City of San Diego Urging CARE Court Reforms

San Diego Mayor Todd Gloria is co-sponsoring state legislation that could lead to more conservatorships for people with serious psychotic illnesses who languish in the CARE Court process. 

A few years ago, Gloria was among the CARE Court proponents who envisioned that people who struggled in the program could end up in involuntary treatment. 

“While CARE Court is not conservatorship, it could eventually lead to conservatorship,” Gloria said at a May 2022 press conference announcing the legislation championed by Gov. Gavin Newsom.  

The law Newsom signed later that year hasn’t played out that way in San Diego County. County officials say CARE Court isn’t a pathway to conservatorship and report that no CARE enrollees have ended up on conservatorships as a direct result of the process. They emphasize that CARE is a voluntary program and only enroll people who choose to participate. While the county and others have hailed San Diego’s CARE Court rollout as the most successful in the state, these moves don’t match the rhetoric that surrounded the legislation. 

The city of San Diego and its police department are among those frustrated with the county’s approach. They argue that San Diegans in the gravest conditions often aren’t willing to accept treatment voluntary – and that these individuals often most disturb other San Diegans and generate emergency calls. 

Since the county isn’t proactively exploring potential conservatorships for struggling CARE participants, Gloria teamed with state Sen. Ben Allen of Santa Monica and the California State Association of Psychiatrists on SB 367. The bill that would give other players –including Superior Court judges who oversee CARE cases – the authority to request investigations that could lead to involuntary care.  

For now, only the county can directly issue those orders and it says it hasn’t pursued any. The county does say its teams have called first responders – namely Psychiatric Emergency Response Teams and Mobile Crisis Response Teams – “many times” when they have encountered people in crisis during the CARE process. It’s unclear how many of those calls led to up to 72-hour evaluation holds that sometimes trigger the process for longer-term conservatorships. 

SB 367 would allow stakeholders including judges, emergency room doctors and psychiatrists to request investigations by county conservators’ offices. Allen said the goal is to empower more players to act and help vulnerable people with psychotic illnesses avoid unnecessary encounters with police or hospitals.  

“The hope is by allowing more people the authority to refer for a conservatorship investigation more people in need will be considered for the appropriate level of care,” Allen told Voice of San Diego. 

Gloria spokesperson Rachel Laing struck a similar tone in a statement. 

“This legislation will address gaps in existing law to ensure the extremely vulnerable people we’re trying to help can access care,” Laing wrote. 

Since San Diego County’s CARE Court program rolled out in October 2023, the county reports that it has reached 105 voluntary treatment agreements that have helped participants stabilize, access medication and move off the street.  

In a statement, the county emphasized this statistic and described CARE as a “valuable new tool to address community mental health needs.” It also emphasized how its program has been viewed across the state. 

“The local implementation of the CARE Act is widely regarded as the most successful in the state,” county spokesperson Tim McClain wrote in a statement. “From our vantage, the San Diego County Superior Court has thoughtfully considered, approved, and monitored individually tailored services delivered for each of the 105 participants. We look forward to continued success.” 

But as of last week, 49 of 285 CARE petitions for treatment – or 17 percent – were dismissed because a person refused to participate.  

Statistics like these and the city’s own experience with CARE have led city officials to conclude that the voluntary program is leaving behind the most vulnerable San Diegans.   

In partnership with the state psychiatrists’ association, the city and its representatives have urged legislative tweaks including SB 367 to ensure people whose conditions are deteriorating are linked with treatment whether or not they agree to participate in CARE Court. This push has been a focus in meetings with legislators and in an October memo to Gov. Gavin Newsom before a virtual gathering with his team this fall. 

“CARE cannot help the severely mentally ill when voluntary willingness is the only way to enter the program,” unnamed city officials wrote in the October memo. 

San Diego Police Officer Dave McGowan of the police department’s Intervention Services Unit, which typically focuses on people in crisis who often generate lots of police calls, said people with psychotic illnesses who police are called to help often aren’t being pushed into treatment.   

McGowan argued that people in the gravest conditions whose behavior most disturbs other San Diegans often aren’t willing or able to voluntarily accept treatment and noted that CARE Court doesn’t factor in whether a person is generating a significant number of emergency calls when considering who qualifies. (The latter is something the city is also lobbying to change.) 

McGowan, who has submitted multiple unsuccessful CARE petitions, said the department has watched multiple patients languish after petitions were dismissed. He declined to detail specific cases, citing federal privacy protections. 

Through mid-January, county data showed 12 of the 48 CARE petitions submitted by first responders including police officers resulted in voluntary care agreements.  First responder submissions accounted for 19 percent of CARE petitions in the program’s initial 15 months. 

The city noted in its October memo to Newsom that some patients’ use of emergency medical services spiked after CARE Court dismissals.  

“We need options for those who are unwilling or unable to engage voluntarily,” McGowan told Voice earlier this year. 

Amber Irvine, program manager of the county’s CARE Court program, said last month that the city isn’t seeing the whole picture – and that the county isn’t giving up on vulnerable San Diegans. She said the county engages a person repeatedly after a petition is submitted and asks other outreach teams to follow up after dismissals in hopes of connecting them with treatment. 

“I think there’s some unrealistic expectations around the timeframes of being able to effectively engage someone,” Irvine said.  

Now the city is pushing legislation to give stakeholders other than the county power to order evaluations during the CARE process and beyond.  

Dr. Aaron Meyer, vice chair of governmental affairs for the state psychiatrists’ association, said Allen’s bill is an attempt to create the connection between CARE Court and conservatorships that was originally envisioned. 

“SB 367 brings back the initial goal of CARE Court in being able to directly refer for a conservatorship investigation,” said Meyer, also a UC San Diego psychiatrist and the city of San Diego’s first behavioral health officer. 

Meyer and city officials argue other changes are also needed to the CARE Act.  

Among the other items on their laundry list of proposed tweaks: Updates to confidentiality protections in the CARE ACT they say can now make it difficult for first responders and other medical providers to make the case for involuntary treatment. They also want to allow government agencies rather than just individuals to list themselves as petitioners when recommending someone as a CARE Court participant, updates to forms that petitioners must file and more data reporting to track outcomes for people who were the subject of CARE petitions. 

For now, the city’s lobbying continues.  

The county says it will “monitor any proposed amendments to the (CARE) Act.”