CARE Court, formally the Community Assistance, Recovery, and Empowerment Act, is a California civil court framework created by Senate Bill 1338 and signed into law by Governor Gavin Newsom in September 2022. It provides a legal pathway for family members, first responders, and certain other parties to petition a court to evaluate and create a treatment plan for a person living with an untreated schizophrenia spectrum or other psychotic disorder. The program is not a criminal proceeding and does not result in arrest or incarceration, but it does carry legal weight, including the possibility of conservatorship referral if treatment is repeatedly refused.
How the Process Begins
CARE Court starts with a petition filed in civil court. The petition asks the court to determine whether a specific individual meets the criteria for a CARE plan. Unlike a conservatorship proceeding, the initial filing does not require proof that the person is completely unable to make decisions. It requires a showing that the person has a qualifying diagnosis and is not currently engaged in treatment, along with evidence that the lack of treatment is putting them at risk of serious harm or destabilization.
Once a petition is filed, the court orders a clinical evaluation of the individual, called the respondent. This evaluation is conducted by a licensed behavioral health professional and looks at the person’s diagnosis, treatment history, current mental state, and whether they meet the statutory criteria. The respondent is entitled to legal representation throughout this process, and if they cannot afford an attorney, one is appointed for them. A supporter, sometimes called a “supporter person,” can also be designated to help the respondent navigate the proceedings and express their preferences.
The court then holds a hearing. If the judge determines the respondent qualifies, the county behavioral health agency is directed to develop a CARE plan. If the evaluation finds the person does not meet the criteria, the case is dismissed. The entire process from petition to initial hearing is designed to move within a matter of weeks, though real-world timelines vary by county.
Who Is Eligible
Eligibility for CARE Court is narrower than many people assume. Not every person experiencing homelessness or untreated mental illness qualifies. The respondent must meet all of the following conditions:
- Diagnosis: The person must have a schizophrenia spectrum disorder or another psychotic disorder as defined by clinical diagnostic criteria. Depression, anxiety, bipolar disorder without psychotic features, substance use disorders on their own, and other mental health conditions do not qualify.
- Age: The respondent must be 18 or older.
- Clinical deterioration or lack of treatment: The person must currently be experiencing a condition that is unlikely to improve without intervention, and they must not be engaged in voluntary treatment that is stabilizing their condition.
- Risk of harm: There must be a clinical basis to conclude that without a CARE plan, the person is unlikely to survive safely in the community without supervision or is at risk of serious harm to themselves.
People who are already under a conservatorship or who are actively receiving and responding to treatment are generally not eligible. The law is specifically aimed at the gap between voluntary treatment, which requires the person’s own initiative, and conservatorship, which strips away most decision-making authority. CARE Court was designed to sit in that middle space.
Who Can File a Petition
The law allows a defined set of people to submit a CARE Court petition. Family members are the most commonly discussed petitioners, including parents, siblings, adult children, spouses, and domestic partners. But the list extends beyond family. Licensed behavioral health professionals, first responders such as police officers and firefighters, and certain public agencies can also petition. County behavioral health directors, public guardians, and tribal leaders of a federally recognized tribe of which the respondent is a member are included as well.
Neighbors, friends, coworkers, or members of the general public cannot file a petition. The law deliberately restricts standing to people who have a defined relationship or professional role with respect to the individual in question. This was partly a response to concerns that an overly broad petition right could lead to misuse or harassment.
What a CARE Plan Includes
If the court approves the respondent for CARE Court, the county behavioral health agency creates a CARE plan tailored to the individual. The plan typically includes several components working together. Clinical treatment, including medication and therapy, is the central element. For people with schizophrenia spectrum disorders, antipsychotic medication is often part of the plan, though the specifics depend on the clinical evaluation and the respondent’s history.
Beyond medication, the plan addresses stabilization needs. Housing is a prominent feature. Counties are expected to connect CARE Court participants with housing resources, which may include short-term crisis housing, transitional housing, or longer-term supportive housing. The law places an obligation on counties to make housing a part of the equation, though in practice the availability of housing slots varies enormously depending on where you are in California.
Other services that may be built into a CARE plan include substance use treatment if a co-occurring disorder is present, case management, peer support, vocational or educational services, and connections to benefits like Medi-Cal. The plan is supposed to be individualized rather than one-size-fits-all. A CARE plan initially lasts up to 12 months and can be renewed once for an additional 12 months if the court determines continued supervision is warranted. At the end of the plan period, the respondent either transitions to voluntary services, or if they have stabilized, exits the system.
