Hamas, Fatah, the Palestinian Authority, and the PLO-affiliated organizations and movements that have dominated Palestinian politics for decades mean little to Aboud.

Instead, the Ramallah university student, who gave only one name out of security concerns, says his loyalty lies with a band of young militants unheard of just a few months ago.  

“The Lions are the ones who will save us,” Aboud says, holding up an image of a young fighter on his phone. “It is my generation’s turn to fight for our homeland.”

The Lion’s Den, a youth-led, nonpartisan, and nonsectarian militia based in the northern West Bank city of Nablus, is among several like it popping up across the occupied Palestinian territories.

The groups are capturing the imaginations and tapping into the frustrations of Palestinian youths amid an uptick in settler attacks and an Israeli military crackdown that intensified further this week with a deadly raid against the Lions in Nablus.

Their popularity marks a more militant turn for Generation Z Palestinians in the West Bank. With no peace process and facing an increasingly autocratic and corrupt geriatric Palestinian leadership, few job prospects, and the expansion of Israeli settlements and movement restrictions, young Palestinians who say they feel “pressured from all sides” are turning their backs on Palestinian civil society and its nonviolent approach.

Instead, young men and women with no political outlets and little memory of the second intifada’s carnage are demanding a “right to self-defense” from what they see as the encroachment of the Israeli military and settlers on their daily lives and communities.

Ayman Nobani/Special to The Christian Science Monitor

A bicyclist passes a poster depicting two local fallen members of the Lion's Den militia, in the old city of Nablus in the West Bank, Oct. 26, 2022.

If 2021 saw the TikTok protest intifada for Palestinians, 2022 has brought Telegram militias, with fears among the older generation over what may come next.

“Young people who are dying are saying, ‘This is my only way to be free, the only moment I had dignity,’” says Mohamed, a Ramallah-based human rights trainer. “And that one moment of dignity is worth dying for. That message has gone viral.”

Growing support

The Lion’s Den first emerged in February as the initiator of a series of shooting attacks on the Israeli military and settlers in and around Nablus.

The group of young men, consolidated within Nablus’ mazelike old city, used its stone alleys as its base and rejected ties to any known political group.

But it was Israel’s August assassination of Ibrahim al-Nabulsi, the 18-year-old and unemployed alleged ringleader of the militia, that brought it to national prominence for Palestinians, with support for the movement growing with each Israeli military operation.

Israel’s raid into the old city before dawn Tuesday targeted Lion’s Den leaders and what it said was a bomb-making factory, killing six people. It prompted a general strike across the Palestinian territories in protest.

Yet even as Israel continues a stifling, 16-day blockade of Nablus and night operations to dismantle what it describes as “terrorist” cells, the militia continues to address viewers directly via Telegram and other apps.

Youth support for the armed groups comes one year after popular protests, also youth-led, erupted across the occupied territories over the evictions of Palestinian residents in East Jerusalem.

Ayman Nobani/Special to The Christian Science Monitor

A vendor displays photographs as a makeshift memorial to 11 young men, local residents who were members of the youth-led Lion's Den, at his stall at the entrance to the old city of Nablus, West Bank, Oct. 26, 2022.

Young Palestinians who took part in protests last year see no contradictions in the two phenomena.

“Young people are saying, ‘I don’t want to be a victim and oppressed. I want to stand up for myself,’” says Marah, a hoodie-donning journalism student in Ramallah. “Last year’s protests were the first steps, and these brigades are the next step; we are all finding different ways to resist.”

The nonpartisan militias also have filled a Palestinian leadership void created by increasingly unrepresentative parties and faction infighting.

Ghassan al Khatib, assistant professor at Birziet University and director of the Jerusalem Media and Communications Centre, a Ramallah public survey center, says, “99% of the population is identifying with this movement without knowing who they are, who is behind them,” or anything about their agenda and ideology.

“This tells you a lot about how desperately the public is actively searching for action and leadership,” he notes.

“After years of young people looking for hope or a cause, suddenly this came,” adds Nablus-based journalist Bassam Abu Alrub. “Each young person sees themselves in Ibrahim Nabulsi. It has woken up something inside of them, and it is spreading fast, like wildfire.”

At the same time, analysts say, Palestinian political factions and institutions are closed to young people, cutting off an outlet for their voices.

“There are no elections, not even within political parties. Youths who cannot find a role for themselves try to find things outside the political structure,” says Mr. Khatib.

Inside the Den

In Nablus’ old city Monday, not a single sign or flag for the Palestinian Authority (PA), Fatah, Hamas, or Al Aqsa Martyrs Brigades was visible. Not even a Palestinian flag.

