Community Assistance, Recovery and Empowerment (CARE) Act Program

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• What is the CARE Act?

  The Community Assistance, Recovery, and Empowerment (CARE) Act program creates a new pathway to deliver mental health and substance use services to individuals who are diagnosed with schizophrenia or other psychotic disorders and are not engaged in treatment.

  Through a new state law, the CARE Act creates a process for families, clinicians, first responders, and others to file a petition with the civil court to connect individuals (ages 18+) to court-ordered voluntary treatment if they meet criteria and would benefit from the program. Petitions will be evaluated by the Superior Court and, for those who meet criteria, a CARE Agreement will be created in collaboration with the person, which will connect them to services that may include mental health and substance use treatment, medication, housing, support services, and social services as needed.

  For those who may not qualify for the CARE Act program, an array of treatment options are always available by calling the County’s Access and Crisis Line at 1-888-724-7240 or 9-8-8.

• What is the CARE Act Process?

  The CARE Act process includes five steps: Referral; Initial Determination; Investigation and Engagement; Establishing a CARE Agreement; and Connection to Services. Refer to the section above for details on the CARE Act process.

• Who is eligible for the CARE Act program?

  CARE Act focuses on individuals, 18 years of age or older, who are diagnosed with schizophrenia, bipolar I disorder with psychotic features, or other psychotic disorders and are not engaged in treatment, substantially deteriorating, and/or unlikely to survive safely in the community without supervision. According to the Judicial Branch of California, only 7,000-12,000 of the 39.2 million Californians, or .02-.03% of the population, are estimated to meet CARE Act criteria. For more information on eligibility, please refer to the Frequently Asked Questions section within the Superior Court of California County of San Diego CARE Act webpage or call the Legal Aid Society of San Diego 1-877-734-3258 (option 6).

• What if my loved one doesn't qualify for the CARE Act program?

  For those who may not qualify for the CARE Act program, an array of substance use and mental health treatment options are always available by calling the County’s Access and Crisis Line at 1-888-724-7240 or 9-8-8.

• How do I start the process? Who can file a petition?

  A qualified petitioner can file a petition with the Superior Court. Qualified petitioners include family members, someone residing with the individual, clinicians, first responders, and other providers. For more information on starting the process, please visit the Superior Court of California County of San Diego CARE Act webpage or call the Legal Aid Society of San Diego 1-877-734-3258 (option 6).

• How can Licensed Behavioral Health Professionals at LPS-designated facilities submit a referral for an internal CARE Act petition?

  Licensed behavioral health professionals or designees at LPS designated facilities can complete the CARE Hospital Referral Form, or referral form.

  Any licensed behavioral health staff can complete this form, and a CARE clinician, or hospital liaison, will meet with the patient to see if they are appropriate for services. Please make sure to include the release of information and applicable records as this expediates the process. Also, the patient must have been placed on a 5150 hold during the current hospitalization in order for the referral form to be valid. If the patient is appropriate and agreeable to services, the CARE clinician can complete an internal petition. 

  Within 14 business days of receipt of the referral form, the CARE Act program shall complete an assessment of the referred patient and shall file a petition if the individual meets or is likely to meet criteria to qualify for the CARE process and the individual does not engage in voluntary treatment. If the CARE Act program is unable to complete an assessment within 14 business days of receipt of a  referral form, but later determines that the person is or may be eligible, the CARE Act program may file a petition pursuant to W&I Code Section 5974, subdivision (h).

• What documents need to be submitted with a CARE Act petition?

  Proof of eligibility must be submitted with each CARE Act petition as required by the State of California (WIC 5975). This can be in the form of either a Mental Health Declaration form completed by a licensed behavioral health provider or evidence (from any source) that the individual was detained for two intensive treatments with the most recent being within the last 60 days. Those filing a CARE Act petition should see Information for Petitioners for more details on required documents.

  Licensed behavioral health professionals can submit the CARE-102 form. This form replaces the CARE-100 and CARE-101 forms.

• How long does someone participate in the CARE Act program?

  Program participation is up to 12 months but may be extended based on individual circumstances. The Superior Court sets progress hearings throughout the 12-month program and may modify the CARE Agreement based on the person’s needs. At the end of the 12-month program, County Behavioral Health Services will work with the individual to develop a graduation plan or extend their CARE Agreement for up to an additional 12 months.

• Is there any cost to individuals enrolled in the CARE Act program?

  There is no cost to individuals participating in the CARE Act program. 

• Is this a program meant for people experiencing homelessness?

  Homelessness is not a requirement to be eligible for the CARE Act program, and not all people experiencing homelessness will be eligible. When a participant is accepted into the program, the person is assigned a representative who will work with County Behavioral Health Services to develop a CARE Agreement tailored to their needs. The CARE Agreement includes community-based resources, including peer support, counseling, stabilization medications, and housing supports as needed.   

• Does the CARE Act program include housing?

  Some CARE Agreement may include recommendations for housing, depending on the needs of the person. If housing is a need, the CARE Agreement will work toward obtaining permanent or transitional housing options.

• What is the difference between the CARE Act Program and LPS Conservatorship?

  The Lanterman-Petris-Short (LPS) Act and the CARE Act are separate processes. There is no pathway directly from the CARE Act program into conservatorship. However, CARE Act respondents should be aware that if a CARE Agreement is established and the person fails to stay connected to treatment, a judge may consider this if the person is evaluated for conservatorship in the future.

  The LPS Act, enacted in California in 1967, governs involuntary civil commitment to mental health institutions for individuals deemed a danger to themselves, a danger to others, or gravely disabled due to mental disorders and/or severe substance use disorders. LPS Conservatorship is established annually as ordered by the court and involves restrictive services, with a court-appointed conservator making decisions for individuals when they're unable to care for themselves or unable to accept treatment voluntarily. The conservatorship typically relies on closed locked placements to appropriately meet the treatment needs of conservatees.

  On the other hand, CARE Act is designed to prevent the need for such restrictive measures by connecting a person in crisis with a court-ordered CARE Agreement for up to 12 months, with the potential to extend up to an additional 12 months. Instead of decisions made by a court-appointed conservator, participants are empowered to make self-directed choices through the help of an attorney and a CARE Supporter. Moreover, the CARE Act program is community-based, advocating for less restrictive care settings, and aims to intervene before individuals end up in a state of severe impairment that might necessitate an LPS Conservatorship.

• How much will the County spend on CARE Act this year?

  The costs are anticipated to be between $15-20 million annually inclusive of staffing, treatment, and support services for clients referred to the CARE Act program. Actual costs may adjust up or down based on actual number of individuals referred and receiving services.

• How much state funding has County Behavioral Health Services received to implement CARE Act?

  County Behavioral Health Services has received $7.4 million in startup and planning funds for the CARE Act program. The Governor’s budget allocates additional funding to county behavioral health departments totaling $67.3 million for Fiscal Year (FY) 2023-24, $121 million in FY2024-25, $151.5 million in FY2025-26, and annually thereafter to support estimated county behavioral health department costs. The allocation for San Diego County is unknown at this time.

• What if my loved one doesn't complete or drops out of the CARE Act program?

  While participation in the CARE Act program can involve an order in civil court, this order is not a mandate for care and engagement is always voluntary. While there is no penalty if your loved one does not complete the CARE Act program, it's important to encourage the person to engage with available mental health and substance use resources. Call the County’s Access and Crisis Line at 1-888-724-7240 or 9-8-8 to explore the array of programs and services available.