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: Authorizing the Implementation of Senate Bill 43
RECOMMENDATION:
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Adopt a resolution authorizing the implementation of Senate Bill 43 in San Mateo County effective January 1, 2026.
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BACKGROUND:
The Lanterman-Petris-Short (LPS) Act was enacted in 1967 to end the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders, developmental disabilities, and chronic alcoholism, as well as to safeguard a person’s rights, provide prompt evaluation and treatment, and provide services in the least restrictive setting appropriate to the needs of each person. The LPS Act contains provisions for the involuntary detention of a person deemed to be a danger to self or others or defined as “gravely disabled” for periods of up to 72 hours for evaluation and treatment or for up to 14 days and up to 30 days for additional intensive treatment in county-designated facilities. The LPS Act also sets out the process for a conservator to be appointed for someone who is gravely disabled as a result of a mental health disorder or impairment by chronic alcoholism and who remains gravely disabled after periods of intensive treatment. For purposes of evaluating and treating an individual who has been involuntarily detained or for placing an individual in conservatorship, the LPS Act currently defines “gravely disabled” as a condition in which a person, as a result of a mental health disorder or impairment by chronic alcoholism, is unable to provide for their basic personal needs for food, clothing, or shelter.
On October 10, 2023, the California Legislature passed Senate Bill 43 (Eggman), effective as law on January 1, 2024. The new law expands the LPS Act’s definition of “gravely disabled” by adding “personal safety” and “necessary medical care” to the definition and including the qualifying conditions of “severe substance use disorder or co-occurring with both a severe mental health and severe substance use disorder.”
In addition to expanding the definition of “gravely disabled” and the criteria for conservatorship, Senate Bill (SB) 43 also makes numerous changes to the conservatorship process. A limited hearsay exception is added for statements of specified health practitioners, which allows certain relevant medical records to be admissible in the proceedings.
Further, the law requires that alternatives to conservatorship be considered during the conservatorship investigation, specifically Assisted Outpatient Treatment, a long-standing program in San Mateo County, and Community Assistance, Recovery and Empowerment Court, which is currently available in the County.
Finally, SB 43 places significant reporting requirements on Behavioral Health directors and LPS facilities. Failure to meet the increased reporting requirements can result in the State issuing corrective action plans and/or civil monetary penalties.
SB 43 further specifies that if counties must expand services to implement the law, these costs qualify as a state-mandated program requiring state reimbursement. The State only recently drafted reimbursement instructions, which are not yet finalized.
SB 43 allows counties to defer implementation of the expanded definition of grave disability until January 1, 2026. On December 12, 2023, the Board of Supervisors approved the deferral of implementing SB 43 for San Mateo County until no later than January 1, 2026. Behavioral Health & Recovery Services (BHRS) recommends that the Board of Supervisors adopt the attached resolution implementing SB 43 in San Mateo County effective January 1, 2026.
DISCUSSION:
The major challenges to SB 43 implementation include: identifying the additional placements and services that will result from an increase in the 72-hour and 14-day involuntary detentions, as well as in the conserved population; the impact of increased detentions on emergency departments; assuring state reimbursement to the County for the costs to expand services and infrastructure; developing funding mechanisms for Substance Use Disorder treatment where none currently exist; developing and building out alternative programs in lieu of conservatorship; expanding the systems for reporting state required information; and aligning these efforts with other County initiatives that address homelessness and street level services.
Since December 2023, BHRS has been actively planning and testing treatment pathways and interventions with local hospitals, law enforcement, first responders, providers, clients, and families. This work has been conducted under the oversight of the SB 43 Steering Committee, consisting of 50 members representing all entities impacted by the new law. The Steering Committee is supported by 10 workgroups made up of Steering Committee members and providers closest to the target population and is headed up by BHRS staff. Changes within the system have been supported by the Internal Implementation Committee that is made up of County staff from BHRS and the San Mateo Medical Center.
The Steering Committee developed an implementation plan for SB 43 that envisions a welcoming and hopeful system, incorporating efficient, integrated services guided by collaborative treatment planning that leads to successes, but also plans for failure to keep individuals engaged in treatment. This is a culture shift across the entire system of care.
FISCAL IMPACT:
At this time, costs associated with the implementation of SB 43 are billed where possible and otherwise covered 100% by realignment. The State has developed claiming instructions that, once implemented, will allow most SB 43 costs to be billed to Medi-Cal, which would generate 50% Federal Financial Participation and have the remaining 50% covered by Realignment.