BY MARIJKE ROWLAND

CV Journalism Collaborative

As Modesto resident Richard Cardoza beamed down at the certificates in his hands, his personal achievement – becoming the first person in Stanislaus County to successfully complete a new mental health court program – meant different things to different people. 

Backers of CARE Court – a controversial civil judicial division that can order people with certain mental illnesses into treatment – heralded Cardoza’s graduation as proof of its potential to help people access treatment and get off the streets.

Critics of CARE Court, including many who work in mental health advocacy, said it points to what they see as the program’s overall inefficiency, exorbitant price tag and potential to strip its participants of their civil liberties. 

For Cardoza’s family, who over the past 30 years have seen him come in and out of their lives – and sometimes jail – because of his substance abuse and mental health issues, it represented a shot at getting their son and brother back. 

And for Cardoza, a 44-year-old Turlock native who hadn’t had stable housing in more than 20 years before entering CARE Court, his accomplishment meant the return of something he had lost – hope. 

“(Before CARE Court) I was not doing too good – drinking too much and lost everything,” he said at his graduation ceremony in December. “Lost my license, lost my vehicle, lost a couple friends.  I was kind of in a deep, dark place.” 

At the start of December of last year, California launched its much-debated CARE Court program across the state. Stanislaus was one of seven counties to launch the new program more than a year early in October 2023.

Passed in 2022, the Community Assistance, Recovery, and Empowerment (CARE) Act that created the court is among a series of sweeping state mental health policy changes championed by Gov. Gavin Newsom that have been touted as a way to tackle the state’s homelessness crisis. 

The new civil division oversees petitions to get people with untreated schizophrenia spectrum and other psychotic disorders into county-funded treatment programs.

While participation in CARE Court is voluntary, after entering the program those who cannot come to a CARE Agreement with the court on treatment direction – which can include housing, medication and other mental health services – will be put in CARE Plans which are court ordered and more strictly monitored. 

People do not have to be unhoused to qualify for CARE Court, nor do they need to be eligible for public assistance. Family members and roommates, law enforcement and first responders and mental health and medical professionals can file petitions with the court on people they believe need the services. 

Fewer petitions filed than expected for new mental health judicial division

After the 14-month pilot period, the Stanislaus court received 67 total petitions, according to data from the county Behavioral Health and Recovery Services, which oversees the outreach and treatment portions of the program. At the start of the pilot, county officials had estimated some 90 to 120 petitions would be filed annually, while the state projections for the first year were set at around 100. 

Of those 67 petitions, only about half have met eligibility requirements and agreed to enter the court program. That includes 30 people who came to voluntary CARE Agreements for treatment and one person in a court-ordered CARE Plan, according to BHRS. Another four cases were deferred while eligibility was being determined. The remainder of the petitions either did not qualify or were dismissed for nonparticipation or other legal or medical issues. 

Stanislaus’s lower than initially projected petition numbers mirror that of other pilot counties across the state. The San Francisco Chronicle reported that San Francisco had only received 42 petitions in its pilot year, well below its 1,000 to 2,000 petition estimate.

Some 869 CARE Court petitions were filed from October 2023 to October 2024 in the early adopting counties, according to the Judicial Council of California.

Across the state, CARE Court was projected to help between 6,000 and 12,000 people annually. Comparatively, the state had some 186,000 people living on the streets or in shelters in 2024, according to its annual count of the homeless population.  

In Stanislaus County, the cost of operating CARE Court for the first six months totaled just over $1.1 million. That included staffing 15 new positions, providing housing, treatment and other services to participants, paying public defender and county counsel costs and covering other administrative expenses. More updated totals for the entire pilot period were not available at the time of publication. 

While 31 people placed into treatment may not seem like a large number, county behavioral health leaders said what CARE Court has really done is give them another way to engage people in need and provide them with treatment and housing.

Of those in treatment in Stanislaus County, 27 were unhoused before entering CARE Court. Some 70%, or about 20 of those people, are now housed through the program in either transitional housing or with family. 

