The California CARE Act is a civil court process that connects adults with severe, untreated schizophrenia-spectrum or other psychotic disorders to behavioral health treatment, stabilization medication, and housing support. Created by Senate Bill 1338 and formally called the Community Assistance, Recovery, and Empowerment Act, it sits between full conservatorship and purely voluntary services. The law launched in a handful of counties in 2023 and expanded to all 58 counties on December 1, 2024.
A CARE case can end in one of two ways: a voluntary agreement between the person and the county behavioral health agency, or a court-ordered plan if no agreement is reached and a clinical evaluation confirms the person meets the criteria.
Who Qualifies
Eligibility is narrow. A person must meet every one of the following, not just some:
- Be 18 or older.
- Have a current diagnosis in the schizophrenia spectrum or other psychotic disorders category of the DSM. Psychotic symptoms caused by a medical condition such as traumatic brain injury, dementia, or neurologic conditions do not qualify.
- Not currently be stable and engaged in ongoing voluntary care.
- Either be unlikely to survive safely in the community without supervision while substantially deteriorating, or need services to prevent a relapse likely to cause grave disability or serious harm.
- Have no less restrictive alternative that would work.
- Be likely to benefit from participation.
Bipolar disorder, major depression, and anxiety disorders do not qualify on their own. A substance use disorder alone does not qualify either, though a person can have both a substance use disorder and a qualifying psychotic disorder.1California Legislative Information. California Welfare and Institutions Code WIC 5972
Who Can File a Petition
The law lets a wide group of people start a case, not just relatives. Petitioners can include parents, siblings, grandparents, and adult children; someone living with the person; peace officers, firefighters, paramedics, mobile crisis teams, and homeless outreach workers; a behavioral health provider who has treated the person within the past 30 days; hospital directors; public guardians; directors of Adult Protective Services; directors of California Indian Health Services programs; and tribal court judges.
The person themselves can also file. A self-petition is an option for someone who recognizes they need structured help but can’t access it on their own.2Contra Costa Health. CARE Act
How to File
The petition is filed in the superior court of the county where the person lives. The main form is the Petition to Begin CARE Act Proceedings, Form CARE-100, available at any California courthouse or through the Judicial Council.3California Courts. Petition to Begin CARE Act Proceedings Most e-filing vendors waive the filing fee for CARE petitions.4California Courts. How to File the CARE Petition
One of two supporting documents must come with the petition. The first option is a Mental Health Declaration, Form CARE-101, completed by a licensed behavioral health professional who examined the person within the last 60 days, or who explains that they tried multiple times to examine the person but could not. The declaration states that the professional believes the person meets the CARE criteria.5California Courts. Mental Health Declaration – CARE Act Proceedings CARE-101
The second option, used when no professional examination is available, is evidence that the person was detained for at least two periods of involuntary intensive treatment under Welfare and Institutions Code section 5250, with the most recent period within the past 60 days. A standard 72-hour hold under section 5150 does not count, and neither do holds under sections 5260 or 5270.15.4California Courts. How to File the CARE Petition
What Happens After the Petition Is Filed
A judge first reviews the petition to see whether it shows on its face that the person meets or may meet the criteria. If it clears that review, the court orders a county behavioral health agency to engage with the person and file a written report within 14 business days.6California Courts. Process After CARE Petition Filed
If the county report supports the showing, the court schedules an initial appearance and appoints an attorney at no cost for the person, who is called the respondent. If the judge finds merit after the initial appearance, the court orders a clinical evaluation by a licensed professional, and a hearing on the merits follows. The merits hearing can run at the same time as the initial appearance if everyone agrees, or it can be set for later. The judge can order county behavioral health departments to provide specific assessments and services during the proceedings.6California Courts. Process After CARE Petition Filed
CARE Agreement vs. CARE Plan
A CARE agreement is voluntary. The respondent and the county agency negotiate an individualized package of services, and the respondent agrees to participate. A CARE plan is court-ordered and comes into play only if no voluntary agreement is reached and the clinical evaluation confirms the person meets the criteria.7California Courts. About the CARE Act
Both can contain the same kinds of services: clinical care, counseling, specialized therapies, stabilization medications, a housing plan, and other community-based support. The difference is judicial authority behind the plan, and one important condition on medication. A court-ordered plan can include medication only if the judge finds by clear and convincing evidence that the respondent lacks the capacity to give informed consent to it.7California Courts. About the CARE Act
What a CARE Plan Can Include
Plans are tailored to the individual, and the law requires services to be delivered in the least restrictive setting that works. Typical pieces include stabilization medications overseen by medical professionals, case management, counseling, specialized treatment programs, and a housing plan for stability during recovery. The court can order county agencies to prioritize the respondent for specific services, subject to available funding.8California Legislative Information. California Welfare and Institutions Code WIC 5977.1
The Supporter Role
The respondent can choose a supporter, an adult who helps them understand the proceedings, make decisions, communicate preferences, and work through the system. The supporter uses a supported decision-making framework, meaning they help the respondent exercise their own choices rather than deciding for them. Supporters cannot sign documents for the respondent or make decisions on their behalf except to prevent imminent physical harm. Their conversations stay confidential and privileged, and they cannot be subpoenaed to testify against the respondent.
