CARE Court should refocus on mentally ill homeless people, the hardest to help

After more than two years of implementing California’s CARE Court homeless intervention program, judges have approved fewer than 900 treatment plans, and only 32 have been definitively court-ordered. 

There is a good explanation for why CARE Court has produced such low numbers. Early results show that the state’s most vulnerable population — homeless people who are mentally ill — are not CARE Court’s true priority. 

That priority must change. 

The intent of the visionary CARE Court law is to allow judges to order treatment plans for people who are homeless, suffering from serious mental illness and who are unable to accept services. 

CARE Court emerged from Gov. Gavin Newsom’s sustained focus on getting more Californians off the streets. It followed years of budget and policy action by the administration and the Legislature, culminating in the passage of Proposition 1, which seeks to focus the massive dollars from my 2004 initiative, the Mental Health Services Act, toward more direct intervention and help for chronically homeless people living with severe mental illness. 

CARE Court is a key strategy for Proposition 1’s success. 

Major programs often take time to gain traction. But one statistic within these early results is both troubling and fixable: only about a third of CARE Court petitions have involved people living on the streets. In Los Angeles County, the figure is under 25%. 

CARE Court is not sufficiently focused on chronically homeless individuals living with schizophrenia or other psychotic disorders. With a few exceptions, chronically homeless participants are not given priority for housing vouchers or other public assistance. 

This shortfall is not surprising, given the track record of prior state mental health initiatives. 

When the Mental Health Services Act passed in 2004, it dramatically expanded funding for public mental health. Its “full-service partnerships” were intended to replicate and scale earlier successes from my early 2000’s pilot projects specifically directed to help homeless mentally ill people. 

Over 20 years, counties gradually shifted funding away from mentally ill homeless people toward other populations — many of whom, while still in need, already had some form of housing. 

As of 2022, more than 200,000 people were enrolled in full-service partnerships. Only 25% of these partnerships served homeless adults living with severe mental illness. The percentage is even lower for chronically homeless individuals living for months or years in worn-out tent encampments.

It is confounding that California’s signature mental health initiatives — even after legal reforms to make it easier to require treatment — are not doing more to address the homeless crisis. Absent a clear legal duty for the state and counties to intervene, the most visibly suffering individuals will continue to be passed over. 

The system often bypasses the sickest individuals because they are the hardest and most expensive to treat. Limited resources and human nature push agencies toward serving those who are easier to reach and more likely to succeed.

That may be rational but it’s also wrong. 

The number of petitions, court orders and — most importantly — people receiving treatment will only increase statewide if state and local governments and the courts act in more purposeful and collaborative ways to reach people in greatest need. 

Today, petitions are filed and adjudicated sporadically. 

There is a better way to expand CARE Court’s reach. Cities and counties extensively map the location of large homeless encampments. A modest state and county investment would enable trained CARE Court outreach workers to proactively work those encampments, identify eligible participants and file petitions for more eligible individuals within defined geographic areas. 

The state and counties should then prioritize Proposition 1 funds, specifically the 30% housing set aside, for CARE Court participants. 

Courts must be full partners by expanding their collaborative court models. Larger dockets which prioritize hearing and deciding more filed cases at one time would still allow each individual petition to be considered on its merits. 

If CARE Court and assuring more people get off our streets are the priority we claim they are, then all branches of government must commit to greater numbers. 

We may not be able to help everyone. But we must never accept modest results for people living in conditions that no human being should endure.