The first time Heidi Sweeney began hallucinating, the voices in her head told her Orange County\u2019s 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.<\/p>\n

For years, she refused help, insisting to all who offered, \u201cI\u2019m not sick,\u201d until police arrested her for petty theft and public drunkenness. A judge gave her an ultimatum: jail or treatment. She chose treatment.<\/p>\n

\u201cI\u2019m so thankful that they did that,\u201d said Sweeney, now 52. \u201cI needed that. I think there\u2019s others out there that need it, too.\u201d<\/p>\n

If she hadn\u2019t been compelled to get care, Sweeney said, she wouldn\u2019t be alive today, back at work and reunited with her husband. It\u2019s why she supports California\u2019s new civil CARE Courts that will launch this fall in eight counties, including San Francisco<\/a>, Los Angeles<\/a>, and Orange, followed by the rest of the state in 2024.<\/p>\n

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\u2019t committed a crime. A judge will then determine if a person meets criteria for the program and may oversee a care agreement or compel a treatment plan. That treatment plan could even include involuntary commitment.<\/p>\n

The bill creating the program sailed through the state legislature with near-unanimous support last year amid growing frustration from voters over the state\u2019s increasing number of homeless people, even as it drew vehement opposition from disability rights groups, who argued CARE Courts\u2019 hallmark \u2014 compelling people who have done nothing wrong into mental health care \u2014 is a violation of civil rights.<\/p>\n

That tension \u2014 between those who advocate for treatment being voluntary and those who say the status quo allows people to die in the streets \u201c with their rights on<\/a>\u201d \u2014 is playing out all over the state of California. In Orange County, officials are threading a delicate needle: how to convince people to accept care without coercion, particularly when their illness causes them to believe they are not ill.<\/p>\n

\u201cWe don\u2019t want to punish people,\u201d said Maria Hernandez, the presiding judge for Orange County Superior Court. \u201cWe want them to maintain their dignity.\u201d<\/p>\n