Ayman Nobani/Special to The Christian Science Monitor

Residents sit by the Manara clock tower in Nablus, built in 1906 on the orders of an Ottoman sultan and a symbol of the West Bank city, Oct. 26, 2022.

Instead, photos of Lion’s Den members were prominently displayed on every stone wall, hanging from coffee shacks and inside restaurants. “Lion’s Den” was spray-painted onto the walls in black.

Young men and women wore pendants with images of Mr. Nabulsi and other fallen militia members; one busy stand even sold mobile phone covers emblazoned with their photographs.

In one cafe, two 16-year-olds scroll their phones, looking at the latest Lion’s Den post: a TikTok montage of a recently killed brigade member set to a sorrowful ballad and emoji.

When asked about their ambitions, they shrug. On the subject of Lion’s Den, they become animated.

“For the first time in my life things are heading in the right direction,” says one. “Next, we need to form Lion’s Dens in the refugee camps and then in every town and village in Palestine to liberate our nation. That is our future.”

Challenge to Authority

The youth militias have become so popular that the PA and its dominant faction, Fatah, dare not publicly move against them.

That forces a difficult balancing act on the PA, which views the movements as a challenge to its control over the West Bank and as damaging to its credibility as a security partner for Israel and a reliable actor for the West.

Ayman Nobani/Special to The Christian Science Monitor

A taxi driver displays a photo of a Lion's Den militia member on the dashboard of his cab in downtown Nablus, West Bank, Oct. 26, 2022.

In the past two weeks, the PA and Fatah have made multiple offers to the young men in return for laying down their arms: places in the security forces, jobs for life, perks for relatives, cash. The brigades have mostly refused, Fatah officials say.

Wednesday evening, four Lions turned themselves into the PA, a decision the group described as the fighters’ individual “choice.” But the group has so far insisted it would fight on.

Lion’s Den members, not PA security services, patrol Nablus’ old city, checking IDs and photographing strangers.

Their influence and celebrity were on display Monday when, as Israeli security drones buzzed overhead, neighbors, relatives, and Fatah representatives sat in a ring of plastic chairs for mourners of Tamir Kilani, a militia member killed by Israeli forces two days earlier.

As a delegation of PA government ministers walked in to pay their respects, mourners barely lifted their heads to make eye contact.

Later, when a group of 20-something young men wearing all black with black baseball caps walked in, suddenly, older men elbowed each other.

“It’s them, it’s them,” one whispered. “It’s the Lions!”

“People are being attacked by settlers, Israel is killing young people, checkpoints are erected everywhere, and the Palestinian Authority cannot protect us,” says a Fatah youth officer for Nablus and cousin of Mr. Kilani.

“By committing to peaceful resistance, Fatah and the Palestinian Authority have left us to defend ourselves. This is the result. Violence begets violence. For every action there is a reaction, eventually.”

Fad or turning point?

Despite the Lions’ viral popularity, older generations and Fatah loyalists dismiss the brigades as a “fad” and a “trend” that, without a formal political structure, will fizzle out within weeks as Israeli military operations against them intensify.

Yet the proliferation of the youth brigades continues.

In addition to Nablus, Jenin, and Balata Camp brigades, which predate the Lion’s Den, new militias have been announced in Tulkarm and Hebron.

Ayman Nobani/Special to The Christian Science Monitor

A woman walks past spray-painted graffiti reading "Lion's Den," one of several militant groups popping up across the West Bank, in the old city of Nablus, Oct. 26, 2022.

Not all young Palestinians welcome the trend.

Mamoun Shaloub, an engineering graduate and resident of Nablus’ old city, says the crisis has negatively hit Nablus and thousands of households.

He had been commuting daily to Ramallah to launch an on-demand scooter rental app service, Yalla Scooter, when the current crisis erupted; he now rents an apartment in Ramallah, unable to return home.

“The second intifada was chaos. People used to steal and kill rivals without accountability,” he says from a Ramallah cafe. “People say we should support these militias to liberate our nation, but who are they, what do they have to do with us, and what can they provide for us?”

“Here in the West Bank, there are no jobs, insufficient salaries, and corruption. But my generation has solutions; we can make things a bit better for our society if we are given a chance.”

Yet more young Palestinians insist that chance is by taking up arms.

Spying reporters exiting the old city Monday, a teenager on a motorbike calls out, smiling, and points to the tattered Lion’s Den “martyr” posters on the opposite wall.

“Next time, God willing, you will see my face next to theirs,” he says.

