Gov. Gavin Newsom named San Francisco County’s CARE Court program as one of the lowest-performing in California on Monday, as part of a new effort to bolster his signature mental health care program.
“Through CARE Court, we have seen inspirational stories of recovery and resilience, but many counties continue to lag behind their peers,” Newsom wrote in a statement. “We will not accept failure and excuses when lives are on the line.”
The news comes weeks after the Chronicle published a detailed account of a man who died shortly after he was rejected from CARE Court in San Francisco.
Newsom launched the program in 2023 as a streamlined path into the state’s mental health system for people with severe mental illness languishing on the streets. San Francisco was one of the first counties to roll out the program, which created a new arm of the courts focused on mental health care.
Families who had struggled for years to get their loved ones into care viewed it as a lifeline. But early numbers show the program has helped far fewer people than initially anticipated. Newsom’s office had initially projected that the program would help 7,000 to 12,000 people, but just 706 people had received treatment plans or agreements through the court as of October 2025.
The program has also proven remarkably expensive for those it does help. An early analysis of the program by the Legislature found that California was spending about $700,000 per person referred. In total, Newsom and lawmakers have appropriated more than $424 million for the program.
Newsom has publicly touted the program’s success since it launched, but CARE Court proceedings are confidential, making it difficult to assess his claims.
Connor Keith, the San Francisco man who died, appeared to be a good candidate for the program. The 35-year-old had successfully participated in treatment before, but had relapsed and declined significantly in the wake of isolation during the COVID-19 pandemic. He was homeless when his mother filed a petition to get him into the CARE Court program.
The barriers he and his family encountered trying to get him into treatment through the program, including a dispute over whether he had a qualifying diagnosis and his reluctance to attend court hearings, illustrate some of the obstacles families across the state have faced trying to access the program.
A judge in San Francisco ultimately dismissed Keith’s case. He died of an overdose 10 days later.
California Health and Human Services Secretary Kim Johnson said Keith’s story “certainly had an impact on” her and her colleagues.
“That kind of tragedy is something that we’re going to pay attention to and really try to understand and unpack where things could have happened differently and where it can be done better,” she told the Chronicle last week.
She said her agency reached out to San Francisco to learn more about the case but declined to share details about the conversation, deferring to the city. She characterized the outreach as part of a larger campaign of visits to and calls with counties that her agency is undertaking to improve CARE Court. She said she expects participation in CARE Court to increase as time goes on, and that they’re already seeing participation increase the longer the program has been live.
“We want to understand what is working and what’s successful in it today,” she said. “We also want to understand what policies we need to change to make sure it is as strong as it can be.”
San Francisco’s CARE Court program was one of 10 the governor identified Monday as the worst-performing, alongside programs in Santa Clara, San Bernardino, Orange, Los Angeles, Kern, Riverside, Yolo, Monterey and Fresno counties.
Newsom also highlighted CARE Courts in Marin, Napa, Alameda, San Mateo, Humboldt, Tuolumne, Merced, Sutter, Santa Barbara and Imperial counties as the state’s top performers.
Johnson and CHHS Deputy Secretary Stephanie Welch noted that CARE Court is just one part of the governor’s strategy to improve the state’s mental health care system, including Prop 1, an initiative voters approved in 2024 to provide billions of dollars to build new mental health treatment facilities and steer more funding toward the people who need the most help.
They also pointed to data from counties showing that more than 4,000 people who were initially referred or somehow recommended for CARE Court, such as because a loved one called a county hotline inquiring about the program or because someone filed a formal petition on their behalf, were diverted into other services instead. In theory, that number could mean that thousands of people are getting into mental health services and housing without needing to go through the bureaucracy of CARE Court.
But Johnson and Welch said there’s not enough data available to guarantee that, yet. They don’t, for example, yet have data on how long someone continued to participate in treatment they were connected to or whether they stayed in the housing they were provided with. They were unable to say whether Keith would have been counted as one of those people who were diverted, but acknowledged it was possible. Keith was placed in public housing shortly after his mother filed a CARE Court petition, which she initially viewed as a positive effect of the program. But he was soon kicked out for violating the rules at the facility.
Welch said sometimes someone is connected with a service that doesn’t end up being right for them.
“Maybe they were connected to services, but that connection was just not the right fit for the person, and it wasn’t meeting their needs,” she said. “The goal, of course, always is to help that person to the end, to recovery.”