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What's a key challenge Stanislaus faces in starting court-ordered mental health treatment?

Modesto Bee - 5/22/2023

May 22—Stanislaus County and Superior Court officials are aiming to meet a state timeline to launch CARE Court in October as one way to expand treatment for a growing population with untreated severe mental illness.

Stanislaus is one of the first seven counties in California to test the Community Assistance Recovery and Empowerment program to see if court-ordered treatment can be effective. County officials are expecting challenges, including housing and limited space in residential care facilities.

Other counties in the state will implement CARE in December 2024.

Stanislaus will receive $3.7 million for planning and implementing the program, in which a civil court can order mental health treatment for adults. In addition, Gov. Gavin Newsom's recent state budget revision included CARE Court funding for counties going forward, though officials don't know how much for Stanislaus.

Officials expect CARE Court will be held twice a week, starting in the fall, to handle the 100 petitions anticipated the first year. The program initially could help up to 12,000 people statewide.

Superior Court Executive Officer Hugh Swift said the court has funding for an analyst who will work as a case coordinator and liaison between the court and the county behavioral health department.

County Behavioral Health and Recovery Services is trying to fill 15 positions to provide treatment services for participants. The staffing is estimated to cost $2.1 million annually.

Ruben Imperial, county assistant executive officer, said $1.6 million will pay for a deputy county counsel, a CARE Court manager and housing for people participating in a two-year court-ordered treatment plan.

The growing number of residents with untreated mental illness is more than CARE Court alone can handle. Imperial said it's part of a continuum of services the county is building to reduce homelessness and commit fewer mentally impaired criminal defendants to overburdened state hospitals.

Imperial said 90 to 120 CARE referral petitions to Behavioral Health and Recovery Services are projected annually, based on an internal analysis.

How CARE Court works

CARE is specifically for untreated people with schizophrenia spectrum and other psychotic disorders to keep them being arrested or placed in conservatorships. It's not for adults with autism, brain injury or substance use problems.

The eligible adults are clinically unstable and unable to live safely without supervision.

A petition referring an individual to the program may be filed by family members, first responders, public guardians, hospital directors, roommates or county behavioral health directors. The court does a review to make sure the petition is valid and appoints legal counsel for the individual, who also can choose a voluntary supporter.

County BHRS will work with the individual, legal counsel and the supporter to develop a care plan, including mental health treatment, medication and housing. The county is responsible for treatment costs. Those not completing the CARE plan in one or two years may be referred to conservatorship.

Imperial said the county plans public education this summer on "what the CARE Court is and what it isn't," and who can file a petition.

The ultimate goal is getting these adults into appropriate community-based treatment and keeping them out of institutions. County leaders foresee challenges in getting results from court-ordered treatment.

Stable housing for people in treatment is considered essential, but not enough is available. In hopes of expanding supportive housing, the county plans to work with the regional Housing Authority, Stanislaus County Affordable Housing, Stanislaus Equity Partners and Self-Help Enterprises.

Many adults receiving mental health services are placed in skilled nursing facilities or adult residential centers for the structured programming.

Officials expect that counties will be competing for the same space in residential facilities for their CARE Court participants.

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