Newsom Proposes Offering More Treatment Services for Unhoused People — and Forcing Some to Participate

Gov. Gavin Newsom proposed a plan Thursday to offer more services to unhoused people who have severe mental health and substance use disorders, even if that means forcing some to receive that care, a move many advocates of the unhoused consider a blatant violation of civil rights.

The governor said at a press conference that he has no intention of rounding people up and locking them away. Instead, he said his plan would offer a way for people to get court-ordered psychiatric treatment, medication and housing, preferably before they are arrested.

Under the plan, which requires approval by the Legislature, all counties would have to set up a mental health branch in civil court and provide comprehensive and community-based treatment to those suffering from debilitating psychosis. People need not be homeless to be evaluated by a court.

But if approved, unhoused people facing criminal charges would be obligated to accept the care or risk adjudication. Those not facing charges, but deemed in need of care, would be potentially forced into psychiatric programs or lengthier conservatorships, in which a court authorizes other adults to make health and legal decisions for them.

"There’s no compassion stepping over people in the streets and sidewalks," Newsom told reporters during the briefing, staged at a mental health treatment facility in San José. "We could hold hands, have a candlelight vigil, talk about the way the world should be, or we could take some damn responsibility to implement our ideals, and that’s what we’re doing differently here."

Newsom, the former mayor of San Francisco, has made homelessness and housing a focus of his administration. Last year, the Legislature approved $12 billion for new housing and treatment beds for the unhoused, and this year Newsom has proposed an additional $2 billion primarily to shelter people suffering from psychosis, schizophrenia and behavioral health disorders.

The governor's office plans to boost the program with more money for psychologists, treatment beds and services, although officials did not provide an estimate of how much it might cost.

Newsom has frequently referred to distressing behavior that's become increasingly common on the streets in some California cities, calling it heartbreaking and maddening and saying residents are right to complain that government is not doing enough.

People with addiction issues or mental health disorders often pinball among various public agencies, namely hospitals, courts and jails. There is rarely one single place that manages someone's health and offers steady and safe housing, combined with resource-intensive care.

California, like the rest of the country, suffers from a severe shortage of treatment beds.

"One of the most heartbreaking, heart-wrenching and yet curable challenges that we face ... is how do we serve the needs of individuals who are the sickest of the sick?" Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, said in advance of Newsom's announcement.

Ghaly said he expects the program, called Care Court, to apply to as many as 12,000 people in California, not all of whom need to be unhoused.

Compare that to just over 200 people forced into court-ordered treatment last year under Laura's Law, a state program for people with severe and persistent mental illness who may pose a risk to themselves or others, he said. The program is optional, and just over half of California's 58 counties participate.

The governor said that, under his proposal, those in need would have a say in their treatment plan and have a public defender to represent them. Most importantly, the proposal allows a broader array of people, including family members, outreach workers and first responders, to refer the person for help, he said. Care could last up to 24 months.

But the idea of forcing people into treatment rattled some civil rights defenders and advocates of the unhoused. Meanwhile, the California State Association of Counties quickly objected to the requirements, citing the burden it would place on individual counties.

“At this point there are a million questions and a million things that could go horribly wrong,” said Kevin Baker, director of government relations for ACLU California Action, in an email. He said homelessness is caused by skyrocketing housing costs "and we won’t solve homelessness, mental health, or substance abuse problems by locking people up and drugging them against their will."

The Western Center on Law and Poverty pointed to a 2020 state audit that found many people put under conservatorship wound up with limited treatment and follow-up.

"Forcing people into temporary hospitalization will not help individuals move out of homelessness when there are not enough services or housing units to begin with," it said in a statement.

Still, others contend that mandated treatment is necessary for some who are too sick to realize they need care.

In San Francisco, a state law designed to get more people into conservatorships has resulted in just two people being forced into care, said Rafael Mandelman, a city supervisor, describing how he has watched helplessly as unhoused residents languish outdoors.

Mandelman says he would welcome more money for emergency psychiatric treatment beds and staffing. But he says there also needs to be a major change in both the deployment of resources and in the way judges think.

"We also clearly need better systems that are able to respond to the needs of this population much better," he said, “and we need laws that are clear to judges, and that reflect the expectations of the community."