Rights of the Respondent
One of the most debated aspects of CARE Court is how it balances the state’s interest in treating severe mental illness against the respondent’s civil liberties. The law includes several built-in protections aimed at keeping the process from becoming coercive without accountability.
The respondent has the right to an attorney at every stage, from the initial evaluation through any compliance hearings. If the respondent cannot afford one, the court appoints a public defender or court-appointed counsel. The respondent also has the right to a supporter, a designated person who helps them understand the process and communicates their wishes. This supporter role is distinct from the attorney and is meant to serve as an advocate who centers the respondent’s preferences rather than the court’s or the county’s.
The respondent can participate in the development of the CARE plan and voice preferences about treatment, housing, and other services. They have the right to be heard in court hearings, to present evidence, and to challenge the clinical evaluation. If they disagree with the diagnosis or the recommended plan, they can contest it. The court cannot simply impose treatment without this adversarial process.
That said, CARE Court does allow the court to order certain treatments. This is the crux of the civil liberties debate. If the respondent refuses medication and the court finds that the CARE criteria are met, the judge can order the respondent to follow the CARE plan. Noncompliance does not directly result in incarceration, but it does open the door to further legal proceedings, including potential conservatorship referral.
What Happens When Someone Does Not Follow the Plan
Compliance in CARE Court is not enforced through arrest or jail time. If a respondent is not engaging with their CARE plan, the process is graduated. The county behavioral health agency is expected to make repeated efforts to engage the person, including outreach and modified approaches. Courts can hold status hearings to assess why the respondent is not participating and whether the plan needs adjustment.
If engagement still does not happen after these efforts, the court can refer the case to the county for conservatorship investigation. Conservatorship is a much more restrictive legal status that gives a court-appointed conservator authority over the person’s treatment decisions and sometimes their finances. The possibility of conservatorship is essentially the enforcement backstop. It is not automatic. The county’s public guardian still has to investigate and petition for conservatorship separately, and that proceeding has its own legal standards and protections.
The graduated approach was a deliberate design choice. Proponents argued that most respondents, once connected to services and medication, would voluntarily continue. The conservatorship backstop is meant to address the small number of cases where severe psychosis makes voluntary engagement impossible over the long term.
How CARE Court Differs from Conservatorship
California already had a system for compulsory psychiatric treatment before CARE Court existed, primarily through Lanterman-Petris-Short (LPS) conservatorships, which have been in place since 1967. Understanding the difference matters because the two systems serve overlapping but distinct populations.
LPS conservatorship requires a finding that the person is “gravely disabled,” meaning they cannot provide for their basic needs of food, clothing, or shelter due to a mental disorder. The standard is high, and the process results in a conservator making medical, housing, and sometimes financial decisions on the person’s behalf. It is the most restrictive civil intervention California allows for people with mental illness.
CARE Court sits below that threshold. The respondent in a CARE proceeding retains their legal decision-making authority. The CARE plan is an order with consequences for noncompliance, but it does not place another person in control of the respondent’s life in the way a conservatorship does. Think of it as structured outpatient treatment with judicial oversight rather than a takeover of decision-making. The respondent can still make choices about where to live, what to eat, and how to spend money. They just have a treatment plan they are expected to follow and a court checking in on whether it is happening.
For families, CARE Court is often seen as a less drastic alternative to pursuing conservatorship. Many families described the pre-CARE Court landscape as offering two options: do nothing and hope for voluntary treatment, or pursue the full weight of conservatorship. CARE Court was explicitly positioned to fill the space between those extremes.
The Statewide Rollout
CARE Court did not launch everywhere in California at once. The rollout happened in phases. A first group of counties, including some of the state’s largest like Los Angeles and San Francisco, began accepting petitions in late 2023. The remaining counties followed in a second wave, with statewide implementation completing by December 2024. This staggered approach gave counties time to build the infrastructure needed to handle petitions, evaluations, and service delivery, though many advocates argued the timelines were still too aggressive given existing resource gaps.
Early data from the initial counties has been limited. Counties have reported relatively modest petition volumes in the first months, with some observers suggesting that the complexity of the petition process and uncertainty about what services are actually available may be keeping numbers lower than projected. The state has committed funding to support implementation, including dollars for housing, but whether that funding will keep pace with demand remains an open question.
