California’s big plan to help people with serious mental illness is struggling to meet expectations

A program that aimed to bring thousands of Angelenos living with serious mental illness under court-led care remains far below initial participation projections, a review of county data shows.

LAist reported earlier this year that participation in the CARE Court program in Los Angeles County was relatively low — a little more than 380 petitions more than a year after its launch.

Now that the program has hit the two-year mark, there have been roughly 700 local petitions filed with the court, according to officials. That’s in a region where there thousands of people are estimated to be living with severe mental illness. And it's about 18% of the number the state projected for CARE Court’s first two years.

As of late November, six participants in L.A. County graduated from the program, according to data from the L.A. County Department of Mental Health.

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Sergio Tapia, presiding judge of the Superior Court of L.A. County, said that number represented a kind of success.

“Did it meet the unrealistic expectations that were set up before CARE Court opened? Obviously it didn’t meet those expectations,” Tapia told LAist. “But I think those expectations were not realistic.”

He said it took up to six months just to get the first participants into the program.

But the low numbers and other concerns have caused some advocates for people with mental health diagnoses to doubt the program is viable.

“The program is not working,” said Monica Porter Gilbert, associate director and senior counsel of public policy at Disability Rights California.

She told LAist state data show that about half of participants statewide last year did not receive at least one of the services ordered for them, including therapy. (Tapia said he was not aware of any shortfalls in carrying out the CARE Court plans in L.A. County.)

Porter Gilbert also said she’s concerned about the expense.

An analysis from the state Assembly Committee on the Judiciary on CARE Court found that the cost per participant statewide during fiscal year 2023-24 was $713,000.

L.A. County officials working with CARE Court say the numbers are low because the work takes time, in some cases months just to locate people who may be unhoused.

And some state authorities agree.

Anne Hadreas, supervising attorney with Judicial Council of California, which organizes training programs for judges, said those who have started the program are making progress.

“Maybe the numbers aren’t what people expected, but there’s still been a lot of successes there,” she said.

How it’s supposed to work 

CARE Court allows family members, behavioral health workers, first responders and others to ask a court — by way of a petition — to step in with a voluntary care agreement for someone living with serious mental illness, like schizophrenia. If the agreement fails, a judge could order the individual to sign on to a treatment plan.

Between Dec. 1, 2023, and mid-December of this year, there were about 700 petitions filed in L.A. County, far below the roughly 3,800 state officials projected for the first two years of the program.

San Diego County, the second most populous in the state, received 445 petitions between October 2023 and November of this year. Orange County, the third most populous, received 206 petitions, according to our media partner CalMatters.

As of October, statewide data for the first two years of the program show that courts throughout California had received a total of 3,092 petitions, according to CalMatters. That’s still about 700 petitions short of what was expected just for L.A. County.

Martin Jones, a program manager with the county Department of Mental Health, said the six local graduations don’t tell the whole story. At least another 16 participants chose to stay in the program for an additional year.

Jones noted one recent CARE Court graduate who was subsequently able to get an apartment and a job.

“When you think about the impact on the individual — on their family, on their loved ones, on the community — the success is multiplied probably many times over,” he said.

But Porter Gilbert said family members of some CARE Court participants have told her they were sold false hope.

“Because many believed that their loved ones would finally get connected with meaningful services,” she said. “And instead they’re getting court dates that don’t lead to immediate housing or recovery-oriented clinical care.”

Data from the state’s CARE Act Annual Report showed that about 56% of participants statewide between October 2023 and June 2024 did not receive at least one mental health service that was ordered for them. The most common services ordered but not provided included medication supports and therapy services.

Porter Gilbert said CARE Court is failing to hold counties accountable for providing the services, even after they appear before a judge. And she said compelling participants into treatment through the court system can feel punitive for some participants.

“It’s blaming individuals for the failure of the system,” Porter Gilbert said.

Expanding eligibility

Next year, a new law signed by Gov. Gavin Newsom will expand eligibility for CARE Court to include people living with bipolar disorder who experience psychotic symptoms.

CARE Court currently only applies to people with schizophrenia spectrum disorders and a limited list of other psychotic disorders.

Marco Saenz, program director of the Independent Defense Council’s Office of L.A. County — which is tasked with representing CARE Court participants throughout the process — said the expansion is a good move.

“Hopefully these changes in the law that extend eligibility will see more people participating and getting the services that they desperately need,” he said.

Saenz also said the county and state need to do more outreach to increase the number of CARE Court petitions from first responders and other eligible petitioners.

About 67% of all petitions in L.A. County were filed by family members who sought to get their loved one into the program, according to data from the Department of Mental Health. Authorities said the county is working to get other eligible petitioners — like first responders and social workers — to file more requests.

“Many of these individuals are known to... fire or ambulance or other first responders. So it’s a matter of leveraging those relationships to really access the help that many of these individuals would benefit from,” said Jones, the program manager.

He and Hadreas at the Judicial Council said the program was still a work in progress, and they noted that while numbers remain far below what the state expected, many people are finding a door into mental health care through the petition process, even if CARE Court isn’t a good fit.

Hadreas said CARE Court was not intended to be a fast process, as many county workers must take time to build relationships with vulnerable people dealing with some of the most difficult times in their lives.

“It’s not an emergency process," Hadreas said. "It is about outreach and engagement and that can take months."