After all, he said, everything the state has done before has failed. One of the state’s prior attempts — a treatment referral program called Laura’s Law – helped just 218 people during the 2018-19 fiscal year, he said.

“That certainly is not demonstrable progress,” Newsom said. His new program would be different. 

But in the nearly two years since Newsom launched CARE Court, it has reached only a few hundred people. That’s barely more than the law he criticized, and certainly not the thousands he promised.

CalMatters requested CARE Court data from every county in California and conducted more than 30 interviews to compile the first detailed, statewide look at the program. Up and down California, the data show low numbers, a slow rollout and predictions that wildly outpaced reality.

The program was designed to allow family members, first responders, doctors and others to petition the courts on behalf of someone with severe psychosis who can’t take care of themselves. If the petition is accepted, that person can then agree to voluntary treatment, which can include counseling, medication, housing and more.

If they refuse, a judge can order them to participate in a treatment plan.

CalMatters received responses from all but four of the state’s 58 counties. Here’s what the data shows:  

• While Newsom’s administration estimated between 7,000 and 12,000 Californians would qualify for CARE Court, just 2,421 petitions have been filed through July, according to the Judicial Council of California. Only 528 of those have resulted in treatment agreements or plans.
• San Diego County anticipated receiving 1,000 petitions in the first year and establishing court-ordered treatment plans for 250 people. But in nearly two years, the county instead has received just 384 petitions and established 134 voluntary agreements.
• Los Angeles County saw 511 petitions filed – the most in the state. Of those, 112 resulted in care agreements or plans. In 2023, officials predicted to news organizations the county could enroll 4,500 people in the first year.
• Courts across California are dismissing a significant percentage of CARE Court petitions – about 45% statewide, although that number includes the handful of cases in which someone has successfully “graduated” from the program. The rate is even higher in some counties, such as San Francisco, where nearly two-thirds of petitions are thrown out. 
• The allure of CARE Court for many supporters was the promise of court-ordered treatment plans that would encourage sick people to accept the help they’d been resisting. But the courts have ordered just 14 treatment plans so far, according to the Judicial Council. Instead, most counties are solely offering voluntary treatment “agreements,” which sick people are free to ignore.
• Very few people have successfully completed CARE Court. Despite the fact that it has the most petitions, Los Angeles County has had no graduations. Nine counties have been operating CARE Court long enough to have graduations (the program takes at least a year to complete). 

“It’s going much more slowly than we thought it would,” said Lisa U’Ren, a former member of the  board of directors at the Solano County branch of the National Alliance on Mental Illness, who helped roll out the program in her county. 

The stakes are high for Newsom, who has tied his legacy in part to big promises that he would address California’s twin problems of homelessness and inadequate mental health services. The establishment of CARE Court was followed by a 2023 law intended to make it easier for a judge to order someone into involuntary treatment. A successful 2024 ballot measure issued $6.4 billion in debt to pay for new mental health housing. 

State officials say CARE Court needs more time to hit the goals initially set by the Newsom administration. Already some counties are doing an “incredible job,” said Stephanie Welch, deputy secretary of behavioral health for the state Health and Human Services Agency. She pointed to Alameda County, which has racked up 125 petitions — among the most in the state – since December. 

“I think this has been a complicated program to implement,” Welch said, “and that’s something that we recognize and we’ve been doing our best to support the counties to be able to expand this program.”

A spokesperson for Newsom’s office said the administration is pleased with what the program has accomplished so far.

“Thanks to the CARE Act, thousands of people are engaging in critical behavioral health treatment through stabilizing medications, community-based care, and — if needed — housing,” Elana Ross said in an emailed statement.

But disability rights organizations say the low numbers are evidence that the program was a waste of money, a reactionary political gambit by a governor with presidential aspirations. And many families who initially threw their support behind CARE Court also say it has come up short. 

Anita Fisher advocated for the program when Newsom proposed it, speaking on 60 Minutes about her family’s story and meeting with the governor himself, she said. When the program was piloted in San Diego County, where she lives, she felt hopeful about its promise to treat people with serious mental illness, like her son.

“I’ve watched my son suffer too many times: jail, prison, homeless,” she said. “And I said, ‘so if this can stop that?’ I said, ‘Yes, I’m all for it.’”

But now?

