A seemingly innocuous proposal to offer stipends to mental health workers in a new court-ordered treatment program in California is sparking a debate over whether the state should prioritize the program or address a broader workforce shortage in behavioral health services.
Nine counties have begun implementing the Community Support, Recovery and Empowerment Act, a law that Gov. Gavin Newsom (D) signed in 2022 aimed at getting people with untreated schizophrenia and other mental illnesses, many of whom are incarcerated or homeless, into treatment. But in many cases, these skilled clinicians have been poached by counties from other understaffed behavioral health programs.
“There’s so much change happening because of the high expectations placed on the county to solve issues like homelessness, with limited workforce and treatment resources,” Butte County Behavioral Health Director Scott Kennelly said. “It’s like turning on a fire hose and saying, ‘Start drinking.'”
A bill introduced by state Sen. Tom Amberg would create an annual scholarship fund for students pursuing mental health professions, provided they serve three years in the CARE Court. Amberg has requested $10 million for the program, but it’s unclear how many students will receive the scholarships, said Amberg’s spokeswoman, Jackie Koenig. The bill passed the Assembly without a single senator voting no.
Amberg, an Orange County Democrat, said CARE Court deserves focused funding because it’s a new program, and noted other state scholarships are available for students pursuing behavioral health degrees. For example, the state announced $118 million in grant funding in March 2023 to support behavioral health providers at 134 nonprofit community-based organizations.
“CARE Court is new and it’s a specialized field that requires special behavioral health skills, working with patients with schizophrenia,” Amberg said, “so we want to encourage people to get into that field because it’s a challenge.”
But local behavioral health administrators say moving experts to CARE Court could create shortages in other programs and overwhelm mental health professionals with multiple, demanding programs.
The CARE Act allows patients or others, such as relatives, behavioral health workers or roommates, to seek help in county court. Individuals who agree to participate can receive up to 24 months of treatment, which can include outpatient substance use disorder treatment, stabilizing medications, connection to social services and housing. It’s one of Governor Newsom’s experimental efforts aimed at getting some of the state’s 181,000 homeless people off the streets and into housing without having to resort to mandatory guardianship.
The Judicial Council, which oversees the program, estimates that only about 7,000 to 12,000 Californians are eligible for treatment.
The state has allocated $251 million in this year’s budget to staff and launch the CARE program, including $122 million in grants to counties, according to the Legislative Analyst’s Office. At the same time, counties are being directed to implement other behavioral health programs, such as mobile crisis teams, and to increase mental health services for Medicare patients. Last year, Newsom also signed a bill expanding the number of Californians eligible for involuntary hospitalization.
“As a high-profile mandate, counties are primarily redeploying their existing, skilled, experienced employees to stand up and staff CARE Court teams,” said Michelle Cabrera, executive director of the California Association of County Behavioral Health Directors, which supports the bill.
That’s why critics, including ACLU California Action, Mental Health America of California and several counties, argue that the CARE Court Scholarship should also support other county programs that treat individuals with serious mental illness and housing insecurity.
“Limiting workforce development efforts to just one of the many new behavioral health initiatives will not solve staffing issues across the entire behavioral health services continuum,” said Alexandra Pierce, deputy director of the Merced County Behavioral Health and Recovery Services Agency.
Cabrera said county behavioral health departments are facing a significant shortage of behavioral health workers, running an average of 25 to 30 percent below capacity, according to a 2023 internal study conducted by the Association of County Behavioral Health Directors and the University of California, San Francisco’s Health Force Center.
More than a dozen rural and urban county behavioral health directors told KFF Health News that recruiting challenges are widespread and not unique to CARE courts, pointing to burnout since the COVID-19 pandemic began and stiff competition from schools, correctional facilities and the private sector that can offer skilled clinicians higher salaries, work-from-home telehealth jobs and plenty of time off.
Michelle Funes, director of Marin County’s Behavioral Health and Recovery Services Department, said the CARE Court Scholarship could motivate students to pursue county jobs helping vulnerable people in the community.
Funes said finding suitable clinicians can be difficult because CARE Court’s work requires skilled personnel to work in homeless encampments and other non-traditional settings.
“It feels like looking for a needle in a haystack,” Funes said, and he is recruiting from “our already small staff who have the skills needed for this kind of work and are up for the challenge.”
The nine counties that have set up the special courts have received more than 600 petitions in the 10 months since the program began, said Leah Myers, a spokeswoman for the state Department of Health Services, which helps oversee the program. The remaining 49 counties are scheduled to start the program by Dec. 1.
The program has seen early success: A year after it began, San Diego County has already begun “graduating” patients, meaning they are getting treatment and making enough progress to stay out of the court system.
As more counties adopt CARE courts, more clinicians will be needed. Scholarships could help, some counties say. But the bill’s cost could be a setback. Newsom signed a state budget in June that closes an estimated $46.8 billion deficit and vetoed hundreds of bills last year that were riddled with problems over cost. Newsom’s spokeswoman, Elana Ross, declined to comment on the bill.
Governor Newsom has until the end of the month to decide whether to sign or veto the bill.
This story was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Healthcare Foundation.
This article was reprinted from khn.org, a national newsroom and one of KFF’s core operating programs that produces in-depth journalism on health issues and is an independent source of health policy research, polling and journalism.
