- Category: Homeless and High-Needs, Safety Net
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
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.