Matt Rourke/AP

Pennsylvania gubernatorial candidate Doug Mastriano, a state senator and retired Army colonel, gestures during a campaign event in York, Oct. 25, 2022. The Republican, who has been called an extremist by some members of his own party, has shut out national and even local reporters.

Hopping out of a black SUV, Doug Mastriano ducks into a side entrance of the Lehigh Valley Active Life center in Allentown, where several hundred supporters have gathered for a “meet and greet.” The Pennsylvania state senator and Republican gubernatorial candidate never so much as glances at the half-dozen journalists a few yards away. It all happens so quickly, the photojournalist beside me doesn’t even have time to put her camera in focus.  

For the past hour, two men in black blazers named Michael and Mark (neither would share their last names) have stood by the doors watching us as we wait in the parking lot. As soon as Mr. Mastriano is inside, Michael escorts me and the other reporters to the back of the event space, where there’s a designated press area: a small rectangle outlined in orange duct tape. He tells us we aren’t allowed to leave this area without permission. When a German reporter goes to use the restroom, Michael follows him.

At the front of the hall, Mr. Mastriano is shaking hands with supporters. We can hardly see, much less hear any of the interactions. When he finally takes the stage after about 30 minutes, a radio reporter asks if she can place her recorder up front. Absolutely not, says Michael. 

“But you have us here, theoretically, to cover the event,” she says, trying to explain that if she can’t get good audio clips, she can’t do her job.  

“I don’t know what to tell you,” Michael responds. “But I know that your phone won’t be on that podium.”

The Mastriano campaign’s well-documented hostility toward the media – which has duly covered the candidate’s presence at the Jan. 6 Capitol riot, his efforts to overturn the 2020 election results in his state, and his Christian nationalist beliefs – is somewhat of an outlier. But only somewhat.

Story Hinckley/The Christian Science Monitor

The view from the small press area at Doug Mastriano's campaign event in Allentown, Pennsylvania, Oct. 18, 2022. Reporters were not allowed to leave the area or talk with attendees.

Ask any political journalist today, and they will tell you: The process of covering campaigns, sometimes even just tracking down the candidates, has become an increasing challenge. The extreme partisanship gripping the nation is causing many campaigns to adopt greater security measures, as politicians face real threats. And partisan echo chambers are giving candidates on both sides of the aisle less of an incentive to cooperate with reporters aiming for balanced (read: not wholly positive) coverage. The potential for a small verbal slip to go viral on social media makes the downsides of press interviews seem to outweigh the benefits.   

The challenge looms larger, however, on the Republican side. Many GOP candidates now routinely echo former President Donald Trump’s verbal attacks on reporters, with “fake news” a reliable applause line at rallies. And some are taking that scorn to new levels. In Arizona, gubernatorial candidate Kari Lake reportedly wears a personal microphone while campaigning to capture her testy exchanges with journalists and repurpose the conservations for campaign materials. 

Republican candidates and the media have had contentious relationships for decades. But many journalists are noting that this election cycle feels different. The lack of access in some places has left reporters struggling to see what’s happening on the ground, creating a discomfiting sense of uncertainty. Is there a big “red wave” coming on Nov. 8, in Pennsylvania or elsewhere? We don’t really know. 

Can we trust the polls? 

Of course, certain data points – like fundraising, party support, and polling – can provide at least a partial picture. The site FiveThirtyEight currently has Mr. Mastriano’s opponent, Democratic Attorney General Josh Shapiro, ahead by an average of 9 points. Mr. Shapiro has reported $44 million in spending, a state record, while Mr. Mastriano, a retired Army colonel, has spent less than $3 million. Equally telling, the Republican candidate has received no obvious support from his national party.  

“Republicans pulled the plug from Mastriano’s campaign a long time ago,” says Dave Wasserman of the Cook Political Report. 

Polls tell a different story in the state’s hugely consequential Senate race, where Republican candidate and celebrity doctor Mehmet Oz has been closing the gap with Democratic Lt. Gov. John Fetterman in the final weeks. Several recent surveys now have Dr. Oz within the margin of error and it was reported Tuesday that Republicans are pouring in an additional $6 million to try to get their candidate across the finish line. Still, Mr. Fetterman remains the Democrats’ best chance to pick up a Senate seat in a cycle that is looking better and better for Republicans.

But that’s all assuming the polls are accurate – and if the past few elections are any indication, they may not be. One of the biggest challenges today, many pollsters admit, is capturing enough Trump supporters, many of whom won’t respond to the news organizations or universities that conduct most nonpartisan surveys. In 2016, polls famously underestimated Mr. Trump’s levels of support in key states, leading reporters, strategists, and much of the public to expect a Hillary Clinton victory. Then in 2020 – despite concerted efforts by pollsters to correct the problem – it essentially happened again, with many polls predicting a bigger win for Joe Biden than actually materialized.  

