“For some people, it’s definitely going to help them and help them achieve a path to wellness and housing and permanent housing,” said Karen Kern, deputy director of the Behavioral Health Division of Santa Cruz County’s Health Services Agency. “I don’t think it’s going to solve the problem for everybody who’s experiencing homelessness in our county.”

In Santa Cruz County, the program is expected to cost about $700,000 annually in local money to fund court proceedings for an estimated 40 participants each year.

Seven counties, including San Francisco and San Diego, started CARE courts in October 2023. State law mandated the rest of the counties to begin by Dec. 1, 2024. 

Some disability advocates said money would be better spent expanding access to health care and low-barrier housing. “There’s this kind of false dichotomy” that without CARE Court or more conservatorships, “we’re basically just going to have people who are dying on the streets,” said Samuel Jain, a senior attorney with Disability Rights California. “There’s another way,” Jain said.

Narrow scope, low impact?

CARE, or Community Assistance, Recovery and Empowerment, is meant to connect people with severe mental illness to treatment, housing and other services.

Eligibility for CARE Courts is narrow. Participation is limited to adults with schizophrenia or certain other psychotic disorders who have symptoms that threaten their ability to live independently. People with psychosis related to brain injury, drug use or dementia are ineligible.  

When state legislators first crafted the program, the new court system was envisioned as a way to address the chronic homelessness of severely mentally ill people. But  because of the small scope, it won’t necessarily make a big dent in homelessness, Santa Cruz County officials said. 

Some counties that have already started CARE Courts served fewer people than expected. As of mid-September, seven of the counties that started their programs in 2023 had produced a combined 127 court-ordered or voluntary treatment plans, KQED reported in October. 

How CARE Court works

A petitioner can request the CARE Court to establish a treatment plan for a severely mentally ill person. The petitioner can be a parent or guardian, mental health professional or first responder. County staff determine whether or not the person is eligible — those who are already receiving mental health treatment are not.

If the person is eligible, county staff will offer participation in the program multiple times, Kern said. The process will be similar to existing outreach efforts to connect people with mental health and housing services, she said.

“We try to keep tabs on where they sleep or where they hang out, and then just basically go out and do outreach and continue to build trust and build relationships,” Kern said. “Sometimes it can take some time, but usually once people feel like they can trust you, they want to engage.”

A new state-funded outreach worker is seeking out potential CARE Court participants. 

People can decline to participate in the program, and still receive outreach and offers of treatment, Kern said. 

Participants take part in court hearings with legal representation from the Public Defender’s Office. Outreach workers may help participants attend remotely by Zoom. 

The proceedings can result in a voluntary CARE Agreement or a court-ordered CARE Plan. Either can involve housing and mental-health treatment, including medication. Throughout the year, the participant and county staff meet with the judge with updates on the plan. After a year, participants can agree to a one-year extension.

Although the court proceedings don’t grant access to mental health resources beyond the county’s normal offerings, they can have “a black robe effect,” of making participants more open to treatment, Kern said.

The black robe effect has been theorized to assist mental health treatment, but no scientific studies have gathered evidence for the idea, according to an April 2024 academic article by mental health researcher Elizabeth Sinclair Hancq.

CARE Court participants are prioritized for temporary housing, and offered help finding a long-term place to live.

In June 2025, the county is expected to open a new 34-bed low-barrier navigation center on Soquel Avenue, where residents could stay for about six months. The facility is set to have 24-hour support from Housing Matters staff, Kern said.

Michael Beebe, board president for National Alliance on Mental Illness Santa Cruz County, said he hopes the program will help keep people with severe mental illness out of jail.

If people are arrested “because of some of the behaviors of these disorders” and are judged incompetent to stand trial, they can face lengthy stays in jail if a judge doesn’t release them to a psychiatric facility, he said. “You’re in a different system, and your rights basically, largely go away,” he said.

Connection to conservatorship

Some participants who don’t complete their treatment plans may be considered for conservatorship, which can enable a conservator to make choices about a person’s finances and housing, and approve psychiatric medication and intake into a locked psychiatric facility. 

“I wouldn’t say that [CARE Court] is really voluntary,” said Jain, the disability attorney. “You’re still in a courtroom.” People who don’t complete CARE Court and are referred for conservatorship could “lose a lot of rights, including your right to vote in some cases.” 

Richard Gallo, a Santa Cruz County resident and disability advocate with the nonprofit Access California Services, said he’s also concerned that CARE Courts will lead to more forced treatment. 

There’s many reasons people with serious mental illness might not want to accept treatment, he said. The experience could bring back the trauma of being shuffled between psychiatric facilities. “They’re being injected with medicine, they’re being mistreated at times,” Gallo said. “Not all facilities are like that, but some can be.” Routing people who don’t complete CARE Plans towards possible conservatorship can lead to more trauma, he said.

Some victims’ advocates have said that forced medication is sometimes necessary to prevent people with severe mental health problems from harming themselves or others.

Conservatorship requires a separate court process from CARE Court. A judge would determine if it is necessary and what powers the conservator would have.

Not all CARE Court participants would be eligible for conservatorship, even if they don’t complete their treatment plan, Kern said. Only people with a “grave disability” would be eligible.

Grave disability is a designation in state law that has long applied to people with a mental health disorder “unable to provide for their basic personal needs” for food, clothing and shelter.

“Just because somebody’s experiencing psychosis or schizophrenia doesn’t necessarily mean that they’re unable to care for themselves,” Kern said.

In October 2023, a state law expanded the definition to include people with alcoholism and addiction unable to meet their basic needs, and added personal safety and medical care as basic needs.

The expansion could mean as many as three times as many people in California are eligible for conservatorship, Jain said.

Kern said the CARE program will be offered to people exiting conservatorships to “ease them back into the community” and provide a stepping stone towards independent living.

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