By MARIJKE ROWLAND

Special to  the

Ceres (Calif.) Courier

For the second time in a year, Stanislaus County is a testing ground for sweeping changes to California mental health policy.

In January, Stanislaus became one of a handful of counties to begin implementing SB 43 a year earlier than required. The new law is aimed at curbing the state’s homelessness crisis, but could also increase the number of people forced into care against their will.

Passed in late 2023, the law adds to the state’s criteria for conservatorship, a kind of legal guardianship for people living with severe mental health disorders. The law expands the definition of “gravely disabled,” which was first set in the 1967 Lanterman-Petris-Short Act (LPS) signed by then Gov. Ronald Reagan. That landmark legislation ended California’s practice of warehousing people with mental illnesses in state psychiatric facilities and instead set up criteria for who could be involuntarily committed for both short and long-term holds.

The “gravely disabled” threshold for conservatorship had previously required a corresponding mental health diagnosis, but SB 43 has now added “severe substance use disorder” and inability to provide for “personal safety or necessary medical care” as standalone criteria. Before, only those who could not provide for their own food, clothing and shelter could be placed in involuntary care.

The new broader definition was championed by Gov. Gavin Newsom along with a slate of other statewide mental health policy and funding shifts made to address homelessness, including Proposition 1 and CARE Court.

Stanislaus County implemented the latter, a new civil court division that can order those with untreated schizophrenia or other psychotic disorders into housing and treatment, a year before most other counties as part of its pilot program.

SB 43 is the first significant change to California conservatorship law in more than four decades. Getting county agencies on the same page took more than a year of monthly meetings with affected stakeholders, including law enforcement, medical staff and mental health professionals.

“This kind of LPS reform, which is unprecedented actually, affects almost all sectors,” said Bernardo Mora, medical director of Stanislaus County Behavioral Health and Recovery Services. “Hospitals, health clinics, doctors’ offices, emergency services, law enforcement, the court system, DA, PD – I’m probably leaving somebody out.” 

Stanislaus County supervisors were eager to implement the new law and agreed to move the deadline up a full year. The county is among four– including Sacramento, San Bernardino and San Diego – that deployed SB 43 this year. San Francisco and San Luis Obispo counties implemented it at the start of 2024. The remaining 52 counties have until January 2026.

Critics of SB 43 said broadening the “gravely disabled” definition has the potential to place many more people into forced conservatorship, which severely limits their civil liberties. Groups like Human Rights Watch and Disability Rights California also worry that involuntary holds would skyrocket across the state. 

But Mora said that has not played out in practice, so far. He said data from San Francisco and San Luis Obispo show an initial increase in 5150 holds, but that numbers leveled off by year’s end. 

State law allows 5150 holds, which can be initiated by law enforcement or medical and mental health professionals, if people meet one of three criteria: danger to themselves, danger to others or gravely disabled. The 72-hour holds are the first step to possibly longer term holds, including 14-day 5250 holds all the way to permanent conservatorship.

Local law enforcement officials also said they were not expecting a sharp increase in their 5150 holds because of the new criteria. Representatives from the Modesto Police Department, among other Valley agencies, were part of the county stakeholder meetings on SB 43 over the past year. 

Modesto Police Lt. Michael Hammond said officers already regularly make in-the-field evaluations on 5150 holds and adding the substance abuse is another part of the criteria. 

“It’s one more tool in our tool belt, but then again it’s just an application for a hold, and we still have to take them to the hospital,” said Hammond. “They still have to be seen by medical staff and mental health staff, and so I don’t expect to see a rise in holds based on that.”

He said all patrol officers participated in two days of training on the new definitions, and received new forms for 5150 hold applications. 

Local health providers, including those who manage regional hospitals were also part of the county stakeholder meetings. A spokesperson for Sutter, which has a large footprint in Stanislaus County and operates Memorial Medical Center, said along with updated training and resources the organization has hired additional substance-use-treatment navigators for its emergency departments.

But Sutter officials said, based on early data, they also are not expecting an influx of new 5150 holds at the hospital. 

Mora said this is because, while the definition may have expanded, the most affected populations often already have a combination of both mental health disorders and substance abuse. 

“It’s actually very common to have both a behavioral health disorder and a (substance use) disorder,” said More. “The estimates are something around half of folks, if you have one, you have the other – and vice versa. So we’re already serving these folks.”

Marijke Rowland is the senior health equity reporter for the Central Valley Journalism Collaborative.