CARE Act

The CARE process is not a criminal proceeding; rather, CARE creates a collaborative, civil court process intended to engage individuals with schizophrenia spectrum disorder over the course of a one-to-two-year period, in a voluntary, non-punitive therapeutic process with County Behavioral Health Services under the oversight of a Superior Court judge. CARE is intended to engage individuals upstream before they are arrested and committed to a State Hospital, before they meet criteria for involuntary conservatorship, or before they experience adverse consequences as a result of untreated mental illness.

The Community Assistance, Recovery, and Empowerment (CARE) Court Program was written into law through Senate Bill 1338, which took effect on January 1, 2023. This legislation added Welfare & Institutions Code Sections 5970 – 5987 and sets out the general provisions, process, and additional details for the implementation of the CARE Act.

San Diego County is one of the first seven counties in the state to implement the CARE Act, effective October 1, 2023.

All of the following requirements must be met for the respondent to be eligible for CARE Act court proceedings.  

1. The respondent must be 18 years or older and must:
2. Have a diagnosis of a schizophrenia spectrum disorder or another psychotic disorder in the same class, as defined in the current Diagnostic and Statistical Manual of Mental Disorders.
3. Be currently experiencing a mental illness that:
   
   1. Is severe in degree and persistent in duration
   2. May cause behavior that interferes substantially with activities of daily living, and
   3. May lead to an inability to maintain stable adjustment and independent functioning without treatment, support, and rehabilitation for a long or indefinite period.

4. Not be clinically stabilized in ongoing voluntary treatment.
5. At least one of the following must be true:
   
   1. The respondent is unlikely to survive safely in the community without supervision, and the respondent’s condition is substantially deteriorating, OR
   2. The respondent needs services and supports to prevent a relapse or deterioration that would likely result in grave disability or serious harm to the respondent or others.
      • Grave disability means a person’s inability, due to mental illness, to provide for their basic personal needs for food, clothing, or shelter. Serious harm includes injury causing extreme pain, high risk of death, or loss of physical or mental functions.

6. The respondent’s participation in a CARE plan or CARE agreement must:
   
   1. Be the least restrictive alternative necessary to ensure the respondent’s recovery and stability, and
   2. Be likely to benefit the respondent.

While all determinations of eligibility are case specific, examples of circumstances that may satisfy the above eligibility requirements are described in JC Form # CARE-050-INFO

Only a person with a schizophrenia spectrum or other psychotic disorder is eligible for the CARE Act process.

• A person only with another serious mental illness, such as bipolar disorder or major depression, is not eligible.
• The psychotic disorder must not be based on a medical condition, including a physical health condition such as a traumatic brain injury, autism, dementia, or a neurological condition.
• A person with a current diagnosis of substance use disorder must also have a psychotic disorder and meet all the other criteria to be eligible.

The petitioner is the person who is requesting to start CARE Act proceedings for a person with a severe mental illness who needs help. To be a petitioner, you must be 18 years of age or older and you must fall within one of the following categories to be able to request CARE Act proceedings for a respondent:

• A person who lives with the respondent.
• A spouse or registered domestic partner, parent, sibling, child, or grandparent of the respondent.
• A person who stands in the place of a parent to the respondent.
• The director of a hospital, or their designee, in which the respondent is or was recently hospitalized.
• The director of a public or charitable agency, or their designee, who has within the last 30 days provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides.
• A licensed behavioral health professional, or their designee, who is or has been supervising the treatment of or treating the respondent for mental illness within the last 30 days.
• The director of a county behavioral health agency, or their designee, of the county where the respondent resides or is found.
• A judge of a tribal court located in California, or their designee.
• The director of adult protective services, or their designee, of the county where the respondent resides or is found.
• The director of a California Indian health services program or a California tribal behavioral health department, or their designee.
• A first responder—including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker—who has had repeated interactions with the respondent in the form of multiple arrests, detentions, and transportation under Welfare and Institutions Code section 5150, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance.
• The public guardian or public conservator, or their designee, of the county where the respondent is present or reasonably believed to be present, or a private court-appointed conservator under the Lanterman-Petris-Short (LPS) Act, if referred from the LPS court.
• The respondent.

