Can CARE Courts ease California’s homeless crisis?

By Jeanne Kuang

California is struggling with the intertwined crises of homelessness and mental illness. But are Gov. Gavin Newsom’s new CARE Courts the right prescription?

That depends largely on whether county courts and mental health departments succeed as they roll out the program starting in October.

Even some local officials are trying to manage expectations for CARE Courts. One reason why is the program is targeted to treat residents with a narrow set of diagnoses and circumstances — specifically, someone who has gone untreated for schizophrenia or some other psychotic disorder — so the scope of CARE Courts is limited from the outset.

• Luke Bergmann, San Diego County Behavioral Health Services department director: “There’s been a presumption… that CARE Court is going to fix homelessness or have a broad impact on the nexus of homelessness and behavioral health. (It’s) actually going to be a pretty small program. It’s not going to be this thing that dramatically changes homelessness.”

The state also estimates between 7,000 and 12,000 people will qualify for the program. But for the seven counties where the program will roll out first (San Francisco, Orange, San Diego, Riverside, Stanislaus, Glenn and Tuolumne), officials say it’s unclear how many cases they’ll receive. San Diego County, for example, estimates it will get 1,000 petitions in the first year, but only about 250 people will likely receive a court-ordered treatment plan.

Counties must also work under tight timelines to persuade clients who may be resistant to mental health treatments. While behavioral health program leaders told Jeanne it takes a county worker an average of 20 visits to persuade a housed respondent to enter treatment — and an average of 40 visits if they are unhoused — counties get only 14 days before the next court hearing to persuade clients to agree to treatment.

• Veronica Kelley, Orange County’s chief of Mental Health and Recovery Services: “I can’t do 40 face-to-face visits in 14 days.”

These reservations are in stark contrast to how Newsom’s administration spoke about CARE Court during its initial formation. As his biggest legislative priority last year, Newsom called it “a paradigm shift.”

But despite these limitations, local officials regard the program as an opportunity to enroll more untreated people into mental health care. CARE Court does not exclusively target homelessness, but success will be determined by how well counties can get people inside and into treatment. In a recent comprehensive report on homelessness in the U.S., researchers at UCSF found that two-thirds of unhoused people reported experiencing mental health symptoms, such as depression or hallucinations, in the past 30 days.

The state’s Department of Health Care Services also says it will be assessing whether the program helps people find stable housing, as well as reduces emergency room visits, police encounters, short-term hospital stays and involuntary psychiatric holds.