The county Board of Supervisors voted 3-2 on Tuesday to delay for one year the implementation of a state law that expands the use of mental health holds, citing concerns about training and the added burden on hospital emergency rooms.
In October, Governor Gavin Newsom signed Senate Bill 43, which expands the definition of “gravely disabled” in terms of who can be involuntarily held and treated in facilities.
Under current law, mental health conservatorships can only be used when a person is a danger to themselves or others, or cannot provide for their own food, shelter or clothing.
SB 43, which goes into effect on 1 January 2024, expands eligibility for conservatorship to situations where people cannot manage their medical care or personal safety. It also adds substance use disorders to mental illness as a qualifying condition, according to San Diego Mayor Todd Gloria’s office.
Gloria has long supported SB 43. He spoke to reporters before Tuesday’s vote and said he understands hospitals are busy, but change is needed now.
“I have to feel that San Diegans feel that a hospital environment is a better place for very sick people than the sidewalk, which is where they’re ending up now,” Gloria said of some unsheltered residents. “We have to figure this out. Delaying isn’t going to help us figure it out, it’s going to delay having to make the hard choices that we know are coming.”
California’s involuntary treatment policy hasn’t changed much since it was written and signed into law in 1967, said Luke Bergmann, director of San Diego County’s Behavioural Health Services Department.
“So this amendment to SB 43 – I think we’ve established – is a big deal,” he said.
Before the vote, Bergmann told supervisors that the expansion would be far-reaching.
“SB 43 will almost certainly result in many more people being brought to emergency rooms… But SB 43 comes with no new resources,” Bergmann said.
More crowded ERs and a shortage of outpatient beds are concerns for the region’s hospital systems, which have lobbied for a delay in implementation.
“We’re just not ready to launch the system today,” said Dimitrios Alexiou, CEO of the Hospital Association of San Diego and Imperial Counties. “None of our hospitals disagree with the context of how to help – it’s more about having a system in place so we can be successful.”
Under the new law, a county government can delay implementation for up to two years. Supervisors on Tuesday passed a resolution calling for SB 43 to be implemented by January 2025. A report on the county’s efforts to implement the state law will be presented to supervisors sometime in March. Board Chairwoman Nora Vargas, who proposed the delay, voted “yes” along with Supervisors Jim Desmond and Monica Montgomery Steppe, who took her seat after being sworn in earlier.
Supervisors Joel Anderson and Terra Lawson-Remer voted against the measure. Vargas said that while the county has been a leader in behavioural health treatment and is not afraid to implement smart policies, it is also important to be careful about the new law and how it could affect residents.
“We’re talking about real families,” she said, adding that the county needs to make sure it has enough beds to accommodate patients, the right type of treatment, and properly trained health professionals and first responders. “Involuntary treatment is a significant action,” Vargas said.
Supervisor Monica Montgomery Steppe said before SB 43 is implemented, there needs to be a hiring plan, feedback from hospitals and the new law’s connection to CARE Court, a state-approved program that allows individuals to petition a court to order treatment and placement for people suffering from severe mental illness.
Montgomery Steppe also said she was concerned about the county enforcing SB 43’s requirements if law enforcement officers hadn’t received proper training.
“We really need to make sure that we’re doing the absolute best we can to comply with this mandate,” she added. “This is on us now. We cannot pass the buck.”
Vice-Chair Lawson-Remer said she couldn’t support the delay because the district hadn’t prepared for SB 43, even though it was unveiled earlier this year.
In a statement, Lawson-Remer said that “considerable time and energy has been spent trying to find the best ways to delay the implementation of Senate Bill 43 … but our region, and most importantly the people who desperately need treatment, would have been better served if those same people had been working on an implementation strategy. “A lot of people tried all kinds of excuses to make me feel better about going along with the delay,” Lawson-Remer added. “I don’t care if other counties delayed their implementation for two years. I represent the people of San Diego County, and we should strive to be better than the rest.”
Lawson-Remer said she would be open to supporting Vargas’ proposal after the 90-day review, with the hope that the county would “pedal to the metal” on SB 43.
Anderson said in a statement that he voted against delaying the new law because “the status quo is not working”.
“Every delay hurts my constituents and the communities I represent, and they cannot afford to wait any longer,” Anderson said. “I put ‘Fix Homelessness’ on my campaign signs and I meant it.”
Desmond said he was “really encouraged that the state has finally given us the kick in the pants to get the help we need” in terms of expanded treatment options, but agreed with Vargas about the lack of resources.
“We’ve got to do this the right way,” he said. “We can’t overrun the emergency rooms.” Desmond added that he wouldn’t support any future delays to the state law.
During public comment, supervisors heard from hospital and mental health professionals who urged a delay.
Cathryn Nacario, CEO of the National Alliance on Mental Illness of San Diego, said the “intentional and purposeful planning process ensures successful programs in our county,” such as mobile crisis response teams and crisis stabilisation units.
With hospital emergency departments already impacted by flu, COVID-19 and RSV cases, a delay in SB 43 “will allow time to address the gaps we already know exist,” she added.
A representative from Cal Fire Local 2881 said a one-year delay would allow all stakeholders to develop a plan and ensure first responders have the resources they need.
“We should not overload an already stressed system until we can fully prepare that system,” he added.
Others said there was no reason to delay implementation of the new law.
Colin Stowell, chief of the San Diego Fire Department, urged the board not to delay implementation. He noted that the SDFD responded to 53,000 calls for behavioural health issues last year, the equivalent of 38 first responders working 10 hours a day.
One woman who testified said SB 43 will extend life-saving care to more people. She said her son was diagnosed with schizophrenia in 2019, and she has spent years trying to get him proper care.
“The bottom line is this: We’re not doing enough for mental health,” she said. “There are people like my family in this country, like my son, who need this intervention now. The delay could be costing people their lives.