Hannah Beier/Reuters

Pennsylvania Attorney General Josh Shapiro, the Democratic gubernatorial nominee, speaks to an attendee during a joint rally with Democratic Senate candidate John Fetterman in Philadelphia, Oct. 15, 2022. Most polls have shown Mr. Shapiro holding a sizable lead heading into the final days of the campaign.

That’s where traditional journalism can still play a key role. Political reporters can often sense momentum building by paying attention to the energy and size of crowds, talking to voters, and interacting with candidates. 

News coverage of campaigns “supplements what we learn from polling,” says Berwood Yost, director for the Center of Opinion Research at Franklin and Marshall College in Lancaster, Pennsylvania. “Mastriano seems to not be holding any events for anyone except for those who are following him and doesn’t talk to the media. I don’t know if we’re missing his support because of that.”

On a recent trip to Pennsylvania, Democratic staffers for races up and down the ballot were generally responsive to queries about campaign events. Mr. Fetterman’s press team was quick to send details about a rally in Bucks County that was also listed on multiple websites. The candidate didn’t take any questions from journalists there, but at least the campaign allowed us to talk to voters. A staffer shuttled reporters to the stage while Mr. Fetterman was speaking so we could take a photo.

By contrast, none of the campaigns for Mr. Mastriano, Dr. Oz, GOP candidate Lisa Scheller in the 7th District, or GOP candidate Jim Bognet in the 8th District responded to calls, Facebook messages, or emails. I found the time and location for Mr. Mastriano’s Allentown event in a post in a Pennsylvania voter Facebook group.  

Michael and Mark told me the restrictions were for Mr. Mastriano’s safety. “I don’t know you, and you don’t know me,” said Mark.

But being so tightly cordoned off meant I couldn’t report on voters’ questions to Mr. Mastriano, or what he was promising them he’d do in office. And I certainly couldn’t ask him any questions about his policy proposals, such as banning abortion with no exceptions and overhauling the state’s voter registration process.

Typically at rallies I try to gauge the enthusiasm of supporters. If multiple attendees tell me it’s their first time at a political event or supporting a certain party, that’s often suggestive of a coming surge.

Yet even when I can talk to voters these days, often they don’t want to talk to me. Particularly since Mr. Trump began encouraging his audiences to boo the reporters in attendance, journalists have faced a drumbeat of hostility from everyday Americans. 

As I stood with the other reporters in the parking lot waiting to be let in to Mr. Mastriano’s event, supporters yelled “fake news!” and “lamestream media!” at us before walking inside. 

A foregone conclusion – maybe

Veteran pollsters in Pennsylvania say there’s no doubt about Mr. Mastriano’s prospects – he’s going to lose. 

“[Mastriano’s] support is Donald Trump’s base,” says Terry Madonna, a senior fellow at Millersville University and a longtime Pennsylvania polling expert. “But here’s the thing: In Pennsylvania, if you’re a Republican, you can’t just win with rural and small-town voters. You need to get suburban support.” 

As Mr. Madonna explains, former President Trump lost Pennsylvania in 2020 despite maintaining his support among the rural, small-town voters he’d won over four years earlier, because Mr. Biden was able to run up his margins in Philadelphia and the surrounding suburbs. 

In order to win statewide in Pennsylvania, a state that still has more registered Democrats than Republicans, GOP candidates have to “reach beyond the [party’s] base,” agrees Mr. Yost.

To that end, Mr. Mastriano’s strategy of stiff-arming the media may be hampering his ability to reach the suburban voters he needs to win over. 

“Mastriano has problems because he is going to get beat significantly among those independent voters. How do you get past your base if you’re not talking to those people?” says Mr. Yost. “If you don’t engage with the media, I’m not sure you can build the momentum.” 

Still, Mr. Mastriano’s Allentown event didn’t exactly feel like a campaign that was cratering. Almost every seat in the community center’s huge rec room was filled. There was cheering, fist pumping, and a 40-minute line to take a selfie with the candidate. 

After reading about his poorly attended September rally on the steps of the Capitol in Harrisburg, I hadn’t expected to see so many people or so much enthusiasm. That doesn’t necessarily mean there’s a big red wave building, or one that would be sizable enough to lift a candidate who’s been labeled an extremist even by some fellow Republicans. But it’s also possible the press could be missing something. 

Mr. Mastriano did not respond to repeated requests for comment.

