These Bay Area counties will launch mental health 'CARE' courts. Can they help solve homelessness?

As communities across the Bay Area continue to grapple with jarring scenes of human suffering on the street, counties in the region are rolling out new state-mandated mental health courts aimed at getting people with serious psychiatric disorders into treatment and housing.

Statewide, most counties must launch CARE courts — conceived of by Gov. Gavin Newsom as part of a broader update to California’s mental health system — by Dec. 1.

Some counties, including San Francisco and San Mateo, already have the new civil court process up and running. But so far, relatively few people have gone before a judge.

Santa Clara, Alameda and Contra Costa counties say their CARE Court programs are on track to start by the beginning of next month. Local officials say the new model can reach those with the gravest needs, even while acknowledging it’s not a solution for the vast majority of homeless people.

“It’s geared toward the people with the most serious problems who have not typically received assistance,” said Alameda County Superior Court Judge Sandra Bean, who will preside over the county’s CARE Court. “Many families are just at a loss for how to deal with their loved ones.”

CARE Court works by empowering family members, close friends, first responders, behavioral health providers and others to refer people with severe, untreated psychiatric issues to the program. If a person is eligible, a judge works to come up with a treatment plan, which may include medication, drug counseling and a spot in supportive housing or a residential care facility. Plans last for a year and can be renewed once for another 12 months.

Judges have the authority to order county health officials to provide treatment, but they can’t force participants to accept such services. While the goal is voluntary participation, a judge can refer anyone who refuses treatment for a conservatorship, in which a court-appointed guardian makes decisions for a person’s well-being and can potentially send them to a locked facility.

Despite being highly touted by Newsom, officials describe the courts — and the county outreach teams and health staff supporting them — as an incremental step toward solving the state’s intertwined mental health, addiction and homelessness crises. They stress the system is designed only for those struggling with the most severe conditions who can’t or won’t seek care on their own.

It’s unclear how many people might be eligible for CARE Court in the Bay Area. Statewide, officials have estimated that 7,000 to 12,000 people could qualify, a small fraction of California’s more than 181,000 homeless residents. Participants do not need to be homeless to enter the program, but the expectation is that many will be experiencing homelessness.

With CARE courts set to open statewide, it’s apparent local officials will need to do more to ensure the program is a success.

After eight counties — including San Francisco, Los Angeles and San Diego — started the state’s first CARE courts last year, only about 450 people were referred to the programs during the first six months. And many of those may not have qualified. San Mateo County’s court, which opened this summer, accepted just three participants in its initial two months.

Officials say the low numbers are partly due to the strict eligibility requirements, including having been diagnosed with severe schizophrenia or another serious psychotic disorder but not receiving treatment. They also acknowledge the need to better educate local communities on how to refer people to the program.

“Counties can prioritize public information sessions, targeted workshops for first responders and health care providers, and direct collaborations with local organizations,” Rovina Nimbalkarm, executive director of mental health advocacy group NAMI Santa Clara County, said in an email.

Some disability rights advocates, however, argue that bringing people with mental illnesses before a judge — who, under a new state law, has expanded authority to refer them for a conservatorship — is a pathway to involuntary treatment that infringes on the civil liberties of the most vulnerable in society.

The program “unnecessarily involves our court systems to force medical care and social services on people,” Helen Tran, a senior attorney at the Western Center on Law and Poverty, said in a statement earlier this year.

Ahead of CARE Court’s initial launch last year, health officials across the state also raised concerns about a lack of mental health workers, supportive housing units and treatment beds for those in the program. According to a 2021 study from the public policy think tank RAND, California had a shortage of roughly 7,730 treatment and residential care beds.

In response, CARE Court backers point to Proposition 1, a $6.4 billion bond measure voters narrowly approved in March to fund an estimated 6,800 treatment beds and 4,350 units of supportive housing, though the money won’t be distributed for at least another year. Proponents also say recent changes to Medi-Cal, the state’s low-income health care program, should help pay for CARE Court participants’ treatment.

As Alameda County prepares to open its CARE Court, officials say they’re ready to hit the ground running. This month, the county superior court and health department began offering online meetings to inform the public about how to refer people to CARE Court.

The county will begin accepting referrals online on Nov. 28, and in person at local superior courts starting Dec. 2. Santa Clara and Contra Costa counties will begin taking petitions on Dec. 1.

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