On September 14, California Governor Gavin Newsom signed the Community Assistance, Recovery and Empowerment (CARE) Act into law. The legislation will create a civil court system in every county designed to force people experiencing substance use disorder and other mental health issues into mandatory treatment plans.
While the proposal flew through the state legislature, harm reduction advocates say that the new law will take away vulnerable people’s basic right to make their own decisions—and that sending them into court-mandated treatment programs, besides being inherently unethical, will worsen harms and health disparities. They warn, too, of increased criminal-legal system involvement for people of color, and penalties for noncompliance.
The CARE Act, in short, runs counter to the evidence-based, person-centered care that activists have been fighting for. Many have cited peer-reviewed studies that show people remanded into court-ordered treatment facing high mortality risks.
New evidence that forced substance use treatment (like other forms of incarceration) causes sharply elevated risk of death post-release, largely from overdose.
— Joseph Friedman, PhD, MPH (@JosephRFriedman) September 13, 2022
Supporters of the legislation, like Newsom, contend that it will help the 100,000 or so unhoused people currently living in California, by allowing loved ones, first responders and judges to draw up one-year treatment plans that could be extended for two years. There will be penalties, including the possibility of a conservatorship, for those who refuse to comply.
“Not only is forced treatment ineffective, there simply are no resources available to implement this strategy.”
On top of removing personal agency and potentially increasing harms, advocates say, the law makes no sense when the state lacks the practical means to provide treatment for so many people.
“The infrastructure for mental health and substance use treatment just simply does not exist,” said Soma Snakeoil, the executive director and co-founder of The Sidewalk Project, an arts and harm reduction organization based in Los Angeles, in a press statement. “Not only is forced treatment ineffective, there simply are no resources available to implement this strategy. You can’t place someone in a bed that does not exist. This new bill is a joke. It would be laughable if it weren’t for the fact that this will inevitably lead to further criminalization and incarceration of our most vulnerable.”
“Care Court is not an effective solution to entrenched and chronic homelessness,” said Kara Ka Wah Chien, managing attorney of the Mental Health Unit at the Office of the San Francisco Public Defender. “Instead, California needs to build a continuum of care to assist those vulnerable Californians transitioning from their crises to wellness and recovery. We need resources to provide access to care, stable housing for all, bolstered programming capacity, and more workers to provide adequate clinical care.”
In recent weeks, Newsom has seemed to turn against the practical and compassionate policies that harm reductionists had long felt he endorsed. At the end of August, only hours before a deadline, the governor vetoed SB 57, a bill that would have legalized safe consumption sites (SCS) in San Francisco, Oakland and Los Angeles. His decision came as a relative shock to harm reduction advocates, drug policy reformers and politicians who championed versions of that bill for the better part of a decade. Newsom had in the past said that he was “very, very open” to SCS.
“Like Newsom’s veto of our overdose prevention bill, the CARE Act will have dire consequences that will harm people who use drugs and marginalized communities.”
Most observers attribute the apparent reversal to Newsom flirting with a 2024 presidential run, conjecturing that he may fear how a right-wing narrative—the story of a governor sympathetic to people who use drugs—would roll out on the national stage.
“The Drug Policy Alliance strongly opposes this plan,” Jeannette Zanipatin, DPA’s California director, said of the CARE Act in a press statement. “Governor Newsom shamefully vetoed SB 57, an overdose prevention center program bill with the false excuse that it wasn’t thoroughly vetted, researched or planned out. Like his veto of our overdose prevention bill, approving the CARE Act will have similar dire consequences that will harm people who use drugs and marginalized communities in California rather than investing in the support and services that are proven to help and keep people alive.”
DPA previously provided a restricted grant to The Influence Foundation, which operates Filter, to support a Drug War Journalism Diversity Fellowship.