“I look at it as a total failure.” 

A petition could be rejected because the person doesn’t meet the narrow eligibility criteria (only people with schizophrenia and other limited psychotic disorders qualify). When the subject of a petition is homeless, outreach workers sometimes have trouble finding them on the street. Other times, the client simply refuses services – and, CARE Court has little teeth to force them to accept, even after a judge’s order.

Making more people eligible for CARE Court

A bill making its way through the Legislature could boost CARE Court numbers by making more people eligible. If Sen. Thomas Umberg’s Senate Bill 27 becomes law, people who experience psychotic symptoms as a result of bipolar disorder would qualify for the program.

The program as it stands is not broken, the senator said, it’s a “work in progress” that needs some tweaking to reach its full potential.

“To some degree, expectations were raised, some that were accurate, some that were not accurate, that this was going to be a panacea,” Umberg said. “And I never thought of it that way.”

But it’s unclear how many more people could enter into CARE Court as a result of Umberg’s bill. His office has no estimate, and other guesses vary widely. San Diego County says the bill could increase its numbers by anywhere from 3.5% to 48.1%.

Many disability rights organizations strongly oppose the bill, saying it will significantly expand an ineffective program, doing nothing to solve underlying issues of housing shortages and inadequate mental health services

“They’re not trying to fix a problem, they’re trying to deliver political optics, and that’s all this ever was,” said Lex Steppling, a founding member of All People’s Health Collective. 

Eve Garrow, a senior policy analyst with the American Civil Liberties Union of Southern California, said that, “given what I consider to be the failure of CARE Court so far,” she expects Umberg’s bill is primarily an effort to increase the number of petitions. 

“A court order doesn’t make resources appear out of thin air,” she said. 

The state spent $88.3 million on CARE Court in the 2022-23 fiscal year, and $71.3 million in 2023-24, according to a Legislative Analyst’s Office analysis. With fewer than 550 people receiving services through the program so far, critics accuse CARE Court of wasting state money.

The Assembly Judiciary Committee’s July analysis of SB 27 described  CARE Court as a “very expensive” way to coordinate services. 

But California counties say the low numbers of CARE agreements don’t capture the entirety of the program’s impact. Even petitions that don’t lead to official agreements have afforded counties the chance to connect with and offer services to people they hadn’t previously known.

“I would say that I think the whole idea of looking at the numbers, it sort of misses the point,” said Michelle Doty Cabrera, executive director of the California Behavioral Health Directors Association. “With anything coercive, the goal is to try to engage people out of their own free will into services.” 

One of CARE Court’s successes, she said, has been in spreading the word about county services to people who might need them. If those people then express interest without the need for any coercion, “that’s a success and so far that has not been quantified,” she said.

The state has attempted to quantify that elusive number: As of December, people were diverted away from CARE Court and into other county services 1,358 times, according to a recent report from the Health and Human Services Agency.

Counties administering CARE Court also said it’s one of the few state programs that funds outreach. It can require a lot of attempts before outreach workers can coax certain people into services, they said, and this provides a mechanism to pay for those efforts.

A flood of petitions that never materialized

Eight California counties rolled out CARE Court at the end of 2023, as part of a pilot group. The rest of the state had the program up and running by December 2024.

As San Diego County counted down to the launch, officials worried they would be flooded with petitions immediately, said Amber Irvine, the county’s behavioral health program coordinator. 

The county hired nearly two-dozen people, including 10 clinicians, two psychologists and support staff to meet the expected demand. The money for those new positions came from county funds, not from the state.

That flood of petitions never materialized. 

Irvine thinks the process of filing a petition was harder than expected. Her team thought first responders, hospitals and behavioral health workers would jump at the chance to refer people into the program. But that didn’t happen. The petitioner has to attend at least the first court hearing, which is something many overworked first responders and clinicians can’t do, Irvine said.

Police and firefighters filed petitions when the program first started, but they were often dismissed – which made the first responders reluctant to file more, said Crystal Robbins, who manages a treatment referral program for San Diego Fire-Rescue.

“We quickly found out that it wasn’t a useful tool for the people that we see,” she said.

The process also is tough for families petitioning on behalf of loved ones, Irvine said. It requires them to prove their loved one has a qualifying mental health condition, but federal privacy laws can make that a big hurdle.

