San Diego’s CARE Court Is Serving Those Formerly in Conservatorships

CARE Court supporters pitched it as a solution for people with serious untreated psychotic disorders. San Diego’s program is also serving people exiting involuntary treatment.

 

by Lisa Halverstadt

Judge Kimberlee Lagotta, who led San Diego Superior Court's CARE Court implementation, and county Behavioral Health Services Director Luke Bergmann during the CARE Act program press conference at the County Administration building in downtown on Sept. 27, 2023. / Photo by Ariana Drehsler

San Diego County’s rollout of CARE Court hasn’t been what many expected – not even the author of the legislation that created the program. 

Proponents touted CARE Court as a way to get thousands of people with untreated psychotic disorders into treatment through court-ordered plans. San Diego County officials, however, have held back from forcing people into treatment and instead made the program voluntary. Not only that, but officials have also tapped into another group for CARE Court participation: people already in the strictest level of forced treatment. 

Twenty-one percent of the 105 voluntary care agreements reached since the county’s program kicked off October 2023 were with people leaving conservatorships, according to county data.  

Conservatorships are considered a step up from CARE Court because they institute involuntary treatment and take away individuals’ decision-making power on their living arrangements and other matters. 

The county and state officials said the law allows for CARE Court to serve as a step-down option.  

They say it’s a tool to help people exiting conservatorships transition from forced care with the benefit of more support and oversight that can help them maintain stability. 

But others, including the author of CARE Court legislation, said they didn’t expect the new court system to be used this way.  

“That wasn’t part of the plan,” said state Sen. Tom Umberg of Santa Ana. 

County officials decided CARE Court was a useful tool to help people already in conservatorships avoid another round of involuntary treatment and that this matched the legislation’s overarching goal to minimize conservatorships. 

Amber Irvine, program manager of San Diego’s CARE Court program, said CARE Court can help people at a high risk of decompensating avoid returning to a conservatorship. 

“(Some patients) need to have this safety net of intensive treatments to step down to and having that court oversight piece to hold providers accountable for delivering those services,” Irvine said. 

Ann Carroll, a spokesperson for the state Department of Health Care Services, also described the conservatorship step-downs into CARE Court as an “appropriate application of the law” that prioritizes connecting patients with services in the least restrictive settings. 

Carroll and county officials separately noted a 2024 law authored by Umberg that they said clarified this. SB 42 allowed health care facilities to refer patients held on involuntary evaluation holds to CARE Court if they believe the person qualifies for this program rather than a conservatorship.  

Yet Umberg said he didn’t imagine counties would use CARE Court to aid conservatees preparing to exit those court-ordered arrangements. 

Umberg’s office also noted the California Department of Health and Human Services pushed for the legislative changes Carroll mentioned, though he agreed to them. An Umberg spokesperson said the senator may consider amending state law if he determines that most CARE enrollees are recent conservatees.  

For now, that doesn’t appear to be the case. Only a fraction of CARE enrollees in San Diego County are former conservatees. 

Still, the practice is catching stakeholders off guard. 

Attorney Samuel Jain of Disability Rights California, whose organization was one of the most prominent opponents of the CARE Act legislation, acknowledged he supported efforts to reintegrate San Diegans who had been conserved into their communities but didn’t expect that counties would do that with CARE Court. 

“It sounds like fitting a square peg into a round hole,” Jain said. “CARE Court wasn’t actually designed for this.” 

Officials with the San Diego Police Department, which has filed CARE petitions, fear the county’s approach could limit treatment access for others. 

“The CARE Act was not meant to just reduce conservatorships, it was meant to offer a lifeline for care to patients falling through the cracks in California’s mental health system,” read a statement sent by the department. 

Irvine said the county’s decision isn’t keeping anyone from accessing treatment in the program. 

“We do not have bandwidth issues,” Irvine said. 

Irvine argued that the county’s approach will minimize potential workload issues in the future because reaching care agreements with people stepping down from conservatorships can ensure they don’t experience gaps in treatment that could later require county outreach and support.  

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San Diego’s CARE Court Is Serving Those Formerly in Conservatorships