Bureaucracies have a way of suffocating good intentions.
Consider the CARE Court program in Los Angeles County. It’s intended to provide a path for family members to get help for a loved one who is suffering from severe mental illness or substance use disorder. The program was launched through state legislation, Senate Bill 1338 in 2022, the Community Assistance, Recovery, and Empowerment (CARE) Court Program.
In Los Angeles County the program was implemented on December 1, 2023. On February 11 of this year, the Board of Supervisors approved a motion directing the Department of Mental Health to work with the Behavioral Health Commission to gather “stakeholder feedback” and report back.
The resulting reports revealed “a shared frustration that the program does not allow for the court and providers to compel treatment” and “also frustration with there not being a process to transition people who require a higher level of care out of CARE Court into a more appropriate treatment program” including “conservatorship when appropriate, when documents clearly support the diagnosis.”
Guess what the next step will be.
Did you guess, “Another motion ordering another report?”
You’re right! On July 8, the Board of Supervisors approved a motion directing the Department of Mental Health to “report back, in writing,” in 120 days with progress updates on the various collaborations, discussions, processes, mechanisms, plans and protocols. The Board ordered another “stakeholder forum” in six months and a meeting in October for the Department of Mental Health and the Behavioral Health Commission to discuss plans to improve the program.
In the meantime, someone who is “suffering from schizophrenia spectrum and psychotic disorders and lacks medical decision-making capacity” might die in a tent on the sidewalk, despite the CARE Act and the desperate efforts of family members. Good intentions are not the same as good results.
Can anything move a government bureaucracy to start acting with a sense of urgency that’s matched to the scale of the problem? What about cutting off the funding that enables self-satisfied bureaucrats to continue failed programs?
That’s what President Donald Trump is attempting to do. On July 24, Trump signed an executive order that seeks to address homelessness by redirecting federal funds and reversing judicial precedents that impede civil commitment.
The executive order is titled, “Ending Crime and Disorder on America’s Streets.” It calls for prioritizing federal grants to states and cities that enforce prohibitions on “open illicit drug use,” “urban camping and loitering” and “urban squatting.” It’s tough language. How much will it resonate with the many fed-up Californians who have complained to their elected officials about filthy encampments, broken-down RVs, passed-out junkies and vagrant criminals in their neighborhoods, only to be told that they must vote for higher taxes to build $800,000 studio apartments for “our unhoused neighbors?”
Will anything change?
Maybe. To quote an old joke that asks how many psychologists it takes to change a light bulb, only one, but the light bulb has to be willing to change. A threat to pull federal funding from failed programs in Los Angeles and elsewhere might be just the thing to prompt an urgent reconsideration.
Trump called for “civil commitment or other available means, to the maximum extent permitted by law,” to address individuals “who are a danger to themselves or others and suffer from serious mental illness or substance use disorder, or who are living on the streets and cannot care for themselves.”
That’s what the CARE Court program was intended to accomplish, but it doesn’t, not yet.
The president seeks to fund “evidence-based” recovery treatment, but not “harm reduction” or “safe consumption” programs that distribute free needles and other addiction-enabling materials. To the extent federal law allows, he wants to defund “housing first” programs that require no treatment participation or “accountability” as a condition of receiving a taxpayer-funded apartment.
“Housing first” is also embedded in California law. It’s illegal to condition government-funded free housing on acceptance of any type of treatment or job training. Only the taxpayers are compelled to participate.
Government officials in California have been fierce in their resistance to the Trump administration’s use of federal funding as leverage to change state policies. But they need the money.
Maybe it will work.
Write Susan@SusanShelley.com and follow her on X @Susan_Shelley