Stanislaus County CARE Court Manager Chandra Campbell said the program has allowed Behavioral Health staff to do more outreach. Even when they speak with people who ultimately do not meet the court’s narrow mental health criteria, they link them with other area programs.

“From the very beginning, a lot of focus has been on the number of petitions that we receive,” Campbell said. “‘How many petitions are there?’ But that is just such a small marker of success for this program. I think that has been probably the biggest win for the CARE Court program, is just our ability to get out in the community and engage people about our services.”

She said another marker of their success has been their ability to then get people into the less restrictive voluntary treatment agreements, instead of the court-ordered plans. 

Critics cite civil rights concerns, costs and low participation 

But critics of the program contend that despite being labeled as voluntary, the process is inherently coercive. Statewide advocacy groups like Disability Rights California and Cal Voices, a peer-support services nonprofit, have strongly opposed CARE Court and other Newsom-backed mental health changes, including the recently passed Proposition 1. 

Critics have compared the agreements to plea deals. The participants, called respondents in the system, are assigned a deputy public defender who works with county counsel as cases make their way through the courts.

Samuel Jain, the senior mental health policy attorney at Disability Rights California, said while agreements may technically be voluntary, the alternative is court-ordered treatment. If someone does not successfully complete that plan after a year, an additional year of involuntary treatment could then be ordered by the judge. After that, if a person still hasn’t successfully completed the plan they can be referred to conservatorship. 

People in conservatorship can be legally stripped of their civil liberties and bodily autonomy. That can include everything from forced treatment to institutionalization. 

“(CARE Court is) part of a number of behavioral health reforms initiated by Governor Newsom in the past three years to really scapegoat people with mental health disabilities for our state’s housing failures,” Jain said. “Ultimately, what these bills are going to do is they’re going to increase the number of people who are institutionalized. And they’re not going to address homelessness.” 

Jain also derides the program’s price, which primarily pays for additional behavioral health staffing and court-associated costs, given the low number of eligible petitions. Funding for the program does not support any additional housing or treatment programs. Housing for those in the program is paid out of existing budgets.

“The CARE Court program pulls money from services that Californians really desperately need,” Jain said. “It pays for an expensive and unnecessary legal process, when what people really need is they need more housing and preventative services…We see care court as a significant misappropriation of resources.”

“Ultimately, what these bills are going to do is they’re going to increase the number of people who are institutionalized. And they’re not going to address homelessness.” 

Samuel Jain, senior mental health policy attorney at Disability Rights California

Indeed, it is the housing element of CARE Court that Cardoza said has helped him most. CARE Court participants get priority for available treatment and housing because otherwise counties could be fined by the court for not providing required services. 

While Cardoza had tried outpatient treatment before, the lack of a stable place to stay led to failure. He said before his older brother filed a petition for him to enter the program last year, he was either “drinking or high or doing something stupid.”

Before CARE Court, Cardoza –  who has been diagnosed with anxiety, bipolar disorder and being on the schizophrenic spectrum – wasn’t taking his medication.  

While initially he was reluctant to enter the program. His past experiences made him wary. But he agreed and gradually, he said, the program won him over. 

“I never really liked the programs – it felt like it wouldn’t really work or anything,” he said. “But after getting used to it, I kind of learned to like it…plus it gives me a place to stay over here and helps me with housing and paying for everything and they feed you. You start looking back like, well, this is a lot better than being out there on the streets. Roof over my head, a place to sleep, definitely beats all that.”

Some families see court process as a lifeline for untreated loved ones

Shortly after the pilot launched in November 2023, Richard’s 57-year-old brother Don Cardoza heard about the program from a TV news report. He was intrigued, but worried what filing the petition on his brother would do to their relationship. Still, despite his hesitations, he took the leap to get Richard into treatment.  

In Stanislaus County, while most pilot petitions have been filed by behavioral health staff ( 27 total), the second-highest were referrals from family members, like Don (21). 

While Richard was resistant at first, Don said what has made the difference has been the housing and follow-up from his care team. 

