Mental Health Concerns Reshape Criminal Cases: California’s CARE Court Expansion and Federal Policy Shifts

Mental health and criminal justice have long been uneasy partners in the United States, but in 2025, California and federal policymakers are taking new, sometimes clashing approaches to the intersection of mental illness, homelessness, and crime.

California’s CARE Court program, championed by Governor Gavin Newsom, was designed to transform how counties support residents with serious mental illness—especially those struggling with psychosis and homelessness. Launched in 2023, CARE Court provided a new legal pathway for courts to coordinate treatment, medication, and housing for those unable to care for themselves. But as CalMatters reports, implementation has lagged behind initial projections: only a fraction of the estimated 7,000–12,000 eligible Californians have been helped, and families often find themselves frustrated when loved ones cannot consent to treatment or the program fails to deliver meaningful change.

Enter Senate Bill 27, authored by Democrat Tom Umberg of Santa Ana, which goes into effect January 1, 2025. This new law expands eligibility for CARE Court: while the original program was limited to people diagnosed with schizophrenia and similar psychotic disorders, SB 27 now includes individuals experiencing psychosis due to bipolar disorder. The hope is to reach more people who fall through the cracks of both the criminal justice and mental health systems.

But the expansion comes with tempered expectations. Umberg himself cautions that the numbers may not dramatically increase, and counties like San Diego are uncertain, projecting anything from a modest 3.5% uptick to a sweeping 48.1% expansion in program use. The law also attempts to streamline court logistics—combining hearings to reduce time spent in court and administrative overhead—potentially making access less daunting for participants.

Perhaps most notably, SB 27 directly links the criminal justice system and mental health care: it allows courts to refer individuals charged with crimes into CARE Court if they are deemed incompetent to stand trial. This is a significant shift, reflecting a growing recognition that many defendants in criminal cases have underlying mental health concerns that cannot be addressed through traditional prosecution alone.

As of October 2025, California courts had received 3,092 CARE Court petitions, approved 684 treatment agreements, and ordered 22 CARE plans—numbers that fall short of the program’s initial ambitions. The reasons are complex: logistical hurdles, participant consent, and the challenge of engaging homeless individuals with severe mental illness all play a role. Families who hoped for transformative change have sometimes been left disappointed, and advocates argue that more comprehensive solutions are still needed.

Meanwhile, on the federal level, mental health and criminal justice policy are moving in a different direction. In July 2025, the Trump Administration issued an executive order—“Ending Crime and Disorder on America’s Streets”—calling for a reevaluation and reduction of HUD funding for local ‘housing-first’ programs aimed at homelessness. According to News-Leader, this order goes so far as to propose expanded powers for involuntarily committing homeless individuals to in-patient mental illness treatment and pursuing criminal prosecution.

This federal stance marks a dramatic policy shift, prioritizing law enforcement and compulsory treatment over voluntary, supportive care. Critics argue that such measures ignore data and best practices, which show that stable housing and voluntary engagement are key to improving outcomes for people with mental illness and reducing recidivism. Advocates fear that cutting HUD funding will undermine local efforts to break the cycle of homelessness and criminalization, pushing more vulnerable individuals into the justice system without adequate support.

So, while California’s new law is attempting to bridge the gap between mental health and criminal justice—expanding eligibility and streamlining court processes—the federal approach may be closing doors, focusing instead on coercion and prosecution. The tension between these models reflects a deeper national debate: Should society prioritize treatment, consent, and housing, or lean into involuntary interventions and punitive responses?

Ultimately, mental health concerns in criminal cases remain a complex, evolving issue. California’s experiment with CARE Court—and its recent expansion—offers hope for more humane, coordinated care, but its limitations are clear. Federal policy shifts, meanwhile, risk undermining these fragile gains by reducing funding and expanding involuntary measures. For those at the intersection of mental illness, homelessness, and crime, the stakes could not be higher.

California’s expansion of CARE Court represents a cautious but meaningful step toward integrating mental health care into the justice system, while federal policy changes highlight the persistent tension between treatment and punishment. The data suggest that sustainable progress requires investment in voluntary care, housing, and cross-system collaboration—not just new laws, but a fundamentally different approach to how we treat society’s most vulnerable.