Newsom Calls Out San Francisco on Mental Health Courts

The mental health court program, officially the Community Assistance, Recovery, and Empowerment (CARE) Act, was signed into law in 2022. It creates a new civil court process to connect individuals with severe mental illnesses, such as schizophrenia spectrum or other psychotic disorders, with treatment and housing resources. The program is designed as an earlier intervention to prevent psychiatric hospitalizations and incarcerations. San Francisco was one of the first seven counties to implement the CARE Act, starting on October 1, 2023. However, by late 2025, the city had seen only 92 petitions filed to refer people into the program. Of those, 60 were dismissed, 18 resulted in treatment agreements, and fewer than 11 individuals had successfully completed the program. Governor Newsom designated San Francisco as one of 10 "underperforming" counties, a list that also includes Los Angeles, Orange, and Santa Clara counties. In contrast, he highlighted 10 "CARE Champions," such as Alameda, Marin, and San Mateo counties, for their successful implementation and higher per capita petition rates. In response to the slow rollout, Newsom has threatened to redirect funding from underperforming counties to those that are successfully implementing the program. He indicated he might propose these changes in his revised state budget in May, a move that would require legislative approval. The state has already appropriated over $424 million for the program. A spokesperson for San Francisco's mayor stated that the city welcomes state support to strengthen its CARE Court. The city also pointed to its broader efforts to address the crisis on the streets, including reimagining outreach and adding treatment resources. The state plans to provide additional support to the "underperforming" counties through a "CARE Improvement and Coordination Unit," which will offer targeted technical assistance and training. This is part of a broader accountability effort to ensure the program is effectively utilized. Challenges to the CARE Act's implementation have been noted across the state, including a shortage of housing and treatment beds. Civil rights groups have also raised concerns that the program could be coercive and disproportionately affect people of color. Statewide, the CARE Act was initially expected to serve 7,000 to 12,000 people annually. As of January 2026, there had been 3,817 petitions filed across California. The state also reported over 4,000 "diversions," where individuals were connected to services without a formal court process.