The CARE Act represents a significant shift in how California addresses severe mental health challenges. It establishes a compassionate and structured civil court framework designed to offer individuals clinically appropriate, community-focused services and support systems that are sensitive to diverse cultural and linguistic backgrounds. These individualized CARE plans are initially structured for up to 12 months and can be extended for another 12 months if necessary. A crucial aspect of CARE plans is ensuring participants have access to a comprehensive suite of essential services. This includes short-term medication to stabilize their condition, wellness and recovery support, and connections to vital social services like housing. Recognizing the fundamental role of stable housing, the program acknowledges that securing and maintaining treatment is exceedingly difficult for individuals experiencing homelessness, whether living in tents, vehicles, or on the streets.
The CARE process is strategically designed as an early intervention, aiming to prevent the need for more restrictive measures like conservatorships or incarceration. This approach is rooted in evidence demonstrating that many individuals can achieve stability, begin their recovery journey, and transition out of homelessness when provided with less restrictive, community-based care environments. Advances in treatment models, including innovative long-acting antipsychotic medications, coupled with dedicated clinical teams and housing support, mean that individuals who have historically faced immense suffering on the streets or through avoidable incarceration can now be effectively stabilized and supported within their communities.
It’s important to clarify that the CARE Act is not intended for every person experiencing homelessness or mental illness. Instead, it is specifically targeted towards individuals with schizophrenia spectrum disorders or other psychotic disorders who meet particular criteria. The program aims to intervene proactively, before these individuals encounter arrest, commitment to a State Hospital, or reach a stage of impairment necessitating a Lanterman-Petris-Short (LPS) Mental Health Conservatorship. CARE may also serve as an appropriate follow-up after a short-term involuntary hospitalization (whether a 72-hour/5150 or 14-day/5250 hold) or as a safe diversion from certain criminal justice system involvements. While homelessness in California presents in many forms, one of the most heart-wrenching is the plight of those suffering from treatable mental health conditions. This initiative seeks to connect these individuals with effective treatment and support, paving the way for sustained recovery. CARE is poised to assist thousands of Californians in their journey toward lasting wellness.
At the heart of CARE is the commitment to supporting recovery and fostering self-sufficiency. The CARE process is initiated through a petition to the Court, which can be filed by a broad spectrum of individuals, including care providers, family members, first responders, and others as outlined in the CARE Act. Participants are guaranteed legal counsel and, if they choose, a voluntary supporter to accompany them, in addition to their comprehensive clinical team. The supporter’s role is to empower the participant by aiding in understanding, considering, and communicating their decisions, thereby maximizing their capacity for self-directed choices. The CARE plan is meticulously designed to identify, coordinate, and concentrate appropriate supports and services on the participant’s unique needs. This encompasses the integration of services, such as clinical treatment and housing, which are often fragmented. To further safeguard participant autonomy, the creation of a Psychiatric Advance Directive allows individuals to legally document their treatment preferences in anticipation of any future mental health crisis.
Mutual Accountability within the CARE Program
Accountability within the CARE framework is a two-way street. If a participant is unable to successfully complete their CARE plan, the Court retains the authority under the LPS Act to ensure their safety and well-being. Critically, if it’s determined that the participant was provided with all the services and supports stipulated in their CARE plan, their failure to complete the plan will be taken into consideration in any subsequent hearings under the LPS Act within 6 months of the CARE plan’s termination. This situation will establish a presumption at such hearings that the individual requires intervention beyond the scope of services and supports offered by the CARE plan.
Furthermore, the CARE Act also establishes accountability for local governments in providing necessary care. It leverages the substantial existing funding streams available to counties, including over $10 billion annually dedicated to behavioral health care through mechanisms like the Mental Health Services Act and behavioral health realignment funds. Cities and counties also have access to diverse housing and clinical residential options, backed by over $15 billion in state funding allocated over the past two years to address homelessness. CARE Court participants will receive priority consideration for suitable bridge housing opportunities funded by the Behavioral Health Bridge Housing program, which allocates $1.5 billion for housing and housing support services. To ensure local governments fulfill their responsibilities under court-mandated CARE plans, the Court is empowered to impose sanctions and, in extreme instances, appoint an agent to guarantee service provision.