Criticisms and Concerns
CARE Court has drawn criticism from multiple directions, and the objections are not all the same. Civil liberties and disability rights organizations have raised concerns that the program amounts to forced treatment dressed in the language of care. Groups like the ACLU of California and Disability Rights California opposed the legislation, arguing that court-ordered treatment undermines autonomy and that the evidence for compulsory outpatient treatment improving long-term outcomes is mixed. They point to the fact that coercion, even when it connects someone to services temporarily, can damage trust and make future voluntary engagement less likely.
From a different angle, some homelessness advocates and public defenders worry that the program will disproportionately affect people of color and unhoused individuals who are already over-policed and over-surveilled. Because first responders can file petitions, critics have raised concerns about the intersection between law enforcement contact and psychiatric intervention.
On the other side, families of people with severe untreated psychotic disorders have been among the strongest supporters. Many describe years of watching a loved one deteriorate while being told nothing could be done because the person refused treatment and did not yet meet the grave disability standard for conservatorship. For these families, CARE Court represents a long-overdue tool to intervene before a crisis becomes a tragedy.
Mental health professionals are split. Some clinicians support the framework as a way to reach people who would otherwise cycle through emergency rooms, jails, and homelessness without sustained treatment. Others worry about being placed in the position of enforcing court orders, which they see as conflicting with the therapeutic relationship.
The Infrastructure Question
Perhaps the most practical concern about CARE Court is whether the services it promises actually exist in sufficient quantity. Ordering a treatment plan is one thing; having the psychiatric beds, supportive housing units, outpatient slots, and trained clinicians to fulfill that plan is another. California has been dealing with a severe shortage of behavioral health workers and affordable housing for years, and CARE Court does not create those resources on its own.
This concern finds support in the broader national picture. Research on court-ordered mental health treatment availability across the United States found that only slightly more than half of outpatient mental health treatment facilities offered specialized services for individuals ordered to treatment by a court, with wide variation from state to state. Facilities that also offered integrated substance use treatment or trauma therapy were significantly more likely to provide court-ordered treatment services, suggesting that the most resourced facilities are the ones equipped to handle these cases, while less-resourced facilities are not.1SpringerLink / Soc Psychiatry Psychiatr Epidemiol. National and state-level trends in the availability of mental health treatment services tailored to individuals ordered to treatment by a court: United States, 2016, 2018, and 2020
If counties lack sufficient outpatient capacity, the risk is that CARE Court becomes a mandate on paper without meaningful services behind it. A respondent ordered into a CARE plan who cannot access housing or timely psychiatric appointments is left in legal limbo, technically under court supervision but practically unchanged. The state has allocated new funding, but advocates from all sides agree that money alone is not enough. Building workforce capacity and adding housing units takes years, not months.
How CARE Court Fits into the Broader Assisted Outpatient Treatment Landscape
California is not the first state to create a mechanism for court-ordered outpatient mental health treatment. New York’s version, known as Kendra’s Law, has been in effect since 1999 and has been studied extensively. Most other states have some form of assisted outpatient treatment statute, though the specifics vary considerably. What makes CARE Court distinctive is its emphasis on housing as a component of the treatment plan and its creation of a new civil court process rather than grafting onto existing probate or mental health court structures.
The evidence on assisted outpatient treatment more broadly is complicated. Supporters cite studies showing that court-ordered outpatient programs reduce hospitalizations and interactions with the criminal justice system. Critics counter that much of the improvement may come from the increased access to services that accompanies the court order, not from the compulsion itself. In other words, if you gave someone intensive case management, housing support, and priority access to psychiatric care without the court order, you might see similar outcomes. Untangling whether the legal mandate or the resource allocation is doing the work has been one of the persistent challenges in this field.
CARE Court’s architects acknowledged this tension. The law was written to require counties to provide robust services alongside the court order, the idea being that the mandate is meaningless without the resources and the resources are underutilized without the engagement structure. Whether that theory holds in practice across California’s 58 diverse counties, each with its own level of behavioral health infrastructure, is something that will take several years of data to evaluate. The early returns suggest that the answer will be uneven: some counties with strong existing systems may see genuine benefits, while others will struggle to deliver on the program’s promises.