California’s CARE Act working group discusses challenges and successes of implementation


Hannah Saunders


Last month’s CARE (Community, Assistance, Recovery, and Empowerment) Act Working Group meeting in California featured discussions about successes with the initiative’s implementation, as well as challenges and how those are being addressed. The CARE Act provides guidance for connecting individuals with a court-ordered care plan and a supporter for up to 24 months. 

“We know, of course, in order to successfully make the CARE Act a reality, counties need not only start-up funding, but they need housing resources. We know individuals with significant behavioral health needs will not be successful without safe and stable housing,” said Tyler Sadwith, deputy director of behavioral health at the Department of Health Care Services.

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Through the Behavioral Health Bridge Housing program, which addresses the immediate housing and treatment needs of unhoused individuals with serious behavioral health conditions, funds are being pushed out to county behavioral health agencies and tribal entities.

Katherine Warburton, statewide medical director of the California Department of State Hospitals, has been a longtime fan of learning the ins and outs of schizophrenia spectrum disorders and the criminalization of behavioral health conditions. 

“My perspective is we have a humanitarian crisis on our hands, and I’m extremely hopeful that if CARE Court is implemented correctly, we have a new mechanism to mitigate some of the crises that I see everyday in my role.”

— Warburton 

Warburton said individuals with schizophrenia spectrum disorders, who have intense auditory and visual hallucinations, make up about one percent of the general population, but account for 20 to 30 percent of the unhoused population. Furthermore, this small subset of individuals represents 15 percent of state prisons, and 24 percent of jail populations.

“These are not good outcomes and these are the outcomes the CARE Court is trying to intervene upon,” Warburton said. 

Warburton is excited to see if CARE Court will put an end to the cyclical pattern of institutionalizing and neglecting individuals, who are released from carceral settings but continue to be neglected.

Marcus Cannon, a licensed marriage and family therapist at Riverside University Health System, provided an update about how the implementation of CARE Court has been going in the county. CARE Court went live in Riverside County on Oct. 2nd. Cannon said a current goal of the health system is to increase staffing levels, especially due to Riverside being the fastest growing county in the state.

“Hiring right now is somewhat challenging, so workforce development is an ongoing need for us,” Cannon said. “Everyone is working through the workforce challenges these days. I think we have reason to be hopeful around that, and we see some signs of movement in a positive direction.”

Since last month’s CARE Act meeting, Riverside County received 40 calls to its behavioral health access line, in which 30 unique callers were looking for more information. The Superior Court Self Help line received 46 callers, and 16 appointments for service were made. Fifteen petitions were filed, which led to two initial hearings. There were also four referrals from the criminal court, and four referrals from the Adult Protective Services’ Department of Public Social Services.

Cannon shared a case study with meeting attendees about the experience of a CARE Court respondent. He said a petitioner had a close family member whom they were concerned about, and filed a petition. The behavioral health department at the county met with the respondent numerous times. But the respondent  “does not perceive a need for these services,” Cannon said. 

“In terms of the CARE Act criteria, it appears the respondent does meet the criteria, both in terms of diagnosis, as well in terms of deficits and functioning, but we would say that this respondent has sort of been a gray area,” Cannon said. “Despite our engagement efforts, the respondent has told us that they do not intend to appear.”

After an initial hearing was held, the respondent did not appear, which is within their rights under the CARE Act. The petitioner was disappointed that the judge couldn’t force the respondent to participate against their will, according to Cannon, who added that the county is likely to see many cases similar to this in the future. 

During the first month of the program’s operation, Riverside County saw successes in the amount of education taking place across the community, first responders, and social service nonprofit organizations. Cannon said the county will continue to build staffing to keep up with the increase in petitions it is receiving, and is hoping to open a boarding and care location with 81 beds.