California’s CARE Court Marks a Paradigm Shift for Those Living With Mental Health Disabilities and Substance Use Disorders

Last year, Gov. Gavin Newsom announced a policy framework for developing Community Assistance, Recovery, and Empowerment (CARE) Court in all of California’s 58 counties, which could place Californians living with mental health disabilities and substance use disorders who experience homelessness and/or incarceration under court-ordered treatment. You can read more about the CARE Court framework here: Fact Sheet: CARE Court 

Gov. Gavin Newsom’s CARE Court proposal swept through the state Legislature with resounding approval from Democrats and Republicans in both houses on Aug. 31 — only two of the state’s 120 legislators voted against it — and was signed into law by the governor on Sept. 14. The proposal was authored by Democratic Sens. Tom Umberg of Garden Grove and Susan Talamantes Eggman of Stockton through Senate Bill 1338. The CARE Act creates a new pathway to deliver mental health and substance use disorder services to the most severely impaired Californians who too often suffer in homelessness or incarceration without treatment. The CARE Act moves care and support upstream, providing the most vulnerable Californians with access to critical behavioral health services, housing and support.

CARE recognizes that to serve those with the most complex behavioral health conditions, we must do the hard work of prioritizing those who need help the most, providing a comprehensive CARE plan that honors self-determination to the greatest extent possible, and holding ourselves accountable to delivering services and housing that are key to long term stability and recovery.

Senate Bill (SB) 1338 (Chapter 319, Statutes of 2022) established the Community Assistance, Recovery, and Empowerment (CARE) Act, which provides community-based behavioral health services and supports to Californians living with untreated schizophrenia spectrum or other psychotic disorders through a new civil court process. CARE is intended to serve as an upstream intervention for the most severely impaired Californians to prevent avoidable psychiatric hospitalizations, incarceration, and Lanterman-Petris-Short Mental Health Conservatorship. CARE connects a person in crisis with a court-ordered care plan for up to 12 months, with the possibility to extend for an additional 12 months. The CARE Process will provide earlier action, support, and accountability for both CARE clients, and the local governments responsible for providing behavioral health services to these individuals.

The system will theoretically work like this: Family, close friends, first responders and behavioral health workers will be able to submit a petition to the court, signed under penalty of perjury, on behalf of a person with untreated schizophrenia spectrum or other psychotic disorders that shows why they qualify for CARE Court. In order to qualify, the person must be either unlikely to survive safely without supervision or be a threat to themselves or others without support. The petition must include either an affidavit from a licensed health care professional who examined them or tried to — or proof the person was recently detained under intensive treatment.

The court would then order a clinical evaluation of the person — and review the evaluation to see if the person qualifies for CARE Court services. If they do, they’ll get legal counsel and a “supporter” — an advocate to walk them through the process, as well as a “Care Plan” that can include recommended treatment, medication and housing. Medication can be court-ordered, but not forcibly administered. During 12 months, a participant will have to attend hearings to make sure they’re adhering to the plan — and counties are providing the court-ordered services.

Following that year, a person could receive another year of treatment or a graduation plan, which would not be enforceable by the court. If a person received the court-mandated services but failed to complete their treatment, they could be considered by the court for conservatorship, though refusing medication alone wouldn’t be grounds for failure. The idea is to make it easier for people who need help, but may not be seeking it, to get it before they lose legal autonomy or end up in jail.

“CARE Court is a paradigm shift: providing housing and services in the community, where people can heal – and not behind locked walls of institutions and prisons,” Newsom said in a statement on Aug. 30.

The CARE Act will be implemented in two phases, with Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne Counties, and the City and County of San Francisco (Cohort I) required to implement the CARE Act by October 1, 2023. Los Angeles plans to implement by December 1, 2023 and all other counties (Cohort II) are required to implement the CARE Act by December 1, 2024.​

Training and Technical Assistance

DHCS has contracted with Health Management Associates (HMA) to provide training and technical assistance (TTA) and data collection and reporting support for the CARE Act. For additional information, or to request TTA, please email info@CARE-Act.org.

HMA has developed the CARE Act Resource Center which provides training, technical assistance and resources to county behavioral health agencies, counsel, volunteer supporters, and other stakeholders to support the implementation of the CARE Act.

Additional Resources

• California Health and Human Services (CalHHS): CARE Act Webpage
  • CalHHS FAQs
  • CalHHS Fact Sheet
  • CARE Informational Webinar (updated 12/19/22): Video / Slides
• Judicial Council of California (JCC): Adult Civil Mental Health – CARE Act Webpage
  • JCC CARE Act Eligibility Criteria      
  • ​JCC Glossary of CARE Act Terms   ​

---

Amy Ghosh is a practicing lawyer in Los Angeles. She migrated to the U.S. in 1987 and has been married to a (retired) rocket scientist for 35 years. She has two adult children. Before becoming an attorney, she was a biochemist and worked for several well-known hospitals and laboratories. Ghosh continues to be very much in touch with her motherland India and her favorite city Calcutta. She has recently produced a Bengali movie “Urojahaj-The Flight” by acclaimed filmmaker Buddhadeb Dasgupta. Ghosh is continually looking for meaningful opportunities to contribute to society through her legal and social work.