San Diego County received 209 CARE Court petitions in its first year of operation with 71 people choosing to meet with a judge and create collaborative agreements that delineate the treatments and other resources needed to address their severe mental illness. But a full accounting of this new program is still in flux. While 71 have voluntarily participated in the CARE Court process, more than 40 are still in the initial stages of investigation, with 41 having initial petitions dismissed because they refused services or could not be located, with 24 more declared ineligible for the program and 18 voluntarily enrolling in a treatment program shortly after a petition was filed. While the numbers from CARE Court’s inaugural year may seem small compared to the many thousands who need mental health care in San Diego County, experts say that it is important to remember that only a very narrow subset qualifies for the statewide program. Launched on Oct. 2, 2023, CARE Court allows a wide range of individuals, from family members to first responders, to file petitions on behalf of adults diagnosed with schizophrenia spectrum or other psychotic disorders. Only those not currently enrolled in ongoing voluntary treatment qualify for the process, and the court must also find that they are “unlikely to survive safely in the community” or that they are “in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm,” in order to proceed. Luke Bergmann, director of behavioral health services for San Diego County, said Wednesday that he was skeptical that asking clients to meet with a judge to build treatment plans would work. These sorts of discussions, after all, have traditionally been handled in therapists’ offices. But, he said, there appears to be a subtle power in everyone together around a courthouse conference room table with the client at the head. “We’re beginning to see outcomes that are unequivocally positive,” Bergmann said. “The thing that is most exciting about this is that it creates a model for collaboration across different parts of the governmental apparatus that is really new and that is different from any that’s come before. “It’s one that puts the client at the center of activity, and that’s empowering for the client in a new way.” Though it’s still early, Bergmann said he is encouraged to see some indications that those who have committed to care plans appear to be using fewer services overall, outside of the program. Among 19 clients who had been on CARE agreements for at least 60 days and who had recent histories of using local crisis services, a significant drop in use of those services was observed. A total of 51 encounters with resources such as mobile crisis response teams, jails, hospitals and crisis stabilization centers fell to just 18. Further research would be necessary to determine if that initial trend holds up over the long term. San Diego Superior Court Judge Kimberlee Lagotta is in charge of CARE Court on the legal side, and from her view, the program “has really been a success.”  She said “the real key in San Diego” is that everyone from the county to the treatment teams to the attorneys and beyond has done “a tremendous job building credibility and trust with the community.” “I think that is why we have such large numbers of petitions and a really solid percentage of people participating in care agreements or receiving voluntary services who were not previously connected to services,” she said. For years, only a select few could ask for court-ordered treatment for someone — think clinicians and police officers. The CARE Act greatly expands that, most significantly to now include family members and several others.  Lagotta said that family members accounted for more than half of the people who petitioned seeking help for a loved one in the first year of the program, October 2023 through September. Another 19% were filed by first responders, she said, and 16% were filed by behavioral health professionals. And, the judge said, three of the petitions came from the individuals asking the court for help. A year in, two people have graduated from the court oversight process and moved forward with their treatment and services without the need for further court oversight. San Diego is just one of eight counties — including Orange, Riverside, Los Angeles and San Francisco — with a CARE Act program in place; the rest of the state must have one by the end of this year. In the first 12 months, the initial numbers indicate that 787 petitions were filed statewide, with 301 petitions dismissed.  Cathryn Nicario, chief executive officer of NAMI San Diego, the local chapter of the National Alliance on Mental Illness, said that she and others in her organization have been closely monitoring the CARE Court process and have received few complaints about how the program has been implemented in San Diego County. “They’ve really focused on each participant as a whole person and as uniquely individual to who they are with their neurodiversity,” Nicario said, indicating that the county public defenders office has been critical in executing that approach. “I really think they should be one of the examples across the state of how to do this really well.” Some, though, have been opposed to CARE Court from the beginning and have not changed their opinions after a full year of operation in nine California counties. Disability Rights California, the Sacramento-based nonprofit organization that opposed the Care Act legislation that created CARE Court, said that after monitoring operations in the first year, it is not clear that the extra level of bureaucracy involved is worth what it costs. Rather than spending cash creating a new court, said Samuel Jain, senior policy attorney for Disability Rights’ Mental Health Practice Group, those resources could instead be used to pay for more treatment. “This is something that we’re going to be spending $300 million a year on statewide and, you know, the number of other services that you could fund with those precious resources, from our perspective, I don’t think that there is really any justification for this program,” Jain said. Others are concerned about those who do not engage with CARE Court. Linda Mimms, chair of the Schizophrenia and Psychosis Action Alliance, is among those who have long advocated for programs to have a route for compulsory treatment of those who do not understand that they are suffering from a severe mental illness. Thus far, she said, CARE Court has not delivered a solution for these citizens. “This is the population that is the sickest, and don’t understand they are sick and are continually abandoned,” Mimms wrote in an email. “We need a clear path to conservatorship for these folks to stop the current endless cycle of misery and death for people who are simply in need of medical care — a basic human right that is being denied.” However, there is significant disagreement on the effectiveness of compulsory treatment. Jain said that most county behavioral health organizations are less interested in what is often termed “coercive treatment.” “There are a number of academic articles on the efficacy on involuntary treatment, and they show that voluntary services are actually more effective,” Jain said.