“It’s been pretty rough going,” Don said of his brother’s addictions and mental health struggles. “I know some people have a certain point, a level where they break off from your family…but I was pretty determined. I felt like if I didn’t do something, I wouldn’t have a brother.”

He is also happy that the program, and his brother’s housing, was voluntarily extended for a year so he can continue to work on himself and rebuild his relationships. 

Richard’s brother, mother and stepfather all attended his graduation at Tenth Street Place last month. Stanislaus CARE Court presiding judge Marcus Mumford oversaw the ceremony, and representatives from behavioral health, law enforcement, the courts and county government all attended and applauded Cardoza for his efforts. 

While those on CARE Agreements are only required to attend progress review hearings every 60 days, Mumford said, participants in Stanislaus County have, in practice, met with the judge more like every 15 to 30 days. Those in CARE Plans have their initial hearings within 14 days of establishing eligibility for the program, followed by more regular hearings and check-ins with the court. . That closer monitoring, the judge said, makes a difference. 

“(I’ve) had many discussions with Richard over the course of the year about the importance of mental health stability, taking his medications, reporting,” Mumford said. “Richard told me that he wanted to reunite with his family because he was on the outs with them…. And I told him, Well, you’re in charge of that. You know, if you take your medications and you participate in the program your family will be willing to welcome you back with open arms. And Richard knew that, and so he did it, and he applied himself.”

Stanislaus Behavioral Health Recovery Services Director Tony Vartan said another key to the program’s launch locally has been its collaboration across departments – including police, hospitals and county agencies – and consistency of care. Once in the program, people like Richard work with the same team throughout their treatment. 

“The majority of our services are voluntary services,” Vartan said. “Our teams, even before the CARE Act, have been providing services under the bridges, in the streets, engaging people into voluntary services. We know that the statistics and the studies show voluntary services do work.”

He said the county will continue publicizing the program, and expects similar if not higher numbers of petitions in coming years. Vartan also anticipates additional staffing will be needed to satisfy new data collection rules passed last year. 

By law, respondents can keep their cases and identities confidential, and little information is publicly available about the demographic breakdown of the pilot program’s respondents so far. Stanislaus County officials declined a request for anonymous data on respondents including information on race, gender and age. 

Some of the pilot counties, San Diego and Riverside, released anonymous demographic data for their programs showing higher numbers of Black and Latino respondents. For instance, in both Riverside and San Diego counties the total number of Black respondents was about 13.5%, while Black residents make up only 7.6% and 5.7% of those counties’ overall populations, respectively.

Besides CARE Court, new laws will reshape state mental health policy

With its statewide rollout in December, CARE Court is also the first in a series of changes that will upend California mental health policy for years to come. They include Prop. 1, which was narrowly passed by voters last March and approved $6.4 billion in bonds for largely institutional treatment and housing facilities and structural funding changes for county mental health departments, and SB 43, which expands the criteria for who can be placed in involuntary conservatorship. 

Stanislaus County Assistant Chief Executive Ruben Imperial said he sees these new laws working hand-in-hand. So while CARE Court aims to only address a small segment of the population with psychotic disorders, when implemented in conjunction with the other new policies he is still hopeful it will have an impact on the state’s homelessness crisis. 

“We don’t see CARE Court as just the stand alone thing that’s going to solve the problem of homelessness,” he said. “But I do believe, with several changes at the state level and how local counties are going to deploy behavioral health resources (including Prop. 1 and SB 43), all of that is going to ultimately serve that number of people that need help.”

For people like Richard Cardoza, who have gone through the system, arguments for and against CARE Court are the last thing on his mind. Instead he’s thinking about getting his license back, and then his car. After that, maybe his own place and a job – possibly in drug counseling. 

He said what helped him most, besides the housing, was the staff and counselors who worked with him every day.

“They show that they’re not just working, making money – that they actually want to help,” he said. “You know that motivates you…you care about me, you’re trying to do all this for me. I want to prove that, okay, I could have hopes, achieve. Finish up this and then move on – something big, get back out there and do good.”