In a head-on collision between good intentions and the stubborn facts of life – and death – on the streets, Santa Barbara County supervisors voted to delay implementation of a new state law that would greatly expand the number of people who can be held against their will and forced into involuntary treatment for severe substance abuse problems. In addition, the new law – Senate Bill 43 – would allow the county to detain and treat people against their will if they can’t pay for their own health care and medical treatment.
If implemented, these changes would increase the number of people currently held for treatment against their will tenfold over what is allowed under current law, said Toni Navarro, executive director of the county’s Department of Behavioural Wellness. Last year, Navarro said, 425 people in Santa Barbara County were placed on so-called 5150 holds. The county has only 16 beds for such holds. If that number increased to 4,250, supervisors were told by a team of executives from Cottage Hospital – including CEO Ron Werft – that emergency rooms would be overwhelmed and chaos would ensue.
The law that allows such detentions has not been changed since it was first enacted 55 years ago. The new law – unanimously approved by both houses of the state legislature and signed by Governor Gavin Newsom in October – seeks to address the tide of addiction, mental illness and homelessness engulfing California’s cities by expanding what qualifies as “gravely disabled”.
While Navarro said she supported the intent of the law, she asked supervisors to wait until 2026 before implementing it. Her department, she admitted, was already under pressure. Early next year, regulators will look at how to improve the delivery of crisis services. At the very least, Navarro said, she needs time to draw up a plan and hire the qualified staff needed to implement it. That won’t be possible before 1 January 2024, when the new law comes into force.
Already, 38 counties have said they will delay implementation. The latest start date allowed by the legislation is 1 January 2026. Even then, it will be a long wait. The big sticking point is where to send people who are involuntarily detained for treatment.
“These facilities do not exist in the state of California,” Navarro said. “Nowhere.”
An even bigger stretch, she added, is whether involuntary treatment programmes work in treating serious substance abuse. Based on her limited research – “Don’t quote me,” she said, only partly in jest – Navarro said involuntary treatment programs tend to produce higher rates of relapse, recidivism, overdose and death. This grim assessment was later echoed by Dr Paul Erickson, director of psychiatry and addiction services at Cottage.
“It’s an idea that has appeal,” Erickson said, “but it has not worked in any of the states that have tried it.”
Arguing for sooner rather than later was Lynne Gibbs, mental health advocate and policy specialist for the National Alliance on Mental Illness. Gibbs dismissed Navarro’s prediction of a tenfold increase in involuntary confinement as a “hysterical overestimation”. Behavioural Health, Gibbs added, “has a history of ideological opposition to any form of involuntary care, even temporary. Gibbs cited a handful of specific cases in which people in extreme duress were not deemed 5150-worthy and later died or suffered dire consequences.
Supervisor Bob Nelson – moved by Gibbs’ testimony – opposed any delay beyond six months. Where would all the people go now, he asked a nurse with 45 years’ experience in the emergency room, who would cause so much chaos in hospitals because of SB 43?
“They’ll be on the street,” she replied.
As the most conservative member of the board, Nelson is also the most open to compulsory treatment. The county spends millions on homeless services, he noted, but treatment remains a critical missing link. Some people will refuse treatment, he noted, and need to be pushed.
In the end, the supervisors voted 4-1 to give Navarro the two-year extension she sought, but told her to come back in July – six months from now – with a well-thought-out game plan.
“Sometimes you have to go slow at the beginning,” said Supervisor Joan Hartmann, “so you can go faster later.