The CARE Act program in California represents a significant paradigm shift in how the state addresses the needs of individuals with severe mental health disorders, particularly those experiencing homelessness. CARE, which stands for Community Assistance, Recovery, and Empowerment, is a compassionate civil court process designed to provide a structured pathway to community-based services and supports. This innovative approach aims to offer culturally and linguistically competent care tailored to each participant’s unique needs.
Individualized CARE plans are initially structured for up to 12 months and can be extended for another 12 months if necessary. These plans are comprehensive, ensuring participants receive a wide array of essential services. This includes short-term stabilization medications, crucial wellness and recovery support systems, and vital connections to social services, most notably housing. Recognizing the fundamental challenge of recovery without stable housing, the CARE Act emphasizes housing as a critical component for successful outcomes. It acknowledges that maintaining treatment adherence and achieving stability is exceedingly difficult for individuals living in unstable conditions such as on the streets, in tents, or vehicles.
The CARE process is strategically designed as an upstream intervention. It aims to divert individuals from more restrictive and less desirable outcomes such as conservatorships or incarceration. This approach is grounded in evidence demonstrating that many individuals can achieve stability, begin their healing journey, and successfully exit homelessness when provided with appropriate care within less restrictive, community-based settings. Advances in treatment models, including the development of new longer-acting antipsychotic medications, combined with dedicated clinical teams and access to housing, make it possible to stabilize and support individuals within their communities. These are individuals who, historically, might have suffered greatly on the streets or experienced avoidable incarceration due to their untreated mental health conditions.
It is crucial to understand that the CARE Act is not intended for every person experiencing homelessness or mental illness. Instead, it is specifically focused on individuals with schizophrenia spectrum disorders and other psychotic disorders who meet clearly defined criteria. The program is designed to intervene proactively, before individuals reach the point of arrest, commitment to a state hospital, or become so severely impaired that they require a Lanterman-Petris-Short (LPS) Mental Health Conservatorship. CARE can also serve as a beneficial step following a short-term involuntary hospitalization, such as a 72-hour (5150) or 14-day (5250) hold. Furthermore, it can be an appropriate alternative for individuals who can be safely diverted from certain criminal proceedings, offering a path towards treatment and recovery instead of incarceration. While homelessness in California is a multifaceted issue, the CARE Act directly addresses one of its most heartbreaking aspects: the plight of individuals with treatable mental health conditions who are suffering without adequate care. This program is designed to connect these individuals with effective treatment and support, guiding them towards long-term recovery and improved well-being. CARE has the potential to significantly aid thousands of Californians in their journey towards sustained wellness.
At the heart of the CARE Act is the commitment to supporting recovery and fostering self-sufficiency. The CARE process begins with a petition to the court, which can be initiated by a broad range of concerned parties. This includes care providers, family members, first responders, and other individuals specified in the CARE Act legislation. To ensure fairness and protect participant rights, individuals involved in the CARE process are provided with legal counsel. They are also offered the option to choose a voluntary supporter, who works alongside their clinical team. The supporter’s role is to empower the participant by helping them understand information, consider their options, and communicate their decisions, maximizing their ability to make self-directed choices. The CARE plan itself is meticulously designed to ensure that appropriate supports and services are not only identified but also effectively coordinated and focused on the specific needs of each participant. This coordinated approach is particularly important for integrating services that are often fragmented, such as clinical treatment and housing. To further enhance participant autonomy, the CARE Act incorporates the creation of a Psychiatric Advance Directive. This legal document allows participants to formally record their treatment preferences in advance, ensuring their wishes are respected should they experience a future mental health crisis.
Accountability is a key principle embedded within the CARE Act, and it operates in both directions. For participants, if an individual is unable to successfully complete their CARE plan despite receiving the outlined services and supports, the Court retains the authority under the LPS Act to ensure their safety and well-being. In situations where a participant has been provided with all aspects of their CARE plan, their failure to complete it will be taken into consideration in any subsequent LPS Act hearings that occur within six months of the CARE plan’s termination. This creates a presumption at such hearings that the individual may require interventions beyond those provided within the CARE framework.
Equally important is the accountability placed on local governments. The CARE Act mandates that local entities are responsible for providing care to individuals in need, leveraging existing and substantial funding streams available to counties. These resources include over $10 billion annually dedicated to behavioral health care, encompassing funds from the Mental Health Services Act and behavioral health realignment initiatives. Furthermore, cities and counties have access to various housing and clinical residential placement options, supported by over $15 billion in state funding allocated over the past two years specifically to address homelessness. Participants in CARE Court are also given priority access to appropriate bridge housing funded by the Behavioral Health Bridge Housing program, which provides $1.5 billion for housing and related support services. To ensure these responsibilities are met, the CARE Act empowers the Court to impose sanctions if local governments fail to fulfill their obligations under court-ordered CARE plans. In extreme cases of non-compliance, the Court has the authority to appoint an agent to directly ensure that necessary services are provided. This robust accountability framework is designed to ensure that the CARE Act’s promise of effective and accessible mental health support becomes a reality for those who need it most.
