Stanislaus County supervisors vote to delay implementing controversial mental health bill
Stanislaus County leaders are delaying implementation of a state law that expands the criteria for involuntary mental health holds to include people disabled by substance abuse.
People with severe mental illness can be placed on a 72-hour hold and admitted to a psychiatric center for emergency care if their mental illness makes them a danger to themselves or others, or if they are gravely disabled.
Senate Bill 43, written by Sen. Susan Eggman, D-Stockton, will add people with severe substance use disorders to the criteria for a “5150” hold, effective Jan. 1. That could serve to extend treatment to people on the streets who are disabled by heavy drug use.
Most of California’s 58 counties are expected to opt for a two-year delay, permitted in the law, while working on details of implementing the changes.
Stanislaus supervisors voted unanimously Tuesday for a delay, but Stanislaus might not wait as long as other counties. Tony Vartan, director of county Behavioral Health and Recovery Services, is expected to talk with hospital officials and other affected agencies and come back Jan. 30 with a recommended date for complying with the bill.
Citing the motivational value of deadlines, Supervisor Terry Withrow proposed setting the implementation date for Dec. 1, 2024. “I think the effect of this will be saving lives,” Withrow said. “We should try to get this up and running as quickly as possible.”
The state bill is aimed at getting treatment for people who are on the streets due to drug abuse but previously didn’t meet the criteria for involuntary treatment.
The new law expands the definition of “gravely disabled” in the Lanterman-Petris-Short Act to include someone who because of severe substance use disorder can’t provide for basic needs of food, clothing, shelter, personal safety, or necessary medical care.
Senate Bill 43 added “personal safety” and “necessary medical care” to what’s now a broader criteria. A person may fall under the gravely disabled definition for involuntary treatment or conservatorship if he or she has a severe substance disorder or co-occurring mental health disorder and severe SUD.
Under the new definition, a health practitioner could determine that conservatorship is necessary to keep a medical condition like diabetes from getting worse and resulting in serious bodily harm.
County staff explained the significance of the new law at Tuesday’s Board of Supervisors meeting. The definition of gravely disabled will allow for involuntary placement in a facility or conservatorship based on a severe substance use disorder or co-occurring mental health disorder and a severe SUD.
Counties may consider less restrictive alternatives such as Community Assistance, Recovery and Empowerment (CARE) Court to put individuals in a treatment plan.
A staff report said the county, police agencies, courts, hospitals and behavioral health facilities will need to plan for the SB43 changes. The Senate bill does not dedicate state funding for implementation, and the county will need additional time to arrange staffing and resources.
Hospital association voices concern
The California Hospital Association has weighed in with concerns, asking the counties to defer implementation and use the time to work with hospitals and law enforcement on policies and procedures for dealing with the changes. The CHA said the new law means that police or designated professionals “could place a broader group of individuals on an involuntary hold and transport them to a facility for assessment, evaluation and treatment.”
Vartan said if the county implements the law prematurely, without available treatment, beds in hospital emergency departments will be taken by people severely disabled by drug use who are waiting for placement in treatment facilities. “There are very few treatment settings that have the capacity to serve individuals with complex co-occurring medical, substance use disorder and mental health treatment needs,” the staff report said.
County staff said no criteria exist for assessing whether a person with a severe substance use disorder is gravely disabled and that will have to be developed.
Another unknown is when to end a conservatorship for someone being treated for severe substance use disorder, as there are no clinical standards for that determination, the staff report said.
As of Oct. 30, county BHRS was acting as public guardian for 252 people in conservatorships, managing housing and caring for their personal needs.
Group opposes Senate Bill 43
The organization Disability Rights of California opposes the new law, charging it will worsen bottlenecks in a state mental health system that’s lacking capacity. The group’s website says: “Many people placed on 5150 holds languish for days in hospital emergency departments while they await referral to community-based services or placement in acute psychiatric units.”
Stanislaus was among the first seven counties that began CARE Court on Oct. 1 for adults with untreated mental illness referred by families or other petitioners.
County Supervisor Vito Chiesa didn’t want to set an arbitrary deadline for implementing SB 43, but Withrow suggested it’s a way to get community partners on board.
Withrow acknowledged there’s a concern about funding for more substance use treatment, but Proposition 1 on the March ballot would, if approved, change how state mental health revenue is spent and includes $6.3 billion in bonds for building behavioral health housing and treatment facilities in California.
This story was originally published December 14, 2023 at 7:00 AM.
