One year of San Diego's CARE Court program

S1: Welcome in San Diego. It's Jade Hindman. Care court started one year ago. So today we will check in on the progress of that program. This is KPBS Midday Edition , connecting our communities through conversation. It's been one year since San Diego introduced a new approach to treating those with severe mental illness. It's called care court. It's designed to get mental health care and services for people struggling with severe mental illness. So what has been the impact of the program and how has it fared in its first year ? I'm joined now by San Diego County's director of behavioral health services , Luke Bergman. Luke , welcome back to Midday Edition.

S2: Thanks so much , Jade. Great to be here.

S1: So glad to have you. So the official name is the Care Act program , but it's commonly known as Care Court. Is that the best way to think about it.

S2: You know , I think it's the court in care. Court is not a thing that we emphasize in San Diego County. And I and I think I'm actually not just speaking for the participation of behavioral health services as a department and saying that I think that officials from the the court also , um , tend not to emphasize the role of courts per se in this program because the courts play a very unusual role. They they , they function in a way , in the context of what we tend to call the Care Act program. That is different than in , uh , certainly traditional , you know , adversarial criminal court settings , but also in ways that are different than in collaborative treatment courts with which actually , I think a lot of people are familiar. We have in San Diego County , a behavioral health court that is a collaborative court. We've got various types of drug court. Uh , those are also collaborative courts. Those court settings , though , they sit within the criminal division , and people who wind up in those court settings are are there to consider opportunities to be diverted from criminal sanction , which is usually jail time. So somebody will have been charged with something. They'll have an opportunity to enter into treatment as opposed to serving time or other punishment or sanction. And with that motivation , we have seen pretty successful engagements in treatment. The Care Act program doesn't sit within the criminal division. It sits within the civil court and it is totally voluntary. There is no sanction. There's no criminal sanction or sanction that would be handed down by the court to people who participate in the Care Act program. And so while it sits in a courtroom and there there is a judge who is presiding over it. And in lots of ways , it feels like a traditional courtroom , the fact that there is no looming criminal sanction makes it a very different setting and a very different dynamic. Yeah.

S1: Yeah. And you mentioned that care court is is voluntary. It's so it's not something anyone can be forced into. But that has been one criticism from family members seeking care for a loved one , say , who may be refusing treatment. So what's the solution to that ? What do you say to the argument that making this program voluntary isn't working for everyone ? Yeah.

S2: You know , I think one of the things that it's been really important for us to clarify and , and we engaged in efforts to clarify this from well before its actual launch in San Diego County. And that is to to use the words that you just did. It is not for everyone. It's not a program that is designed to address all needs or , or those of , of every population or person across this , um , across this county or across the state of California. It actually is meant to address a , a very specific cohort of people who number of relatively modest amount. And those are people with schizophrenia or schizophrenia spectrum disorders who are not currently engaged in treatment , uh , but who clearly need to be. And I certainly have heard the frustration that you've described , uh , in particular from family members who have long suffered a lot of frustration in many cases with trying to get and maintain , um , their loved ones in care. And many of them feel that the only way that they , that they would be able to to do this would be if , if , uh , a care arrangements are involuntary , they are mandatory. The Care Act program is simply not designed to do that. It is it is designed to focus on people of greatest need , and it's designed to create an incentive for really for me , Jade and the department that I run , the Behavioral Health Services department to focus on people who are , um , who are respondents in in the Care Act program to focus on people who have their cases petitioned to the court and to to do really everything we can to address the needs of those people. And speaking of sanctions , while the the folks who have been petitioned into the Care Act program , they are meant to consider that as a totally voluntary option. The Behavioral Health Services Department does face sanction if we don't carry out the imperatives of the Care Act program as it's written in and as it was passed as statute in the state of California. Um , so what the Care Act program does , is it And I think is very effective in this regard , is that it creates a cohort of people who I am meant to prioritize , who my teams of clinicians are meant to prioritize as receiving care. And we've got to make that happen. Or we face sanctions , not the people themselves , but we the department faces sanctions if we don't get people what they need in the ways that they want it.

S1: Well , then , in terms of what people need , what is the experience of going through care court like.

S2: This is one of , I have to say , my greatest concerns heading into this , this program is it was hard to imagine that we would be successful in engaging people , many of whom we know or knew at the time would would be folks experiencing , in some cases , long episodes of homelessness. We're able to find people. We then engage them really using the tools that that we know traditionally work. And most of those are about establishing a trusting relationship with the person whom we're trying to engage. So we use teams of people that include clinicians , but also people with lived experience , people who who are peer support providers to engage relationally with people to help them understand that we we really are committed to meeting them where they are , that we want to get them , not what we determine is most important for them , but what they determine is most important. And as we are building that relationship , we introduce them gradually to the idea that there's this program called a cardiac program. And maybe that would be a thing that they might find helpful. And we emphasize a couple of things in introducing the correct program to , to to people. One is of course , first. First and foremost , it's a voluntary program. They they don't have to do it. They face absolutely no sanction. Um in , in uh , engaging with this program , the second thing that we note , um , is that this program entitles them to the advocacy of the court system. So , so they will get to have a public defender working with them to make sure that their rights are protected and that their priorities as they state them , um , are the ones that are observed. So that introduction of the criminal justice system or the legal system is one that I had suspected would run a lot of people off. What we're finding is that the introduction to folks who were engaging of the public defender's office , and in particular , doing that , as we are making clear to folks , the really cool thing about this program is that it is one that is going to ensure that the service system does what you need to do. We're finding that the engagement is really better than in any program we've ever seen. I mean , I was skeptical about that , and I feel like I have learned something that , uh , something that's new , something that I didn't expect to learn , which is that this kind of engagement , where there's an emphasis on the system of care being held to account , is really especially effective.

