The Abridged Version:
- A state program aimed at helping Californians with severe mental health problems get treatment is used very little across the Sacramento region, especially in rural areas.
- The CARE Act was touted as a solution for people stuck in the so-called “revolving door” between chronic homelessness, jails and hospital stays by allowing family and some others to initiate action.
- Gov. Gavin Newsom signed a new bill into law that aims to expand the program’s use.
Update: This article has been updated to note that Senate Bill 27 was signed into law. An earlier version of this article stated that the bill was pending a decision from the governor. Updated 2:16 p.m. on Oct. 13, 2025.
A new court program aimed at reducing chronic homelessness and placing people with severe psychoactive disorders into treatment is barely used across the Sacramento region.
After the passage of the Community Assistance Recovery and Empowerment Act, or CARE Act, in 2022, each county in California was required to develop a civil court program that provides court-mandated treatment plans for people struggling with schizophrenia or psychotic disorders.
The county programs debuted locally on Dec. 1, 2024, and so far have seen a trickle of use. Some rural counties have helped just one person enter a treatment plan. Most of the region has seen few petitions filed in local court programs.
The CARE Act model allows people who are close to someone with schizophrenia or a psychotic disorder to file a court petition. Roommates and family members are eligible to fill out a petition for a loved one, as well as county behavioral health officers, hospital directors and first responders who have had repeated interactions with the person named on the petition.
The petition is then vetted by a county judge and by the county‘s behavioral health director. If the petition receives a sign-off from the judge and the county, the county then develops a treatment plan with counseling, medications, housing plans and other services intended to help someone become more stable. Compliance is largely voluntary.
Sacramento use well below state average
Participation rates in the program across the four-county region were below the state average, according to an analysis from CalMatters.
As of September, courts in the four-county Sacramento region had the following participation in the program, according to records tracked down by Abridged:
- Sacramento County: 93 petitions filed, 13 people on CARE agreements
- Placer County: 16 petitions, four people on CARE agreements
- Yolo County: 16 petitions, four people on CARE agreements
- El Dorado County: four petitions, one person on a CARE agreement (as of July)
The CARE Act was widely touted as a solution for people stuck in the so-called “revolving door” between chronic homelessness, jails and hospital stays. When Gov. Gavin Newsom signed it into law, he called it “a paradigm shift” that was “offering hope and a new path forward for thousands of struggling Californians.”
El Dorado mother struggles to find a solution for her son
Diane Rabinowitz doesn’t think the program is working in El Dorado County. She spent the summer months worried she would see her son, Tariq, land in the emergency room or a county jail cell before she could get him connected with care. Now 34, Tariq has struggled with severe mental illness since he was a teenager and has been diagnosed with schizophrenia.
The years have been filled with numerous stints in psychiatric hospitals, arrests, time behind bars in county jails and winding paper trails of court and medical records.
“When your loved one is very sick and self-destructive, in a way you’re like relieved, because you know where they are and know they have a bed to sleep in,” said Rabinowitz, who also leads the board of El Dorado County’s chapter of NAMI, the National Alliance on Mental Illness.
More recently Rabinowitz has looked to CARE Court in El Dorado as one possible solution to finally bring Tariq toward services and treatment. She faced difficulty in June, she said, because she was unable to get help from the county filing the petition.
She said that interacting with the courts can be an intimidating process, especially for those who haven’t had to work with the courts or hire a lawyer.
“I’m waiting until he gets hospitalized again,” Rabinowitz said last June, adding that a hospital director is another authority who can sign off on the petition.
By August, her son was arrested on trespassing charges and booked in the El Dorado County jail. At the urging of a friend who works in mental health, she decided to file the petition again. Rabinowitz is also hoping the court will approve a conservatorship for her son, which would give her more legal authority to steer her son toward psychiatric hospitalization.
