Sacramento City Council members are weighing changes to how the city connects people with serious behavioral health problems to treatment after city figures showed startlingly low participation and completion rates, following a report on heavy emergency use tied to homelessness and mental illness. The discussion, which took place Tuesday, drew residents who shared personal experiences and called for changes to how the city handles people in crisis.
According to ABC10, the city's director of community response told the council that 216 people filed for CARE Court in 2025, but only one person completed the program. The same report noted that Sacramento's conservatorship program, which provides involuntary assistance to people experiencing severe behavioral health crises, served 55 people even as emergency cases tied to homelessness and mental illness numbered more than 10,000. One meeting speaker argued that stronger laws, mandatory treatment, and behavior modification are needed to address the scale of the problem.
The City's Front-Line Role
The City describes Sacramento's Department of Community Response as providing outreach and support to people experiencing homelessness, including connections to shelter, and says a multi-department incident team responds to 311 calls, according to the City of Sacramento.
Mayor Pro Tem Eric Guerra said the CARE and conservatorship programs are difficult to navigate, per the ABC10 report, and pointed to eligibility criteria that can prevent people from completing the programs in the first place. He said improving mandated care is necessary to preserve prevention resources for mentally ill and drug-addicted people living on the street. The council and Mayor Kevin McCarty do not want to scrap the programs, the station's report notes, but instead plan to improve how they function.
Wider Doors, New Tools Under Consideration
Mayor McCarty said there are many ways to exit the system and few ways to enter it, according to the same account. One piece of the city's plan involves creating a team of psychiatric clinicians and paramedics who could evaluate people immediately and determine program eligibility on the spot, rather than funneling everyone through slower existing channels. City officials also want to advocate for changes to state CARE Court and conservatorship laws to help more people actually complete the programs.
Sacramento's low completion numbers are not new. Sacramento County received 74 CARE Court petitions and 51 referrals to Behavioral Health Services between its December 2024 launch and July 2025, resulting in 13 clients being granted CARE Court and 12 entering CARE Agreements by July 2025, according to Sacramento County. County officials noted that many dismissed petitions still led to referrals to voluntary community recovery providers. The county also marked a milestone in March, when Sacramento County Superior Court held its first CARE Court graduation ceremony under Collaborative Courts Supervising Judge Jennifer K. Rockwell.
State Law Keeps Shifting Underneath the Local Debate
Eligibility rules have been moving targets at the state level. Senate Bill 43 expanded the definition of gravely disabled. Then, effective January 1, 2026, Senate Bill 27 expanded CARE Court eligibility statewide to include people diagnosed with Bipolar I disorder featuring psychotic symptoms, beyond the original restriction to schizophrenia spectrum disorders, per the California Department of Health Care Services.
In August, Senate Bill 28, which would link CARE Court and conservatorships, died in the Assembly Appropriations Committee, amid continued opposition from public defender associations against coercive treatment mandates, as reported by CalMatters. Public defenders have argued that CARE works best with participant buy-in and voluntary engagement, a tension that runs through Sacramento's own debate over whether to lean harder into mandated care.
Parallel Programs Already in Motion
In August, county officials and District Attorney Thien Ho announced an expansion of the Chronic Offender Rehabilitation Effort, partnering with Monarch Recovery Center to reserve 25 residential beds for repeat offenders with mental health and substance abuse issues who have at least 10 arrests or citations in a year.
The city council expects a report on its own program's progress next month, per ABC10's reporting. Until then, the gap between the people cycling through emergency calls and the small number who make it through court-ordered treatment remains the central problem city and county officials are trying to close together.
