Community Assistance, Recovery & Empowerment Act
The CARE Act creates a new pathway to deliver mental health and substance use disorder services to the most severely impaired Californians who too often suffer in homelessness or incarceration without treatment. The CARE Act moves care and support upstream, providing the most vulnerable Californians with access to critical behavioral health services, housing and support.
CARE recognizes that to serve those with the most complex behavioral health conditions, we must do the hard work of prioritizing those who need help the most, providing a comprehensive CARE plan that honors self-determination to the greatest extent possible, and holding ourselves accountable to delivering services and housing that are key to long term stability and recovery.
More information about CARE:
- Quarter 1 Update: English / Spanish
- CARE Act Working Group webpage
- CARE Informational Webinar (updated 12/19/22): Video / Slides
- CARE Act: SB 1338
- Department of Health Care Services (DHCS): CARE Act Website
- Judicial Council of California (JC): CARE Act Website
- Fact Sheet: English / Spanish
- FAQ: English / Spanish
- Behavioral Health Funding Overview (updated 8/17/22)
- Housing and Homelessness Funding Overview (updated 8/18/22)
- Major State Behavioral Health Funding by County (updated 6/20/22)
- Major State and Federal Housing and Homelessness Funding by County (updated 6/20/22)
CalHHS will continue to work collaboratively, with a focus on equity, with the many passionate and thoughtful individuals and organizations we have engaged with over the past many months to support the successful implementation of the CARE Act. Our agency and our departments will work with the Judicial Council of California and the counties, cities and communities who will implement CARE to ensure a person-centered and responsive set of services and supports for participants. We know continued partnership is essential for the success of the CARE Act, and look forward to continuing engagement with representatives from a wide variety of networks, including peers, disability rights organizations, families, racial equity advocates, housing and homelessness stakeholders, behavioral health providers and associations, and more.
Email us at CAREAct@chhs.ca.gov to join the CARE listserv to receive updates and information on future stakeholder events.
A New Approach
The CARE Act is a paradigm shift
CARE is a compassionate civil court process that provides participants with a clinically appropriate, community-based set of services and supports that are culturally and linguistically competent. Individualized CARE plans 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. Housing will be an important component of many successful CARE plans —we recognize that finding stability and staying connected to treatment, even with the proper supports, is next to impossible while living outdoors, in a tent or a vehicle.
The CARE process is an upstream diversion to prevent more restrictive conservatorships or incarceration; this is based on evidence which demonstrates that many people can stabilize, begin healing, and exit homelessness in less restrictive, community-based care settings. With advances in treatment models, new longer-acting antipsychotic treatments, and the right clinical team and housing, participants who have historically suffered tremendously on the streets or during avoidable incarceration can be successfully stabilized and supported in the community.
CARE is not for everyone experiencing homelessness or mental illness; rather it focuses on people with schizophrenia spectrum or other psychotic disorders who meet specific criteria – before they get arrested and committed to a State Hospital or become so impaired that they end up in a Lanterman-Petris-Short (LPS) Mental Health Conservatorship. 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. Although homelessness has many faces in California, among the most tragic is the face of the sickest who suffer from treatable mental health conditions—this proposal aims connect these individuals to effective treatment and support, mapping a path to long-term recovery. CARE will help thousands of Californians on their journey to sustained wellness.
Supporting a path to recovery and self-sufficiency is core to CARE. CARE engagement begins with a petition to the Court from a wide range of individuals, including care providers, family members, first responders, and others specified in the CARE Act. Participants will be provided with legal counsel and a voluntary supporter chosen by the participant, if desired, in addition to their full clinical team. The role of the supporter is to help the participant understand, consider, and communicate decisions, giving the participant the tools to make self-directed choices to the greatest extent possible. 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.
Accountability in CARE goes both ways
If a participant cannot successfully complete a CARE plan, the Court may utilize existing authority under the LPS Act to ensure the participants safety. If the respondent was provided all the services and supports in the CARE plan, the participants failure to complete a CARE plan will be considered in any subsequent hearings under the LPS Act that occur within 6 months of the termination of the CARE plan, and shall create a presumption at that hearing that the respondent needs additional intervention beyond the supports and services provided by the CARE plan.
CARE will also hold local governments accountable for providing care to the people who need it, using the variety of robust funding streams available to counties today. These funding sources include over $10 billion annually for behavioral health care, including the Mental Health Services Act and behavioral health realignment funds. Various housing and clinical residential placements are also available to cities and counties, including over $15 billion in state funding that has been made available over the last two years to address homelessness. CARE Court participants will also be prioritized for any appropriate bridge housing funded by the Behavioral Health Bridge Housing program, which provides $1.5 billion in funding for housing and housing support services. If local governments do not meet their specified responsibilities under the court-ordered CARE plans, the Court will have the ability to order sanctions and, in extreme cases, appoint an agent to ensure services are provided.
Pathway through CARE
Family members, behavioral health providers and first responders with a history of engagement with the individual, or other parties specified in the CARE Act may refer an individual with untreated schizophrenia spectrum or other psychotic disorder who meets specific criteria in order to prevent institutionalization and ensure appropriate care.
After outreach by the county, if the individual is unable to voluntarily engage in services, the court reviews the petition for evidence as to whether the individual meets the CARE criteria, and appoints legal counsel and a voluntary supporter selected by the individual if desired. The court may also order a clinical evaluation to help determine the individual’s eligibility for CARE. If the individual is determined to meet the CARE criteria, the court orders the development of a CARE plan.
An individualized CARE plan is developed by the county behavioral health agency, participant, participant’s legal counsel, and supporter. The CARE plan may include behavioral health treatment, stabilization medication, and a housing plan. The court reviews and adopts the CARE plan with both the participant and county behavioral health as party to the court order for up to 12 months.
County behavioral health agency begins treatment to support the recovery and stability of the participant, and the court will review and update the CARE plan and associated progress during regular status hearings. The court may approve the participant to remain in the CARE plan for up to one additional year.
Successful completion and graduation by the Court. Participant remains eligible for ongoing treatment, supportive services, and housing in the community to support long term recovery. The participant may elect to execute a Psychiatric Advance Directive, allowing them to document their preferences for treatment in advance of potential future mental health crisis.
CARE Act Working Group
March 24, 2022 – Napa
Governor Gavin Newsom convened a CARE roundtable at Napa State Hospital alongside Californians who could benefit from the new framework, medical professionals, service providers, and elected officials to discuss his new CARE Act proposal.
March 17, 2022 – Fresno
Governor Gavin Newsom’s Administration visited a health and wellness center in Fresno and hosted a roundtable to discuss the new CARE Act proposal.
March 10, 2022 – Los Angeles
Governor Gavin Newsom visited a residential facility in Los Angeles, where he met with clients, health care and service providers, and local and judicial officials to discuss his CARE Act proposal.
March 2, 2022 – Santa Clara
At a mental health treatment center in San Jose, Governor Gavin Newsom unveiled CARE Act, a new framework to provide individuals with mental health and substance use disorders the care and services they need to get healthy.