Family members, behavioral health providers and first responders with a history of engagement with individuals struggling with untreated mental illness, may begin using a new program for government assistance called CARE Court.

San Francisco is one of the first of seven California counties to implement the Community Assistance, Recovery and Empowerment (CARE) Act on Monday. The new state law includes a civil court process designed to provide community-based behavioral health services to residents who are living with untreated schizophrenia or other psychotic disorders. 

“While participation in the program is voluntary, it will provide another tool to engage those who are not currently seeking care,” according to a statement from San Francisco Mayor London Breed.  But for gravely disabled people who decline voluntary care, this law includes a potential work-around.

CARE Court can be used by two parties. A petitioner can request care on behalf of a respondent. That means someone who cannot help themselves can receive care upon the request of someone else. If a respondent meets the qualifications, the court will oversee the development of a CARE Plan for them. 

The plan will consist of holistic components, which can include treatment and housing plans, according to the mayor.

“CARE Court participants may be eligible to receive prioritized housing placements and care by way of the State’s Bridge Housing Grant, which has allocated $32 million over four years towards new stabilizing housing options in the City,” the mayor’s statement said.

According to the CARE Court website, eligible persons must be 18 years old. They must have symptoms that are severe and persistent enough to interfere substantially with basic activities and personal care. They should not be receiving voluntary outpatient that already stabilizes them. They must be unlikely to survive independently or need support services to prevent deterioration. And participation in the CARE program must be the least restrictive and most beneficial option. 

Civil rights groups’ concerns

CARE Court has received criticism from civil rights groups. The American Civil Liberties Union and Human Rights Watch have lobbied against the law. They fear the potential abuse of involuntary conservatorship and a risk that the program might disproportionately impact communities of color, among other concerns.

The CARE Act received full support from State Senator Scott Wiener (D-San Francisco), who said in a statement that over 1,000 San Francisco residents will be eligible under the program’s strict clinical criteria that focus heavily on schizophrenia and related disorders.

“Over the last several months, the Mayor’s Office, the San Francisco Department of Public Health (SFDPH), the City Attorney’s Office, the Department of Homelessness and Supportive Housing (HSH), the Public Defender, the San Francisco Superior Court, and non-profit legal aid providers have worked hard to prepare for implementation,” Wiener’s statement said.

Weiner has also co-sponsored State Senate Bill 43, which expands the criteria for involuntary behavioral health treatment, including conservatorships, by updating the definition of “gravely disabled” to include severe substance abuse disorder.  The new bill recently passed the state senate and is awaiting the Governor’s signature.