California Gov. Gavin Newsom announces a proposed 2024 ballot initiative to treat people at risk of homelessness and with mental illness and drug addiction across the state at Alvarado Hospital in San Diego on March 19, 2023. (Courtesy of Office of Governor Gavin Newsom)
A bill designed to increase involuntary commitment for those in need of mental health treatment, but unwilling or unable to seek it themselves, was signed into law by California Gov. Gavin Newsom Oct. 10.
“California is undertaking a major overhaul of our mental health system. The mental health crisis affects us all, and people who need the most help have been too often overlooked,” Mr. Newsom said in a press release announcing the signing. “We are working to ensure no one falls through the cracks, and that people get the help they need and the respect they deserve.”
Senate Bill 43, authored by Sen. Susan Talamantes Eggman (D-Stockton), expands the current definition of individuals considered “gravely disabled” to include those with a substance abuse disorder or mental health concerns and are experiencing or at substantial risk of harm.
Previous definitions—which did not specify substance abuse as a qualifying condition for conservatorship—became California law in 1972.
“Like many things that are decades old, it has long been time to make some adjustments to the law to address the realities we are seeing today on our streets,” Ms. Eggman stated in the press release. “SB 43 maintains the strong due process protections provided ... while expanding the criteria for making a ‘gravely disabled’ determination, so that the most severely ill can get the help they need and the dignity they deserve.”
Family members will now be allowed to petition for the review of loved ones at risk of harm. If deemed appropriate, conservatorship hearings are conducted in local courts, with representation made available to those in question.
When granted, conservatorship allows family members and officials to involuntarily commit for medical treatment an individual that is incapable of caring for themselves.
The new law makes eligible for conservatorship those unable to provide food, clothing, and shelter needed for personal safety because of drug addiction or mental health issues.
California State Senator Susan Talamantes Eggman speaks at a hearing about Senate Bill 923 in Sacramento, Calif., on April 6, 2022. (Screenshot via California State Senate)
“Our current model is leaving too many people suffering with significant psychotic disorders in incredibly unsafe situations, leading to severe injury, incarceration, homelessness, or death,” Ms. Eggman said in the Senate Judiciary Committee’s analysis. “While well-intentioned, the dated criteria ... no longer work for today’s needs and have contributed to the mass incarceration of those with mental illness. This bill will help to provide dignity and treatment to those who are the most difficult to reach.”
For authorities to seek conservatorship, “serious harm” must be demonstrated, as defined by “significant deterioration, debilitation, or illness due to the person’s failure to satisfy the need for nourishment, attend to necessary personal medical care, utilize adequate shelter, be appropriately or adequately clothed, or attend to self-protection or safety.
Risks of harm may be proven if an individual previously suffered adverse effects and their condition is declining, or if they are unable to comprehend their illness.
Under the new law, the state’s Department of Health Care Services is required to collect and publish annual reports beginning in 2025 detailing the prevalence of conservatorship, the number of individuals detained, and how many times the same person was committed.
With a long list of supporters and opponents listed in the legislative analyses, consultants noted that change is needed.
Proponents argued the new law will provide more opportunities for those seeking assistance for their loved ones.
“Senate Bill 43 is essential to both those living with severe mental illness and their families by making it easier to provide mental health treatment for individuals unable to care for themselves,” said Jessica Cruz, CEO of the nonprofit National Alliance on Mental Illness, in the governor’s press release.
A homeless man sits passed out next to an empty syringe in San Francisco on Feb. 23, 2023. (John Fredricks/The Epoch Times)
Medical professionals agreed the bill will be beneficial by offering treatment for those at risk of harm.
“Treatments for mental illness can be wonderfully effective, but our laws often prevent us from providing them to individuals who are at mortal risk on our streets. SB 43 will help us provide life-saving care,” said Dr. Ron Thurston, president of the Psychiatric Physicians Alliance of California—a Sacramento-based advocacy group.
Critics argued that personal liberties are at stake due to the new involuntary commitment guidelines.
“Under the criteria proposed in this bill, there would be no requirement to prove that an individual lacks capacity to make decisions for themselves, or that they are at imminent risk of harming themselves or others,” the County Behavioral Health Directors Association of California—a nonprofit advocacy group representing directors from the state’s 58 counties—said in the legislative analyses. “This would constitute an enormous, gross overreach of the state’s power.”
The group also raised concerns regarding funding, suggesting that local jurisdictions could be forced to pay for some costs.
“If courts were to order involuntary [substance abuse disorder] treatment, they would not be bound by what Medi-Cal or other insurance payers would cover, leaving counties with a significant unfunded mandate,” the behavioral health association wrote. “This structural lack of reimbursement, across our major public and private insurance payers, has directly led to the scarcity of [substance abuse disorder] residential and inpatient treatment capacity.”