Orange County Superior Court Presiding Judge Maria Hernandez says Orange County\u2019s CARE Court, launching this fall, will resemble the county\u2019s other collaborative courts, like her young adult diversion court, where compassion and science drive her decisions.(April Dembosky\/KQED)<\/span><\/figcaption><\/figure>\n
Orange County is expecting between 900 and 1,500 residents will be eligible for CARE Court in any given year, according to the county public defender\u2019s office. Local lawyers, judges, and health officials have all aligned in designing their program with a distinct patient focus, endeavoring to make the process as benign and nonthreatening as possible.<\/p>\n
Hernandez said that means modeling the new civil court after the county\u2019s other collaborative courts, where judges often lose the black robe and come down off the bench to work with people, eye to eye.<\/p>\n
One prototype, she said, is her Young Adult Court<\/a>, 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 \u201cgraduated\u201d from the diversion program.<\/p>\n
\u201cJudge Hernandez is so awesome,\u201d said Abraham, 25, a graduate of the program, 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. \u201cI don\u2019t even look at her as the judge. She\u2019s just like a mom figure. She\u2019s only trying to push you to be the better you.\u201d<\/p>\n
A minute later, Hernandez walked through the aisle of the courtroom and gave Abraham a hug.<\/p>\n
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Even if CARE Court is overseen by a judge like Hernandez, patient advocates object to the idea. Orlando Vera, who lives with bipolar disorder, said helping a vulnerable person heal from mental illness shouldn\u2019t involve dragging them into a courtroom.<\/p>\n
\u201cIt\u2019s not a place you resolve your emotions. It is a very business-oriented environment. So I do feel that this is not the place for it,\u201d Vera said, adding, \u201cCan we stop it? I would say we can\u2019t.\u201d<\/p>\n
After advocates failed to persuade<\/a> the state Supreme Court to block the program on constitutional grounds, some started referring to gearing up for the rollout of CARE Court as \u201cdisaster preparedness,\u201d equating it with a devastating earthquake or wildfire.<\/p>\n
Peer Voices of Orange County<\/a>, a group Vera co-founded and runs, plans to install patient advocates at the courthouse to attend all CARE Court hearings.<\/p>\n
\u201cOur focus is how do we support those that are going through the system,\u201d he said. \u201cWe need to be their voice.\u201d<\/p>\n
$\"A$
Orlando Vera, a co-founder of Peer Voices of Orange County, says he and other people with lived experience of mental illness will attend CARE Court proceedings on behalf of patients.(April Dembosky\/KQED)<\/span><\/figcaption><\/figure>\n
Orange County behavioral health director Veronica Kelley is sympathetic to advocates\u2019 concerns. She said CARE Court is not the program she would have created to improve the state\u2019s mental health system. But she serves at the will of the governor and other elected officials who control her budget.<\/p>\n
\u201cSo we end up building the Winchester Mystery House,\u201d she said, referring to the 100-year-old mansion in San Jose known for its mazelike layout. \u201cIt 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\u2019s what our system looks like.\u201d<\/p>\n
Kelley is trying to shape the new court process into something its critics can accept. This is why she wanted Orange County to go first: \u201cso we can help craft it into something that\u2019s not another colossal waste of time and funds, and that we don\u2019t destroy the people we\u2019re trying to serve at the same time,\u201d she told a roomful of patient advocates during a meeting of the state Patients Rights Committee<\/a>, held in Santa Ana.<\/p>\n
This means social workers from her behavioral health department<\/a> or the public defender\u2019s office<\/a> might visit people 20, 30, or 40 times to build trust, listen, and set goals.<\/p>\n
Under the CARE legislation, county courts are allowed to fine public behavioral health agencies $1,000 a day if they can\u2019t find a patient and enroll them in treatment by certain deadlines.<\/p>\n
Kelley said her county\u2019s judges have agreed to give her staff the time and extensions they need to do their jobs well. She also vowed that no one who declined services in her county would be institutionalized involuntarily, even though the new legislation allows it.<\/p>\n
\u201cIf 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,\u201d she said.<\/p>\n
Kelley pointed to the county\u2019s success with another civil court process, established by Laura\u2019s Law in 2002<\/a>, in which, for every person involved in court-ordered outpatient care, another 20 accepted treatment willingly.<\/p>\n
She said the county has the same goal for CARE Court, with the focus on finding a treatment plan people accept voluntarily, before a judge has to order it.<\/p>\n
$\"A$
Veronica Kelley, the behavioral health director for Orange County, will oversee mental health outreach and care provided through the local CARE Court, launching in October.(April Dembosky\/KQED)<\/span><\/figcaption><\/figure>\n
*This article is from a partnership that includes* *KQED<\/a>, NPR<\/a>, and KFF Health News.<\/em><\/p>\n*
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\n\t\t\t\t\t\t\t\t\t\t\tApril Dembosky, KQED: <\/span>
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t@adembosky<\/a>\n\t\t\t\t\t\t\t\t\t<\/p>\n<\/aside>\n
