- BIST10011,577-1.87%
- USD49.58+0.05%
- EUR55.62+0.09%
- GOLD4,152.40+0.24%
- INTEREST37.00%-1.00
- BITCOIN84,624+2.03%
- October 21, 202618°
- BIST10011,577-1.87%
- USD49.58+0.05%
- EUR55.62+0.09%
- GOLD4,152.40+0.24%
- INTEREST37.00%-1.00
- BITCOIN84,624+2.03%
- October 21, 202618°
Assertive Support Model for Patients in Difficult Situations in California
In California, CARE Court aims to direct individuals with severe psychotic disorders to housing, treatment, and monitoring. The Orange County example is a long-term...
The CARE Court program in California, aimed at individuals with severe mental health issues, stands out as an intervention based on persistent follow-up and support rather than a classic court process. The program's goal is to connect individuals with severe psychotic disorders to housing, medication, and treatment before they are driven to extreme outcomes such as prison, guardianship, or death.
Janina Estrada, living in Orange, hoped this program would be a turning point for her 42-year-old son Jimmy Barela, who has struggled for years with schizophrenia, addiction, diabetes, homelessness, and psychiatric crises. Estrada recalled calling her son on a rainy Thanksgiving night; she said he often slept around the trash container behind Jack in the Box.
Estrada applied to CARE Court herself in October 2023. Shortly after, two behavioral health specialists working in Orange County, Juan Banda and Chauncey Bowie, were assigned to Barela's case. Estrada said she believes her son would not be alive today without the attention of these two individuals.
The team that persistently knocks on doors
The most striking aspect of the program was its approach to individuals with severe psychotic disorders. Field workers try to build trust with people who are unaware of their illness, distrust institutions, or may perceive even the simplest greeting as a threat.
The slogan "Hope Happens Here," written in large letters in front of the Hub Resource Center in Orange, reflects the understanding at the heart of this approach. Banda explained that he sometimes first brings some clients here to shower and offers free meals and laundry facilities. According to him, the relationship begins not with a court summons but by asking about needs.
Orange County's CARE model adopts a voluntary approach rather than coercive methods, even if the legal framework allows it. Authorities prefer to continue visits despite repeated refusals or relapses by an individual.
Veronica Kelley, Director of the Orange County Health Care Agency, said pressure does not work for long-term change. According to Kelley, it takes about 20 visits to build trust when a person has housing and nearly 40 visits when they are homeless. After trust is established, she noted that the majority of patients voluntarily transition to treatment.
Jimmy Barela’s long journey
Jimmy Barela’s history shows both the hopeful and challenging sides of the program. Previously working as a dental assistant and truck driver, Barela married and raised two children; however, over the years, he moved between shelters, hospitals, prisons, and temporary guardianship processes. Police and crisis teams usually intervened only if he was violent.
Before CARE, Estrada explained that when her son called for help, he had to talk to different people each time and start over. She said that during a crisis, her son ran into oncoming traffic, and the police issued him a traffic ticket. Estrada noted that this situation added a significant burden to the family.
Banda and Bowie recounted that when they first met Barela at an Arco gas station, the situation was very fragile, so they immediately hospitalized him. Afterwards, Barela did not speak to them for a month. Nevertheless, the team tried to build trust over six months by offering various options such as motels, shelters, and halfway houses.
The process did not progress easily. Barela missed curfew, relapsed into substance use, and sometimes distanced himself. However, after starting to take antipsychotic medications regularly, his thoughts began to stabilize. It took four months for him to sign and accept the care agreement.
Today, Barela lives in a halfway house. He says he sometimes goes to the beach and baseball games. In January 2026, he became the second CARE Court graduate in Orange County. His mother believes that reaching this point would not have been possible without CARE Court.
A new but costly path for the county
CARE Court also serves as an alternative to incarceration and guardianship options. Banda said that if a person commits a crime due to mental illness, the program can intervene and provide treatment; otherwise, the prison process takes precedence.
Still, contradictions in the system continue. Critics argue that a model operating under judicial oversight cannot be entirely voluntary. Families think the program sometimes responds too slowly to individuals in life-threatening situations.
The debate over how to handle severe mental health issues in California has swung between institutionalization, deinstitutionalization, coercion, and neglect for decades. Since the 1950s, involuntary psychiatric treatment criteria have been increasingly narrowed. The consequences have become visible in tent camps and on the streets of the state's large cities.
Governor Gavin Newsom, after taking office in 2019, said he would prioritize homelessness and mental health crises in the state and supported CARE. However, it was recently reported that he criticized the program's slow expansion in Orange County.
Kelley believes the bigger problem is structural. She says the county can provide services but cannot solve the housing shortage, funding gap, and disconnect between public and private care alone. She describes CARE Court as a burden that must be run without additional resources for staff and states the annual cost is about 4 million dollars.
Thus, although the law opens a new door, local governments still have to build the path to enter it with their own means. The experience in Orange County shows that in severe mental health crises, not only the law but also patience, contact, and sustainable resources are decisive.
Stay Updated with Ally Daily
Subscribe to be informed about special news, developments and announcements. We will keep you informed.
By signing up, you agree to our Privacy Policy