The county is trying to make the process less cumbersome, Irvine said. It is letting family members and some other petitioners attend court hearings virtually, for example. And in some cases, the court is allowing petitions to move on to the next step even if they don’t have all the required paperwork.

So far, San Diego County Superior Court has received the second-largest number of petitions in the state — 384, with 35% leading to CARE agreements.

But that’s still far behind initial projections.

The slow start could be a “happy accident,” Irvine said, because the low case load allows clinicians to spend more time with each CARE Court client. 

But Anita Fisher isn’t the only family member who feels discouraged about the program’s roll out in San Diego. 

Tanya Fedak said she has twice filed petitions in the county on behalf of her son, who continues to cycle between homelessness and jail despite being accepted into CARE Court.  

“These are our loved ones,” she said. “It’s our taxpayers’ money. There’s no accountability. And it’s frustrating to see it go down, because my son is going to end up dead.”  

Orange County, which was part of the initial CARE Court cohort, expected to receive 1,400 petitions and establish between 400 and 600 treatment plans its first year. Two years later, it has received at least 176 petitions , reached 14 CARE agreements and ordered one CARE plan, according to the county’s behavioral health department. That doesn’t include additional petitions that could have been dismissed by the court before reaching the county.

Orange County was the only superior court in the state with a significant number of petitions that did not disclose its data to CalMatters.   

Veronica Kelley, director of the Orange County Health Care Agency, said she never expected to reach as many people as the original estimate. She attributed that in part to the county already reaching many people with schizophrenia spectrum disorder through its existing assisted outpatient treatment program (the program created by the law Newsom criticized at the 2023 press conference), which provides similar services to CARE Court.

Kelley believes expanding the older program would have been a better use of the resources now going to CARE Court. In part, she said, that’s because Orange County’s assisted outpatient program makes it easy for people to ask the county for help, whereas filing a CARE petition is “a laborious process” that requires significant work from the petitioner.

Other people blame the low CARE Court numbers on a lack of awareness.

After CARE Court rolled out in Solano County, the local branch of the National Alliance on Mental Illness hosted town halls to teach the community about the program. An in-person town hall drew about 10 people, said NAMI Solano County Executive Director Deb Demello. Two Zoom meetings drew about four people each. And they didn’t see people from the main group they were trying to reach: family members of people with a severe mental illness.

“We had very little turn out,” Demello said.

How is CARE Court going in your county?

Several counties launched their CARE Courts in 2023, and the rest started by December 2024.

CARE Court use  varies widely county by county, with some smaller counties appearing to struggle with the resources to implement the program. Colusa County, with a population of fewer than 22,000 people on the edge of the Mendocino National Forest, told the state last year that its courts weren’t prioritizing CARE Court because of court vacancies. The county has received just one petition.

Eight small counties, including Mendocino and San Benito, said they’ve had no petitions filed. 

Some county courts refused to disclose their data to CalMatters because the numbers were too small, citing the California Rules of Court, which allow courts to withhold data if the sample size is so small that people could be identified. 

Courts are required to report limited CARE Court data to the California Judicial Council, including the number of petitions submitted, number of agreements and plans, and number of dismissals. But the council would give only statewide totals to CalMatters, not a county-by-county breakdown. 

Will expanding CARE Court help more people?

Even if someone becomes one of the few Californians represented in a CARE Court petition, it doesn’t mean they’ll get help.

In San Francisco, the majority of petitions filed end up getting dismissed – 49 of the 75 – or 65% – of those filed. That’s one of the highest dismissal rates in the state.

Some counties, including San Francisco, told CalMatters that people may still receive services even if their CARE Court petition is dismissed. But a state report released in July found that of the 160 people whose petitions were dismissed during the first nine months of CARE Court, 90 did not receive county behavioral health services. 

Of the 130 petitions dismissed in Los Angeles County between December 2023 and February of this year, 43 were dismissed because the person was already receiving “adequate mental health services,” according to a report by the county’s department of mental health. It’s the most common reason for a dismissal in that county.

Umberg wants to address that with his bill. Currently, someone can’t qualify for CARE Court if they are already “clinically stabilized” in another treatment program. Umberg’s bill would clarify that just being enrolled in an outside treatment program doesn’t mean someone is stable. He hopes that will cut down on the number of people whose petitions are dismissed even though their mental illness is not under control. 