S1: This is KPBS Midday Edition. We're back after the break. Welcome back to KPBS Midday Edition. I'm Jade Hindman , speaking with the director of behavioral health services for San Diego County , Luke Bergman. We are talking about the care court program and its progress. Well , I want to talk about people who have graduated from the program. Two people have graduated so far.

S2: There is an agreement laid out , the foundation of which is about engagement and care and a trajectory in care that the court and the Care Act program generally would be involved in for the subsequent year. And over the course of that year , there are hearings that happen at a given cadence round every couple of months , and progress is tracked at the end of the year. It's anticipated that if somebody who has been involved in the correct program and working with the various parties involved with a care agreement in hand , the anticipation is that at that point it would be appropriate for that person to to graduate from the program , to absolutely continue in care as it's , as it's needed. So that would be the expectation. Mental health conditions like schizophrenia and schizophrenia spectrum disorders are , as far as we experience in most cases , lifelong challenges for people. They need to stay connected and care. So graduation doesn't mean disengagement. It means continued engagement , but continued engagement without the additional resources that the Care Act program involves. So , you know , the the changes for people at the point of graduation are in some ways subtle , but I wouldn't say that they're they're inconsequential. And one of the things that's been really gratifying is that the couple , people who have thus far graduated , have actually of their own volition , of their own interest , stayed in touch with folks from the Keroack program , with the public defender in particular , has been has been a person who has remained a correspondent of people who have graduated and and and really you can see in in how she talks about these folks and you can see in how they interact with her that what they've developed is a real relationship.

S1: And so , you know , while this , this program is , is really just getting started. And 71 people were in the program just two graduated. What does that what is that indicative of and how do we get more people to graduate.

S2: You know , I think over time , this will continue to be a program that affects directly a relatively modest number of people in San Diego County for the time being. This may change , but changes around this would depend on state policy changes or state regulatory changes around the character. As far as we know , it will continue to focus on on the same cohort of people. And again , that's a relatively small cohort of folks. It's a program that we know works in part because it involves such intensive ness of services , right ? We see success in the program in relation to the intensity of work that we do with people. And that means that we have to have a large staff working with a relatively modest number of people. I would anticipate that we will absolutely see more people graduate. I would anticipate that the numbers will stay relatively small as we're seeing them , but in each case , the success will be , I think , momentous. I mean , you know , we have seen among people who have become involved in the Care Act program , right ? Very high rates of of people experiencing homelessness at the point of , uh , of initial petition among people with care agreements who were homeless. At the point of the initial petition , four out of five are now housed , um , people who have who are working with the Care Act program and have care agreements are two thirds Less likely to have had any involvement with our with our crisis service system because they are more stable. Again , this really is the hardest to reach , the hardest to stabilize cohort of folks. And we're seeing with the kind of laser focus and service intensity that the Care Act program involves , we're seeing really , really heartening success.

S1: Well , last year , Governor Gavin Newsom signed Senate Bill 43 into law , which aims to make conservatorship easier , which really redefines the definition of gravely disabled.

S2: San Diego County is one of only two counties that opted to to defer implementation for just one year , so the date of go live for San Diego County is January 1st , 2025. So quite soon and the changes will be pretty significant to what has been established practice , uh , with , um , involuntary detainment and transport for care that the the Senate Bill 43 really involves changes to , to what is commonly understood as 5150 , uh , hold law. What had been practice was that people with mental illnesses or suspected mental illnesses could be subject to 5150 with SB 43. Now we add to people with mental illness , suspected people with substance use disorder suspected , and we also add a few new categories to what amounts to grave disability , which traditionally has meant the absence or or failure to access food , shelter and clothing , and now failure to access necessary medical care and also compromised personal safety. In short , Senate Bill 43 dramatically widens the net of people who could be put on 5150 and transported involuntarily for care. One of the things that we are doing , and this in reference to your previous question. This may impact the overall size of the Care Act program here in San Diego. One of the things that we are really emphasizing is making the consideration of the Care Act program compulsory. In any case , that looks like it's heading toward conservatorship.

S1: Well , as you mentioned earlier , you are seeing a lot of success with the program. People who were not functioning in society due to their mental health status are now able to do so.

S2: You'll reach the same resource though , if you just call 988. If you've got a San Diego County area code phone , just dial 988. That will connect you to the access and crisis line , which will connect you to care court resources if those are appropriate and if you're interested in them.

S1: I've been speaking with Luke Bergman , director of San Diego County's behavioral health services. Luke , thank you so much for joining us.

S2: Really appreciate it. Thank you.

S1: That's our show for today. If you missed anything , you can download KPBS Midday Edition on all podcast apps. I'm Jade Hindman. Thanks for listening.