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Opinion Behind Newsom’s move on California’s chronic problem with the mentally ill

California Gov. Gavin Newsom (D) speaks at a mental health treatment center in San Jose on March 3. (Karl Mondon/Bay Area News Group via AP)

Dan Morain, former editorial page editor of the Sacramento Bee, is the author of “Kamala’s Way: An American Life.”

In 1967, Ronald Reagan, California’s Republican governor, signed legislation that would have far-reaching impact on people with severe mental illness. That was also the year Gavin Newsom was born; now, 55 years later, he is the state’s Democratic governor, attempting to deal with the fallout — for those who are mentally ill and for the communities where they live — from the law.

The 1967 legislation had been years in the making, a bipartisan undertaking that proponents hailed as the Magna Carta for people in state hospitals. It provided patients with basic rights, accelerated the emptying of those antiquated institutions and became a template for states across the country.

As hospital population fell, Reagan cut state hospital funding but also allocated more money to counties to provide care for newly released patients. Among the legislation’s flaws, it did not compel counties to spend the money to help former patients, who were under no obligation to seek care. It was a prescription for social disaster.

Like virtually every California governor before him, Newsom has ambitions that go beyond Sacramento. Unlike his predecessors, he is confronting the daunting issue of untreated mental illness. His success or failure could determine his future.

The problem is huge: 160,000 homeless people in California, a fourth of them severely mentally ill. Tens of thousands of others with mental illness are confined in prisons and jails. Newsom understands why few have taken on the issue.

“You’re just immediately criticized and protested, and the ROI” — return on investment — “on that often is pretty modest,” Newsom told me in a recent interview.

On the national stage, his presidential ambitions are hardly a secret. Newsom regularly trolls Republican Florida Gov. Ron DeSantis, including challenging him to a debate over immigration and last week sending hurricane disaster aid to the state, underlining DeSantis’s past opposition to hurricane aid elsewhere.

Tending to his own state, Newsom last month signed what could be the governor’s legacy legislation, creating what he calls Care Court, short for Community Assistance, Recovery and Empowerment. It’s aimed at compelling those with severe mental illness to obtain help.

People would come under Care Court jurisdiction if they were diagnosed with serious psychotic disorders, unlikely to survive without supervision and would deteriorate without help.

Family members, doctors and police could petition to have individuals placed into the Care Court system, and judges could refer defendants to the system if they were deemed to be incompetent to stand trial.

Once in the system, individuals would receive treatment, access to medication and housing in the least restrictive setting. They would also have attorneys and could refuse medication.

Assuming the law survives inevitable court challenges, seven counties will implement the system by next October, followed by the state’s other 51 counties no later than Dec. 1, 2024.

It won’t be cheap. California will spend at least $37.7 million just to operate Care Courts, a Senate staff analysis shows. Newsom says 12,000 people could qualify. Additionally, the California State Association of Counties estimates the price tag for treatment and other services at $40,000 per participant, with a total annual cost of up to $1.3 billion.

Reflecting voter impatience over tent cities throughout the state, the bill received only two no votes in the 80-seat Assembly; the 40-seat Senate approved it unanimously — over the objections of civil liberties groups.

In writing about mental health care over decades, I found that the subject is often personal to those attempting to address it. So it was with the Care Court bill. Legislators involved in its passage told of a brother-in-law, an aunt or some other family member who was ravaged by mental illness.

I, too, have a story. My brother, Frank, crashed his car in 1969 when he was 22. Because of a brain injury, he could not care for himself, and, try as they did, our parents could not handle him. He spent his days in California state hospitals and a nursing home until his death in 2000.

Frank was not mentally ill. His brain was damaged. But he taught me that society has an obligation to care for people who are incapable of caring for themselves. He received care, but many others with brain disease and damage end up on the streets or worse, as we Californians witness each day.

In August, a few days after grabbing headlines by donating $100,000 to DeSantis’s Democratic challenger, Charlie Crist, Newsom announced at a Fresno high school that the state would spend $4.7 billion on mental health programs for the young, including training 40,000 mental health workers.

He also did something he rarely does in public, telling the gathering that his maternal grandfather killed himself. His mother, he later told me, never recovered. It’s one reason he has focused on mental illness throughout his years in public office.

Cynics may note that if Newsom does aspire to higher office, he must be able to show that he tried to address California’s chronic problems with the homeless and mentally ill. That might be true, but political calculation that achieves something worthwhile could also be called leadership.

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