If Luiz Inácio Lula da Silva wins Brazil’s presidential runoff Sunday, his victory would mark the 11th leftist elected in the region in less than five years – a wave harking back to the so-called pink tide, when Latin America’s brand of left-wing politics upended the political status quo.

It’s been a turbulent period for politics around the globe: A party with fascist roots won the Italian elections in September, election deniers are poised to win seats in the U.S. November midterms, and Europe’s brand of far-right populism has continued to inch toward the mainstream for the past several years.

Here in Latin America, deep-seated polarization and swings toward the authoritarian have started to define the political landscape, too. So this weekend all eyes are on Brazil, where Lula, as the two-time former leftist president is popularly known, faces incumbent Jair Bolsonaro, who has strained Latin America’s largest democracy by spreading fake news about the media and governmental institutions and deepening polarization. 

If Lula wins the runoff, Latin America’s largest economies, including Chile, Colombia, and Argentina, will be led by the left, countering right-wing populism and buoying hopes among supporters that the region can usher in the liberal agendas reminiscent of Latin America’s initial “left turn” – and on social issues go even further.

But experts caution that, if victorious, Lula could soon discover what leftists already in office have learned: There’s no re-creating the pink tide of the early 2000s. The economic and political context has changed dramatically in the region, leaving few leftist governments the funds for programs aimed at closing inequality gaps. Growing political polarization means shorter grace periods for presidents. That can in turn lead to anti-incumbent sentiment that undermines hope for a true alternative.

“Nobody who is president right now in Latin America, or aims to be president, can expect to be popular or to implement huge reforms,” says Oliver Stuenkel, professor of international relations at the Getulio Vargas Foundation, a Brazilian school and think tank. “That shapes the entire political environment.” 

Washington Alves/Reuters

Former Brazilian president and current presidential candidate Luiz Inacio Lula da Silva gestures during a march in Belo Horizonte, Minas Gerais state, Brazil, Oct. 22, 2022.

Lula, who is projected to win in the Oct. 30 vote, polling with around 52%, has pledged to reduce inequality and improve education and health services. When challenged on the execution of his promises, he often points to the past.

“I can do it because I’ve done it before,” he told one Brazilian interviewer recently.

Lula brought about vast change as president of Brazil between 2003 and 2010, creating scores of universities and technical schools, slowing the deforestation of the Amazon, establishing Brazil as a diplomatic presence on the world stage, and perhaps most importantly, lifting an estimated 30 million people out of poverty.

The pink tide is often associated with populist or charismatic leftists who signaled a distinct change from neoliberal agendas. They were “pink” leftists – not communist red – and took advantage of China’s hunger for commodities like iron ore, soy, copper, and oil to fund generous social welfare programs. Income inequality fell in practically every Latin American country during the first 10 years of the 2000s, and the results were even greater in countries led by the left, according to a recent Tulane University study.  

But that accomplishment was marred by widespread corruption scandals that implicated many of these leftist governments themselves, including Lula, who briefly served time in prison before charges against him were annulled.

“I’m not sure people want to go back to the 2000s, because that period of time in a lot of people’s minds is associated very deeply with corruption,” says Nicolás Saldías, an analyst at the Economist Intelligence Unit in Washington. “They don’t trust the people in power at that time to do anything good.”

A new era

Many gains in poverty reduction were eroded as conservatives started winning office and stopped spending on social programs – and with the arrival of COVID-19. Now amid high rates of inflation and lower prices – and demand – for Latin American commodities from China, governments in the region simply don’t have the cash they once had.

Victor R. Caivano/AP

People line up outside a soup kitchen to receive a meal in Brasiliandia, one of São Paulo's poorest neighborhoods, Sept. 29, 2022. Although this year the economy started to recover, rampant inflation put even basic foodstuffs out of people's reach and 33 million Brazilians experience hunger.

The pink tide became a movement of like-minded leaders – many of them allies – across the region. But the leftists in office today are a “much more heterogeneous group of leaders and parties,” says Christina Ewig, professor of public affairs at the University of Minnesota.

Peru’s current president won on a Marxist ticket, while a former student organizer is at the helm in Chile, and an ex-guerrilla with years of mainstream politicking won the presidency in Colombia. What they share is an increased commitment to social inclusion – and that could ripple out across the region.

Many governments are now more socially progressive than their ideological predecessors, those that lasted roughly from 1999 to 2012. What they may be curbed from spending on welfare programs, they could make up for by putting more focus on legislation around inclusivity and protections, from Indigenous rights to access to abortion or environmental protection.

“While the left remains anachronistic in several ways ... it has changed quite significantly over the last 20 years,” Dr. Stuenkel says. “Growing concern about racism, women’s and LGBT rights, and the environment are proof of that.”  

