A lab technician cares for a patient in the Emergency Department at Providence St. Mary Medical Center in Apple Valley, Calif., on March 11, 2022. (Mario Tama/Getty Images)
A newly signed California law to address the growing number of individuals suffering from mental health crises is being met with caution by some county officials, with others urging implementation as soon as possible.
Senate Bill 43—which becomes effective on Jan. 1, 2024—expands criteria for involuntary treatment to include those suffering from substance abuse or chronic alcoholism.
The new measure offers mental health services for those unable to care for themselves, giving family members and others the opportunity to petition for treatment for at-risk individuals.
“People are struggling with severe substance abuse and mental health challenges in our city to the point where they cannot help themselves,” San Francisco Mayor London Breed said in a Dec. 7 statement highlighting the city’s readiness to enact the measure on day one. “When we have an opportunity to put a new solution into place, we must work quickly to do everything we can to implement it.”
But, nearly 50 of the Golden State’s 58 counties are planning to delay implementation, some for up to two years—the maximum amount the law allows.
In recommending holding off until 2026, officials from Alameda County—neighboring San Francisco—told its board of supervisors on Dec. 12 that many steps will need to be taken to prepare for the new law, including identifying additional treatment settings and coordinating with law enforcement and other agencies regarding education and training required to effectively follow the new law.
“Given the impact to vulnerable populations living with severe [substance abuse disorder] conditions, additional planning and consideration is required,” the county’s bureau of health wrote.
Questioning the need to delay implementation for two years, some pointed to Los Angeles County and its plan to implement the changes in January 2024 as evidence that a faster rollout is possible.
In some instances, city officials have differing opinions than county leaders, including in San Diego County.
Nearly two dozen mayors and city officials from across the region sent a letter on Dec. 4 to that county’s board of supervisors requesting no delay in action.
“Putting implementation off will cost people their lives and is an abdication of the county’s responsibility to provide critical mental health services to the most vulnerable in our communities,” officials wrote. “Residents directly feel the impacts of our broken behavioral health system and deserve good faith efforts to implement tools like SB 43 early.”
Some residents agree, saying the longer it takes to enact the new law the more lives are at risk.
“There is no excuse for our county to delay implementation of SB 43—none,” Linda Mimms, vice chair of the Schizophrenia and Psychosis Action Alliance—a nonprofit public policy group focused on mental health—wrote on Dec. 6 on X, formerly known as Twitter. “Time delayed equals lives lost.”
However, San Diego County supervisors ultimately voted to delay implementation for one year, citing letters from health care organizations requesting more time and the need to train law enforcement, among other things, as reasons for holding off.
In several counties, supervisors questioned the costs of enacting the new law—with a need for more beds and locked facilities for involuntary substance abuse disorder treatment. While the new law provides for Medi-Cal reimbursement, no timeline for payment is given, leaving counties to initially foot the bill.
Gov. Gavin Newsom signs CARE (Community Assistance, Recovery, and Empowerment) Court into law alongside state and local leaders and stakeholders in San Jose, Calif., on Sept. 14, 2022. (Courtesy of Office of Governor Gavin Newsom)
Supervisors in Santa Clara County—south of San Francisco—estimated “significant financial resources” will be needed and said the issue is “of particular concern” for the county during a Dec. 5 board meeting presentation.
“The bill was signed by the governor just weeks ago, and is a very substantial, unfunded mandate on counties,” James R. Williams, county executive for Santa Clara, said during the meeting. “We’re committed to moving forward ... and we anticipate making it a legislative priority in the coming year to recommend the state put money behind this.”
Though concerned about costs, the board decided to move forward in 2024, noting that cuts would be needed in other areas, yet to be determined, to make such possible.
While the new law is creating debate as local governments struggle with how to adapt to the new regulations, the bill flew through the Legislature with strong bipartisan support.
Originally introduced by Sen. Susan Talamantes Eggman (D-Stockton), the measure passed every committee and both houses of the Legislature without a single no vote recorded.