Newsom calls San Francisco a low performer on CARE Court, citing limited statewide participation

San Francisco singled out as state seeks tighter oversight

Gov. Gavin Newsom on Monday identified San Francisco as one of California’s lowest-performing counties in implementing CARE Court, the statewide framework created to connect people with untreated severe psychotic disorders to treatment plans, services and, in some cases, housing. The governor also named nine other counties as lagging and separately highlighted a list of counties he described as top performers.

CARE Court began rolling out in October 2023, with San Francisco among the first counties to launch. The program is structured to allow specific petitioners—such as family members and certain public officials—to ask a court to initiate a process that can culminate in a CARE agreement or, in limited circumstances, a court-ordered care plan. Proceedings are confidential, limiting public visibility into individual cases and making outcome comparisons more dependent on aggregate reporting.

Program scale remains far below early projections

Newsom’s administration originally projected CARE Court would reach thousands of people statewide. As of October 2025, 706 people had received treatment plans or agreements through the court process, a figure that has drawn attention as implementation expanded across California.

Cost has also become a focal point. A legislative analysis cited an estimated average of about $700,000 per person referred to CARE Court, and state leaders have appropriated more than $424 million for the initiative.

San Francisco’s high dismissal rates and key barriers

Available county-level reporting has shown that San Francisco has had a high share of petitions dismissed. In earlier reporting on county results, dismissals were attributed to factors including disputes over whether an individual has a qualifying diagnosis, difficulties locating unhoused respondents, and challenges in securing participation in hearings and assessments.

State officials have also pointed to a broader data gap: referrals do not always translate into sustained treatment engagement, and counties have not consistently tracked whether people diverted away from CARE Court remain connected to services or housing over time.

CARE Court eligibility is limited primarily to schizophrenia spectrum and other specified psychotic disorders, with additional statutory criteria intended to ensure the program is used as a least-restrictive intervention.

A recent San Francisco case intensifies scrutiny

The governor’s renewed emphasis on county accountability follows heightened attention to a San Francisco case involving Connor Keith, 35, who died of an overdose shortly after a judge dismissed his CARE Court matter. State health leaders have said they are reviewing such cases to better understand where processes may break down and what changes could improve outcomes.

What happens next

State officials have framed CARE Court as one component of a broader behavioral health strategy that also includes Proposition 1, approved by voters in 2024, which is designed to expand mental health treatment facilities and recalibrate funding priorities. In the near term, the effectiveness of the state’s new accountability push is expected to be measured by changes in petition outcomes, consistency of county reporting, and evidence that people routed into services remain engaged beyond initial referrals.

• CARE Court launched in San Francisco in October 2023 as part of a phased statewide rollout.
• As of October 2025, 706 people statewide had received a CARE treatment plan or agreement.
• San Francisco has been identified among counties with high dismissal rates and low throughput relative to expectations.