President Alberto Fernández legalized abortion in Argentina in 2021. Colombia’s new administration introduced a bill for a ministry of equality and equity this month. If Lula wins, he’s expected to put a premium on protecting the Brazilian Amazon.

Cycle of polarization

Although moves like these are often in response to citizen demands and a modern ethos on human rights, they also fuel polarization and culture wars.

Bruna Prado/AP

A supporter of Brazilian President Jair Bolsonaro holds up a painting of him at a campaign rally for his reelection in Sao Goncalo, Rio de Janeiro state, Brazil, Oct. 18, 2022. The presidential runoff election is set for Oct. 30.

President Bolsonaro shocked many with his positive performance in Brazil’s first-round vote earlier this month. His 2018 victory was interpreted broadly as a rejection of Lula’s Workers’ Party and the corruption that scarred its nearly four terms in power, not a vote of confidence for right-wing populism.

Over the past four years, President Bolsonaro downplayed the severity of the COVID-19 pandemic, the economy has sputtered, and large swaths of the middle class have fallen back into poverty. Since the runoff campaign got underway three weeks ago, Brazil’s electoral court has sanctioned Mr. Bolsonaro’s camp several times for spreading fake news. 

If he wins over the weekend, that suggests more support for right-wing leadership in Brazil. If he loses, though, some question whether we’re seeing another leftist shift in the region at all, or whether the growing map of leftist presidents is also anti-incumbentism.

Mr. Saldías says he’s skeptical about any narrative of the left returning to power in the region as a symbol of hope or faith in its promises. “The initial pink tide was real,” he says. “There was actual hope. But those hopes were dashed.”

The swinging pendulum of politics has left many voters disillusioned. At a newspaper kiosk on Avenida Faria Lima in São Paulo, Jefferson Lemos isn’t optimistic about the next four years – regardless of who wins.

Mr. Lemos is one of the roughly 4% of Brazilians who say they’re still undecided before this weekend’s election. He chose Mr. Bolsonaro in 2018 and cast a protest ballot in the first-round election earlier this month, voting for no one. “One lies as much as the other. You don’t know what’s true and what’s not true,” he says.

Others are convinced their candidate is the only hope for the country. “We’re an underdeveloped country that has everything to be a great country,” says chef Altamiro Junior, who supports Mr. Bolsonaro. “But it all depends on who’s in charge.”

Karl Mondon/Bay Area News Group/AP/File

California Gov. Gavin Newsom, speaking at a mental health treatment center in San Jose, announces Care Court, a program that would let courts order treatment for people suffering from extreme mental health disorders, March 3, 2022. The mandate, which was signed into law in September, will be implemented in phases over the next few years.

Last month, California Gov. Gavin Newsom signed into law legislation that he described as “transformative” – a new path forward to help people diagnosed with severe mental health and substance abuse disorders, thousands of whom live on the streets. As a sign of the urgent need, the bill passed with only two state lawmakers opposed.  

The law creates Care Courts, civil courts that will allow a broad array of interested parties to petition a judge to order treatment. It is meant to reach people with the most serious mental illnesses who don’t have access to care or don’t think they need it, as well as to break the cycle of people shuffling in and out of crisis treatment and jails, which have become America’s de facto mental health institutions. The law’s many supporters hope it will divert people to treatment before they lose their legal autonomy in conservatorship or wind up in jail. 

Though the law is touted by the governor’s office as a “first-in-the-nation” framework, behavioral health experts say that the Community Assistance, Recovery, and Empowerment Act actually resembles laws in many other states. It also piggybacks on existing California statutes. As with the other laws, the Care Court’s effectiveness will depend on how well it can be carried out, the experts say. That’s an open question, given expected legal challenges, and an acute shortage of supportive housing and mental health workers, not only in California, but across the nation.

“If well implemented, it would be very significant for the state,” and potentially add momentum to other states’ statutes that are generally known as community-based “assisted outpatient treatment” or “involuntary outpatient commitment” laws, says Marvin Swartz, professor of psychiatry and behavioral sciences at Duke University. Forty-seven states have such statutes, he says. California’s Care Court “twist,” as he calls it, stands out for two reasons: It has funds, and it targets the homeless population, though not exclusively.

“Homeless mentally ill people are a huge problem in California, and a very visible example of the failure of the mental health system. [Governor Newsom] needed to do something bold and new, and sometimes you do that by putting old wine in new bottles,” says Dr. Swartz.

