The San Diego County Board of Supervisors voted 3-2 on Tuesday to delay implementation of SB43, a new state law that has changed the rules for conservatorships in California.
The state of California has given counties a two-year window to implement the law, which advocates say will help address the urgent addiction and mental health crisis among the homeless population.
SB43 has expanded who is eligible for conservatorship to include people with substance abuse disorders. Previously, people could only be considered for involuntary treatment if they were a danger to themselves or others, or if they were unable to support themselves with food and shelter. Now, people who are unable to get the medical care they need can also be placed on a 72-hour psychiatric hold. Law enforcement officers would take people to emergency departments where they would be held for 72 hours, at which point a clinician would conduct an assessment to determine whether the person should be placed in a longer psychiatric hold or a long-term conservatorship, a decision ultimately made by a judge on the recommendation of a clinician.
Dr Luke Bergmann, the director of San Diego County’s Behavioural Health Services Department, said SB43 does not provide any new resources for hospitals, substance use treatment providers or county-run public conservatorships.
“It doesn’t establish clinical assessment criteria that will lead clinicians to extend detentions, and it doesn’t do anything to create the operational tools that will actually get people with substance use disorders out of emergency departments and into ongoing addiction treatment,” Bergmann said.
The doctor estimated that there are 10 times as many people with substance use disorders as people diagnosed with mental illness. San Diego County Board of Supervisors Chairwoman Nora Vargas proposed the resolution to delay implementation of SB43 by one year, to 1 January 2025, after several medical professionals in the region appealed to the board for an extension. They said their hospitals’ emergency rooms were already at capacity and could not handle the sudden influx of new patients they expected to see as a result of SB43.
Others, including representatives from the San Diego Police Department, San Diego Fire Department and Mayor Todd Gloria’s office, made public comments urging the board to vote against Vargas’ resolution and calling for immediate implementation of the new law.
Supervisors Terra Lawson-Remer and Joel Anderson voted against the delay.
“I joined the Board of Supervisors to move our region past decades of stagnant, status quo politics, and for the better part of three years we have been successfully doing that with the actions we have taken in response to COVID-19, natural disasters and wildfires, and being one of the first in the state to implement Care Court – but today I felt like we took a step backwards,” said Lawson-Remer. “We can and must do better and act with urgency to address this crisis.”
Lawson-Remer asked the board to consider amending the resolution to specify that implementation must occur “no later than” 1 January 2025, but Vargas rejected the amendment.
The resolution calls for a working group of stakeholders to report to the board at its March meeting on their plans for implementation and what they need to do to prepare.