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Newsom’s mental health court faces $50M hurdle in San Francisco as key deadline approaches

White man sits on sidewalk while speaking to Black man sitting on pavement as two other men stand nearby looking on
Gov. Gavin Newsom, far left, and Dr. Mark Ghaly, far right, speak with a homeless person in Fresno on March 10, 2022. | Courtesy California Health and Human Services | Source: Courtesy California Health and Human Services

A new court program sponsored by Gov. Gavin Newsom to compel mentally ill people into treatment is running into serious obstacles in San Francisco, according to those who are working on the program locally. 

Called Community Assistance, Recovery and Empowerment Court or CARE Court, the program became law in September but is already running into challenges in San Francisco as city officials face the daunting task of locating funding and staff for the program before an October deadline. San Francisco is one of seven cities tasked with implementing the court system first in advance of a broader statewide rollout.  

The city has received $4.3 million from the state to launch the program but estimates that treatment and housing for 400 participants would cost more than $50 million annually on top of the court’s operating costs, according to an internal Department of Public Health presentation obtained by The Standard.

Those estimates point to a potential disconnect between what CARE Court requires and what is needed for the program to succeed.

Under the law, social workers, family members and employees of the criminal justice system can refer people with mental illnesses into CARE Court, where a judge is then empowered to order them into treatment.

The legislation aims to move people with untreated schizophrenia or other severe mental illnesses into housing and treatment without force and before they require legal guardianship.  

But the city stands to be sanctioned for every person who falls out of compliance with their treatment plan and some local officials predict that a shortage of treatment beds, a lack of funding and other inefficiencies may mean that few people will benefit. The health department said in a statement that it estimates up to 2,000 people will be eligible for the court annually.

“Without additional state funding […] a potential high volume of clients may mean that San Francisco may not be able to meet the demand for all CARE Court services,” the department’s statement read.

The department said that it’s working to secure state funding to address the need for more case managers and treatment beds. 

Short on Housing, Services

Tal Klement, a mental health attorney at the Public Defender’s Office, said that despite the city’s best efforts, he’s unsure how San Francisco will meet the demand for treatment and housing that CARE Court may require. 

“There’s already people waiting for care who aren’t in CARE Court,” Klement said. “The only way you can get people to participate is by providing attractive treatment options.”

At the state level, counties often fight over treatment beds, particularly when attempting to locate long-term care for patients who need intensive case management. 

As a result, many patients who are referred to conservatorships, a mechanism that grants legal authority over a person who has been deemed unable to care for themselves, end up languishing in local hospitals and jails, inhibiting their progress and placing undue stress on frontline workers. 

The California Department of State Hospitals estimated last October that its intensive care facilities for conserved people were 99 patients over capacity. The San Francisco Department of Public Health has also acknowledged that its long-term treatment beds are usually filled. 

Newsom has contended that CARE Court will serve as an alternative to conservatorship, arguing that the program will allow people to enter treatment before they require such intensive care.  

However, if a person doesn’t comply with their treatment plan they may be referred for conservatorship, the legislation states. 

The legislation doesn’t allow for other forced treatment methods and those working on the court’s implementation are skeptical that many clients will participate at all without adequate treatment and housing options.

Several people involved in the court’s implementation cited the city’s housing shortage as potentially the program’s biggest obstacle.  

“I’m skeptical given the funding shortfall and the lack of services,” said Teresa Friend, director of the Homeless Advocacy Project. “I would be very pleasantly surprised if [CARE Court] ends up making a big difference.”

Jackie Thornhill, legislative aide for Supervisor Rafael Mandelman, who has advocated for CARE Court, said that despite the challenges, she’s optimistic that the new court will at least serve as a way to determine the need for services.

“It calls to question whether we are able to provide adequate services,” Thornhill said. “I think that calling that question and having that conversation in a public way is definitely a step in the right direction.”

David Sjostedt can be reached at