Care Courts in California to Combat Mental Health Substance Abuse Disorders

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Community Assistance, Recovery, and Empowerment (CARE) Court is a new program in California that launched in October 2023 and slowly rolled out throughout the year to other counties to help people with mental health and substance use disorders get the support they need while combating California’s homeless crisis. Eight counties are enrolled in this plan: San Francisco, Orange, San Diego, Riverside, Stanislaus, Tuolumne and Glenn, and Los Angeles.  

A report from the Substance Abuse and Mental Health Services Administration Found 3.79% of those aged 18 and older in California are suffering from a serious mental illness. Additionally, California has the largest homeless population in the nation, with more than 170,000 estimated to be unsheltered, according to a 2022 report from the U.S. Department of Housing and Urban Development. Severe mental illness is a major risk factor for homelessness, and homelessness is connected to the worsening of mental illness symptoms and more intense substance use.  

It is believed that the CARE Court was made into California law as a way to stall or prevent people with untreated mental health disorders and substance abuse disorders from falling into the slippery slope of incarceration and homelessness.

So, how does the process work?

Under this initiative, people with mental illness or substance abuse disorders can be recommended, or petitioned, for CARE Court proceedings, and their case reviewed at a clinical evaluation hearing with a public defender. CARE Court empowers anyone, including family members, roommates, friends, healthcare providers, and first responders the ability to make the call to CARE Court to file a petition if they believe an individual needs help.   

A special civil court in each county will review each petition, and the county behavioral health agency will evaluate eligibility. The individual will be appointed a lawyer and a support person of their choice. If clinically proven, the individual, their lawyer, support person, and the county’s behavioral health agency collaborate on a “CARE Plan.” CARE Court connects a person with a court-ordered, patient-centered Care Plan for up to a year, possibly extending it for another year. Each plan is managed by a care team in the community and can include clinically prescribed, individualized interventions with several supportive services, medications, and a housing plan.

Who is eligible?

For this petition to undergo court proceedings, the person must be 18 years or older, and there must be an affidavit from a licensed mental health professional stating they examined or attempted to examine the person within 60 days of the petitioner’s submission or the person was detained for at least two intensive treatments. This means that the person must have previously undergone an evaluation in the recent past before the court of law can intervene. To be eligible, the person needs a diagnosis of the schizophrenia spectrum or other qualifying disorders. People with severe depression or bipolar disorder do not qualify. A person does not have to be homeless to be eligible.  

These “restrictions” make it tricky for individuals struggling with severe mental illness and substance abuse who do not fit under the criteria to receive help through CARE court. It also makes it difficult for their loved ones who cannot file a petition because they do not meet the requirements but may still need professional help.

What happens if the person refuses treatment?

Going back to the early 18th Century, American prisons and mental health wards have used coercive or involuntary treatment on their populations, while so-called drug courts, invented in the 1970s, often make enrollment into substance use treatment programs, like methadone, a condition for favorable settlement in courts instead of serving time in jail. CARE Courts are presented in a more compassionate and flexible way while still having the courts of law involved.  

Although CARE Courts, by law, cannot force a person to undergo treatment for mental illness or drug abuse, if the person refuses to voluntarily go into treatment after the court deems that they should undergo treatment, a conservatorship can be imposed by court officials. When Governor Newsome signed into law CARE Courts, he also signed a law that made it easier for courts to appoint guardians, known as conservators, to control vital life decisions, like psychotropic medications. Many critics of CARE Courts call this “coercion” because if the person refuses treatment, they can then be controlled under a conservatorship, so they are “coerced” into going into treatment once the court rules that CARE court should be involved. As a result, many critics fear that the CARE Courts will be used to make the case for conservatorships when people fail to comply with voluntary treatment.   

However, the statute also allows the court to dismiss the proceedings if the individual refuses to participate or follow the agreement. Many judges believe that the best they can do in these cases is to start building rapport with the person, which can take time. Extra time can be granted to build rapport and give the teams additional time to reach voluntary agreements.

The good and the bad

Families of people diagnosed with severe mental illness are rejoicing because this new law allows them to petition the court for treatment for their loved ones. Residents dismayed by the estimated 171,000 homeless people in California are excited at the possibility of helping this population and placing them in homes.  

Critics blasted the new program as ineffective and punitive, given that it could coerce people into treatment. 

How is it progressing? It is only a few months in.

CARE court has been in effect for six months in some counties in California; however, there has not been much published on recent proceedings. A local news article written in January 2024 says that since Dec 1, when LA County officially launched this program, 28 petitions were filed in December. As of January, when the new article was published, none of the petitions filed have reached the formal care agreement stage yet, which could take six weeks or more.  

 “Judge Samantha Jessner, presiding judge of the Los Angeles County Superior Court, said ‘all of the petitions filed in the county so far have come from family members of the person named in the documents’”   

Since CARE Court launched Oct 2 in Orange County, 45 petitions have been filed. As of January, 20 of those petitions met the initial requirements, and people in three of those petitions had been given court dates.  

“An estimated 2,000 people throughout California could be helped by CARE Court by the end of 2024”.   

Increasing awareness of the many community-based resources available is critical to addressing these issues outlined above. That is why when you call Akua, no matter your situation or circumstance, we are committed to helping you. We can provide referrals to local services, even Medi-Cal facilities that accept unhoused individuals. We at Akua aim to make quality addiction and mental health treatment more accessible. That is why we accept Medi-Cal in Sacramento and offer most levels of care – from Detox and Residential to Outpatient (IOP & PHP) and Now: Sober Living! If you or someone you know is struggling, call us anytime, 24/7 to get help: 888-740-5164