CARE Court has got to work because so many severely mentally ill Californians need it

Mark Rippee rests on the side of a bus stop in August, just a couple months before he died blind, mentally ill and homeless on the streets of Vacaville. (Renée C. Byer/

There are so many reasons that the CARE Court idea proposed by Gov. Gavin Newsom can’t possibly work, and only one reason that it will: because we owe it to those we’ve failed so thoroughly and so long to make sure that it does.

Senate Bill 1338, which is almost sure to become law, will create a new kind of court, set up to mandate and monitor up to two years of treatment for those too severely mentally ill to say yes to the help they desperately need.

Right now, those who require this kind of intervention are dying on our streets as we watch, somehow convinced that it’s more righteous to protect their civil rights than to even try to save their lives. Doing nothing also costs us nothing and that’s nice, too.


Last week, I wrote about one such man, Mark Rippee, who is blind, brain-damaged, and suffers from schizophrenia yet has gotten next to no help while living on the street in Vacaville for 15 years. His devoted sisters have been unable to get treatment for him because he also has anosognosia, a condition associated with schizophrenia, which prevents him from understanding that he even needs it.

Mark is convinced that all he’s missing is an apartment and some relief from the extraterrestrials who torment him with the hateful messages they send via military submarines. Only he can’t keep an apartment without treatment and supervision, because the voices urge him to set fires.

One of his sisters, Catherine Rippee-Hanson, used to do civil rights work herself but has long since had it with the argument that he should be able to choose whether or not to be treated for the illness that in her view stripped him of any true agency long ago. “He has no free will.”

As a Bee reader named Jason Schilling wrote to me in response to my column, “if we all keep hiding behind the very noble conceptual idea of the individual having the ultimate right of self-determination at all costs,” then Mark and others like him will continue to die in our streets, while the rest of us “walk around their bodies taking comfort in the fact that although not morally right, it is legally correct” to just keep on walking. “We have found our utopia. May God forgive us.”

Some of the other knocks against CARE Court cancel each other out.

For instance: There are too few psychiatric beds now, and this bill won’t expand their number. But if it passes, even people who don’t need that level of care may be forced to receive it.

It’s true that there is too little treatment now, and yes, we will have to fund a lot more for this thing to work. But given that shortage, not to mention how hard it is to hire behavioral health workers, how likely is it that this tool will be overused? Not very.

Other objections ignore reality: Because first responders, as well as loved ones and social workers, will be able to refer someone to a CARE Court, well then we will be involving the criminal justice system in caring for the seriously mentally ill.

As if that isn’t what happens now? The largest providers of mental health services have for ages been our jails and prisons, and this is an attempt to move away from that unacceptable situation. These courts are supposed to be set up with great sensitivity to how important it is to avoid triggering people who’ve unfortunately been in front of judges before. The judges for these courts will have to be trained with this in mind.

Another objection is that Newsom is trying to sell this new approach as the key to ending all homelessness when it’s no such thing. Since, on the contrary, his office has said that it could help just 12,000 of the state’s most seriously mentally ill people, I don’t think he’s even promising that CARE Courts will help all seriously mentally ill homeless people, who make up somewhere between a quarter and a third of those living on the street.

State Sen. Thomas Umberg, co-author of the CARE Court bill, with Sen. Susan Eggman, told me he thinks it will help many more than 12,000 people, especially since “schizophrenia is becoming more prevalent as a result of meth-induced schizophrenia.”

“No one is going to be forced into this,” he insists. They are, though, even if the preference is to see this instead as “creating the conditions that lead to the best choices” through short, hopefully stabilizing hospitalizations followed by transitional housing — housing that includes treatment and supervision, in other words — in the community.

Umberg also says there will be money for all of this housing and treatment, both through existing state and federal programs and with more funding over time. “We’re phasing in more resources,” he said, “but what’s been lacking is accountability.”

That last part is definitely true.

This bill says that if the court “finds the county or other local government entity not complying with court orders,” then the judge can fine it up to $1,000 a day. That’s a big incentive to fund treatment instead of fines, but it’s not a guarantee.

And just as counties will from now on be held accountable, so will lawmakers and the governor. They’ll have to make good on the promise of this ambitious, difficult, and necessary new option for people who deserve so much better.