Rabinowitz said she believes an assisted outpatient treatment program could also be a good fit for her son. Those programs, which have been available for counties since 2002, provide similar services to CARE Court but are court-mandated instead of voluntary. El Dorado County is not among the patchwork of California counties that run such programs.
The agreements made under CARE Court are largely voluntary. Judges also have the option of placing someone on a court-mandated CARE plan for treatment. None of the courts in the four-county Sacramento region have placed someone on a court-mandated CARE plan, according to records acquired by Abridged. A total of 19 people have been placed on the voluntary CARE agreements.
As for CARE Court, Rabinowitz said, “there’s nothing really of substance there.”
Her saga appeared to be heading to a close in late September. Rabinowitz said she was thrilled when the county responded to her petition. They told her they would pursue conservatorship for her son and CARE Court options as a second-choice.
“The struggle that we have to endure to get homeless people with mental illness off the street and into care, there‘s something just not right about that,” Rabinowitz said.
Some program candidates lack family, roommates to help them
Mario Garcia, director of the legal clinic at Loaves and Fishes in Sacramento who works with homeless residents and those with severe mental illness, said that so far, the program is of little use.
“I’m not even sure who would recommend them for CARE Court,” Garcia said. “A lot of them don‘t have families, they don‘t have roommates.”
Some of the people who show up at Garcia‘s door might not know what time it is, let alone be able to keep track of when a court date is or find transportation to the courthouse.
“I don‘t know if these individuals are capable of committing to these plans,” Garcia said.
Some people with severe mental illnesses may experience anosognosia, or a symptom that prevents them from having insight about the existence of the illness.
“It can be extremely difficult for family members in particular to impress upon that person that they need help because they don‘t see anything as wrong with them,” said Jen Boschee-Danzer, the director of Yolo County‘s NAMI chapter.
Boschee-Danzer said that she wasn’t surprised that the program had low use in Yolo County, as she doesn’t hear much interest from local families in the program nor much from the county about it. She added that CARE Court is potentially a useful tool for families with loved ones with schizophrenia to know about, but some worry that “there‘s no teeth” to it.
Is low use a good sign?
One county official said low use of Care Court may be a good sign.
“It would be my hope that we‘re successful in engaging before they rise to the level of requiring court-mandated service,” said Jim Diel, acting behavioral health director in El Dorado County.
The latest point-in-time count of unhoused people in El Dorado County was 284 in 2024. Diel said that number is small enough that the county can work with all on an individual level.
“I’m not sure there‘s a lot of evidence this is an effective intervention,” Diel said, referring to the CARE Court system.
Sacramento County says ‘early outcomes show promise’
While Sacramento County has a higher use rate, the number of people living on the street and with severe mental health is higher as well. Sacramento’s point-in-time count found 6,615 unhoused people in 2024.
Sacramento County has dismissed 32 referrals and petitions for CARE Court so far and refers some people to other treatment programs maintained by the county, including assisted outpatient treatment. County leaders say that the program is still gaining momentum and that “early outcomes show promise,” according to a July update.
County Behavioral Health Director Ryan Quist pointed to a number of challenges that make the CARE Court an uphill battle. County health workers have difficulty finding people who might be in an encampment or in “questionably safe environments” workers have difficulty accessing, Quist said. Other times, individuals may not recognize that they need support.
“What’s important to note is that the data doesn’t show the whole picture,” Quist said in a statement. “When an individual’s petition is dismissed from the CARE Court process, BHS staff work to link those individuals to other programs that are better suited.”
Newsom signed an expansion of the CARE Act into law on Oct. 10. Senate Bill 27 makes more people elligble for the program by including people diagnosed with bipolar I disorder with psychotic features. The expansion also requires county judges to consider CARE Court as a “frontline option” for misdemeanor defendants with serious mental illness, according to the Governor’s Office.
Felicia Alvarez is a reporter at Abridged covering accountability. She has called Sacramento home since 2015 and has reported on government, health care and breaking news topics for both local and national news outlets.