To: Board of Supervisors
From: Anna Roth, Health Services Director
Report Title: Deferred Implementation of Senate Bill 43
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
ADOPT Resolution No. to defer, until January 1, 2026, implementation of changes made by Senate Bill 43 to the Lanterman-Petris-Short Act.
FISCAL IMPACT:
Deferring implementation of the changes made by Senate Bill 43 has no fiscal impact.
BACKGROUND:
Senate Bill 43 (SB 43) amends the Lanterman-Petris-Short Act (LPS Act) by expanding the definition of “gravely disabled” for purposes of placing a person on an involuntary psychiatric hold or an LPS conservatorship. Commencing January 1, 2024, the expanded definition of “gravely disabled” will include individuals with a severe substance use disorder (or a co-occurring mental health disorder and a severe substance use disorder) who, due to their mental health or severe substance use disorder, are unable to provide for their personal safety or necessary medical care. SB 43 authorizes a county, by adoption of a resolution of its board of supervisors, to defer implementation of these changes until January 1, 2026, thereby postponing implementation of the new definition of “grave disability.”
Expanding the definition of grave disability to include persons believed to have a severe substance use disorder (SUD) is projected to increase the portion of the county’s population subject to involuntary treatment. Peace officers and county-designated professionals will have the ability to place a broader group of individuals on an involuntary hold and transport them to an LPS-designated facility for assessment, evaluation, and treatment. As a result, implementation of SB 43 is expected to result in a significant increase in the utilization of county health facilities, sub-acute treatment facilities, and treatment programs.
For SB 43 to be effective, the County’s behavioral health system will need the infrastructure and resources to address the increased utilization of existing facilities and programs and to develop new treatment programs and facilities for the influx of individuals who will now meet criteria for grave disability and may be subject to involuntary treatment and conservatorship. A full evaluation needs to be conducted; however, the Behavioral Health Services Division (CC-BHS) has made a preliminary determination that the following areas must be addressed before the County can provide the newly-mandated treatment and services in compliance with SB 43:
• Expand existing treatment facilities and programs and establish new treatment programs and facilities for the involuntary treatment of individuals who are gravely disabled as a result of severe SUD. This will entail the identification of private sector treatment facilities for the SUD population deemed gravely disabled as a result a severe SUD.
• Recruit, hire and train qualified mental health professionals, including professionals specializing in the treatment of severe SUD.
• Develop policies, procedures and protocols for the assessment and treatment of individuals who are gravely disabled as a result of a severe SUD. No policies, procedures or protocols currently exist.
• Develop assessment criteria for grave disability due to a severe SUD. (No such criteria presently exists.)
• Train Psychiatric Emergency Services (PES) staff, emergency department staff for all hospitals situated in Contra Costa County, and hospital psychiatric inpatient staff in the assessment and treatment of severe SUD for individuals detained pursuant to the expanded involuntary treatment criteria.
• Train law enforcement, who initiate the majority of involuntary LPS holds.
• Develop criteria for determining whether an individual is gravely disabled on the basis of the risks of non-treatment of a physical health condition.
• Obtain state agency clarification regarding the involuntary treatment of medical conditions for individuals in behavioral health treatment programs.
• Identify funding source(s) to support SB 43 implementation, including the financing necessary to support the expansion of treatment facilities, the increased staffing needs, the recruitment, hiring and training of a specialized workforce, and expansion and development of treatment programs. In addition, the County is responsible for the costs of the Public Guardian/Public Conservatorship Program, which will experience an increase in the number of mandated investigations and petitions for conservatorship for individuals rendered gravely disabled as a result of a severe SUD. The County is also responsible for all costs for treatment of conservatees in sub-acute facilities, which are subject to the IMD Exclusion Rule, which prohibits the use of Medi-Cal funds for care.
In conclusion, delaying the implementation of SB 43 will provide the County with the additional time necessary to work with local hospitals, law enforcement, and other stakeholders to develop necessary policies and procedures. It will also provide the time necessary to increase the behavioral health workforce, provide the necessary training, and increase treatment capacity. In addition, the California Department of Health Care Services has not yet developed standards for programs and facilities providing involuntary substance use treatment, as well as licensing and certification of these programs.
CONSEQUENCE OF NEGATIVE ACTION:
If implementation of the changes made by SB 43 is not deferred, beginning January 1, 2024, the County will be unable to provide mandated services for the assessment and treatment of individuals who are gravely disabled pursuant to the amended Welfare & Institutions Code § 5008.
THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA
and for Special Districts, Agencies and Authorities Governed by the Board
body
IN THE MATTER OF DEFERRING IMPLEMENTATION OF THE CHANGES MADE TO THE LANTERMAN-PETRIS-SHORT ACT BY SENATE BILL 43
WHEREAS, the Lanterman-Petris-Short (LPS) Act (Welfare and Institutions Code section 5100, et seq.) provides for the evaluation and treatment of a person who is gravely disabled, which is defined to mean a condition in which a person, as a result of a mental health disorder, is unable to provide for his or her basic personal needs for food, clothing, or shelter; and
WHEREAS, Senate Bill 43 (2023-2024 Reg. Session), Statutes 2023, Chapter 637 (SB 43), signed by the Governor on October 10, 2023, expands the definition of gravely disabled to include a person who, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, or as a result of impairment by chronic alcoholism, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care; and
WHEREAS, this expanded definition of gravely disabled becomes effective on January 1, 2024; and
WHEREAS, the responsibility for administering the LPS system falls largely with counties; and
WHEREAS, SB 43’s expansion of the definition of grave disability will require a significant effort in building and expanding the treatment, workforce, delivery networks, housing capacity and models for locked treatment settings or models of care for involuntary substance use disorder treatment to successfully meet the needs of the population; and
WHEREAS, the breadth of that effort requires more time than SB 43’s effective date allows; and
WHEREAS, in recognition of this need for more time, Welfare and Institutions Code section 5008, subdivision (h)(4), as enacted by SB 43, provides that a county, by adoption of a resolution of its governing body, may elect to defer implementation of the changes made to this section by SB 43 until January 1, 2026, thereby postponing implementation of the new definition of grave disability.
NOW, THEREFORE, BE IT RESOLVED by the Contra Costa County Board of Supervisors as follows:
1. Pursuant to Welfare and Institutions Code section 5008, subdivision (h)(4), as enacted by SB 43, Contra Costa County hereby elects to defer, until January 1, 2026, implementation of the changes made by SB 43 to Welfare and Institutions Code section 5008.
2. This resolution goes into effect on January 1, 2024.