California's CARE Court Opens in San Francisco and Six Other Counties, With Questions About Its Reach

A new court process meant to steer people with untreated psychotic disorders toward housing and medical care began operating Monday in San Francisco and six other California counties. Supporters see it as a fresh tool for families and communities, while critics warn it could pressure vulnerable people into treatment.

The program, known as CARE Court, was created by Democratic Gov. Gavin Newsom as part of a broad effort to confront homelessness in California. Lawmakers approved it despite serious concerns about a lack of housing and services, arguing that something new was needed to help people in visible distress from apparent psychotic breaks. The state has an estimated 171,000 homeless residents.

Those who can file a petition include family members and first responders, who may act on behalf of an adult they believe is unlikely to survive safely without supervision and whose condition is quickly worsening. A petition can also be filed for an adult who needs support to avoid a relapse that would likely lead to grave disability or serious harm to themselves or others. Families of people with severe mental illness welcomed the option, though eligibility is narrow. A person must have a diagnosis on the schizophrenia spectrum or a related qualifying disorder. Severe depression, bipolar disorder and addiction alone do not qualify, and the person need not be homeless.

Each county has a special civil court that reviews petitions, with the county behavioral health agency assessing eligibility. The individual is given a lawyer and a support person of their choosing. If the person qualifies, they are asked to work with the county on a voluntary plan covering housing, medication, counseling and other social services. Such an agreement can last up to a year and be extended for another. If the parties cannot agree, the statute says the court will order them to develop a plan.

Civil rights advocates fear the process will force people into care. Tal Klement, a San Francisco deputy public defender and critic of the program, said someone who fails to complete a plan could face conservatorship and involuntary treatment. The statute, however, also lets the court dismiss the case if the person declines to take part or follow the agreement. San Francisco Superior Court Judge Michael Begert, who will supervise the court, said he cannot compel anyone to engage and that the best he can do is begin building a relationship. He expects limited impact: "It's hopefully going to help some people who need some help, and it is probably not going to make a huge dent in what you observe in the community."

Questions about capacity persist. The state has set aside money for emergency shelters, but critics say case managers, suitable inpatient facilities and supportive housing remain in short supply. San Francisco officials said roughly 10% of more than 2,500 beds are open to new people, with treatment beds ranging from detox to step-down care for those leaving long-term facilities. Samuel Jain, senior policy attorney at Disability Rights California, said the problem is not that people refuse available resources but that voluntary community services are under-resourced and hard to reach. Opponents argue the state should have invested in housing and existing services rather than a new court system.

The National Alliance on Mental Illness in California pushed for the program, noting that some families have long wanted a way to direct loved ones into treatment. CEO Jessica Cruz urged families whose relatives do not qualify not to give up, since other resources may exist. "Living on the streets and dying on the streets is not the way for anybody to live," she said.

San Francisco, Orange, San Diego, Riverside, Stanislaus, Tuolumne and Glenn counties started the program Monday, and Los Angeles County follows Dec. 1. The state estimates 1,800 to 3,100 people could be eligible in the first seven counties, with Los Angeles potentially raising that to between 3,600 and 6,200, although uptake may take time. Orange County's behavioral health director, Veronica Kelley, said local judges have agreed to give her team extra time to reach voluntary agreements despite the statute's deadlines. The remaining counties have until December 2024 to set up their courts.