California’s CARE Court is a court-based effort launched in 2023 to connect some of the state’s most vulnerable residents with severe mental illness to treatment when voluntary efforts have failed. Gov. Gavin Newsom said Monday that the rollout has not moved fast enough across all counties, and he warned that he may redirect funding away from counties he described as behind. The governor spoke during a news conference at a mental health campus in Alameda County as his administration compared county performance using metrics tied to CARE Court petitions.
During the briefing, Newsom named Los Angeles, Orange, San Francisco, Santa Clara, San Bernardino, Kern, Riverside, Yolo, Monterey and Fresno as counties he said are underperforming in implementing CARE Court. He linked that performance to outcomes for people living with severe mental illness, including those in crisis who, in his administration’s view, have not been moved into treatment and related supports quickly enough. “I’m happy to redirect every damn penny in these programs to the counties that are getting things done, period, full stop,” Newsom said, adding: “Unless they stop doing what they’ve done. Don’t make any more excuses.”
California’s CARE Court program has been implemented in stages. The state rolled it out in eight counties at the end of 2023, and the administration said it was adopted across the entire state by December 2024. Newsom framed the program as a way to reach people whose severe mental illness is in the grip of psychosis and who may be unable to take care of themselves because other treatment paths have not worked.
At the same news conference, Kim Johnson, secretary of the California Health and Human Services Agency, cited state numbers reflecting petitions and court outcomes. Through January, the state received 3,817 petitions for care on behalf of people with mental illness, and Johnson said judges approved 893 treatment agreements. Johnson said judges ordered 32 people into CARE plans when a participant would not agree to, or did not follow, a voluntary treatment agreement. The governor’s administration had previously estimated between 7,000 and 12,000 Californians would qualify for CARE Court. Johnson said more than 4,000 people were diverted away from the CARE program and received services another way, and she also outlined which counties she said were doing better on implementation.
Newsom’s administration calculated county “success” using the number of CARE Court petitions received per capita, labeling the 10 counties with the highest number as “CARE champions” and the 10 with the lowest as “CARE ICU.” The governor highlighted counties he said are doing well using CARE Court to connect people with treatment, including Alameda, Humboldt, Santa Barbara, Tuolumne, Marin, Napa, Merced, Sutter, San Mateo and Imperial. He said counties on the “CARE ICU” list would receive extra help from the state’s CARE Improvement and Coordination Unit, though he did not specify what the assistance would include beyond saying the state already is working with some communities to provide technical support and training.
Newsom spoke from inside an under-construction wing of Regis Village in Alameda, a mental health campus that includes 44 beds prioritized for people in CARE Court. He also invited Alameda County Judge Sandra Bean, who oversees the county’s CARE Court program, to share examples of outcomes. Bean described a woman living with a developmental disability, a substance use disorder and a significant mental illness who, she said, now has her own apartment and is taking medication. “We’ve had a number of people who have done really, really well,” Bean said.
Other officials and counties disputed or questioned parts of the administration’s approach. Orange County said it was quick to challenge Newsom’s assertion that it was lagging, according to an email from the OC Health Care Agency, which said it is “utilizing the CARE intervention fully.” In that email, the agency said Orange County has received 231 CARE Court petitions and has 79 participants who have agreed to treatment and are receiving housing, medication and other services. “It’s not just about how many petitions you have, which we have the fifth highest in the state, it’s about the services provided helping change the trajectory of untreated disease,” the agency wrote.
The administration’s metrics also drew criticism in the details of how counties are compared. The administration’s per-capita petition calculation does not, critics said, account for other measures such as CARE agreements reached, petitions dismissed without someone getting treatment, or the number of people who have graduated from CARE Court. The CalMatters investigation referenced by the news story reported that CARE Court has served fewer Californians than initially anticipated and that some families who had expected the program to help loved ones with severe mental illness have been disappointed, while describing challenges in moving people from streets into housing.
Newsom did not specify what exact funding amount might be at risk in counties that do not increase what his administration sees as CARE Court performance. He said new money would be directed toward programs that can support CARE Court participants, including $131.8 million in Homekey+ awards funded by Proposition 1 to create 443 homes for people needing substance use and mental health services. The administration also rolled out another $159 million in Homeless Housing, Assistance and Prevention dollars, part of the $1 billion allocated in the 2024-25 budget.