July 23, 2024
The program launched Monday in seven counties including San Francisco.

California’s CARE Court system, a new initiative to make it easier for judges to compel mentally ill residents into treatment plans and facilities, starts Monday in seven pilot counties, including San Francisco, the only Bay Area county where the program is now underway.

The initiative was spearheaded by Gov. Gavin Newson, with a goal to help homeless people who are too sick or reluctant to seek care by bringing them indoors and providing treatment toward recovery.

All counties across California must phase in the civil mental health courts by the end of next year. Officials estimate between 7,000 to 12,000 people could be eligible for the program statewide.

A new poll by the Bay Area News Group and Joint Venture Silicon Valley found overwhelming public support for CARE Court, with 86% of respondents across the core five-county region in favor. It’s a clear reflection of mounting frustrations over officials’ inability to aid many of those on the street with severe mental illnesses.

“I take statements like that as expressions of distress over the status quo,” said Dr. Margot Kushel, director of the University of California, San Francisco’s Benioff Homelessness and Housing Initiative. But disability rights groups raise thoughtful concerns about the program, and medical professionals “don’t make decisions based on public opinion,” she said.

By focusing on the chronically mentally ill, a relatively small but visible subset of the state’s estimated 171,000 homeless people, Newsom appears likely to score a political win. In the survey, CARE Court received strong support among all racial and ethnic groups, ages and income levels. Strikingly, Republicans and Democrats back it at an identical level: 87%.

In a press briefing ahead of Monday’s launch, Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, framed CARE Court as the centerpiece of a broader effort to revamp the state’s mental health care system. Next year, California voters will likely decide on a multibillion-dollar ballot measure to reform mental health funding and add thousands of treatment beds.

“When you look at our behavioral health system across California, it has many parts where people are falling through the cracks,” Ghaly said. “This bold system transformation is meant so that everyone, every Californian, can see themselves in it, their families, their loved ones, and their communities.”

How does CARE Court work?

The new initiative targets those with severe, long-term schizophrenia and other untreated psychotic disorders. Participants do not need to be homeless.

The program allows families, first responders, behavioral health professionals or others with a close relationship to someone with severe mental illness to refer a person to the court. A judge can then order patients to follow an individually tailored plan for their mental health treatment, medication and housing needs.

The plan would last one year and could be renewed for a second year. If patients do not comply, they could be referred to more restrictive treatment in a locked facility or be jailed if they have a pending criminal case. However, patients cannot be forcibly medicated or jailed solely for refusing to comply with a treatment plan.

While disability rights advocates contend the program could infringe on people’s personal freedom, officials say the aim is not to force patients into facilities or conservatorships against their will, but rather to work with them to achieve voluntary participation.

The first seven pilot counties to launch the program this month are San Francisco, Orange, San Diego, Riverside, Stanislaus, Glenn and Tuolumne. Los Angeles County starts its CARE Court in December.

Is the state’s mental health system prepared?

Ahead of CARE Court’s launch, county officials across the state have raised concerns about a lack of psychiatric beds and supportive housing for patients in the program.

A 2021 RAND analysis found California needs more than 4,700 treatment beds and 3,000 beds in long-term residential care facilities. In Santa Clara County, researchers with the think tank said at least 700 beds are needed, more than double the available amount.

To bolster the state’s mental health care system, Newsom is expected to send a ballot measure passed by state lawmakers before voters in March 2024.

The measure would raise nearly $6.4 billion that could help build around 10,000 psychiatric treatment units. It would also shift about $1 billion currently spent on county efforts such as outpatient care and crisis response to housing programs, including rental subsidies and navigation services — a move decried by some advocates worried the money will also go toward involuntary treatment institutions.

How can I refer a loved one to CARE Court?

In San Franciso, people can refer loved ones to CARE Court by filling out a form and filing it online or in person at the county courthouse. More information is available at https://sf.courts.ca.gov/divisions/civil-division/care-act-court.

Other Bay Area counties will share more information about local mental health courts ahead of their launch by December 2024.

If you or someone you know is struggling with feelings of depression or suicidal thoughts, the National Suicide Prevention Lifeline offers free, round-the-clock support, information and resources for help. Call or text the lifeline at 988, or see the 988lifeline.org website, where chat is available.