His bill would also make it easier for the criminal justice system to funnel people into CARE Court, by allowing a judge to refer someone directly into the program if they are charged with a misdemeanor and deemed incompetent to stand trial. 

Irvine, San Diego County’s behavioral health program coordinator, is not thrilled about Umberg’s plan to expand CARE Court. The California Behavioral Health Directors Association also opposes the bill. 

Irvine takes pride in the amount of time and energy her staff put into each CARE Court client. She says they spend weeks or even months getting to know them, bringing them their favorite foods, and helping with minor tasks, such as getting a new phone, before finally convincing them to participate in the program. In at least one case, that process took as long as five months, she said.

By some accounts, San Diego County’s approach is working. It has had 10 graduations so far, the most of any county that reported that metric to CalMatters.

Adding a lot more people into the program would give clinicians less time to spend with each client, Irvine said. And Umberg’s bill doesn’t come with money to hire more staff.

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Video from inside a Southern California jail shows a violent confrontation in October 2020 in which 10 sheriff’s deputies burst into the cell of a man who was having delusions and resisting medical care, restrained him and repeatedly shocked him, leading to his death days later.

Officials in Riverside County did not bring charges against any of the deputies involved in the encounter with the man, Christopher Zumwalt, 39, but quietly agreed in December 2023 to pay $7.5 million to settle a lawsuit filed by his family.

Depositions from the case and video footage obtained by The New York Times show the frantic and violent minutes when deputies tried to force Mr. Zumwalt out of his cell as he paced and talked incoherently. In the video, deputies wearing helmets and shields toss canisters of pepper spray into the small concrete room, struggle with Mr. Zumwalt, and strap him to an emergency restraint chair. They cover his head with a spit mask and move him to another cell, where he sat unmonitored and appeared to stop breathing for at least five minutes. He died on Oct. 25, 2020, after experiencing cardiac arrest.

Mr. Zumwalt, who was arrested near his home on Oct. 22, 2020, on suspicion of public intoxication, was never charged with a crime, and the arrest report indicates that he was to be released with a citation after he sobered up from the methamphetamine he admitted to taking the night before. On the day of his arrest, he was issued a citation for bringing drugs into a jail.

In a statement Friday, Sheriff Chad Bianco said his deputies did nothing wrong and characterized the settlement as a business decision by lawyers that does not imply wrongdoing.

“The facts of this case clearly show the actions of our deputies were appropriate and lawful,” Sheriff Bianco said, adding that actions taken by Mr. Zumwalt in a “methamphetamine-induced psychosis caused his death.”

The practice of forcibly removing people from their cells, which is known as cell extraction, often turns violent, and has been a point of controversy and costly litigation in the county and across the country for years.

Another man died after a similar extraction from the same Riverside County jail in 2017. In 2018, a detainee died after a cell extraction in a San Diego County jail. In 2015, a 37-year-old woman died after Virginia deputies used a stun gun on her four times during an extraction. In 2010, a man died in a jail yard after being forced from his cell in Tennessee.

The Riverside County Sheriff’s Department ultimately reported Mr. Zumwalt’s death as a justified homicide, meaning he died as a result of police use of force determined by a county investigation to be legal. Later medical examinations cited other contributing factors, including methamphetamine overdose, lack of food and water, and asphyxiation from the use of restraints and pepper spray, but all found that the confrontation played a role in the cardiac arrest that killed him.

In most California counties, including Riverside, the sheriff also acts as the coroner, investigating the cause and manner of deaths.

Mr. Zumwalt’s death has not previously been reported by the news media, and the Sheriff’s Department had not acknowledged the court settlement publicly.

In recent years, there has been a surge in deaths at the jails in Riverside County.

Mr. Zumwalt was among 12 people to die in county custody in 2020. In 2022, deaths in the county’s five jails rose to 19 — nearly four times the county average of five deaths each year since 1980. The spike in jail deaths, in part, spurred a civil rights investigation by the California Justice Department into the department led by Sheriff Bianco, a powerful political force in the Inland Empire, the region east of Los Angeles and Orange Counties that encompasses San Bernardino and Riverside Counties. That investigation into the deaths, which included drug overdoses, suicides and homicides resulting from inmate violence, is ongoing.

