In a move impacting efforts to combat California’s ongoing homelessness crisis, the board of supervisors in San Joaquin and Stanislaus counties has chosen to defer the implementation of significant changes to the state’s conservatorship law. Originally set to take effect in January, the adjustments, outlined in a bill from Sen. Susan Eggman, D-Stockton, signed by Gov. Gavin Newsom in October, represent the first major alterations to the state’s landmark 1967 Lanterman-Petris-Short Act.
The Lanterman-Petris-Short Act, signed by then-Governor Ronald Reagan, marked a departure from California’s approach to dealing with the “gravely disabled,” putting an end to the practice of housing individuals with mental illnesses in state hospitals or psychiatric facilities.
Joining Stanislaus and San Joaquin counties in postponing implementation are several other Central Valley counties, including Merced, Fresno, Sacramento, and Kern. Once enacted, the law will grant officials greater latitude in determining who can be placed in involuntary short-term psychiatric holds, as well as longer detention and treatment programs.
Under the existing law, only those deemed “gravely disabled” could be subjected to involuntary mental health care or conservatorship, including 5150 holds initiated by law enforcement or health providers that detain individuals in psychiatric facilities for 72 hours.
The revised law expands this definition to include “severe substance use disorder” without accompanying mental illness. It also broadens the criteria for individuals with existing mental health disorders to encompass those unable to provide for their “personal safety or necessary medical care.” Previously, eligibility for involuntary care was restricted to those unable to provide for their own food, clothing, and shelter.
While organizations like NAMI (National Alliance on Mental Illness) California and the California State Association of Psychiatrists support the bill, it has faced opposition from Disability Rights California, Human Rights Watch, and other disability and mental health organizations. Critics argue that it could infringe on the civil rights of an already vulnerable population and potentially lead to more mass involuntary conservatorships.
Behavioral health services directors in Stanislaus and San Joaquin counties successfully requested additional time to implement the changes. Concerns over insufficient capacities at county behavioral health facilities, emergency rooms, and drug treatment facilities were cited as reasons for the extended two-year window.
Stanislaus County Behavioral Health and Recovery Services Director Tony Vartan emphasized that the changes would impact beyond his department, affecting law enforcement, courts, hospitals, and other mental health providers in the region. Insufficient treatment programs or care facilities could lead to hospitals being burdened with patients in involuntary holds, potentially reducing beds for other sick or injured patients.
The California Hospital Association has reached out to county administrators statewide, including in Stanislaus and San Joaquin counties, urging them to delay implementation.
In San Joaquin County, Behavioral Health Director Genevieve Valentine stated that the extra time is necessary to build out infrastructure and staffing. Statewide, it is predicted that the changes will result in approximately a 10% increase in conservatorships. However, Valentine anticipates an increase of 20% to 25% in San Joaquin County due to the specific needs in the region.
Valentine emphasized the importance of strategic implementation to address the state’s mental health challenges, especially among the homeless population. The passage of SB 43 follows the state’s implementation of the CARE Act, establishing specialized courts called CARE Courts in each county, where mental health providers, first responders, family members, and others can petition the court to provide individuals with mental illness voluntary services and treatment.
While the CARE Court and SB 43 are unrelated, they both represent significant changes in how the state handles individuals with severe mental health disorders, aiming to address California’s ongoing homeless crisis.
To implement SB 43, San Joaquin County officials plan to build a new psychiatric facility opposite the existing county general hospital. If approved and funded, the up to 90-bed facility would commence construction in the coming summer.
In Stanislaus County, supervisors have requested Vartan to return to the board in January to provide a more detailed timeline and possibly an earlier deadline for SB 43’s implementation.
Supervisor Terry Withrow expressed enthusiasm during last week’s board meeting, considering the effort as crucial to saving lives. The governor has also voiced displeasure with what he called the “slow-walking” of the new conservatorship criteria. While most counties have chosen to delay implementation, San Francisco and San Luis Obispo counties are the only ones indicating readiness for the changes by January 1.
Governor Newsom emphasized the urgency, stating, “We can’t afford to wait; it’s time for the counties to do their job. They have to understand people are dying on their watch.”