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New California law addressing mental illness, addiction among homeless delayed by Valley counties. Here's why

Community Medical Center's CareLink Mobile Outreach Team leaves water and snacks at an empty encampment in Stockton hoping their patient returns to find the supplies on Nov. 9, 2023.
Vivienne Aguilar
Central Valley Journalism Collaborative
Community Medical Center's CareLink Mobile Outreach Team leaves water and snacks at an empty encampment in Stockton hoping their patient returns to find the supplies on Nov. 9, 2023.

Historic changes to California’s conservatorship law, which will expand who can be placed in involuntary care and treatment in an attempt to address the state’s ongoing homelessness crisis, will have to wait in the Central Valley.

The board of supervisors in San Joaquin and Stanislaus counties have opted to defer the new law, which otherwise would have gone into effect in January. Officials in both counties will now have an additional two years to comply with the changes.

The bill from Sen. Susan Eggman, D-Stockton, signed by Gov. Gavin Newsom this October, represents the first major changes to the state’s landmark 1967 Lanterman-Petris-Short Act. Signed by then Gov. Ronald Reagan, the legislation upended how California dealt with the “gravely disabled” and ended the state’s previous practice of warehousing those with mental illnesses in state hospitals or psychiatric facilities.

Stanislaus and San Joaquin counties are joined by other Central Valley counties, including Merced, Fresno, Sacramento and Kern, as with much of the state in postponing implementation. Once enacted, the law will give officials greater leeway in who can be placed in involuntary short-term psychiatric holds, longer detention and treatment programs.

Currently, only those deemed “gravely disabled” can be placed in involuntary mental health care or conservatorship, including 5150 holds initiated by law enforcement or health providers that detain people in psychiatric facilities for 72-hours.

The new law expands that definition to include “severe substance use disorder” without any accompanying mental illness. It also broadens the criteria for those with existing mental health disorders to include those who cannot provide for their “personal safety or necessary medical care.” Previously only those who could not provide for their own food, clothing and shelter could be eligible for involuntary care.

While groups like the NAMI (National Alliance on Mental Illness) California and California State Association of Psychiatrists have supported the bill, its signing was not without controversy. Disability Rights California, Human Rights Watch and other disability and mental health organizations have argued it would infringe on the civil rights of an already vulnerable population, and could lead to more mass involuntary conservatorships.

The behavioral health services directors for both Stanislaus and San Joaquin counties successfully asked their supervisors for more time to implement the changes. They cited worries of insufficient capacities at county behavioral health facilities, area emergency rooms and drug treatment facilities among the reasons for the additional two-year window.

Stanislaus County Behavioral Health and Recovery Services Director Tony Vartan told the board last week that the changes would have an impact beyond his department. Law enforcement, courts, hospitals and other mental health providers in the region will also have to grapple with the new expanded definition of “gravely disabled.”

He said without sufficient existing treatment programs or care facilities, it would force “hospitals to be stuck with a lot of patients in an involuntary hold,” which could mean less beds for other sick or injured patients.

The California Hospitals Association has reached out to county administrators across the state, including in Stanislaus and San Joaquin counties, urging them to delay implementation.

In San Joaquin County, Behavioral Health Director Genevieve Valentine said the extra time is needed to build-out infrastructure and staffing. While statewide it is predicted the changes will result in an about 10% conservatorship increase, Valentine said in San Joaquin County they expect an increase of 20% to 25% because of the need in the region.

“I would hate to rush something when someone’s life is at risk — when their civil rights are at risk,” Valentine said. “I want to make sure in San Joaquin County we are very strategic in how we put this into place.”

She called the law another “tool” in their toolkit to help deal with the state’s mental health challenges, particularly among its homeless population. The passage of SB 43 follows the state’s implementation of the CARE Act, which established specialized courts (called CARE Courts) in each county. County mental health providers, first responders, family members and others can petition the court to give individuals with mental illness voluntary services and treatment.

New psychiatric facility planned

Stanislaus County is part of a seven-county pilot program that launched its CARE Court this October. The rest of the state has until December 2024 to finalize the new courts.

While the two laws are not related, they both represent significant changes to how the state handles those with severe mental health disorders in an effort to address California’s ongoing homeless crisis.

To implement SB 43, San Joaquin County officials plan to build a new from-the-ground-up psychiatric facility across from the existing county general hospital. If approved and funded, the up to 90-bed facility would begin construction this coming summer.

In Stanislaus County, supervisors have asked Vartan to return to the board in January to give a more detailed timeline, and possibly earlier deadline, for SB 43’s implementation.

“I look at this as a godsend,” said Supervisor Terry Withrow during last week’s board meeting. “We’re talking about saving lives…I can’t think of a better way for us to spend our time and resources than to try to get this thing up and running as quickly as possible.”

The governor has also been vocal in his displeasure in what he called the “slow-walking” of the new conservatorship criteria. Most counties have opted to delay implementation, which was allowed in the act, with San Francisco and San Luis Obispo counties the only ones so far indicating they’d be ready for the changes by Jan. 1.

“We can’t afford to wait,” Newsom told reporters last week. “The state has done its job; it’s time for the counties to do their job. … They have to understand people are dying on their watch.”

Marijke Rowland is the senior health equity reporter for the Central Valley Journalism Collaborative, a nonprofit newsroom based in Merced.