The respondent’s attorney explains the option before the initial appearance. The respondent can decline a supporter or change supporters at any time. The court can remove one only for an unmanageable conflict of interest.
Limits on Medication
Even when a court includes medication in a plan after the capacity finding, the medication cannot be forcibly administered. If the respondent refuses to take it, that refusal cannot result in contempt, penalties, or removal from the CARE plan.8California Legislative Information. California Welfare and Institutions Code WIC 5977.1 The court can make medication available and recommended, but it cannot physically force pills or injections through the CARE process.
How Long It Lasts
A CARE plan runs up to 12 months. In the 11th month, the court holds a status hearing to decide whether the respondent should graduate or continue for up to one more year. If the respondent wants to graduate, the court orders a graduation plan and schedules a graduation hearing in the 12th month. After graduating, the person stays eligible for ongoing treatment, housing, and supportive services in the community.
A respondent who did not complete the plan but wants to keep going voluntarily can request up to one more year, which the court grants if it finds the person would benefit. Involuntary reappointment is possible only once, for up to one additional year, and only if the court finds the person still meets the criteria, that all required services were actually provided, and that the person would benefit from continuing.9California Health and Human Services. CARE Court FAQ
When CARE Can Lead to Conservatorship
If a judge develops serious concerns about the respondent’s safety at any point, the judge can use existing authority under the Lanterman-Petris-Short Act to have the person evaluated for more intensive treatment or considered for conservatorship. County behavioral health agencies can start that process on their own as well.
The law also sets a specific consequence for someone who was offered all the services in a CARE plan and did not participate. If conservatorship proceedings are brought within six months after termination from CARE, the person’s failure to participate creates a presumption that they need intervention beyond what the CARE plan provided.9California Health and Human Services. CARE Court FAQ
Rights the Respondent Keeps
A court-appointed attorney is provided at no cost as soon as the initial appearance is scheduled. The respondent keeps decision-making authority through the supported decision-making framework, can choose or decline a supporter, and can request graduation at the status hearing. Refusing medication cannot be used as grounds for punishment or removal. Services must be the least restrictive alternative that works, so the court cannot default to institutionalization when community-based services would do the job. Termination from CARE does not cut off access to the behavioral health services and supports the person would otherwise qualify for.
Where the Debate Stands
Disability rights organizations, peer advocacy groups, and civil rights organizations have criticized the law on several grounds. They argue it conflates homelessness with mental illness in ways that stigmatize people with psychiatric disabilities; that the court process is coercive even when labeled voluntary, because declining to agree can lead to a court-ordered plan; and that the money spent on court infrastructure would do more good invested directly in community mental health services that are already proven but underfunded.
Early implementation data has also raised concerns about racial disparities, with critics pointing to disproportionate impacts on Black, Indigenous, and other people of color, and noting that the program has had trouble connecting participants with housing and adequate services. Supporters of the law respond that existing voluntary systems were failing the most seriously ill Californians and that the judicial structure creates accountability for counties that were not delivering services. How the law plays out will turn largely on whether counties receive and direct enough funding to provide what CARE plans promise.