Support state CARE court efforts

Individuals with untreated MH/SUDs, but particularly untreated psychosis, are at very high risk of homelessness, incarceration, and early mortality.[1] Yet, too often, our system fails to help individuals get the help they need. Such help is especially important when the person’s illness results in agnosia, a symptom of their condition that impairs their ability to understand and perceive their own illness. Through a compassionate civil court process, states can help individuals with untreated serious mental illnesses (SMI) – particularly schizophrenia spectrum disorders and other conditions with psychosis – access clinically appropriate, community-based services.

This new approach is currently being implemented in California, which enacted the CARE Act in 2022. California’s CARE Court process allows family members, close friends, first responders, and MH/SUD providers to petition the CARE Court on behalf of an individual with untreated SMI and co-occurring SUDs.[2] The individual is provided legal counsel and is able to choose a voluntary supporter who can help the individual understand and communicate decisions. If the petition meets established criteria designed to protect the rights of individuals and ensure system accountability, the CARE Court can create a 12-month CARE plan (which can be extended to 24 months) to provide the individual with a broad range of services, including medications, recovery supports, and social services such as housing. Counties are mandated to provide these services. While medications can be ordered as part of a CARE plan, the administration of medications can never be forced.[3]

By moving upstream, California’s CARE Court is designed to prevent individuals with the most complex MH/SUD needs, who are frequently living on the streets, from much more restrictive conservatorships or incarceration.[2] Congress should support such efforts, while ensuring that states are protecting individuals’ legal and constitutional rights and building in accountability to prevent abuses.