Why housing advocates oppose a new California law designed to help the homeless

Tens of thousands of people in California have no access to housing. Tent-strewn streets have become ubiquitous across the state as the cost of living rises and wages stagnate. For months, California Governor Gavin Newsom has been pushing for a solution: forcing homeless people with mental illness into treatment.

Although some groups have opposed the plan since its conception – including Disability Rights California, the American Civil Liberties Union of California, the Drug Policy Alliance and Human Rights Watch – they were unable to prevent its passage. On Wednesday, September 14, Newsom signed SB 1338, the Community Assistance, Recovery and Empowerment Act (CARE), into effect. The CARE Act includes a court system that targets people with schizophrenia and other psychotic disorders who may also have substance use disorders.

Newsom’s office describes the program as a “paradigm shift” – but some proponents say the shift is going in the wrong direction.

People with severe mental illness can already be held involuntarily in psychiatric care without accommodation, but only for three days. They can only leave if they promise to take medication and keep specific appointments. Through a court order, the CARE Act extends this period by up to one year, which can be extended to two years.

Family members, service providers, and first responders — including paramedics or law enforcement officers — are among those who have the legal authority to petition the CARE court. If a criminal charge is filed, the person could avoid punishment by enrolling in a mental health treatment plan. A judge could then order someone for treatment, including housing and medication.

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“With overwhelming support from lawmakers and advocacy groups across California, CARE Court will now become a reality in our state, bringing hope and a new way forward for thousands of struggling Californians and empowering their loved ones to help,” Newsom said in a statement.

“This law violates a person’s right to self-determination and people’s right to choose how they want and need to address their problems,” Sam Tsemberis told Salon.

It’s a unique law in the United States, but a few other states have laws that share elements of the plan. The CARE Act was drafted by Senator Thomas Umberg (D-Santa Ana) and Senator Susan Talamantes Eggman (D-Stockton). It goes into effect next year, but only in seven counties: Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne.

Newsom’s office describes the program as a “paradigm shift” – but some proponents say the shift is going in the wrong direction.

“This law violates a person’s right to self-determination and the right of people to choose how they want and need to address their problems,” Sam Tsemberis Salon said in an email. Tsemberis is the Founder and CEO of the Pathways Housing First Institute, a nonprofit organization founded in 1992 that pioneered the Housing First model of access to housing. He called the law politically motivated, citing Newsom’s alleged run for president and appealing to voters “tired of seeing homelessness.”

“Based on my clinical experience and research comparing voluntary and involuntary court-mandated treatment programs, it is very clear that better outcomes are achieved when treatment is voluntary, trauma-informed and compassionate,” Tsemberis said, adding, “This law will.” it does not have any impact on reducing homelessness as it does not provide funding for housing.

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Meanwhile, homes for people with serious mental illness are closing rapidly, with at least 96 facilities closing since 2016, according to the Los Angeles Times. In January 2020, the US Interagency Council on Homelessness reported that homelessness affected 161,000 people in California, including 7,600 college students. According to Newsom’s office, the CARE Court program is estimated to help 12,000 people.

But the fact that the police can intervene in such situations has alarmed some advocates. “Law enforcement and outreach workers would have a new tool to threaten homeless people with a referral to a court to pressure them to leave a certain area,” Human Rights Watch said in April.

“Newsom’s ‘CARE’ Courts Bill will not stop homelessness and it will not stop our mental health crisis,” James Burch, associate director of the Anti Police-Terror Project, said in a statement, citing statistics affecting people with untreated mental health disabilities 16 times more likely to be killed by police. The San Francisco Chronicle recently reported that nearly 1,000 people have been killed by California police in six years.

“The last thing the homeless, mentally ill and addicted need is more surveillance putting them under police surveillance. The only real solution is permanent housing, access to adequate health care and community support,” Burch said.

Burch also said the CARE Act would exacerbate systemic racism.

“Less than 7 percent of the state’s residents are Black, but Black people make up 40 percent of the state’s homeless population,” Burch said. “It is clear that ‘CARE’ courts will continue this country’s legacy of disproportionately policing and incarcerating Black people. ‘CARE’ courts will besmirch Newsom’s legacy as future generations will question how such an assault on human rights came about.”

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Tsemberis proposed an alternative to the CARE Act, emphasizing his belief that housing is a basic human right and that self-determination is the “best path to recovery”.

“The Pathways Housing First program is very effective in ending homelessness for people struggling with mental health and addiction issues,” Tsemberis said. “There are more than two dozen randomized controlled trials reporting that participants in Housing First programs achieve 85 percent housing stability, compared to 40 percent in programs that require sobriety and abstinence before offering housing.”

The CARE Act comes face-to-face with a bill vetoed by Newsom last month that would have authorized supervised places of use, which are services that prevent overdose deaths by allowing drug use under medical supervision. New York recently opened two such locations and has so far saved more than 400 drug overdose deaths. Such services are often used by homeless people and have existed in other countries for decades without anyone ever dying.

“The same dysfunctional and unscientific approach that we are taking to homelessness is evident in the way we are tackling other public health issues,” Tsemberis said. “This CARE Court law plays politics with the lives of people with serious addiction problems who will be left homeless.”

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