San Francisco — CARE Court Overview

Source: https://sf.courts.ca.gov/system/files/general/care_overview.pdf

CARE Act Overview

1. What is the CARE Act? CARE Act proceedings involve CARE stands for Community Assistance, assessments and hearings to determine Recovery, and Empowerment. The CARE whether the respondent meets eligibility Act will ensure mental health and other requirements. A county behavioral health support services are provided to the agency will be involved in the process. If most severely impaired Californians the respondent meets the standards for who too often languish without the CARE eligibility, a CARE agreement or plan treatment they desperately need. CARE may be created and, if approved, ordered will divert and prevent more restrictive by the court. conservatorships or incarceration to 2. Who is eligible for CARE?connect a person in crisis with a court- All eligibility determinations are case-ordered CARE plan or agreement for up to specific and respondents must meet all of12 months, with the possibility to extend the eligibility criteria below for a petitionfor an additional 12 months. Individuals to be considered. Homelessness andengaged in CARE plans and agreements a diagnosis alone are not sufficient tomay be prioritized for a range of services meet eligibility requirements. While CAREand programs, including supportive respondents may and are often likely tohousing. The design of the CARE Act be experiencing homelessness or housingprovides support and accountability for insecurity, untreated severe mentalindividuals with severe, untreated mental illness and the resulting impairment isillnesses, as well as for local governments the primary driver of CARE eligibility. Aresponsible for providing behavioral health respondent must meet the followingservices. The CARE process functions as criteria to be eligible for CARE:a structure for counties to intensively engage individuals over a sustained • Have a diagnosis of a schizophrenia period who may need additional support spectrum disorder or another psychotic to consistently access services. disorder in the same class, as defined in the current Diagnostic and StatisticalSpecifically, the CARE Act is a way to allow Manual of Mental Disorders.certain people, called “petitioners,” to

request court-ordered treatment, services, • Be currently experiencing a mental support, and a housing plan for certain illness that: people 18 years of age or older, called “respondents,” who have untreated severe o Is severe in degree and persistent in mental illnesses, specifically schizophrenia duration or another psychotic disorder and who o May cause behavior that interferesmeet certain health and safety criteria. substantially with activities of dailyPetitioners are encouraged to consider living, andalternatives to CARE Act proceedings in advance of filing a petition. o May lead to an inability to maintain

(8-23)

stable adjustment and independent stages of the process, the right to replace the functioning without treatment, support, court-appointed attorney with an attorney of and rehabilitation for a long or indefinite their choosing, the right to have a supporter period. of their choosing throughout the process, and other rights. The role of the supporter is• Not be clinically stabilized in ongoing to help the respondent understand, consider, voluntary treatment. and communicate decisions to ensure the respondent can make self-directed choicesAdditionally, at least one of the following must to the greatest extent possible. A supporter isbe true: an adult chosen by the respondent to assist • The respondent is unlikely to survive safely them to understand, make, and express in the community without supervision and their decisions throughout navigating the the respondent’s condition is substantially CARE process. The supporter may be a deteriorating. friend, family member, faith leader, mentor, person with lived experience in mental• The respondent needs services and health and/or substance use disorder, supports to prevent a relapse or or other support person chosen by the deterioration that would likely result in respondent. The Department of Health Care grave disability or serious harm to the Services, in consultation with disability rights respondent or others. groups, county behavioral health and aging The respondent’s participation in a CARE plan agencies, individuals with lived expertise, or CARE agreement must: families, racial justice experts, and other appropriate stakeholders will be providing • Be the least restrictive alternative necessary optional training and technical resources for to ensure the respondent’s recovery and volunteer supporters on the CARE process, stability, and community services and supports, supported decision-making, people with behavioral• Be likely to benefit the respondent. health conditions, trauma-informed care, and Petitioners are required to provide facts and psychiatric advance directives. supporting information at the time of filing If the respondent requires translation orto demonstrate that a respondent is eligible disability accommodations, requests can befor CARE Act proceedings, as laid out in form made with the court.CARE-050-INFO. Supporting documentation must include either a declaration by a 4. Who can file a petition?licensed behavioral health professional (form To file a petition, petitioners must fit one of the CARE-101) or evidence that the respondent following categories: was detained for a minimum of two intensive treatments, the most recent one within the last • A person who lives with the respondent 60 days. • A spouse or registered domestic partner, 3. What rights does a respondent parent, sibling, child, or grandparent of the have? respondent. Supporting a self-determined path to • A person who stands in the place of a recovery and self-sufficiency is core to CARE. parent to the respondent. Respondents have the right to be informed of the proceedings, the right to take part in the • The director of a hospital, or their designee, proceedings, the right to be represented in all in which the respondent is or was recently