First in the nation for homelessness

California has more homeless people than any other state, at least 170,000 people living in shelters, in vehicles, or outdoors. Californians rank the “big problem” second only to “jobs, the economy, and inflation,” according to the Public Policy Institute in California. Despite billions of dollars spent, homelessness has increased since before the pandemic, and features prominently in midterm elections. 

Many factors contribute to homelessness, including mental health and substance abuse disorders. The governor’s office estimates that Care Court will help 7,000 to 12,000 people each year, many of them unhoused. 

Melanie Stetson Freeman/Staff/File

A tent for a homeless person sits on the sidewalk in the Tenderloin neighborhood, on Jan. 28, 2022, in San Francisco.

Pointedly, the governor did not attempt to reform existing paths for people with serious behavioral health issues, such as the state’s conservatorship law, its mental health courts in the criminal court system, and Laura’s Law, which also uses civil courts to order assisted outpatient treatment in local communities. The 20-year-old law is named for Laura Wilcox, a volunteer at a mental health clinic who was shot and killed by a man with mental illness. 

Care Courts in every county

“We need to do something different and something better,” said Jason Elliott, a senior counselor to Governor Newsom in a press call proposing the new Care Court tool in March. Unlike the state’s criminal courts for mental health and Laura’s Law, Care Courts are mandatory for each of the state’s 58 counties, which will administer the courts and their services. Also new: Counties will be fined if they don’t comply. Another difference is the broader number of people who can petition Care Courts to hear a case, from family members and roommates to first responders and behavioral health workers. 

To qualify for Care Court, individuals must be unlikely to survive safely without supervision or be a threat to themselves or others, and have a diagnosis of schizophrenia spectrum or other psychotic disorders.

The court orders a clinical evaluation of the individual to see if they qualify for a care plan, which could last up to two years and include support services, medication, and housing. The person would have an attorney as well as a volunteer supporter. The participant would have to attend hearings to make sure they are sticking with the plan (though they could refuse medication), and if not, the court could order conservatorship, send them to criminal court, or order hospitalization.  

Counties can tap into $15.3 billion of existing state funds dedicated to homelessness – including $11.6 billion for mental health services annually. The law provides $63 million for Care Court planning and startup. 

“The lift is significant to actually stand up a program like that,” says Jacqueline Wong-Hernandez, deputy executive director of legislative affairs for the California State Association of Counties. Counties are already stretched, she says. “These are just new people being put into an existing pot of funding, and an existing number of people on the ground, and an existing number of beds in crisis residential treatment.” That’s why the counties insisted on a phased-in approach, with seven of them implementing the law by next October, and the remaining 51 following the year after. At the counties’ insistence, the state must come up with ongoing funding before the law goes into effect.

“Let’s try this”

In Santa Clara County, which does not need to implement the law until the end of 2024, David Mineta is cautiously optimistic about Care Court. As the president and CEO of Momentum for Health, the county’s largest private, nonprofit provider of mental health services, he says he keeps seeing the same patients cycle through jail or crisis care. A certain segment resists treatment, he explains, and many are arrested for infractions due to their illness. When they are released, they miss a court date, or don’t know they have a court date, and are remanded back into custody.

“Their path through our present system has hit a wall. Let’s try this,” he says in a phone interview. He particularly welcomes the civil court path of the new law. “I don’t want to criminalize people for a health condition.” 

Help couldn’t come soon enough. At Momentum for Health, the number of clients since the pandemic has surged by 21%. At the same time, the provider faces a severe shortage of mental health workers, having to compete with hospitals and the county, as well as contractors and private practice. Last month, the nonprofit had a 31% vacancy rate for clinicians (therapists). It was twice that for the more intense crisis stabilization unit. 

Momentum for Health

David Mineta is the president and CEO of Momentum for Health, the largest private, nonprofit provider of mental health services in California's Santa Clara County. He sees the same people cycle through crisis treatment and jails, and says the current system has hit a wall. "Let's try this," he says of the new Care Court law.

“This is the worst workforce shortage I’ve ever seen for 30-plus years in this field,” says Mr. Mineta. He is “relieved” that the state is focusing on workforce training, providing more than $1.4 billion to boost the overall pipeline for health care and psychiatric providers. To try and fill his workforce gap, Mr. Mineta says he is turning to interns in Ph.D. programs and “peer” workers – people who have lived similar experiences as the clients.

The workforce shortage is a national challenge, with an underlying structural cause related to pay, says Steven Siegel, the Franz Alexander Chair in psychiatry at the Keck School of Medicine at the University of Southern California. The problem, says Dr. Siegel, is that mental health professionals are greatly undervalued compared with their colleagues in physical health, particularly when it comes to insurance reimbursement. 

