Newsom expands his marquee mental health program with new law. Will it help more people?

One of Gov. Gavin Newsom's marquee mental health programs may broaden its reach despite persistent questions about the number of people it’s helping and whether it’s achieving the goals he set out for it when it launched.

Newsom on Friday signed a law that expands eligibility for CARE Court to include people who experience psychotic symptoms as a result of bipolar disorder. Under the law’s previous constraints, only people with schizophrenia and other limited psychotic disorders were eligible.

Newsom in a written statement called the law and its expansion an important part of his administration’s efforts to bring people with serious mental illness into treatment.

“California doesn’t sit on the sidelines while people fall through the cracks,” he said. “We don’t stand by while people spiral on our sidewalks or cycle through emergency rooms and jail cells — we step up. We built CARE Court to connect people to treatment, dignity, and accountability — because care and accountability belong at the center of how we serve our communities.”

Newsom introduced CARE Court in 2022, creating a program that allows family members, first responders, doctors and others to petition the courts on behalf of people with severe psychosis who couldn’t care for themselves.

Once a petition is accepted, individuals are presented with a voluntary treatment plan, which can include counseling, medication and housing. If they refuse, a judge can, in theory, order them to participate in a treatment plan.

Almost two years in, CARE Court has struggled to fulfill Newsom’s initial promises. A recent CalMatters investigation found that the program has so far reached a few hundred people, far short of the thousands originally projected.

The new law, by Sen. Tom Umberg, a Santa Ana Democrat, sailed through the Legislature with nearly unanimous bipartisan support, no votes against and just a handful of abstentions.

“The beauty of CARE Court is that it holds both institutions and individuals accountable, ensures individuals get the care they need and gives judges a clear role in overseeing and guiding the process,” Umberg said in a written statement today. “This bill focuses on implementation by listening to and learning from counties about what’s working and what’s not, in order to meet the goals of the original CARE Court legislation.”

But the bill faced plenty of criticism in the community, with counties questioning how they will implement an expanded program on a tight timeline and disability rights advocates raising concerns about the effectiveness of a program they consider “unimplementable.”

“We have to tell the truth,” said Lex Steppling, a founding member of All People’s Health Collective. “This is not workable. It’s not going to be workable. And I personally believe the cracks in the foundation are getting bigger and bigger and it’s going to collapse.”

Steppling saved his harshest criticism for “the state’s self-described ‘liberal and progressive’ politicians,” who he said were too afraid of the Newsom administration to oppose the bill.

Wide estimates on CARE Court expansion

Umberg’s legislation could expand CARE Court enrollment, though it’s unclear by how much. Umberg’s office doesn’t have an estimate of how many more people will be eligible for the program under the new parameters. San Diego County said the new rules could increase its numbers by anywhere from 3.5% to 48.1%.

“We’re trying to focus on the right populations,” Umberg said. “I do think it will expand it, but not dramatically.”

Monica Porter Gilbert, a mental health policy advocate with Disability Rights California, said the lack of clear information from the state about how the program has been implemented thus far is a big part of the problem.

“It feels concerning to massively open the gates to expand eligibility for the program when we really have no evidence that the program is having a positive impact,” she said.

Umberg initially wanted to expand CARE Court in a way that would have made even more people eligible for it. An earlier draft of his legislation would have included all mood disorders with psychotic features. But critics, including the County Behavioral Health Directors Association, warned that “massive expansion” would lead to people flooding into CARE Court faster than counties could provide services. As a concession, Umberg eventually limited his bill to bipolar disorder.

Newsom's mental health overhaul

In addition to expanding eligibility, Umberg’s bill also eliminates what he said are some "inefficiencies" from the CARE Court process. That includes combining two early court hearings into one, he said, thereby reducing the amount of time participants have to spend in court and saving administrative resources.

The legislation also allows the criminal justice system to refer someone directly into CARE Court if they are charged with a crime and are deemed incompetent to stand trial.

Michelle Doty Cabrera, executive director of the California Behavioral Health Directors Association, said her organization opposed the new law. She worries that counties won’t have the staffing or housing resources necessary to handle an influx of people. And they are still working out kinks in a system that is still relatively new, she said.

At the same time, she said, county behavioral health departments are also pivoting to address dozens of other new initiatives, including Newsom’s 2024 mental health housing bond known as Proposition 1 as well as CalAIM, the governor’s overhaul of Medi-Cal for mental health services.

“We need to allow counties to implement the very many things that have been put on the table,” she said.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.