Forced Treatment Isn’t What Unhoused People Need

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Forced Treatment Isn’t What Unhoused People Need

I remember how my heart pounded as I drove cross-country to Los Angeles in the fall of 2019. I was anxious about whether I could start again and leave behind a string of traumas, including a forced hospitalization in New York.

The violations that I saw in that hospital plague the behavioral health system. My ward held mostly unhoused people. After a drive-through-style clinical assessment that lasted only 20 minutes, the staff pressured me to accept injections of a powerful anti-psychotic drug, without fully informing me of alternatives and side effects.

I also did not feel safe to ask questions, for fear of being labeled uncooperative, service resistant, or impaired in my ability to make decisions. There is no informed-consent process within these jail-like state-run institutions.

When I moved to LA, I became involved in peer-support efforts for the unhoused community living in Echo Park Lake. After my own living situation became abusive and unsafe, I became a resident of the park. Like all communities, ours was not perfect, but we took care of our own and lived with a sense of belonging, not shame.

Our encampment centered around voluntary community-based care. We built showers, organized a food pantry, and looked out for those experiencing mental health crises. All of this ended in March 2021, when the police invaded the camp and violently evicted our community. City workers erected a chain-link fence around the park, cordoning off a public space. This targeting and displacement was one of many similar efforts throughout Los Angeles.

Now, Governor Gavin Newsom, with support from politicians across the state, has a plan called CARE Courts—the acronym stands for Community Assistance, Recovery, and Empowerment—to remove unhoused people from sight. CARE Courts will allow family members, police, homeless outreach workers, and others to consign people to a complicated civil process that can extend court control over life and health decisions.

CARE Courts have the power to coerce people into involuntary mental health care, like I experienced in New York, and they will funnel resources into a new surveillance infrastructure that targets unhoused people perceived to have mental illness.

Politicians present CARE Court as an alternative to our broken behavioral health system, but it fails to provide what people need most. People need four things to be in recovery: permanent supportive housing, community, purpose, and health care. There is no pathway to recovery when people are routinely losing their documents and medication in sweeps, when tenants struggle to hold on to their homes, and when obstacles to accessing community-based voluntary treatment remain.

Instead, CARE Court extends the coercion embedded in forced treatment systems. For those under its control, CARE Court can dictate treatment options, including medications. It would be structured as forced recovery, with the threat of conservatorship—entailing the loss of our ability to make our own decisions—hanging over anyone who doesn’t comply.

The criteria for sending someone into this system are allegations of certain mental health conditions, a perception that the person is unlikely to survive safely in the community, and a determination that the person needs these services. These guidelines are vague, flawed, and rooted in misunderstanding. For instance, people often lose track of days or current events on the street, exactly the kinds of lapses flagged in psychiatric evaluations.

The CARE Court will monitor unhoused Californians through multiple court hearings, which is just not practical. Transportation is often an obstacle for unhoused people, and court can be a traumatic experience for many in our community. The CARE Court framework vaguely describes the role of a “supporter,” who supposedly champions “the will and preferences” of the person under supervision, but this merely appropriates existing peer-support efforts and creates another possible conduit of state coercion. Our community worries that state-appointed advocacy is just another area that the police can co-opt, making it part of the state’s mental health outreach.

Instead of CARE Court, we need community solutions. We need to abolish targeting and surveillance by police. We need ways and places to heal among community and, most of all, affordable permanent supportive housing.

I have seen these community-based solutions work. Street Watch LA and the Sidewalk Project, among others, successfully employ harm reduction techniques that empower those with lived experiences of houselessness, poverty, and addiction to make the choices that are best for them. Other organizations like the Los Angeles Community Action Network and Unhoused Tenants Against Carceral Housing build a sense of community between the housed and unhoused. Mobile peer-to-peer mental health outreach units have also been effective.

CARE Court is just another approach to criminalizing our communities that displaces work best situated in the community and exacerbates the trauma of violence by police and other state actors. CARE Court will further stigmatize unhoused people with mental health conditions. It will be used as a tool to silence and threaten us. What we really need are community-based safe spaces to enable healing, destigmatize trauma, and end the harm we experience in state-controlled settings.

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