By Moryt Milo
It’s been more than two years since Gov. Gavin Newsom signed the Community Assistance Recovery and Empowerment (CARE) Act. The legislation is designed to provide better treatment access for those with a serious mental illness like schizophrenia and other psychotic disorders. Now, after watching and learning from seven other counties over the past year, Santa Clara County is ready to implement CARE Act on December 2.
Egle Narevic, PhD, LCSW, a member of the Behavioral Health Services Department (BHSD) management team overseeing the County’s launch of the legislation, told a large NAMI audience in November that this is a new civil court process supported and served by existing programs. She also clarified that the goals may not be what families envisioned. CARE aims to avert institutionalization, incarceration, and conservatorship.
“I know the community was excited about opening up a pathway to conservatorship,” she said. “But what we see in the legislation is that nothing could be further from the truth. CARE is to prevent conservatorship as much as possible.”
Who Is Eligible?
Not everyone is eligible for CARE. The individual must be 18 or older, on the schizophrenia spectrum, or have other psychotic disorders. Other criteria include: the person is not clinically stable in voluntary treatment, has been on two 5250s–known as 14-day involuntary hold–and is unlikely to survive safely without supervision. The objective of CARE is to help these individuals before they deteriorate further. The CARE process will be available to all residents whether they have private insurance or Medi-Cal.
Those who have a mood disorder like bipolar disorder, severe depression, or post-traumatic stress disorder would not be eligible for CARE. Nor would individuals with psychotic disorders caused by medication, such as a traumatic brain injury, autism, or dementia.
The legislation opens a new path for individuals who don’t fit into the county’s voluntary treatment model. Those going through CARE Court will be prioritized in the BHSD system. But it’s too early to know how demand and prioritization will impact others seeking behavioral health services, Narevic said.
How to Start the CARE Court Process
The CARE Court process begins with filling out a petition. The petitioner can be a family member, behavioral health provider, first responder with a history of engaging the individual, even the individual can petition if incarcerated with the help of a public defender.
The petition can be filed directly through the Santa Clara County Court’s forms portal, although it’s more complicated. Narevic suggests reaching out to the BHSD at 800-704-0900 option 3 or email CAREoutreach@hhs.sccgov.org. The staff can assist a petitioner with the process, which should include medical history, hospitalizations, any acts of violence or interactions with law
enforcement, unsafe behavior, among others. The more information the petitioner can provide, the more helpful it will be as the court reviews the situation to determine if the individual is a candidate.
When the BHSD receives a CARE outreach referral, the staff will first try to interact with the individual before petitioning the court. If the individual doesn’t respond, the qualified petitioner or BHSD will move the CARE petition forward.
What Happens After the Petition?
Once the court receives the petition, it will ask the BHSD to investigate the situation and report its findings within 14 days. Narevic acknowledged that two weeks is a very short time to work with the individual, especially someone with a severe mental illness or anosognosia, a condition where the individual doesn’t understand they are ill. During that time, an individual may or may not show a willingness to receive treatment. If they do, CARE Court might be avoided. If not, or the BHSD is unable to locate the person, the court has to rule on whether to proceed.
If the court agrees that the individual meets the criteria, the person has a right to legal counsel, to actively participant in the development and plan process, and appoint a voluntary supporter like a family member or someone with lived experience, a trusted ally.
The Court Process
The CARE Court plan is developed in partnership with legal counsel, a clinical team, and the voluntary supporter. The goal is behavioral health treatment, stabilization with medication, and a housing plan. This is the three-legged stool, Narevic said.
“If you sit down on a three-legged stool, you are going to be sitting sturdy,” she said. “These are the main things we are offering in very general strokes.”
If the plan is reviewed and adopted by the individual and BHSD, the department and the participant will work together for 12 months. If more time is needed, an extension may be granted by the court.
But the entire court process is viewed as voluntary treatment, which means even after receiving a court-ordered plan, the individual can decline and walk away.
Some families questioned about maintaining compliance, but there has been limited guidance on how this could turn into a conservatorship, Narevic said. The only footnote is if the process becomes a qualified failure within the first six months. Then the situation can be a review. But the definition of “qualified failure” has not been defined.
“We don’t want anyone to erroneously think we are opening up a new pathway to conservatorships,” she said.
Once an individual graduates from CARE Court, the person is not abandoned, Narevic said. The individual is still eligible for services, ongoing treatment, and housing.
“Graduating from CARE Court means the individual has reached a level of insight and stability and can now engage with treatment and services without court support,” she added.
To watch the complete video about the CARE Act, click here.
To reach out via email to BHSD about Care Court petitions, click here or go to the BHSD CARE website.
