Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Jei Africa, Director, Behavioral Health and Recovery Services
Subject: Recommendation to Approve Resolution Authorizing the Use of an Additional 30-day Involuntary Psychiatric Hold (Welfare & Institutions Code Sections 5270.10-5270.)
RECOMMENDATION:
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Adopt a resolution authorizing in the County of San Mateo implementation of Section 5270.10-5270.70 of the Lanterman-Petris-Short (LPS) Act, which allows persons on a 14-Day Involuntary hold to be certified for up to two additional involuntary hold periods of 30 days of involuntary intensive treatment.
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BACKGROUND:
The LPS Act allows for the County Board of Supervisors to authorize implementation of Welfare and Institutions Code § 5270.10 et seq. (Section 5270). Section 5270 provides for an additional 30-day involuntary hold for intensive treatment for persons already on a 14-day hold and allows the professional staff of the agency or treating facility to petition the Superior Court for a second additional 30 days of intensive treatment. Currently, persons that would benefit from additional intensive treatment are required to be placed on a temporary conservatorship; otherwise, they are discharged from care.
However, not all persons needing additional intensive treatment need a conservator. The intent of Section 5270 is to reduce the number of gravely disabled persons for whom conservatorship petitions are filed in order to obtain an additional period of treatment, without the belief that a conservator is actually needed and without the intention of proceeding to trial on the conservatorship petition. A 5270 hold allows additional time for the provision of involuntary, intensive psychiatric treatment, is less restrictive than a conservatorship, and may avoid the need for a conservatorship altogether.
This request has been brought forward as part of the implementation of Senate Bill (SB) 43, which is to occur by January 1, 2026. SB 43 expands the LPS Act to include individuals with severe substance use disorder and added medical care and personal safety to the definition of gravely disabled. Challenges with SB 43 implementation include identifying the additional placements and services that will result from an increase in the involuntary detentions, and developing and building out alternative programs in lieu of conservatorship. Implementation of Section 5270 is intended to address these challenges, by completing the continuum of care for involuntary holds necessary to meet the needs of individuals with severe substance use disorder.
DISCUSSION:
We are asking the Board to authorize the implementation of Section 5270 in order to expand treatment options available to those persons who qualify as gravely disabled and avoid placement in a higher and more restrictive level of care. This option to implement a 30-day intensive treatment certification in San Mateo County will expand treatment options available to inpatient psychiatric units and Maguire Correctional Facility’s Acute Stabilization Unit (ASU). The Conservatorship Investigations Unit determined that there were 39 temporary conservatorships (T-Cons) of 30 days or less that ended in dismissal in both 2022 and 2023. These clients would likely have been appropriate candidates for 5270 holds, under which they would receive the treatment needed, without referral to a T-Con. Similarly, the option of a 5270 hold is expected to reduce the number of referrals to T-Con from the San Mateo Medical Center Inpatient Psychiatric Unit and allow additional time to serve the patient without imposing greater restrictions of conservatorship.
Additionally, individuals who are not County residents but who are being held in the County, for instance in the ASU, may be placed on a 5270 hold. Thus, implementation of 5270 holds would allow facilities to provide further involuntary, intensive psychiatric treatment for these such individuals, rather than referring them for a T-Con. It is hoped that these individuals stabilize during the additional 30-day hold, and a T-Con will no longer be needed. This is important because once an individual is put on a T-Con in San Mateo County, those individuals are the responsibility of the County, regardless of whether they “reside” in another county.
Practitioners in our neighboring counties recognize the many consequent benefits of the implementation of 5270 holds. For instance, referrals by the Stanford inpatient psychiatric unit for temporary conservatorships of San Mateo County residents decreased by about 75% since Santa Clara’s implementation of 5270 holds. In Marin County, 35 individuals were placed on 5270 holds in the first year of implementation, and only two 5270 holds converted to temporary conservatorships.
Additionally, officials from hospitals in San Mateo County with inpatient units support 5270 implementation. Seton Hospital estimates up to 30 individuals per year would avoid a T-Con, and Mills-Peninsula estimates 90% of their T-Con referrals could be held under 5270, a reduction of 8 T-Con referrals a year. Further, the Office of the Patient’s Rights Advocate is in support of the 5270 hold because it is less restrictive for the patient.
Under a 5270 hold, individuals are more likely to receive treatment within or near their community and transition back more quickly than those under temporary conservatorship. By contrast, individuals placed under temporary conservatorship often remain in higher levels of care for longer periods due to their conserved status. This delays their transition to lower levels of care-frequently located in or near their community-and creates additional strain on the care system.
As part of implementation, Behavioral Health Recovery Service staff will collaborate with other County departments and the Superior Court to establish the necessary policies, procedures, and workflows to implement the 5270 processes. The expected implementation date is June 30, 2025. We have worked with the County Attorney’s Office to prepare for this Board’s consideration the attached resolution implementing California Welfare and Institutions Code § 5270.10 - 5270.65 in San Mateo County. Implementation will be subject to the Health Chief providing this Board with written confirmation that the processes are in place to implement the law.
EQUITY IMPACT:
The implementation of 5270 benefits vulnerable populations in San Mateo County by avoiding the burdens of more restrictive temporary conservatorships. Among individuals temporarily conserved in the County, the racial/ethnic demographics are 22% Black, 15% Latine, 15% Asian, 8% Mixed Race, 1% Native Hawaiian or Pacific Islander, and 39% White. A 30-day hold under 5270 reduces the stigma and discrimination associated with conservatorships, which disproportionately affect a predominantly non-White population. These holds allow individuals to receive extended treatment without the necessity of assigning a conservator or pursuing a conservatorship trial.
FISCAL IMPACT:
We expect the implementation of 5270 holds to be cost neutral, given the expected reduction in the number of temporary conservatorships, which are more labor intensive than the 5270 process. Any additional costs incurred by the County in the implementation of WIC 5270 shall be funded by the resulting cost savings or by new funding so that no current service reductions will occur. Thus, there is expected to be no net County cost.