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Orange County Superior Court Presiding Judge Maria Hernandez says Orange County\u2019s CARE Court, launching this fall, will resemble the county\u2019s other collaborative courts, like her young adult diversion court, where compassion and science drive her decisions.(April Dembosky\/KQED)<\/span><\/figcaption><\/figure>\n
Orange County is expecting between 900 and 1,500 residents will be eligible for CARE Court in any given year, according to the county public defender\u2019s office. Local lawyers, judges, and health officials have all aligned in designing their program with a distinct patient focus, endeavoring to make the process as benign and nonthreatening as possible.<\/p>\n
Hernandez said that means modeling the new civil court after the county\u2019s other collaborative courts, where judges often lose the black robe and come down off the bench to work with people, eye to eye.<\/p>\n
One prototype, she said, is her Young Adult Court<\/a>, 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 \u201cgraduated\u201d from the diversion program.<\/p>\n
\u201cJudge Hernandez is so awesome,\u201d said Abraham, 25, a graduate of the program, 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. \u201cI don\u2019t even look at her as the judge. She\u2019s just like a mom figure. She\u2019s only trying to push you to be the better you.\u201d<\/p>\n
A minute later, Hernandez walked through the aisle of the courtroom and gave Abraham a hug.<\/p>\n
\n
\n\t\t
\n\t\t\tEmail Sign-Up\t\t<\/a>
\n\t<\/h4>\n
\n\t\tSubscribe to KFF Health News’ free Morning Briefing.\t<\/p>\n<\/div>\n
Even if CARE Court is overseen by a judge like Hernandez, patient advocates object to the idea. Orlando Vera, who lives with bipolar disorder, said helping a vulnerable person heal from mental illness shouldn\u2019t involve dragging them into a courtroom.<\/p>\n
\u201cIt\u2019s not a place you resolve your emotions. It is a very business-oriented environment. So I do feel that this is not the place for it,\u201d Vera said, adding, \u201cCan we stop it? I would say we can\u2019t.\u201d<\/p>\n
After advocates failed to persuade<\/a> the state Supreme Court to block the program on constitutional grounds, some started referring to gearing up for the rollout of CARE Court as \u201cdisaster preparedness,\u201d equating it with a devastating earthquake or wildfire.<\/p>\n
Peer Voices of Orange County<\/a>, a group Vera co-founded and runs, plans to install patient advocates at the courthouse to attend all CARE Court hearings.<\/p>\n
\u201cOur focus is how do we support those that are going through the system,\u201d he said. \u201cWe need to be their voice.\u201d<\/p>\n
$\"A$
Orlando Vera, a co-founder of Peer Voices of Orange County, says he and other people with lived experience of mental illness will attend CARE Court proceedings on behalf of patients.(April Dembosky\/KQED)<\/span><\/figcaption><\/figure>\n
Orange County behavioral health director Veronica Kelley is sympathetic to advocates\u2019 concerns. She said CARE Court is not the program she would have created to improve the state\u2019s mental health system. But she serves at the will of the governor and other elected officials who control her budget.<\/p>\n
\u201cSo we end up building the Winchester Mystery House,\u201d she said, referring to the 100-year-old mansion in San Jose known for its mazelike layout. \u201cIt 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\u2019s what our system looks like.\u201d<\/p>\n
Kelley is trying to shape the new court process into something its critics can accept. This is why she wanted Orange County to go first: \u201cso we can help craft it into something that\u2019s not another colossal waste of time and funds, and that we don\u2019t destroy the people we\u2019re trying to serve at the same time,\u201d she told a roomful of patient advocates during a meeting of the state Patients Rights Committee<\/a>, held in Santa Ana.<\/p>\n
This means social workers from her behavioral health department<\/a> or the public defender\u2019s office<\/a> might visit people 20, 30, or 40 times to build trust, listen, and set goals.<\/p>\n
Under the CARE legislation, county courts are allowed to fine public behavioral health agencies $1,000 a day if they can\u2019t find a patient and enroll them in treatment by certain deadlines.<\/p>\n
Kelley said her county\u2019s judges have agreed to give her staff the time and extensions they need to do their jobs well. She also vowed that no one who declined services in her county would be institutionalized involuntarily, even though the new legislation allows it.<\/p>\n
\u201cIf 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,\u201d she said.<\/p>\n
Kelley pointed to the county\u2019s success with another civil court process, established by Laura\u2019s Law in 2002<\/a>, in which, for every person involved in court-ordered outpatient care, another 20 accepted treatment willingly.<\/p>\n
She said the county has the same goal for CARE Court, with the focus on finding a treatment plan people accept voluntarily, before a judge has to order it.<\/p>\n
$\"A$
Veronica Kelley, the behavioral health director for Orange County, will oversee mental health outreach and care provided through the local CARE Court, launching in October.(April Dembosky\/KQED)<\/span><\/figcaption><\/figure>\n
*This article is from a partnership that includes* *KQED<\/a>, NPR<\/a>, and KFF Health News.<\/em><\/p>\n*
\n
\n\t\t\t\t\t\t\t\t\t\t\tApril Dembosky, KQED: <\/span>
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t@adembosky<\/a>\n\t\t\t\t\t\t\t\t\t<\/p>\n<\/aside>\n
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