Psychologists make half as much via insurance payments as they do accepting cash in private practice. And psychiatrists, who are fully trained medical doctors, make a third as much as their counterparts in other medical specialties, according to Dr. Siegel.  

“We won’t pay for mental health care, so we don’t get mental health care,” he says. 

Up first: San Diego County

Luke Bergmann has less than a year to implement the new law. As director of Behavioral Health Services in San Diego County – the largest department in the county with a budget that tops $1 billion – he has to adjust his department to Care Court requirements by the start of next October. 

He, too, faces an acute worker shortage: a deficit of 8,000 to 9,000 behavioral health workers in the county just to meet present demand, he says. Add to that the decline in supportive “board and care” long-term housing. “We’ve lost almost half of our board and care in San Diego County since the pandemic,” he says. The reason? The increased cost of housing. “People who own houses are not incentivized to make money with them by providing board and care services.”  

Uncertainty around the law is also a challenge. Dr. Bergmann has no idea how the community will respond with referrals to Care Court – will there be an avalanche, a trickle, or something in between? And he’s hearing “conflicting narratives” about the law’s impact. From some quarters, he hears that it will fundamentally transform behavioral health care, amounting to a “tectonic” shift. From others, he understands that the scope of it will be “relatively narrow.”

Right now, he’s trying to figure out what to do with his department’s public conservators office. There might be more demand if people fail to fulfill their Care Court obligations. Or, there might be less demand, if more people go through Care Court and succeed. “Right now, I’m hearing both things.” 

Compulsory ... or not?

The governor’s office describes Care Court as voluntary. But that’s not how civil liberty groups such as the ACLU of Southern California see it. 

“Nobody is going to be strapped down and injected with medication against their will,” says Eve Garrow, a policy analyst and advocate with the group. But, she explains, “a court order is compulsory.” And, she adds, there is an enforcement mechanism that can order conservatorship if there is noncompliance. The law is a “pipeline to conservatorship which strips people of almost all of their rights.” She expects legal challenges to Care Court. 

The new law is “simply a misdiagnosis of the problem,” according to Ms. Garrow, who cites research that shows court-ordered treatment is no more effective than services received voluntarily. She adds that the real need is more treatment services, supportive housing, and affordable housing. 

Looked at more broadly, Care Court is part of a welcome national trend to move away from a criminal court pathway to treatment and toward a health care approach, says Michael Champion, co-chair of the Judges and Psychiatrists Leadership Initiative at the American Psychiatric Association Foundation. “I’m very encouraged right now. We are moving with momentum with broad-based support on this issue,” he says. As for the specifics of Care Court, “time will tell in its implementation.” 

Reuters

Russian President Vladimir Putin and Kazakh President Kassym-Jomart Tokayev attend a regional summit in Astana, Kazakhstan, Oct. 14.

Russia’s invasion of Ukraine has stirred many countries to rethink how to safeguard their societies. Sweden and Finland opted to join NATO. Dozens of nations are adjusting to the war’s disruption in oil and wheat supplies. The U.N. General Assembly voted overwhelmingly to affirm the sovereignty of nation-state borders.

On one measure, the invasion brought a more subtle influence. The latest global index by the World Justice Project found most of the countries that have improved their rule of law over the past year are near Russia: Bulgaria, Estonia, Kazakhstan, Kosovo, Latvia, Lithuania, Moldova, and Uzbekistan.

Most are former parts of the Soviet empire that Russia seeks to reconstitute. Russia’s own ranking dropped to 107 out of 140 countries surveyed by the Washington-based watchdog. That reflects a worldwide decline in what the survey defines as universal principles of rule of law, such as open, democratic government and impartial justice in the courts. In two-thirds of the countries, “fundamental rights” have fallen.

The best example of a country eager to improve rule of law is the giant Central Asian nation of Kazakhstan. Reform efforts under President Kassym-Jomart Tokayev, such as tackling corruption, pushed Kazakhstan up the survey’s rankings to outscore Hungary. And Hungary is a member of the European Union, albeit one on an EU watchlist for backsliding on basic rights.

Kazakhstan is in the crosshairs of Russian President Vladimir Putin and his arbitrary exercise of power. He has said “Kazakhs never had a state,” a claim similar to one he made about Ukraine before the invasion. This threat has pushed more reforms in Kazakhstan that affirm equality before the law and accountable government, helping to shore up the country’s identity and unity.

Ukraine itself had made enough progress on rule of law and democracy in the decade before the invasion that its people were quite willing to defend the country against Russia. Universal principles are a binding force for people that put them into practice. Russia’s neighbors know that better than most.