Senate Bill 43 (SB 43)
Learn More about SB 43, the broadening of “grave disability”, and expansion of involuntary behavioral health treatment.
What is Senate Bill 43?
Senate Bill (SB) 43 was recently signed by the Governor and expands the definition of Grave Disability. Grave Disability is one of the criteria used to place people with disabilities on involuntary holds.
Overview
Senate Bill (SB) 43 updates the Lanterman-Petris-Short (LPS) Act – a California law governing involuntary detention, treatment, and conservatorship of people with behavioral health conditions. This new statute 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.
Old Definition
A condition in which a person, as a result of a mental health disorder, is unable to provide for his or her basic personal needs for food, clothing, or shelter.
New Definition (Under SB 43)
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 personal needs for food, clothing, shelter, personal safety, or necessary medical care.
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 Changes the Definition of Grave Disability in TWO ways:
1. Adds severe substance use disorder as a reason someone could be placed on an involuntary hold.
2. Adds inability to provide for one’s personal safety or necessary medical care as reasons that a person could be placed
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.
FAQS
About 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 Emergency Medical Services in the field to determine who specifically requires emergency medical services, and who can be safely transferred to alternative behavioral health settings such as crisis stabilization units, 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.
-
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.
-
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.
-
For minors, SB 43 does not change the definition for the first 72 hours of detention pursuant to grave disability, but it does apply to minors if any other detention beyond 72 hours is used. Refer to WIC § 5585.20 and WIC § 5585.25.
Substance Use
-
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.
-
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.
-
An array of substance use and mental health treatment options are always available by calling the County’s Access and Crisis Line at 1-855-838-0404.
SB 43 and the 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.
-
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.
-
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.
-
County LPS Designated facilities are mental health treatment facilities that are designated by the county for evaluation and treatment, approved by the State Department of Health Care Services (DHCS), and licensed as a health facility or is certified by the State DHCS to provide mental health treatment. LPS Designated facilities include, but are not limited to, licensed psychiatric hospitals, licensed psychiatric health facilities (including some hospitals), and crisis stabilization units.