A seemingly innocuous proposal to offer scholarships for mental health workers in California’s new court-ordered treatment program has sparked a debate over whether the state should prioritize that program or address a broader workforce shortage in behavioral health services.
Nine counties have begun implementing the Community Assistance, Recovery and Empowerment Act, which Gov. Gavin Newsom (D) signed into law in 2022 to make treatment available to people with untreated schizophrenia or other psychotic disorders — many of them incarcerated or homeless. But those trained clinicians have often been pulled by counties from other, understaffed behavioral health programs.
“There are a lot of changes coming with a limited workforce, limited treatment resources and high expectations for counties to solve problems like homelessness,” said Scott Kennelly, director of the Butte County Behavioral Health Department. “It’s like you’re turning on a fire hose and saying, ‘Start drinking.’”
State Sen. Tom Umberg’s bill would create an annual scholarship fund for students pursuing a mental health-related profession, provided they work for three years with CARE Court. Umberg had requested $10 million for the program, but it’s unclear how many students would receive the scholarship, said Jackie Koenig, a spokeswoman for the senator. The bill passed through the legislature without any lawmakers voting against it.
Umberg, an Orange County Democrat, said CARE Court deserves specific funding because it is a new program and noted that there are other state grants available for students pursuing behavioral health studies. For example, the state announced in March 2023 that it would award $118 million in grants to support behavioral health providers at 134 community-based nonprofit organizations.
“CARE Court is a new and unique space that requires unique behavioral health skills to deal with schizophrenics,” Umberg said. “So we want to encourage people to come to that space, because it is challenging.”
But local behavioral health administrators say moving experts to CARE Court could create shortages in other programs or push mental health specialists into multiple, demanding programs.
The CARE Act allows patients or others, such as their family members, behavioral health care providers or roommates, to petition their county court for relief. People who agree to participate can receive up to 24 months of treatment, which can include outpatient substance use disorder treatment, stabilizing medication, connection to social services and housing. It is one of Newsom’s experimental initiatives aimed at getting some of the state’s 181,000 homeless people off the streets and into housing without resorting to mandatory guardianships.
Only an estimated 7,000 to 12,000 Californians are eligible for the treatment, according to the Judicial Council, which helps oversee the program.
According to the state Legislative Analyst’s Office, the state has allocated $251 million to staff and launch the CARE program during the current budget year, including $122 million in grants to counties. At the same time, counties have been directed to implement a range of other behavioral health programs, such as mobile crisis teams, and to beef up mental health services for Medi-Cal patients. Last year, Newsom also signed a law that expanded the number of Californians who could be involuntarily committed.
“As a high-profile mandate, counties are largely shifting existing, trained and experienced staff to launch and staff CARE Court teams,” said Michelle Cabrera, executive director of the California County Behavioral Health Directors Association, which supports the bill.
That’s why critics, including ACLU California Action, Mental Health America of California and some counties, say a CARE Court grant should also support other county programs that treat people with serious mental illness and housing instability.
“Restricting workforce development initiatives to just one of the many new behavioral health initiatives will not solve staffing issues across the spectrum of behavioral health services,” said Alexandra Pierce, deputy director of Merced County’s Behavioral Health and Recovery Services Department.
County behavioral health departments are in the midst of a massive behavioral health staffing shortage — they are 25% to 30% below their full staffing capacity, on average, according to a 2023 internal survey by the county behavioral health directors association and the University of California-San Francisco Healthforce Center, Cabrera said.
More than a dozen behavioral health directors from rural and urban counties told KFF Health News that hiring challenges are widespread and not unique to CARE Court, pointing to burnout since the start of the Covid-19 pandemic and stiff competition from schools, correctional facilities and the private sector, which can offer trained clinicians higher salaries, telehealth work from home and generous vacation time.
Michelle Funez, division director of Marin County Behavioral Health and Recovery Services, said a CARE Court scholarship could encourage students to seek jobs in the county that support vulnerable people in the community.
Finding the right doctor for CARE Court can be tricky because the job requires people trained to work in homeless encampments and other nontraditional settings, Funez said.
“It may seem like we’re looking for a needle in a haystack,” Funez said, turning to “an already smaller pool of staff who have the skills needed for this type of work and who are also up for the challenge.”
The nine counties that have launched the specialized courts have received more than 600 requests in the first 10 months of the program, said Leah Myers, a spokeswoman for the state Department of Health Care Services, which helps oversee the program. The remaining 49 counties are expected to have their programs up and running by Dec. 1.
The program has had some initial successes. A year later, San Diego County is already beginning to “graduate” patients, meaning they have received treatment and made enough progress to exit the court system.
As more counties implement CARE Courts, they will need more doctors. A scholarship program, some counties say, could help. But the bill’s price tag could be its undoing. In June, Newsom signed a state budget that closed an estimated $46.8 billion deficit, and last year he vetoed hundreds of bills, many of them for excessive cost. Newsom spokeswoman Elana Ross declined to comment on the measure.
Newsom has until the end of the month to sign or veto the bill.
This article was produced by KFF Health Newsthat publishes California Health Linean independent editorial service of the California Health Care Foundation.