California Health & Human Services Agency | chhs.ca.gov

hospitalized. Note: After the initial appearance, the petitioner will be replaced by the director • The director of a public or charitable of the county behavioral health agency, or agency, or their designee, who has designee. within the last 30 days provided or who is currently providing behavioral health 5. What happens during the CARE services to the respondent or in whose process? institution the respondent resides. Once a petition is filed, the court reviews it to determine if a respondent meets, or • A licensed behavioral health may meet, the criteria for CARE. If not, the professional, or their designee, who is matter is dismissed. or has been supervising the treatment of or treating the respondent for mental If the petition is not dismissed, the court illness within the last 30 days. orders the county to investigate and submit a report that determines if the • The director of a county behavioral respondent meets, or is likely to meet, health agency, or their designee, of the CARE criteria, and includes conclusions county where the respondent resides or and recommendations regarding is found. the respondent’s ability to voluntarily • A first responder. engage in treatment and services. If the respondent engages in services voluntarily, • A judge of a tribal court located in the matter is dismissed. California, or their designee. If the respondent is likely to meet the If the petitioner lives with the respondent, CARE criteria and does not engage in is their spouse, parent, sibling, child, or services voluntarily, the court will set grandparent, or is someone who stands an initial appearance and hearing on in the place of a parent, they have the the merits (which may be combined right to participate during the hearing if all parties agree). Before the initial to determine the merits of the petition. appearance, the court will appoint counsel The court may assign these petitioners for the respondent and order the county ongoing rights of notice. If the respondent to provide notice of the hearing to the agrees, the court may allow the petitioner petitioner, respondent, counsel, and county to participate in the proceedings. behavioral health. • If the petitioner is someone not on the If the court finds that a respondent meets list above, they have the right to make a the CARE Act requirements, the court will statement at the hearing on the merits order the county behavioral health agency of the petition but will not be assigned to work with the respondent, their attorney, ongoing rights. and their supporter (if applicable), to participate in behavioral health treatment • If the matter is dismissed and later there and determine if a CARE agreement will is a change in circumstances, petitioners be possible. The court will also set a case may file a new petition with the court. management hearing. • If the petitioner requires translation If it is determined at the case management or disability accommodations, those hearing that a CARE agreement is likely requests can be made with the court. to be reached, a progress review hearing

California Health & Human Services Agency | chhs.ca.gov

will be set If it is determined that a CARE with the respondent to address medication agreement is not likely to be reached, concerns and make changes to the then there will be a clinical evaluation treatment plan as necessary. Stabilization followed by a hearing to review that clinical medications may not be forcibly evaluation. administered. If the clinical evaluation finds that the A CARE agreement is a voluntary respondent is eligible, a CARE plan will be agreement entered into by the respondent developed and reviewed in a hearing. There and the county behavioral health agency will then be a status review hearing at least after a court has found that the respondent every 60 days. is eligible for the CARE process. If a CARE agreement is not reached, the court willAt month 11, there will be a 1-year status order the creation of a CARE plan, whichreview hearing to determine next steps, will include an individualized range ofincluding graduation or reappointment community-based services and supports.(which requires certain criteria be met and can only happen once). If the respondent If a CARE plan is ordered by the court, there and the court agree that graduation is will be periodic status review hearings appropriate, the court orders the creation during which progress and challenges are of a graduation plan and schedules a discussed. Adjustments to the services and graduation hearing in the 12th month. Upon supports in the CARE plan can be made to successful completion and graduation by support the respondent’s success. the court, the participant remains eligible for ongoing treatment, supportive services, 7. What housing is available to a and housing in the community to support respondent in CARE? long term recovery. Housing is an important component to CARE, since finding stability and 6. What is a CARE agreement or a staying connected to treatment is next CARE plan? to impossible while living outdoors, in a A CARE agreement and a CARE plan are tent or a vehicle. Respondents served by written documents that specify services CARE will need a diverse range of housing, designed to support the recovery and including clinically enhanced interim stability of the respondent, which can or bridge housing, licensed adult and include clinical services: behavioral senior care facilities, supportive housing, health care; counseling; specialized or housing with family and friends. The psychotherapies, programs and court may issue orders necessary to treatments; stabilization medications; support the respondent in accessing a housing plan; and other supports and housing, including prioritization for these services provided directly and indirectly services and supports. The state made through a local government entity. If significant investments in the 2021-2022 included in the CARE plan or agreement, and 2022-2023 budgets in order to support stabilization medications would be the development of supportive housing, prescribed by the treating licensed including a $1.5 billion allocation to support behavioral health care provider, and Behavioral Health Bridge Housing, which medication management supports will will fund clinically enhanced bridge housing be offered by the care team. The treating settings that are well suited to serving CARE behavioral health care provider will work respondents.

California Health & Human Services Agency | chhs.ca.gov

8. What is the implementation process for CARE? All counties will participate in CARE through a phased-in approach. On October 1, 2023, Cohort 1 counties will implement CARE, including Glenn, Orange, Riverside, San Diego, Stanislaus, Tuolumne, and San Francisco, and Los Angeles on December 1. All remaining counties will begin implementation by October 1, 2024, unless the county is granted additional time by DHCS. Counties will not have an option to opt-out. To support successful implementation, CalHHS convenes regular meetings of the CARE Act Working Group to provide coordination and on-going engagement with, and support collaboration among, relevant state and local partners and other stakeholders during implementation of CARE.
9. How does CARE ensure accountability? Accountability in care goes both ways. If a respondent cannot successfully complete a CARE plan, the Court may use existing law to ensure their safety. The CARE Act also holds local governments accountable for using the variety of funding streams available to provide care to the people who need it. If local governments do not meet their responsibilities under CARE plans, Courts have the ability to order sanctions.
10. Where can I find more information about the CARE Act? For more information, please visit: the CalHHS CARE Act site, the DHCS CARE Act site, the Judicial Council’s CARE Act site, and the Training and Technical Assistance site, where you can also sign up for updates. You can also send a message to CAREAct@chhs.ca.gov to join the CalHHS CARE Act email list for information and notifications.

California Health & Human Services Agency | chhs.ca.gov