The CARE Act in California represents a significant shift in how the state approaches mental health care for individuals with specific behavioral health conditions. It’s designed as a compassionate and structured civil court process aimed at providing community-based services and supports. These services are clinically appropriate, culturally sensitive, and linguistically competent, ensuring individuals receive care tailored to their unique needs.
The core of the CARE Act program lies in the creation of individualized CARE plans. These plans are initially structured for up to 12 months and can be extended for another 12 months if necessary. A CARE plan is comprehensive, encompassing a wide array of essential services. These include short-term stabilization medications to manage immediate crises, wellness and recovery supports to foster long-term well-being, and crucial connections to social services, most notably housing. Recognizing the fundamental role of stable housing, the CARE Act acknowledges that maintaining treatment adherence and achieving stability is exceedingly difficult for individuals experiencing homelessness. Therefore, housing is considered a vital component of successful CARE plans.
The CARE process is strategically positioned as an “upstream” intervention. It’s intended to divert individuals away from more restrictive and often detrimental pathways such as 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 settings. Advances in treatment models, including new longer-acting antipsychotic medications, coupled with dedicated clinical teams and access to housing, empower participants who have historically faced immense suffering on the streets or through avoidable incarceration to successfully stabilize and thrive within their communities.
It’s important to clarify that the CARE Act program is not a universal solution for everyone experiencing homelessness or mental illness. Instead, it is specifically targeted towards individuals with schizophrenia spectrum and other psychotic disorders who meet clearly defined criteria. The program aims to intervene proactively, before these individuals reach a crisis point that leads to arrest, commitment to a State Hospital, or the need for 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) or as a safe diversion from certain criminal proceedings. While homelessness in California is a multifaceted issue, the CARE Act focuses on addressing the needs of the most vulnerable – those suffering from treatable mental health conditions. The program’s central goal is to connect these individuals with effective treatment and support systems, paving a clear path towards sustained recovery and improved well-being. The CARE Act is envisioned to be a transformative program, guiding thousands of Californians towards lasting wellness.
Recovery and fostering self-sufficiency are central tenets of the CARE Act. The CARE engagement process begins with a petition to the Court, which can be initiated by a broad spectrum of individuals, including care providers, family members, first responders, and other entities outlined in the CARE Act. To ensure fairness and protect participant rights, individuals involved in the CARE process are provided with legal counsel. Furthermore, they can choose a voluntary supporter to assist them, in addition to their comprehensive clinical team. The supporter’s role is to empower the participant by aiding in understanding information, considering options, and communicating decisions, thereby maximizing their ability to make self-directed choices. The CARE plan itself is meticulously designed to identify, coordinate, and focus on the individual needs of the participant, encompassing crucial services like clinical treatment and housing which are often fragmented in traditional systems. To further safeguard participant autonomy, the creation of a Psychiatric Advance Directive is incorporated. This legal document allows participants to formally document their treatment preferences in advance of any potential future mental health crisis, ensuring their wishes are respected and followed.
Accountability is a key feature of the CARE Act, operating in both directions. Participants are accountable for engaging with their CARE plan, while local governments are accountable for providing the necessary services and supports outlined within those plans.
Should a participant be unable to successfully complete their CARE plan, the Court retains the authority under the LPS Act to ensure their safety and well-being. Importantly, if it’s determined that the participant was provided with all the stipulated services and supports within their CARE plan, their failure to complete the plan will be taken into consideration in any subsequent hearings under the LPS Act that occur within six months of the CARE plan’s termination. This creates a presumption in such hearings that the individual requires interventions beyond the scope of the CARE plan’s supports and services, ensuring appropriate next steps are taken.
Simultaneously, the CARE Act establishes accountability for local governments to deliver care to those in need. This is supported by California’s robust network of funding streams dedicated to behavioral health, including over $10 billion annually allocated through sources like the Mental Health Services Act and behavioral health realignment funds. Furthermore, cities and counties have access to various housing and clinical residential placement options, including over $15 billion in state funding allocated in recent years 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 specifically for housing and housing 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 guarantee that services are provided, reinforcing the commitment to care delivery and program effectiveness.