• Once the CARE Act proceedings have started, the respondent has the right to be informed of the proceedings, the right to take part in the proceedings, and the right to be represented in all stages of the process.
• The court will appoint an attorney for respondent who will contact the respondent at the beginning of the CARE Act proceedings.
• The respondent has the right to replace their court-appointed attorney with an attorney that they choose. Note: If they choose their own attorney, the respondent is responsible for paying their fees, if any.
• The respondent has the right to request the presence of any family member or friend.
• The respondent has the right to choose a person to support them through the CARE Act process. The CARE Act calls that person "supporter." The court may appoint the person the respondent has chosen as their supporter. The supporter’s role is to assist the respondent with understanding, communicating, making decisions, and expressing preferences throughout the CARE Act process.

If the petitioner lives with the respondent; is their spouse, parent, sibling, child, or grandparent; or is someone who stands in the place of a parent, that person has the right to participate during the hearing to determine the merits of the petition. The court may assign these petitioners ongoing rights of notice. If the respondent agrees, the court may allow the petitioner to participate in the respondent’s CARE Act proceedings.

If the petitioner is someone not on the list above, they have the right to make a statement at the hearing on the merits of the petition but will not be assigned ongoing rights.

The court will review the petition and supporting documents to determine they show that the respondent meets or might meet CARE Act eligibility requirements. Then, it will do one of the following:

• Dismiss the petition. The court will do this if it finds: (1) the petition does not show that the respondent meets or may meet CARE Act eligibility requirements, or (2) the respondent is voluntarily working with Behavioral Health Services, their engagement is effective, and the respondent has enrolled or is likely to enroll in voluntary treatment through the county or another provider.

• Order a report. If the court finds the petition does show that the respondent meets or may meet criteria for the CARE Act process, the court will order Behavioral Health Services to engage with the respondent and file a written report with the court within 14 business days.  

• Set an initial appearance. The court will set an initial appearance if it finds that the report filed by Behavioral Health Services supports the petition’s showing that the respondent meets or may meet CARE Act eligibility requirements and the county’s engagement with the respondent was not effective. Note: The procedures are somewhat different if Behavioral Health Services is the petitioner.

The petitioner must be present at the initial hearing or the court may dismiss the petition. The petitioner and respondent will receive a notice in the mail of the date, time, and place of the hearing.

•  The petitioner must be present at the initial appearance, or the petition may be dismissed.
• The respondent has the right to appear in person. They can choose to give up their right to attend personally, and their attorney can appear on their behalf.
• A representative from County Behavioral Health Services will be present.
• If the original petitioner is not the director of a county behavioral health agency, the petitioner will be replaced by the director of the county behavioral health agency, or their designee, who will take over as the petitioner, as provided by Welfare & Institutions Code Section 5977(b)(7)(A).
• If the respondent does not indicate through their attorney that they are choosing not to attend and does not appear, and the court makes a finding on the record that reasonable attempts to encourage them to appear have failed, there may be a hearing without the respondent, if the court finds that it would be in their best interest.
• The court will set a hearing on the merits of the petition or, the hearing on the merits may happen at the same time as the initial appearance, but only if the respondent, the petitioner, and the court agree.

If the matter is dismissed and later there is a change in circumstances, a new petition may be filed with the court.

The court will determine if the respondent meets the CARE Act criteria. In making this determination, the court will consider all evidence properly before it, including the report from the county agency and any additional evidence presented by the parties, including the petition and any information the respondent provides.

• If the court finds the respondent does not meet the CARE Act requirements: The court will dismiss the petition.

• If the court finds that the petitioner has shown that the respondent does meet the CARE Act requirements: The court will order Behavioral Health Services to work with the respondent, their attorney, and their supporter, if they have one, to participate in behavioral health treatment and determine if the respondent and Behavioral Health Services will be able to enter into a CARE agreement. The court will also set a case management hearing.

CARE Act hearings are closed to the public and all information related to the respondent’s health including reports, evaluations, diagnosis, and other information, is confidential.

Because CARE targets severely impaired individuals who are living with schizophrenia spectrum or a qualifying psychotic disorder, only 7,000 to 12,000 individuals statewide are estimated to meet criteria for CARE proceedings. If the process doesn’t make sense for your loved one, you can contact Behavioral Health Services to discuss additional options. These may include voluntary services such as full-service partnerships, assertive community treatment, or supportive housing.