California's New CARE Courts Prompt Orange County to Weigh Best Practices

Editor’s note: This story is part of an occasional series examining the rollout of CARE Courts across the state. Read or listen to KQED’s reporting on San Francisco County here.

When Heidi Sweeney first began hallucinating, the voices in her head told her Orange County’s Huntington Beach was where she would be safe. There, behind the bikini-clad crowds playing volleyball and riding beach cruisers, she slept in homeless encampments, then beside a bush outside a liquor store, drinking vodka to drown out the din only she could hear.

For years, she refused help, insisting to all who offered, “I’m not sick,” until police arrested her for petty theft and public drunkenness. A judge gave her an ultimatum: jail, or treatment. She chose treatment.

“I’m so thankful that they did that,” said Sweeney, now 52. “I needed that. I think there’s others out there that need it, too.”

If she hadn’t been compelled to get care, Sweeney said she wouldn’t be alive today, back at work and reunited with her husband. It’s why she supports California’s new civil CARE Courts, which will launch this fall in eight counties, including San Francisco, Los Angeles and Orange, followed by the rest of the state in 2024.

Under the new system, family members and first responders can ask county judges to order people with psychotic illness into treatment, even if they are not unhoused or haven’t committed a crime.

The bill creating the program sailed through the state Legislature with near unanimous support last year amid growing frustration from voters over the state’s increasing population of unhoused residents, even as it drew vehement opposition from disability rights groups, who argued CARE Courts’ hallmark — compelling people who have done nothing wrong into mental health care — is a violation of civil rights.

In Orange County, that tension — between those who advocate for voluntary treatment and those who say the status quo allows people to die in the streets “with their rights on” — is playing out in the implementation of the program.

Its officials are threading a delicate needle: particularly, how to convince people to accept care without coercion, when their illness causes them to believe they are not ill.

“We don’t want to punish people,” said Maria Hernandez, the presiding judge for Orange County Superior Court. “We want them to maintain their dignity.”

Orange County is expecting that between 900 and 1,500 residents will be eligible for CARE Court in any given year, according to the county public defender’s office. Local lawyers, judges and health officials all have aligned in designing their program with a distinct patient focus, endeavoring to make the process as benign and nonthreatening as possible.

Hernandez said that means modeling the new civil court after the county’s other collaborative courts, where judges often lose the black robe and come down off the bench to work with people, eye to eye.

One prototype, she said, is her Young Adult Court (PDF), where, on a day in June, the mood was downright jovial. Defendants and their family members were chatting and laughing, munching on snacks laid out on a table in the back as three young men “graduated” from the diversion program.

“Judge Hernandez is so awesome,” said Abraham, 25, a former graduate, who asked to be identified only by his first name because he was charged with a felony that has since been expunged from his record. “I don’t even look at her as the judge. She’s just like a mom figure. She’s only trying to push you to be the better you.”

A minute later, Hernandez walked through the aisle of the courtroom and gave Abraham a hug.

‘Disaster preparedness’

Even if CARE Court is ruled by the likes of Mary Poppins, Orlando Vera, who lives with bipolar disorder, said helping a vulnerable person heal from mental illness shouldn’t involve dragging them into a courtroom.

“It’s not a place [where] you resolve your emotions. It is a very business-oriented environment. So I do feel that this is not the place for it,” Vera said, adding, “Can we stop it? I would say we can’t.”

After advocates failed to convince the state Supreme Court to block the program on constitutional grounds, some started referring to the rollout of CARE Court as “disaster preparedness.”

Peer Voices of Orange County, a group Vera co-founded and runs, plans to install patient advocates at the courthouse to attend any and all CARE Court hearings.

“Our focus is how do we support those that are going through the system,” he said. “We need to be their voice.”

‘CARE’ without coercion

Orange County behavioral health director Veronica Kelley is sympathetic to advocates’ concerns. She said CARE Court is not the program she would have created to improve the state’s mental health system. But she serves at the will of the governor and other elected officials who control her budget.

“So we end up building the Winchester Mystery House,” she said. “It is a structure that was OK, but then it just started adding hallways to nowhere and basements that are on top of the building. That’s what our system looks like.”

But Kelley is committed to making sure CARE Court is not a hallway to nowhere.

“It is a hallway that I’m going to, at the end, construct a door that opens out to a bunch of different options,” she said.

Kelley is shaping the new court process into something its critics can accept. This is why she wanted Orange County to go first.

“So we can help craft it into something that’s not another colossal waste of time and funds, and that we don’t destroy the people we’re trying to serve at the same time,” she told a roomful of patient advocates during a meeting of the state Patient Rights’ Committee, held in Santa Ana.

This means social workers from her behavioral health department or the public defender’s office might visit people 20, 30 or 40 times to build trust, listen and set goals.

“If they can’t be convinced, CARE Court isn’t for them. But we’re not going to give up on folks because they say no the first time,” said Martin Schwarz, Orange County’s public defender, who plans to devote eight full-time staff to represent the interests of patients referred into the program.

Under the CARE legislation, the court is allowed to fine behavioral health agencies $1,000 per day if they can’t find a patient and enroll them in treatment by certain deadlines.

Kelley said her county’s judges have agreed to give her staff the time and extensions they need to do their jobs right. She also vowed that no one who declines services in her county would be institutionalized, as the legislation allows.

“If someone agrees to do something of their own accord, it is far more probable that there will be long-term success and long-term commitment to the services being provided,” she said.

Kelley and Schwarz pointed to their success with another civil court process established by Laura’s Law in 2002, where for each individual involved in court-ordered outpatient care, there were another 20 who accepted treatment willingly.

They say they have the same goal for CARE Court, where the focus will be on finding a treatment plan people accept voluntarily — before a judge has to order it.

“Success is measured by who we keep out of the court system,” Schwarz said.