This month, Sacramento County Superior Court began receiving CARE Court petitions. The program’s Dec. 1 start date expands its service from 11 to all 58 California counties.
The process is complicated, designed to protect people’s civil liberties while increasing accountability for mentally ill people and the local behavioral health departments that are meant to serve them.
If you have a family member with untreated schizophrenia or related disorder and you choose to try CARE Court, we’d love to hear from you in the form at the bottom of this story.
What is CARE Court?
CARE Court is a civil court process that aims to connect individuals struggling with schizophrenia spectrum or other psychotic disorders with behavioral health services, housing and support. It came out of the Community Assistance, Recovery, and Empowerment (CARE) Act, passed in 2022, and all counties in California were required to begin implementing it in December.
The legislative action was spurred by California’s overlapping homelessness and mental health crises.
During an interview with “60 Minutes” about the CARE Court pilot, Governor Gavin Newsom expressed his frustration with the existing behavioral health system.
“It’s a fail-first system, not a care-first system, which means you have to end up in the criminal justice system before someone finally provides support, a bed, a solution,” he said. “We’ve got to change that and that’s what we’re doing.”
The process hasn’t been without controversy. Disability Rights California sued the Newsom administration at the beginning of 2023 over the CARE Act, arguing it violates people’s fundamental and due process rights.
Who qualifies for CARE Court?
According to the Sacramento County Behavioral Health, a person qualifies for CARE Court if they are:
- 18 years and older.
- Have a diagnosis of schizophrenia spectrum or other psychotic disorders.
- Are currently experiencing behaviors and symptoms associated with severe mental illness (SMI).
- Not clinically stabilized in ongoing voluntary treatment.
- Unlikely to survive safely in the community without supervision OR in need of services and support to prevent relapse or deterioration that would likely result in grave disability or serious harm to the person or others.
- Participation in a CARE Plan or Agreement is the least restrictive alternative.
- Likely to benefit from participating in a CARE Plan or Agreement.
Officials with the California Health and Human Services Agency say criteria are so narrow because “CARE is focused on people [of] a certain class of diagnoses that are both severely impairing and also highly responsive to treatment, including stabilizing medications.”
Courtesy California Health and Human Services Agency
Courtesy California Health and Human Services Agency
Who can initiate a CARE Court petition?
Referrals can come from the community, specifically:
- Family members limited to:
- Parent, spouse, sibling, child or grandparent.
- A mental health professional or other service provider who is treating or has recently treated the individual.
- The director of a hospital in which the individual was recently or is hospitalized
- The directors of public service agencies, such Behavioral Health, Adult Protective Services, Public Guardian or Public Conservator.
- A first responder who has had repeated contact with the individual
- Homeless outreach worker.
- A roommate or housemate.
- The individual themselves.
What if my family member doesn’t exactly meet the definition?
“If an individual comes in and wants to petition on behalf of somebody and they don't quite meet the criteria, we still want to be there and accessible to the individual to be able to offer our services,” said Sacramento Behavioral Health Services Director Ryan Quist. “We want to take advantage of the opportunity.”
Quist said other county behavioral health departments have told him they’ve been linked with many people who aren’t actively self-seeking care but are in need of services. A recent report showed pilot counties “diverted” 362 people from the CARE Court process before they engaged.
Anyone can file a mental health request with Sacramento Behavioral Health Services online, or call the agency’s Screening and Coordination unit during business hours at 916-875-1055 or toll-free at 888-881-4881.
Sacramento Behavioral Health Services Director Ryan Quist.Kate Wolffe/CapRadio
How can someone initiate a CARE Court petition?
The first step in CARE Court is to send in a petition to kick-start the process for the person you’re concerned about. The petition requires documentation from a health care provider to prove the respondent meets the criteria of having a serious mental illness.
California’s Health and Human Services Agency put together a one-sheet for sending in a petition.
For those who desire in-person assistance, Sacramento Superior Court’s Self Help Center is located in the Hall of Justice at 813 6th Street, Room 117 (on the first floor).
Here’s more information on CARE Court from the Sacramento Superior Court System.
What happens after a petition is filed?
Once a petition is filed, the court will do a first-look determination regarding the person’s eligibility. Then, county behavioral health will assess the individual and try to engage them and offer services.
If the individual declines initial voluntary services, the court gets engaged and attempts to get them to join into a CARE agreement. If the respondent doesn’t agree to those terms, they may be ordered to follow a CARE plan for a year, with an option to extend for another year.
The goal is to get the person into a stable place where they can graduate from the CARE Act and take the next appropriate steps.
Sacramento Superior Court Judge Larry Brown says courts in pilot counties have mostly stayed away from court-ordered CARE plans.
“I think there's probably going to be a certain amount of persuasion, encouragement, cajoling, what have you, to get a person to ultimately have a CARE Agreement,” he said. “My experience in the past decade plus dealing with thousands of persons with serious mental illnesses, you know, folks don't readily always come to treatment even when it's being offered and I think everyone recognizes that, but I don't think it's going to be a heavy-handed approach — that is, forcing treatment down people's throats as it were.”
What kind of treatment is offered under CARE Court?
Treatment plans would be variable depending on the respondent, and may include therapy, medication, and housing support.
For a given case study of a fictional 43 year old man named Michael, who has schizophrenia and is homeless, DHCS and their partners HMA provided this example:
- “Behavioral health treatment: Michael is ordered to attend weekly individual and/or group counseling.
- Stabilization medication: Michael must see a psychiatrist and work on a plan for stabilization which may include psychiatric medications.
- Michael will work with a Housing Navigator on a plan for housing.
- Michael will also work with a social worker/case manager to apply for MediCal benefits and discuss which services are available to him.”
How has CARE Court gone in pilot counties?
A November 2024 report that outlined outcomes in 8 counties from October 1, 2023 to June 30, 2024 provides some early results. It found the following:
- 557 petitions filed.
- 217 petitions dismissed.
- 100 Care Agreements/Plans created.
- 240 CARE petitions still active (no agreement or plan had been created).
One lesson shared in the report is the “CARE Act process can take time - like all mental health and substance use disorder care - to build the trust and to develop the self-directed plans needed for longterm recovery and stability.”
Some behavioral health leaders have said the rollout has been more gradual than they expected.
How is CARE Court different from existing mental health or criminal justice interventions?
CARE Court is expected to serve as a middle step between drop-in mental health centers and people needing to reach mental health collaborative courts, where low-level offenders are often ordered to attend treatment instead of serving time.
Judge Larry Brown has presided over mental health courts since 2013.
“This is sort of a middle ground, it's to avoid people ending up in the criminal justice system and coming into, one of my courts, by the fact that they've been arrested for something,” he said. “And it's something not having to go all the way as far as an LPS [Lanterman Petris Short] conservatorship.”
How can people find more information about Sacramento’s CARE Court?
Sacramento Behavioral Health maintains this list of resource guides on their website.
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