In 2022, Governor Newsom signed SB 1338 establishing the Community Assistance, Recovery, and Empowerment (CARE) Act. The CARE Act creates a new pathway to deliver mental health and substance use disorder services to a subset of Californians with the most complex behavioral health conditions who too often suffer in homelessness or incarceration without treatment. This requires prioritizing those who need help the most, providing a comprehensive CARE plan that honors selfdetermination to the greatest extent possible, and holds our public systems accountable to delivering services and housing that are key to long term stability and recovery. The CARE Act is designed as an upstream intervention to divert from and prevent more restrictive conservatorships or incarceration.

The CARE Act provides a pathway for individuals to participate in creating their own CARE plan that outlines individual needs. The CARE plan is implemented by local government entities – primarily counties – who are obligated by court order to deliver on the individualized elements of the plan, which include behavioral health services, housing, and support.

The local civil courts have the authority to monitor the implementation of the plan components by local government entities, hear implementation concerns by either the participants or local government partners, and take steps to ensure the plan is fully implemented. Court actions include the potential for sanctions of local government partners who fail to implement CARE plan components. Court monitoring is meant to provide support and encouragement to participants who will often require some assistance to continue with the plan’s components and to ensure the services and housing being offered meet the needs of the participant.

Unlike the requirement on local government, individual CARE Act participants are not forcibly compelled to participate. There are no locked doors in the CARE Act. Robust engagement practices support active participation, however, if the individual does not participate in their plan, they may be scheduled for additional court hearings and may eventually be terminated from the CARE proceedings and/or the Court may use existing law to ensure their safety.

The CARE Act is a pathway to allow certain people, called “petitioners,” to request civil court-ordered treatment, services, support, and a housing plan for eligible people 18 years of age or older, called “respondents,” who have untreated severe mental illnesses (schizophrenia or another psychotic disorder) and who meet specific health and safety criteria. Petitioners are encouraged to consider alternatives to CARE Act proceedings in advance of filing a petition. "Some respondents may “self-petition” to secure the services they need to gain and maintain stability living in the community."

CARE Act proceedings involve assessments and hearings to determine whether the respondent meets eligibility requirements. A county behavioral health agency must be involved in the process and must actively outreach to the respondent and initially seek to engage the respondent in voluntary services.

If the respondent does not engage in voluntary services and meets the CARE eligibility standards, a CARE agreement or plan may be created and, if approved, ordered by the civil court. The CARE plan or agreement lasts for up to 12 months, with the possibility to extend for an additional 12 months.

Individuals engaged in CARE plans and agreements may be prioritized for a range of services and programs, including supportive housing.

A number of guides, resources, and tools are available to family members to help guide them through CARE Court.

1. At a glance: CARE Act At a Glance 10302023 vL3 (care-act.org)
2. Care court process: CARE Act Brief - CARE Process Flow 08.30.2023 vL2 (care-act.org)
3. Court assistance: San Luis Obispo County Self Help Website
4. Petition form CARE-100 to commence CARE Act proceedings: Petition to Commence CARE Act Proceedings | California Courts | Self Help Guide
5. What happens after petition is filed: Process after CARE petition filed | California Courts | Self Help Guide
6. Understanding legal roles: CARE Act Brief Legal Roles in the CARE Act for public v3 (care-act.org)
7. Glossary of terms - https://www.courts.ca.gov/documents/Glossary-of-CARE-Act-Terminology_rev-03.22.23-Final.pdf
8. NAMI: CARE Act - NAMI California
9. Family resource guide: Family Resource Guide - CARE Act Resource Center (care-act.org)
10. Family role: Role of the Family in the CARE Process - CARE Act Resource Center (care-act.org)
11. Information sharing in CARE Court: CARE TTA Information Sharing with Family Members v1 (care-act.org)

All eligibility determinations are case specific, and respondents must meet all eligibility criteria listed below for a petition to be considered. Homelessness and a diagnosis alone are not sufficient to meet eligibility requirements.

While CARE respondents may be experiencing homelessness or housing insecurity, untreated severe mental illness and the resulting impairment is the primary driver of CARE eligibility.

A respondent must meet the following criteria to be eligible for CARE:

• Be 18 years of age or older.
• Have a severe mental illness with a diagnosis of a schizophrenia spectrum disorder or other psychotic disorder.
• Not be clinically stabilized in ongoing voluntary treatment.
• Additionally, at least one of the following must be true:
  • The respondent is unlikely to survive safely in the community without supervision and the respondent’s condition is substantially deteriorating, OR
  • 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.
• The respondent’s participation in a CARE plan or CARE agreement must:
  • Be the least restrictive alternative necessary to ensure the respondent’s recovery and stability, AND
  • Be likely to benefit the respondent.

To be a petitioner, you must be 18 years of age or older. You can be related to the respondent or be the director of an agency who has had frequent contact with the respondent due to their mental health disorder. 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 certain county agencies, specifically adult protective services, a county behavioral health agency, or the public guardian or public conservator, or that person’s designee
• The director of a hospital, or their designee, in which the respondent is hospitalized
• A licensed behavioral health professional or director of a public or charitable agency, who is currently or has been recently treating, or supervising the treatment of, or providing behavioral health services for the respondent within the last 30 days
• A first responder who has had repeated interactions with the respondent
• A judge of a tribal court located in California, before which the respondent has appeared within the previous 30 days, or the judge’s designee
• The director of a California Indian health services program or a California tribal behavioral health department, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or the director’s designee
• The respondent themself

To begin CARE Act Court proceedings, a petition must be filed by someone who is familiar with the person requiring help.

The petition and other CARE forms are available on the California Courts website. The petition must be filed using the mandatory form CARE-100. Certain documents must be attached to support the claims made in the petition. The petitioner may be referred to the Self-Help Center if the petition is incomplete.

