Three years ago, Gov. Gavin Newsom called for a court with real power both to force a government agency to treat a mentally ill patient, and to compel that patient to stick to the program.

In October, Gov. Gavin Newsom said, “We built CARE Court to connect people to treatment, dignity, and accountability — because care and accountability belong at the center of how we serve our communities.”

That’s how many Californians remember his CARE Court proposal: As a mandate to bring people with severe mental illness off the street and into treatment. Noncompliance, Newsom said at the time, would lead to consequences — counties could face fines for not providing court-ordered services, and participants who fail the program could be referred to conservatorship, which often means involuntary treatment in locked facilities.

But a CalMatters review of the legislative record shows that vision is not what became law, and, as a result, the state has rarely mandated treatment of a mentally ill person or referred someone to conservatorship. It has not handed down a single fine for counties that failed to provide court-ordered services to many CARE participants.

The bill went through several amendments:

• Narrowed eligibility for CARE court
• Demanded more time and information from people filing petitions
• Favored voluntary treatment agreements over court-ordered plans
• Eliminated requirements that counties provide certain services, according to a CalMatters analysis of versions of the 2022 bill.

Newsom had envisioned that 7,000 to 12,000 Californians would qualify for the program. But by July, only 528 people enrolled in treatment plans. Almost all — 514 — were through voluntary agreements instead of court-ordered plans.

Law was ambitious start

“I think the law that was promised was pretty ambitious,” said Assemblymember Ash Kalra, a San Jose Democrat and the only lawmaker to consistently vote against the 2022 measure. “It’s not surprising to me that it didn’t live up to all the hype of what was promised.”

While Newsom’s proposal sailed through the state Legislature with near-unanimous, bipartisan support, it was contentious among various interest groups.

Civil rights organizations, such as ACLU and Disability Rights California, wanted to protect the liberties of mentally ill people and fought the proposal on principle. Counties and behavioral health professionals worried about funding and execution as they pressed for adjustments to the bill text.

Some mental health advocates, including the National Alliance on Mental Illness of California, were supportive from the start. The Steinberg Institute, founded by former California Senate President Darrell Steinberg, applauded CARE Court as a “huge step forward” to protect vulnerable Californians.

But the final product pleased few, if any. The law was both too coercive for the civil rights groups and not coercive enough for many families who wanted to see their loved ones in treatment.

“I’ve wondered (about) the point of a court with no real power,” said Anita Fisher, a San Diego mother who advocated for Newsom’s idea but later called the program a “total failure” in practice.

Newsom, who campaigned on eradicating chronic homelessness, unveiled CARE Court as the state’s unhoused population surged and public frustration climbed despite the tens of billions of dollars his administration spent on homelessness and affordable housing.

Cities such as Sacramento and Los Angeles were mulling ballot measures to prohibit homeless people from sleeping in public spaces when Newsom unveiled the proposal.

Newsom said he was ‘disgusted’ by some homeless

“There’s no compassion with people with their clothes off defecating and urinating in the middle of the streets, screaming and talking to themselves,” Newsom told the San Francisco Chronicle in 2022. “I’m increasingly outraged by what’s going on in the streets. I’m disgusted with it.”

Eve Garrow of ACLU of Southern California called Newsom’s focus on accountability a “political maneuver” that shifts the blame for homelessness onto counties while ignoring the lack of resources to support them. Without guaranteed permanent housing, CARE Court is merely “window-dressing,” she said.

The law stipulates that CARE Court participants get priority from certain existing state housing funds, but did not come with any additional money, a concern cities, counties, and care providers raised throughout the bill process.

“There’s very little political will in Sacramento for (funding permanent housing), given the price tag,” Garrow said. “I honestly think that the houselessness crisis in California has … contributed to a political climate, in which state legislators are looking for easy fixes.”

When asked by CalMatters if Newsom believed the individual and county-level accountability he spoke of materialized, Newsom spokesperson Tara Gallegos did not give a direct answer. Instead, she said the law has improved in recent years and that is evidence that “(the) government is working as it should.”

The core of CARE Court, Gallegos stressed, was “voluntary” participation. “Coercion rarely works with those who need care,” she said in a statement last week.

She took a more forceful tone on counties’ responsibility to provide care.

Care replaced housing as priority

“It shouldn’t take stronger accountability measures for counties to do the right thing,” she said. “The public has called for action and counties should be listening and acting with urgency — or voters will do it for them. There’s no excuse for counties failing to deliver — and the variability in implementation that we are seeing now is completely unacceptable.”

State Sen. Tom Umberg, a Santa Ana Democrat who co-authored the original bill, acknowledged it’s still a “work in progress.” In recent years, he’s introduced “cleanup” bills to expand eligibility for CARE court and boost program uptake.

The law largely relies on the “soft power” of judges, leaving it at their discretion to hold counties and individuals accountable, Umberg said.

“I don’t think that we’ve done the kind of job that needs to be done,” he said. “Do we need to have more folks who are engaged and successfully complete the program? Absolutely. Have we gotten there yet? No.”

CARE Court’s target demographics were those who were too sick to help themselves. So how sick is too sick? The answer kept changing.

In its first iteration, the program was designed to serve those with mental illness and substance use disorders.

As the bill progressed, the criteria narrowed.

The bar for petitioners — often family members, first responders and behavioral health professionals who ask the court to enroll someone with psychotic disorders in a CARE agreement or plan — also kept getting higher.

In general, filers must fill out a form with basic information and show evidence that the person they are petitioning for needs care. They must be present for the initial court hearing if a judge decides to hear their case.

Changes to Umberg’s bill by the middle of 2022 tightened timelines and added requirements for petitioners. The bill also gained a warning that filing a meritless petition could lead to consequences.

Hurdles to care added to bill

Those provisions became law, and the requirement for petitioners to attend first court hearings remained. Some first responders are so overworked that they simply cannot participate in hearings in person, and proving a loved one’s mental health condition can be challenging for families due to federal privacy laws, San Diego County behavioral health program coordinator Amber Irvine previously told CalMatters.

As the bill evolved, it loosened requirements on counties to provide certain services, such as housing and behavioral health treatments, and made it harder for judges to order medication against someone’s will.

One of Newsom’s two major pillars of accountability was that courts would have the ability to fine counties up to $1,000 a day for not complying with court orders to provide services. But the devil’s in the details.

At the March 2022 press conference, a reporter asked Newsom what “force component” CARE court would have to remove homeless people from the streets.

“It’s why it’s court ordered, court oversight with specific stepped up sanctions if (they) can’t meet the plan,” he said. “The courts,” he stressed, “initiate the CARE plan and the process.”

But that April, the bill was amended to prioritize the use of “settlement agreements” — voluntary treatment plans agreed upon by both the county and the person subject to the petition, with court supervision. Under the law, only when that option is unlikely can judges order counties to evaluate the person for a potential court-ordered treatment plan.

Even with a court-ordered plan, judges cannot ensure that participants follow through on treatments they don’t want, said Scott Herin, a judge of the Los Angeles County Superior Court who has overseen some CARE court cases.

“We don’t mandate involuntary treatment in the CARE Act at all,” he said at a November hearing about CARE court. “It is at the discretion of the individual to accept them.”

Yue Stella Yu and Erica Yee are reporters with CalMatters. CalMatters’ Jocelyn Wiener and Marisa Kendall contributed to this report.