As the sweeping promises of a new behavioral health court take shape slower than expected across California, Santa Clara County is one of the last to roll it out.
A new civil court process known as the CARE Program — or CARE Court — allows anyone from a family member to a first responder to petition the court to help an adult with schizophrenia, or other psychotic disorders. The process, which launches Dec. 2, works out a voluntary mental health treatment plan with the individual and the Santa Clara County Behavioral Health Services Department. Advocates hope it opens a pathway for people to access community-based services to avoid landing on the street or in jail.
While disability rights advocates have warned against the idea, the results from other counties — who implemented CARE as early as October last year — are tempering expectations as to how big a splash it will make in Silicon Valley’s mental health and substance use crisis.
One of the reasons is potential clients who qualify for the program don’t have to participate. Meanwhile, the state hasn’t fronted any money to help the 58 counties it’s mandating to run the program. The law was signed in October 2022.
County Executive James Williams said he’s committed to the program’s success, but called it “yet another example of a state mandate that lacks the funding it needs.”
“That means that other critical services and functions get shortchanged,” Williams told San José Spotlight. “New initiatives need to come with the resources to make them a reality.”
CARE Court’s success depends on having enough behavioral health workers, housing and court personnel, including clinicians who can diagnose candidates. A specific concern: back-and-forth logjams between the courts and county behavioral health workers on client assessments, especially if, at any time into the process, people change their minds about participating.
Susan Ellenberg, president of the Santa Clara County Board of Supervisors, said she’s concerned the program’s rollout may create inappropriate expectations, both with regard to the number of people it will actually serve and the fact it offers out-patient, community-based treatment as opposed to in-patient, secure placement.
“To the extent the CARE Court process brings very high need individuals into a treatment program, that is unquestionably a win for each of those individuals. But the overall impact may not be visible to the average resident who may become discouraged that a promised program is not delivering as they had hoped,” Ellenberg told San José Spotlight. “Further, the fact that the program is unfunded only exacerbates our existing challenge of expanding access to inpatient beds, outpatient treatment slots and a larger workforce. Santa Clara County does hard things every day and we will continue to drive every available resource to expanding access to care at every level of need.”
Supervisor Otto Lee said he’s watching counties across the state report lower petition, hearing and CARE plan numbers than hoped for.
“Although we anticipate a similar situation in Santa Clara County, we will be ready to serve as many county residents who come through CARE Court as possible,” he told San José Spotlight.
Rovina Nimbalkar, executive director of NAMI Santa Clara County, said it’s unrealistic to expect big results from the get-go.
“Transforming lives through mental health and substance use treatment is a gradual process that requires sustained effort,” Nimbalkar told San José Spotlight. “Over time, with consistent implementation and support, we may begin to see reductions in homelessness and behavioral health crises in public spaces, but these outcomes will take patience and ongoing investment.”
Southern California lessons
Los Angeles County, California’s most populous, was among a cohort that jumped to the front of the CARE line. Since the program’s rollout, officials have reported 308 petitions, established 28 CARE agreements and four CARE plans. LA County officials have another 81 CARE hearings scheduled through Jan. 14.
Behavioral health workers in Los Angeles are learning just how long it takes to fulfill the vision of the program — from coaxing hesitant clients into agreeing to hearings and assessments, to following up and locating them later in the process.
“It’s been time consuming just to build relationships,” Martin Jones, LA County’s CARE program manager, told San José Spotlight. “We approached it through what we call relentless engagement. Someone on our team might have coffee with someone who isn’t willing to talk about what they’re going through. So we try to find something they are willing to talk about — sports, whatever it is — and then we approach it again.”
Jones said his team has seen success this way. But then comes another challenge: knowing where to find people at key junctures in their case.
“If an individual is unhoused and moves around a bit, then the team would have to locate a picture of the individual, talk to their loved ones or friends and find out where they’re known to spend their time during the day,” Jones said. “It takes a lot of time, creativity, flexibility to really be able to engage individuals who may initially be reluctant to receive mental health services. It can be a slow, methodical process.”
But while systemic results have yet to materialize, Jones said the impact on individuals has been “dramatic.”
“When it comes to their life trajectory — between being unhoused and untreated to moving back and forth in the justice system, multiple hospitalizations — we’ve seen some movement in those areas,” Jones said. “A bulk of the petitions we have received have been from family members.”
Closer to home, San Francisco officials declined to get as specific with their numbers. A spokesperson said the city’s courts have received 47 petitions since implementing the CARE program, but declined to say how many have resulted in agreements and court-ordered plans.
Working the program
People who can petition someone for CARE Court include family members, behavioral health providers and first responders with a history of engaging the individual. CARE Court excludes people with certain conditions and disorders, including mental illnesses outside of the psychotic disorder class, such as bipolar disorder, major depression and post-trauma stress disorder. Psychotic disorders due to medical conditions, such as traumatic brain injury, autism and dementia are also excluded.
Incoming Santa Clara County Supervisor Betty Duong is one of two new board members inheriting the program and its development.
“I have been checking in regularly with county staff and have been assured repeatedly that CARE Court has the resources, staffing support and administrative support to roll out,” Duong told San José Spotlight. “With anything new, and as someone who knows there are already going to be unforeseen challenges from unfunded mandates — and there are many of them coming our way — resources have always been a concern.”
Duong said Santa Clara County’s advantage is seeing what other counties have already gone through.
“That’s critical to our success,” she said.
Contact Brandon Pho at [email protected] or @brandonphooo on X, formerly known as Twitter.
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