Senate Bill 43: Expanding Involuntary Behavioral Health Treatment

Overview

Senate Bill (SB) 43 makes changes to the Lanterman-Petris-Short (LPS) Act – a California law governing involuntary detention, treatment, and conservatorship of people with behavioral health conditions.

This new statute significantly updates California’s civil detention and conservatorship laws for the first time in more than 50 years by establishing new diagnostic criteria and by broadening the definition of “grave disability.” The criteria by which people may be civilly detained under the LPS Act includes:

  • Danger to self,
  • Danger to others, or
  • Grave disability.

Existing law, for purposes of involuntary commitment, defines “gravely disabled” as either a condition in which a person, as a result of a mental health disorder, is unable to provide for their basic personal needs for food, clothing, or shelter.

New law as indicated by bold text, SB 43 expands the definition “gravely disabled” to include:

  • people with a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder,
  • and, who are unable to provide for their basic needs for food OR clothing OR shelter OR access to necessary medical care OR personal safety.

SB 43 also makes the following changes:

  • Expands the array of testimony that can be submitted into conservatorship proceedings without requiring in-person cross examination.
  • Requires counties consider less restrictive alternatives in conducting conservatorship investigation.
  • Expands State reporting requirements.

Critical Actions in San Diego County

  • In October 2023, the Governor signed SB 43 into law effective January 1, 2024, with the option for counties to delay implementation, via a Board Resolution, until January 1, 2026.
  • On December 5, 2023, the County Board of Supervisors adopted a Resolution to delay implementation of SB 43 to January 1, 2025 to ensure adequate time to partner with community members, providers, and stakeholders to identify infrastructure and resource needs, assess service and financial impacts, and to develop an action plan to support successful implementation of the new requirement.
  • In January 2024, the County began convening a multi-sector planning group to support rapid implementation of SB 43. Planning efforts are supporting four key strategies needed to support readiness for the changes brought forth by this major update to State law:
    • Education and training,
    • Expanding treatment, services and supports for those with substance use disorder,
    • Establishing alternatives to emergency departments for 5150 holds, and
    • Updating procedures and add capacity to support the Office of the Public Conservator.

Details on this implementation strategy were presented in a Board Letter at the County Board of Supervisors meeting on April 9, 2024. Watch the meeting video to see the presentation.

 

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Frequently Asked Questions

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  • What is the Lanterman-Petris-Short (LPS) Act?

    The LPS Act is a California law signed in 1967 related to involuntary detention and conservatorship of people with behavioral health conditions. The LPS Act established a system of short-term holds as well as a path to temporary and “permanent” conservatorships.

  • What is conservatorship?

    LPS Conservatorship is for the most severely impaired individuals and involves a court-appointed conservator who can make decisions related to treatment and placement for individuals when they are unable to care for themselves.

    • People on a conservatorship receive case management and often reside in congregate care settings such as mental health rehabilitation centers, skilled nursing facilities, and board and care facilities.
    • Conservatorship may last for up to one year and is evaluated for renewal annually.
       
  • Who will be impacted by SB 43?

    People with a severe substance use disorder who may have trouble caring for themselves could be detained by peace officers and placed on a 5150 detention. This may result in people with a severe substance use disorder being more likely to receive involuntary treatment or be placed on a conservatorship.

    Peace officers will need to make a decision on whether a person meets the expanded criteria for grave disability which is defined as a condition in which a person as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic needs for food or clothing or shelter or access to necessary medical care or personal safety.

    Local hospitals and emergency rooms will likely see more people on 5150s brought in for evaluation and treatment. Because emergency rooms are best suited to manage the medical aspects of care associated with substance use disorders (versus the management of behavioral health and social needs), it is anticipated that peace officers will collaborate with EMS in the field to determine who specifically requires emergency medical services, and who can be safely transferred to alternative behavioral health settings such as CSUs, the County’s Emergency Psychiatric Unit (EPU) and other sites. A clinical decision will need to make as to whether continued detention is appropriate. Collaborative work will need to be done to mitigate concerns of additional behavioral health “boarding” in the emergency room setting.

    Community-based substance use providers will likely have increased requests and contacts from crisis stabilization units, emergency departments, and hospitals for care transitions of clients.

  • What is considered "severe" substance use disorder under this new law?

    Clinically, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) allows clinicians to specify how severe or how much of a problem a substance use disorder is. Out of eleven criteria outlined in the DSM-5-TR, a person would need to have six or more symptoms to indicate a “severe” substance use disorder. 

    In practice under SB 43, a peace officer will need to determine in the field whether a person appears to have a severe substance use disorder and would qualify for an initial 5150 hold under the new expanded criteria. 

  • What happens if someone is placed on an LPS detention due to severe substance use disorder?

    The person would be transported to an LPS-designated facility – likely an emergency room or hospital (or an alternative site designated as LPS by the County) – for evaluation and treatment for up to 72 hours. After the 72 hours expires, a few different things could happen: 

    • The person could be released if the person does not continue with treatment; (e.g., they are no longer considered “gravely disabled");
    • The person is relased from the hold and enters voluntary treatment; or
    • The person continues to receive involuntary treatment by being placed on a 5250 hold for up to 14 days.
  • If a person is brought in intoxicated, does the clearance of their intoxication mean that they'll be released?

    Severe substance use disorder is a diagnosis made independent of intoxication. Someone brought in on a 5150 detainment suspected of severe substance use disorder may continue to be detained even after intoxication clears.

  • What if my loved one needs substance use treatment now?

    An array of substance use and mental health treatment options are always available by calling the County’s Access and Crisis Line at 1-888-724-7240. 

  • When will SB 43 be implemented in San Diego County?

    The County of San Diego, in collaboration with community partners, is currently planning key actions needed to support readiness for the changes brought forth by SB 43 which will occur on January 1, 2025. 

  • How does SB43 intersect with the CARE Act Program?

    The Community Assistance, Recovery, and Empowerment (CARE) Act program creates a new pathway to deliver mental health and substance use services to people who are diagnosed with schizophrenia or other psychotic disorders and are not engaged in treatment. The intention of the CARE Act Program is to connect people to voluntary treatment through a civil court process.

    With SB 43, the CARE Act program will be considered as a less restrictive path to treatment for people who are referred for LPS conservatorship through the Office of the Public Conservator.

  • How is SB 43 funded? Is there State or federal funding that comes with these changes?

    At this time, there is no designated State or federal funding to support implementation of SB 43. The County of San Diego is pursuing pathways to allow for services to be eligible for federal and State reimbursement.

  • Does SB 43 mandate or coerce people into treatment?

    Yes it could, if the person meets criteria and does not go into treatment voluntarily. SB 43 broadens who is eligible to be detained for involuntary treatment.  

  • What steps is the County of San Diego taking to be ready by January 1, 2025?

    The County has started a multi-sector planning process to support rapid implementation of SB 43 on January 1, 2025. Planning efforts for four main readiness strategies are underway including:

    • Education and training,
    • Expanding treatment, services and supports for those with substance use disorder,
    • Establishing alternatives to emergency departments for 5150 detentions, and
    • Updating procedures and add capacity to support the Office of the Public Conservator.
       

    Details on this implementation strategy were presented in a Board Letter at the County Board of Supervisors meeting on April 9, 2024. Visit the Clerk of the Board of Supervisors webpage to watch the meeting video.

  • I have questions. Who can I talk to for answers?

    Please email Behavioral Health Services: BHSContactUs.HHSA@sdcounty.ca.gov

 

Page last updated 4/19/24