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President Trump wants to make it easier to force people with mental illness into treatment. It is a position he shares with an unlikely ally, the governor of California, Gavin Newsom. California is two years into a new experiment that gives judges the authority to order people with psychotic illness into care. But several counties, including Orange County, are using an approach focused more on coaxing and less on coercing. It's called the relentless outreach. From member station KQED, April Dembosky reports.
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APRIL DEMBOSKY, BYLINE: Giovanni Figueroa put 30,000 miles on his car last year.
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DEMBOSKY: He's a social worker for Orange County's CARE Court program.
AUTOMATED VOICE: Starting route to Royal Grand Inn.
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DEMBOSKY: He spends a lot of time visiting his clients who have schizophrenia or looking for them when they disappear.
GIOVANNI FIGUEROA: I see an individual over there sleeping on the ground, so I don't know if that is or isn't my client. It might be.
DEMBOSKY: He makes a U-turn to get a closer look. The man is wearing a knit hat, his face covered by a Mexican blanket.
FIGUEROA: What I will do is I will pull over, and I will say the individual's name, just their first name. And if I see any movement, I'll be like, hey, it's Giovanni. And if I see further movement, then I know that's my person.
DEMBOSKY: Figueroa says this work is his calling. His younger brother has schizophrenia and he often became paranoid, heard voices, broke furniture. Over and over, he watched his family call the doctor, call the police.
FIGUEROA: We're reaching out. We're asking for help, and no one is helping us until now.
DEMBOSKY: California's CARE Court created a new legal pathway for intervention. Counties are allowed to lean on a threat of conservatorship to induce people into outpatient treatment. But more are drawing on the law's new funding for intensive outreach to keep their programs fully voluntary.
FIGUEROA: Relentless pursuit and engagement.
DEMBOSKY: Existing health care funding, like Medicaid, does not cover the cost of looking for a potential patient or persuading them to see a doctor. CARE Court does. And so Figueroa can now visit someone 30 or 40 times before they officially accept care. In one of his earlier searches for his client, the man was hostile when Figueroa found him.
FIGUEROA: They're like, I don't want to talk to you no more. Leave me alone. Get away from me. And I respect that.
DEMBOSKY: Figueroa came back a week later, then the next. Then he got a call that his client was in the hospital in San Bernardino. He drove an hour and a half to visit him there, then came back again and again.
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FIGUEROA: He was more stable.
DEMBOSKY: That's when Figueroa broached the subject of ongoing treatment, and the client agreed.
FIGUEROA: He saw the doctor, got medication, got placed at a room and board.
DEMBOSKY: Figueroa says this is how relentless outreach works.
FIGUEROA: When they see you one time, two time, three times, then they see you in San Bernardino County one week...
AUTOMATED VOICE: Make a right. Use the right lane to turn...
FIGUEROA: ...Two weeks, three weeks, four weeks, then they realize, like, oh, wow. They really are here to help me. They actually do care.
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EBRAHIM BAYTIEH: The court will call matter number 22 on the court calendar. That's the Riley matter, case number 2023 01321974.
UNIDENTIFIED PERSON: You can come in.
BAYTIEH: May I please have your appearance for the record?
DEMBOSKY: The judge overseeing CARE Court in Orange County is Ebrahim Baytieh. Even though the law gives him the power to fine the county a thousand dollars for each day clients don't show up in court, he doesn't do it.
BAYTIEH: It takes time. You have to be patient.
DEMBOSKY: Even though he's allowed to order people into treatment, he doesn't.
BAYTIEH: We've had cases where somebody says, I don't want to take medication, right? They need it. We all agree that they need it. The court can order it, but the court cannot enforce that order. So, to me, it's counterproductive to do that.
DEMBOSKY: Data collected by California's court system from the state's 58 counties suggests this philosophy is widespread. As of late September, more than 600 people across the state have entered care voluntarily, but only 19 people have been court ordered into treatment. The reliance on voluntary approaches can be frustrating for families. Lisa Dailey is executive director of the Treatment Advocacy Center. She says some people are too sick to ever be persuaded. They might need involuntary treatment.
LISA DAILEY: If you build a system that is entirely dependent on the idea that eventually people will seek care, that very ill segment of the population is just trapped outside of it.
DEMBOSKY: Dailey calls relentless outreach never-ending outreach.
DAILEY: You're really just prolonging a miserable state for people.
DEMBOSKY: Figueroa is sympathetic to families. He felt the same frustration with his brother. But he says violating people's civil liberties is not the answer.
FIGUEROA: This is more about accountability for the county and the provider.
DEMBOSKY: This is where the court comes in. After Figueroa outreached one client relentlessly for six months, he finally agreed to go back to therapy, but it was the clinic that didn't want to take him back.
FIGUEROA: Once they know that the judge is overseeing them and there's the possibility of sanctions or fines, they play ball.
DEMBOSKY: Figueroa says CARE Court is about making sure the health care system does a better job.
For NPR News, I'm April Dembosky in Orange County.
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