The petition and supporting documents may be filed electronically or in person. For information on electronic filing please refer to the court’s Online Case Filing page. 

The confidential CARE proceedings will be heard at the San Luis Obispo Courthouse. Once a petition is approved by the court, County Behavioral Health provides mental health outreach, assessments, and treatment. 

Please visit the CA Courts Self-Help Guide for more information on the CARE Act process.

The following Groups are involved in the CARE Act Court proceedings:

1. Petitioner-the individual who files a petition to bring a person who they believe to be eligible into CARE Court. A petitioner can be a person or an organization. 
2. Respondent- the individual who is the subject of the CARE Court petition.
3. Court/Judge- responsible for receipt of petitions, and the oversight of CARE Court proceedings.
4. County Behavioral Health- responsible for providing mental health services and supports to the respondent. 
5. Public Defenders/Legal Aid Attorneys- responsible for representing the respondent in court proceedings.
6. County Counsel-County of San Luis Obispo's lawyers. 

 

Supporting a self-determined path to recovery and self-sufficiency is core to the CARE pathway. Respondents have the right to be informed of the proceedings, the right to take part in the proceedings, the right to be represented in all stages of the process, the right to replace the court appointed attorney with an attorney of their choosing, the right to have a supporter of their choosing throughout the process, and other rights. In the CARE process, each respondent can choose a volunteer supporter. A supporter is an adult chosen by the respondent to assist them to understand, make, and express their decisions throughout navigating the CARE process. The supporter may be a friend, family member, faith leader, mentor, person with lived experience with a mental health and/or substance use disorder, or other support person chosen by the respondent. The role of the supporter is to help the respondent understand, consider, and communicate decisions to ensure the respondent can make self-directed choices to the greatest extent possible.

Housing is an important component to CARE, since finding stability and staying connected to treatment is next to impossible while living outdoors, in a tent or a vehicle. Respondents served by CARE will need a diverse range of housing, including clinically enhanced interim or bridge housing, licensed adult and senior care facilities, supportive housing, or housing with family and friends. The court may issue orders necessary to support the respondent in accessing housing, including prioritization for these services and supports.

A CARE agreement and a CARE plan are written documents that specify services designed to support the recovery and stability of the respondent. These services can include: behavioral health care; counseling; specialized psychotherapies, programs and treatments; stabilization medications; a housing plan; an opportunity to complete a psychiatric advanced directive; and other supports and services provided directly and indirectly through a local government entity. A CARE agreement is a voluntary agreement entered into by the respondent and the county behavioral health agency after a civil court has found that the respondent is eligible for the CARE process. If a CARE agreement is not reached, the court will order the creation of a CARE plan, which will include an individualized range of community-based services and supports. If a CARE plan is ordered by the court, there will be periodic status review hearings during which progress and challenges are discussed. Adjustments to the services and supports in the CARE plan can be made to support the respondent’s success. If included in the CARE plan or agreement, stabilization medications would be prescribed by the treating licensed behavioral health care provider, and medication management supports will be offered by the care team. The treating behavioral health care provider will work with the respondent to address medication concerns and make changes to the treatment plan as necessary. Stabilization medications may not be forcibly administered.

In California, county behavioral health departments are responsible for delivering Medi-Cal Specialty Mental Health Services, publicly funded substance use disorder treatment, and community mental health services. Most respondents in CARE will be MediCal beneficiaries or eligible for MediCal. For a respondent who has commercial insurance, CARE requires that a health plan reimburse the county for eligible behavioral health care costs. Existing funding sources that may be used for CARE plan services and supports include nearly $10 billion annually for behavioral health care and $1.5 billion in funding through the Behavioral Health Bridge Housing program, as well as various housing and clinical residential placements available to cities and counties including over $14 billion in state funding to address homelessness made available over the last two years. In addition, the state will provide CARE funding for technical assistance, data and evaluation, legal representation for the respondent, as well as funding to support court and county administration.

To learn more, please visit the CalHHS CARE Act website.   

Yes. These may include voluntary services, such as full-service partnerships, assertive community treatment, or supportive housing, or court-ordered services, such as Assisted Outpatient Treatment (AOT) or services under the Lanterman-Petris-Short Act (LPS). You can contact the SLO Behavioral Health Access Line at 1-800-838-1381 to get more information and be connected with our services. 

The CARE Act Toolkit includes informational documents about implementation and eligibility. Additional documents will be posted here as they are developed.

• CARE Act Fact Sheet (March 2023)
  • Also available in: Chinese, Farsi, Korean, Spanish, and Vietnamese 
• Glossary of CARE Act Terminology 
  • Also available in: Chinese, Farsi, Korean, Spanish, and Vietnamese
• CARE Act Eligibility Criteria 
  • Also available in: Chinese, Farsi, Hmong, Korean, Punjabi, Spanish, Tagalog, and Vietnamese
• 10 Things to Know About the CARE Act 

The following resources include information about CARE Act proceedings and assist petitioners and respondents with the filing of petitions. CARE Act forms are available in Farsi, Chinese, Korean, Spanish, and Vietnamese and can be accessed by clicking the links below.

•    CARE-050-INFO (Information for Petitioners-About the CARE Act)
•    CARE-060-INFO (Information for Respondents-About the CARE Act)
•    CARE-100 (Petition to Commence CARE Act Proceedings)
•    How to File the CARE 100
•    CARE-101 (Mental Health Declaration-CARE Act Proceedings)
•    CARE-113 (Notice of Respondent’s Rights-CARE Act Proceeding)

 

If you have more questions about the CARE Act Court program, please visit https://care-act.org/library/faqs/.