelt, NPR News, Sacramento. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Eric Westervelt is a San Francisco-based correspondent for NPR's National Desk. He has reported on major events for the network from wars and revolutions in the Middle East and North Africa to historic wildfires and terrorist attacks in the U.S.
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