On September 14, 2022, Governor Gavin Newsom signed into law the Community Assistance, Recovery & Empowerment (CARE) Act. [fn1] CARE is a civil court process intended to address the problem of homelessness and mental illness. It focuses on people with schizo-phrenia spectrum (schizophrenia, schizoaffective disorder and other diagnoses in the category) or other psychotic disorders who may also have substance abuse problems. Participants must meet specific criteria [fn2] and offers participants with a clinically appropriate, community-based set of services and supports that are culturally and linguistically competent. The goal is to support a path to recovery and self-sufficiency before they get arrested and committed to a State Hospital or become so impaired that they end up in a LPS Mental Health Conservatorship.

     CARE engagement begins with a petition to the Court from a wide range of individuals, including not only care providers, but also family members, first responders, and others specified in the CARE Act. The state and all counties are is currently developing plans for specific implementation of the program. Basically, the petition will bring identified eligible persons before a civil court judge specifically assigned to such cases. The county behavioral health system would then decide whether the person needs treatment that s/he is not already receiving. The participant will receive legal representation and assigned a support person but must comply with an order to undergo care.

     The county agency (in our case, Alameda Co. Behavioral Health Services), with participant’s involvement as much as possible, will prepare individualized CARE plans that can initially be structured to last up to 12 months, and can be extended for an additional 12 months as necessary. CARE plans ensure participants receive a broad range of necessary services, including short-term stabilization medications, wellness and recovery supports, and connection to other social services such as housing.

     CARE may also be an appropriate next step after a short-term involuntary hospital hold (either 72 hours/5150 or 14 days/5250) or for those who can be safely diverted from certain criminal proceedings. The CARE plan ensures that appropriate supports and services are identified, coordinated, and focused on the individual needs of the participant. This includes coordination of services such as clinical treatment and housing, which are often disconnected.

     The creation of a Psychiatric Advance Directive will help protect the autonomy of participants by legally documenting their treatment preferences in advance of a potential future mental health crisis. The program will be phased in over two years. On October 1, 2023, Glenn, Orange, Riverside, San Diego, Stanislaus, Tuolumne, and San Francisco counties will begin implementing CARE. • Other counties – including Alameda County – will begin by December 2024, unless the county is granted additional time by DHCS.