In interviews, some experts said that the department’s deputies used too much force against Mr. Zumwalt given the circumstances, while others said that they seemed to follow department guidelines. But most experts said that they thought the deputies left him alone, unattended and without medical care for too long after the extraction.

John Burton, a lawyer representing Mr. Zumwalt’s family, said: “It starts with the fact that he was picked up for almost nothing. To use this amount of force, to extract him in the way they did, to allow him to die unmonitored — it’s appalling.”

Peter Williamson, another lawyer for the family, said Mr. Zumwalt had no serious criminal history.

“He wasn’t violent,” Mr. Williamson said. “In fact, he was calm during his arrest. How does a guy go from that situation to dead?”

Ron McAndrew, a jail consultant and former Florida prison warden, said that Mr. Zumwalt’s actions warranted mental health treatment, not violent extraction.

“In 40 years, I have never seen a team of 12 officers fully equipped with riot gear line up for one man,” Mr. McAndrew said. “I’d not only call this overkill, this is very punitive. They’re not there to punish anybody. They’re there to follow policy and procedure to maintain security and control. None of those things were done.”

Lawyers representing the department wrote in court filings that Mr. Zumwalt grew belligerent because of his drug use, and that he needed to be extracted from his cell to undergo a medical examination and complete the booking process.

The department’s lawyers confirmed the settlement amount but declined further comment.

The videos reviewed for this article were edited by the family’s lawyers for use in the civil case. The footage appears to be a continuous feed of the entire incident, but some parts were sped up and some portions of audio redacted. None of the depositions dispute the essence of the videos. The Sheriff’s Department sealed the raw footage when submitting it in the case, making it inaccessible to the public.

In the footage, Mr. Zumwalt appears calm as he enters the jail, the Larry D. Smith Correctional Facility in Banning, Calif., even as deputies find a small bag of meth in his pocket. He was placed in a sobering cell just before 2:30 p.m. on Oct. 22, 2020.

In the cell, a camera recorded Mr. Zumwalt pacing, shoeless and wearing only a pair of jeans. He hits the door a few times. He sits. Rises. He tries to dig into the bowl of a toilet, telling a deputy he’s searching for lost money. He takes off his jeans. One deputy tells him to stop kicking the door or he’ll hurt himself. He stops momentarily but otherwise doesn’t seem to respond.

Hours in a sobering cell

The department’s policy requires a medical evaluation within six hours of a person’s placement in a sobering cell. But that time can be extended in certain circumstances.

At around 9 p.m., Christine Odhiambo, a jail nurse, asks Mr. Zumwalt to submit to a medical evaluation. In a deposition, she said he refused and became confrontational. The interaction through the cell window was brief, and the door was never opened.

Ms. Odhiambo called a doctor, court records show, who extended Mr. Zumwalt’s stay in the sobering cell. Given the doctor’s order, it is unclear why the deputies felt an urgent need to remove him from the cell.

At 12:03 a.m. on Oct. 23, deputies arrive in riot gear and ask Mr. Zumwalt to lie on his stomach, the beginning of the confrontation that led to his death.

‘Please, I’ll die’

“If you do not comply with my commands, we’re going to have to use force against you,” one deputy says, according to the footage. “I do not want to do that.”

For the next three minutes, Mr. Zumwalt kneels in the back of the cell or paces without clothes, speaking incoherently if at all.

At 12:06 a.m., a deputy tosses into the cell an aerosol canister, which emits pepper spray. The chemical agent has an almost immediate effect: Mr. Zumwalt and some of the deputies can be heard coughing moments later.

Mr. Zumwalt, who is largely out of the camera’s frame, appears to kneel by the cell door as deputies continue to order him to get on his stomach.

At 12:09 a.m., a deputy sprays a two-second burst of the chemical agent into the cell. Mr. Zumwalt gets onto his stomach momentarily, before growing increasingly agitated, pacing and yelling.

“No, please, please, I’ll die, dude,” Mr. Zumwalt shouts during the chaos.

“You need to lay on your stomach, right by the door,” one deputy yells, adding: “Christopher, it’s going to get worse.”

At 12:11 a.m., a deputy throws a second pepper spray canister into the cell and continues to order him to get on his stomach.

