FRESNO COUNTY – The Fresno County Board of Supervisors approved an amendment that will bring the county into compliance with the state’s Community Assistance, Recovery and Empowerment (CARE) Act to provide a new pathway for people with schizophrenia or a related condition to receive voluntary treatment.
At the Nov. 5, 2024 Board meeting, Susan Holt, director of the Department of Behavioral Health and the county’s Behavioral Health Public Guardian, explained the recent amendment. She explained that it would allow TURN Behavioral Health to petition the court and provide CARE Act services, introducing a new pathway – not a new treatment – for a small segment of the population.
“It’s a new civil court process for a very narrow target population of persons to access care because they’re unable to access care currently,” Holt said. “Individuals who are eligible for the CARE Act services and civil court processes are individuals with schizophrenia or schizophrenia spectrum disorders.”
The population is small – roughly .3 to .75% of the population, according to Holt. The problem is roughly half of individuals with schizophrenia have a condition known as anosognosia, which renders them unaware they have the illness.
“It is that lack of awareness that they are ill that often inhibits their ability to accept certain services,” said Holt.
THE CARE ACT
Gov. Newsom signed the Care Act into law on Sept. 14, 2022. Supporters of the law pointed to the fact that people suffering from mental illness lack the awareness they are ill, as Holt mentioned. Because schizophrenia typically develops in late adolescence or early adulthood, the individual is legally an adult, which means they have the final word regarding what treatment, if any, they receive.
The CARE Act made it possible for individuals, such as family members, first responders, behavioral health directors and other professionals to petition a CARE court on behalf of the individual. By approving the amendment, the Board added TURN to that select group to intervene on the individual’s behalf. These individuals and/or organizations can petition a civil court to create a court-ordered CARE treatment plan.
When the CARE Act was proposed, opponents said it would strip individuals of their civil liberties. In answer to Supervisor Steve Brandau’s question regarding this scenario, Holt said nowhere in the CARE Act does it say an individual will be involuntarily detained.
“There is no involuntary containment associated with the Care Act,” she said.
“At its core, the CARE Act is still a voluntary process,” said Holt. “There is no involuntary treatment nor is there forced medication.”
Brandau asked what happens if the individual refuses services or treatment.
“Does the court step in and have somebody enforce the situation?” he asked.
Holt maintained at no point can the court order involuntary detainment. “What the court can do is continue hearings to allow us to continue to try to engage the individual,” she said.
Chairman Nathan Magsig brought up 51/50 holds, where a person can be involuntarily detained for up to 72 hours.
“So, just to clarify that point,” said Magsig. “If law enforcement 51/50s someone and they (the individual) chooses to engage with the county, bringing in the courts using the CARE Act, can the courts extend the involuntary stay beyond the hold?”
Hold replied, “The court would not have any authority to extend an involuntary detainment, even if the person was brought into a designated 51/50 facility.”
She clarified that while a court does not have the authority to order a 51/50 hold, a physician does have that authority. But this is current law; the Board authorizing the amendment does not impact this.
Holt reminded the Board that the CARE Act is not about homelessness. She mentioned that very few of the county’s unhoused population have been diagnosed with schizophrenia or schizophrenia spectrum disorder.
“I do think it’s important that we manage expectations,” Holt said. “This is not a homelessness program. It is not going to eliminate homelessness.”
FIRST COHORT
Senate Bill (SB) 1338 created the CARE Act and the establishment of CARE Courts. Seven counties – Glenn, Orange, Riverside, San Diego, Stanislaus, Tuolumne and San Francisco – were mandated to implement the CARE program beginning Oct. 1, 2023, with the remaining California counties to follow suit by Dec. 1, 2024. Hold said the first cohort of seven counties has paved the way for success for other counties.
“One thing I want to say is courts across the state in cohort one are creating a welcoming environment,” Holt said. “It is not intended ever to be perceived as punitive, but really as a supportive approach to engaging a person.”
But SB 1338 does contain punitive measures for counties or local governments that do not support the CARE process or fail to enforce a court-ordered treatment plan. According to the legislation, if a presiding judge or their designee finds that a local government has failed to comply with the process, the judge can fine the government up to $1,000 per day.
Magsig brought up this fact when, referring to a doctor having the authority to extend a 51/50 hold, he said to Holt, “So, the courts aren’t going to order that (hold). A doctor might. The CARE process engages the county more and makes us responsible.”
“Correct,” she replied.
Despite concerns the county lacks the resources to pay for CARE-related services, Magsig said he believes the CARE process, as a whole, is good for Fresno County. “I don’t believe there is a whole lot of money being made available. We’re having to figure out how to pay for this pretty much on our own,” he said.
He added, “The CARE Act provides another opportunity for individuals to be engaged with behavioral health professionals and to access our excellent County behavioral health services.”
