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Policy Brief

766 San Francisco Residents May Be Eligible for Referral to CARE Court

Image of street in front of San Francisco City Hall. There are 3 tents on the right sidewalk.

PRESS RELEASE: New Analysis Estimates 766 People may be Eligible for Referral to CARE Court in San Francisco, Though Capacity is a Concern

The state of California passed the Community Assistance, Recovery, and Empowerment (CARE) Act in 2022 to provide behavioral health and housing services to individuals with psychotic spectrum and schizophrenia disorders who are deemed unable to care for themselves. This policy brief uses anonymized data to estimate how many San Franciscans in a database of individuals who have contact with the urgent and emergent care system may be eligible for referral to CARE Court and describe their service needs.

The research team identified a larger sample of 1,700 San Francisco residents who had at least two instances of a psychosis diagnosis, and either at least one 5150 involuntary hold, or four or more urgent or emergent visits for Serious Mental Illness (SMI) in Fiscal Year 2020. The brief focuses on the subgroup of 766 people in the larger sample who had four or more SMI visits as potentially eligible for referral to CARE Court.

Figure: Among 1,700 San Francisco residents diagnosed with psychotic spectrum disorder in FY 2020, a subgroup of 766 may be eligible for referral to CARE Court

The chart shows three boxes representing 1,700 San Francisco residents who had at least 2 psychosis diagnoses in FY 2020. Each box represents a subgroup. The far left box is largest, and represents 934 people who had at least one 5150 hold during FY 2020, but fewer than 4 urgent visits for Serious Mental Illness (SMI). The top right box represents 569 people who had 4 or more urgent visits for SMI and at least one 5150 hold. The bottom right box represents 197 people who had 4 or more urgent visits for SMI, but no 5150 holds. There is a line grouping together the two right hand boxes, and a note that says “these 766 people may be eligible for referral to CARE Court.”

Note: Of the 3,798 individuals in the CCMS data who had at least two psychosis diagnoses in FY2020, 2,098 had neither a 5150 hold or 4+ SMI urgent visits. The 4+ SMI urgent/emergent visit group includes 766 people who had 4+ SMI visits, of which 197 had no 5150 holds, and 569 had at least one 5150 hold.

Key Research Findings

Finding 1: Individuals in the 4+ urgent visits for SMI subgroup had high rates of all physical and mental health comorbidities: more than 75% had a diagnosis for stimulant use disorder and over 70% had a diagnosis for depression.

Finding 2: About 1 in 4 eligible people in the 4+ urgent visits for SMI subgroup received Intensive Case Management in FY 2020.

Finding 3: 83% of the 4+ urgent visits for SMI subgroup reported being homeless in the past year while 4% (30 people) had been housed in permanent supportive housing.

Finding 4: Almost half (49%) of the 4+ urgent visits for SMI subgroup had six or more emergency department visits in FY 2020, compared to over one-quarter (27.3%) of the entire sample of 1,700 individuals. Smaller shares utilized urgent or emergent substance use services (e.g. residential social and medically supported detoxification and rehabilitation services including the SF sobering center): 7.6% of the entire sample of 1,700 people, and 13.5% for the 4+ urgent visits for SMI subgroup.

Finding 5: Over one quarter of the 1,700 people in the larger sample had criminal legal involvement in the past year: 456 were arrested at least once in San Francisco and 136 were convicted. There was a median of two arrests for this group, and the highest number was 12. There are no notable differences in criminal legal involvement between the larger sample of 1,700 and the 4+ urgent visits for SMI subgroup.

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