In small counties, CARE Court gains early momentum

Could CARE Court be having some of its biggest impacts in California's smallest counties?

The numbers from the initial two years of the program suggest the intimacy of the legal and behavioral health communities in small counties has helped them get up and running more quickly than their larger counterparts.

Under the Community Assistance, Recovery and Empowerment Court (CARE) model, people in behavioral health, courts and law enforcement needed to work together in new ways. Kristin Doyle said that in her tiny county, people in these separate silos were already familiar with one another.

"We did know each other, even if we didn't work extremely closely before that, where in other counties people literally did not know who the people were in their county," said Doyle, the program manager of the adult unit of Glenn County Behavioral Health Services. "They had to form partnerships to even come to the table together."

CARE Court launched in 2023, first in seven pilot counties and then statewide last year. Gov. Gavin Newsom's signature program sought to address the state's problems with homelessness, mental illness, and substance abuse through tools like court-managed conservatorships.

In the months since, the program has been widely criticized for the small numbers of people enrolled. In California's smallest counties, there are often around a dozen people enrolled at all steps of the process.

But on a per-capita basis, some smaller counties are putting up big numbers. Amador County (population 40,000), Glenn (29,000), and Tuolumne (56,000) all top 30 petitions per 100,000 people, despite only having around 40 petitions total. By contrast, large counties like Los Angeles and Alameda have reported five to eight petitions per 100,000 people, though that means they have logged hundreds of petitions between them.

Glenn and Tuolumne did have one clear advantage: They were among the seven pilot counties.

"We're a tiny little court," said Glenn County Superior Court Executive Officer Chris Ruhl. "We're a two-judge court with 20 staff. We're the only county this small that was part of the first cohort."

He added, "There's more to the story than just the numbers."

Part of that story, Ruhl said, has been a sharp uptick in year two. There were only three petitions during the first year, he said, but about nine in the second.

"We spent a whole year prepping for CARE Court," Doyle said. "I was involved from day one."

She added that "at first it didn't seem feasible" to be part of the first cohort. But county officials decided to go for it, knowing they would eventually roll out CARE Court anyway and would be able to access additional state money by diving in early.

It's hard to compare big and small courts in California, said Judge Robert S. Harrison, who oversees Los Angeles County's mental health court. Many small counties have not traditionally had the budget to fund extensive mental health services. In Los Angeles, he said, many people are already enrolled in mental health services.

"Here, the Department of Mental Health is quite robust," Harrison said. "They have programs all over the city, and people are accessing services."

He added, "There are a lot of people that are untreated. We know that. They're just not getting into CARE Court because no petition has been filed because they're in the street, usually, and there's no family to file the petition."

Doyle and Ruhl declined to discuss any individual cases before the local CARE Court. Several other small counties declined to comment for this story, citing privacy concerns.

This reticence hints at another concern for small counties: that any minor details might give away the identity of people enrolled in CARE Court. Not only are the professionals involved in a small county known to one another, some people subject to CARE Court petitions might be well known in the local community in a way few people are in a larger city.

According to several people involved with CARE Courts in small counties, this makes it both more important and more difficult to protect the privacy of people enrolled in the process. With so few people involved in CARE Court in each smaller county, any personal details could be connected to an actual person.

But there is a positive side as well, Doyle said: more personalized relationships between staff and people under CARE Court supervision.

"If you don't have somebody the clients can connect with or isn't out there hitting the pavement and looking in the creek beds and finding the clients that are out there not coming to the office, you're not going to be successful," she said.

This is the second story in a three-part series. Catch up on the first story here.