Living with the symptoms of a serious mental illness can feel isolating and debilitating. It can also breed distrust, which makes it difficult to accept services and support. These challenges were top of mind when the CARE Act launched in Los Angeles in December 2023, establishing a civil court pathway to connect people living with eligible psychotic or mood disorders to treatment, services, and housing.
In Los Angeles County, we have found that engaging peers in this work on the front end of the civil court pathway is essential to help our clients engage in the process and significantly advances their recovery.
One of our Senior Community Health Workers, Liroy Williams, experienced childhood adversity and mental health challenges. He recently shared a story of a client with schizophrenia living in unstable housing.
“When I would go get him to take him to appointments in the community, he had all of these concerns,” Williams said. “He was afraid to go outside and communicate with other people. I said, ‘Is the world going to end if you go? We can’t control how people think or expect them to think the way we do.’ To overcome my own challenges, I’ve had to accept that and stay focused on what I can control.”
After building trust and engagement through consistent peer support, Williams’s client began regularly going to his therapy appointments on his own, and is now living in stable, independent housing and able to manage weekly activities.
In LA County, peers—both certified peer support specialists and those with lived experience in other roles—often lead the first interaction with CARE clients. They are a relational bridge to participants and a constant buffer to disengagement. They contribute to recovery plans and normalize treatment and court involvement. This partnership helps lower clients’ stress response and brings compassion into what may otherwise feel like a scary legal process.
“I can never understand what [clients] are going through completely, but I can relate,” said Williams. “I know what they’ve been through. When they ask really tough questions like, ‘Why am I here?’ I share my challenges. It can be a big motivator.”
Unlike traditional case management, which can center on service coordination or treatment compliance, CARE begins with understanding. Peers have a unique lens into the stigma that surrounds psychotic disorders and the hesitancy some people feel about voluntary participation in a process with legal oversight. It makes peers like Reyna Leyva, a Medical Case Worker for CARE, even more effective in the field.
“I was skeptical at first about how our program would make a difference. Because I’ve been through the system, I know it’s not easy. Now I advocate for our clients,” said Leyva.
Peers’ distinctive skill set is respected within our treatment teams. Our CARE teams meet daily. Everyone from clinicians and nurses to peers consult closely when there are high-acuity clients who need specialized support.
“We’re able to pull in other systems experts so we can meet a person’s needs,” Leyva said. “For example, we had a client who had challenges with her medication. Trust is crucial for most of our client base, and we maintain it by helping them voice their preferences. By advocating for her, we collaborated with the medical team to take a different approach, and that adjustment led to her remaining in treatment.”
LA County was one of the first counties to implement CARE, and now it is live in all 58 California counties. First responders, behavioral health clinicians—including nurse practitioners and physician assistants—community outreach teams, or family members can initiate CARE Court petitions. Once the court accepts a petition, the county behavioral health agency department assumes responsibility for the case.
While CARE continues to grow to scale across the state, the LA County program has grown dramatically. As of March 1, 2026, this program filed 850 petitions, received 272 referrals, 183 Public Guardian requests for stepdown from conservatorship to CARE, and 826 orders from the Mental Health Court.
Monthly petitions continue to increase in 2026, and LA County’s plan is to maintain this momentum in keeping with state goals. Staff recruitment and retention have been key to providing both the increase in petitions as well as providing the intensive field-based services geared toward assisting clients in achieving their recovery. This growth underscores LA County’s strong uptake of CARE services as the program continues to gain awareness, and our work to build a strong person-centered, peer-forward approach will provide a strong foundation to receive this increased engagement.
Embedding peers at the outset and throughout CARE has changed our approach from one building toward treatment compliance, to one that prioritizes treatment engagement. For complex, high-acuity populations, that’s not a small shift in the dynamics of systems of care. It’s transformative. And peers have been key to making that happen.
“Trust is a big deal with clients,” said Williams. “It’s more than what you say or share, it’s how you carry yourself. I know they’re thinking about how I make them feel safe, am I consistent, will I call if I’m going to be late. I think I care about trust with clients more than anything.”
To learn about the CARE Act and how it works, visit www.care-act.org.
Linda Boyd and Nilsa Gallardo are Mental Health Clinical Program Managers III, Los Angeles County Department of Mental Health CARE Program. To contact the authors, email Linda Boyd at lboyd@dmh.lacounty.gov and Nilsa Gallardo at ngallardo@dmh.lacounty.gov.