At 12:13 a.m., a deputy throws a Stinger 15 grenade into the cell, which explodes with a flash, firing some 150 rubber pellets and tear gas.

“Go, go, go,” a deputy yells as he opens the cell door.

The extraction

A deputy carrying a stun shield, which emits an electrical current, leads the group in, and they pin Mr. Zumwalt into a corner of the cell. The confrontation that ends with Mr. Zumwalt in handcuffs cannot be seen clearly because the cell is filled with smoke from the grenade.

Mr. Zumwalt can be heard screaming in pain during three discrete Taser shocks. At least four deputies can be seen amid the smoke kneeling on or leaning over him.

“Stop resisting,” a deputy repeats.

“I can’t breathe,” Mr. Zumwalt yells in a gasp, among other pleas.

Some deputies said during depositions that he tried to bite them as they tried to handcuff him. Other deputies said they did not see any evidence or threat of biting.

At 12:19 a.m., 13 minutes after pepper spray began saturating the air in his cell, Mr. Zumwalt is wheeled out in a restraint chair. Blood is visible on the spit mask deputies put over his head. Mr. Zumwalt’s breathing appears labored, his eyes vacant and head hung loosely to the side.

He was taken to a safety cell, where, before closing the door, one deputy tapped him on the shoulder.

“You all right?” the deputy asked at 12:21 a.m. “Can you hear me?”

The deputy said in a deposition that Mr. Zumwalt “just groaned” in response.

None of the deputies noted that Mr. Zumwalt appeared to need medical attention after the extraction. Department policy required that he receive a medical evaluation and be continuously monitored while restrained in the safety cell.

Seven minutes alone

A deputy noticed he was unresponsive at 12:29 a.m. He was rushed to a hospital and resuscitated. But he was taken off life support and died on Oct. 25, 2020.

Some sheriff’s departments require trying alternative methods before ordering cell extractions, but Riverside is not among them. Sgt. Joel Grajeda said during a deposition that he ordered the extraction because Mr. Zumwalt refused to comply, and that no alternative tactics were required before he did so.

Sheriff Bianco did not comment on the timing of Mr. Zumwalt’s extraction or the fact that jail officials left him restrained and unmonitored in a safety cell for seven minutes after he was removed.

“Fighting with deputies, required to do their job, increased his already taxed circulatory system,” Sheriff Bianco said in the statement. “The settlement in this case is irrelevant and solely a business decision between attorneys, insurance companies, and risk management of the county. It in no way reflects on the facts of the case or points toward wrongdoing by deputies.”

Sheriff Bianco added that in deciding to settle, the department considered the ability of civil attorneys “to manipulate already anti-law-enforcement jurors with partial truths.” He did not provide any evidence to support his claim that civil juries are biased. And he did not say whether any of the deputies involved were found to have violated policy or whether any policies were changed after the incident.

In interviews, experts were divided over the decisions the deputies made.

Edward Obayashi, a deputy sheriff in Modoc County, in northeast California, who also trains correctional officers, acknowledged that at the start of Mr. Zumwalt’s extraction, “there is no immediate threat to anyone.” But, he said, deputies have a responsibility to maintain order in the jail, which may require the extraction of an inmate who does not pose a direct physical threat but refuses to follow orders. “You can’t allow disruption,” Mr. Obayashi said. “If it impacts the security of the jail, it can become contagious.”

Mr. McAndrew, the jail consultant, pointed out that departments often require extraction teams to include a mental health professional or a deputy trained in crisis intervention who talks to the person first.

“It’s ludicrous to think barking orders is going to get you any results in a situation like that,” Mr. McAndrew said.

Gary Raney, a former sheriff in Idaho and a corrections consultant, said deputies should have done more to de-escalate the situation.

Both Mr. Raney and Mr. McAndrew said that rubber pellet grenades are most often used for crowd control during riots or group fights — and that their use here was excessive and dangerous in the small cell.

Mr. Raney served as an expert witness for the plaintiffs in the case, for which he wrote a 60-page report in which he found that the deputies violated department policy.

“One of the most disturbing things about this case is that the extraction did not need to occur, at least when it did,” he said. “There was no urgency, there was no harm occurring to Zumwalt, and they still had not exhausted verbal efforts to get him to comply.”

Natalie Reneau contributed video production.

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