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Adopt a resolution deferring implementation of Senate Bill (SB) 43, which significantly updates California’s conservatorship laws under Lanterman-Petris-Short Act, until January 1, 2026
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Published Notice Required? Yes ___ No _X_
Public Hearing Required? Yes ___ No _X_
DEPARTMENTAL RECOMMENDATION:
The Department of Health and Social Services (H&SS) recommends that the Board of Supervisors adopt a resolution deferring implementation of Senate Bill (SB) 43, which significantly updates California’s conservatorship laws under Lanterman-Petris-Short Act, until January 1, 2026.
SUMMARY:
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 currently 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. As a result of SB 43, signed by the Governor on October 10, 2023, the definition of gravely disabled will expand 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.
SB 43 makes several significant changes to the State’s involuntary detention and conservatorship laws under the Lanterman-Petris-Short (LPS) Act and since this responsibility falls largely on counties, Solano County H&SS, mainly the Behavioral Health Division and the Public Guardian, will need to develop an extensive array of new policies, procedures, reporting, training, workforce, and treatment capacity such as substance use residential beds and services in order to implement these changes. SB 43 does not include dedicated State funding to support the expanded obligations; therefore, Solano County will need additional lead-time to arrange for staffing and resources necessary to support implementation. SB 43 allows counties to delay implementation until January 1, 2026, through the adoption of a county board resolution.
FINANCIAL IMPACT:
The costs associated with preparing this agenda item and resolution are nominal and absorbed by the Department’s FY2023/24 Working Budget. There is no additional funding for SB 43 implementation activities or services. Deferred implementation will allow exploration of funding availability and access to Medi-Cal for specialty mental health services and Drug Medi-Cal.
DISCUSSION:
The H&SS Behavioral Health Division supports approximately 5,805 adults and youth through County behavioral health programs, contract programs and the Managed Care Provider Network. Of those, 25% had a co-occurring mental health and substance use condition requiring specialty mental health services. Based on these numbers, the increased impact to the Behavioral Health Division is expected to be substantial.
The process of a LPS evaluation begins with what is called a “5150” assessment by a mental health professional (authorized and designated by the Behavioral Health Director) or a peace officer (law enforcement). As a result of SB 43, the Behavioral Health Division will need to develop criteria for a “severe substance use disorder” grave disability assessment, as no such assessment currently exists, as well as protocols for designating individuals to perform severe substance use disorder gravely disability assessments. Solano Behavioral Health and contractors will need to recruit and hire staff to perform severe substance use disorder grave disability assessments.
The H&SS Behavioral Health Division currently has 455 individuals across Solano County (staff, contractors, hospitals, public and private health care entities) that have current 5150 designation authority to place involuntary holds. Training is offered monthly and 149 people have been trained since January 2023. After a person is placed on a 5150 hold, they are transported to the Crisis Stabilization Unit (CSU), Solano County’s local designated facility in Fairfield, or a hospital emergency department for an assessment. Solano Behavioral Health will need to develop policies and procedures for these severe substance use disorder determinations.
The CSU currently cannot accept an individual if they are under the influence of substances and require medical clearance; therefore, hospitals will be significantly impacted. Hospitals already experience difficulty retaining qualified designated individuals to perform the assessments needed to remove involuntary holds, when appropriate, or recommend conservatorship when appropriate. Additionally, it may be determined that a person placed on a 5150 hold requires conservatorship through the Public Guardian. By expanding LPS to capture any person who has a severe substance use disorder, this change in policy would significantly expand the portion of the population potentially subject to detention and conservatorship under LPS from approximately 1% to approximately 10% of the population. Last year, the Solano County Public Guardian received 21 referrals for conservatorship; this year there is currently 54 referrals. It is expected that the broadened definition of gravely disabled will more than double these numbers, particularly for those with substance use disorders.
Those who are conserved are usually placed by Behavioral Health in locked psychiatric or rehabilitation treatment facilities which are Solano County’s costliest programs and there are limited beds for those who meet this level of need. These facilities only exist to support those with mental health conditions; there are no locked facilities for those with substance use conditions and currently there are no clinical standards to determine when to end involuntary substance use disorder treatment. Additionally, because there is no locked treatment capacity for individuals with severe substance use disorder, hospitals may be impacted by the need to hold additional individuals who are awaiting placement.
Furthermore, by adding physical health conditions as a basis for conservatorship, the State is requiring counties to develop a new set of medical services to evaluate and assess physical health risks and status. These LPS law changes do not trigger new State funding. The State provides no funding for public guardians (100% County General Fund), funding for designated individuals to conduct assessments, or the Patient’s Rights Advocates needed to make determinations, conduct hearings and investigations, and manage conservatorships. There is no new funding for expanded treatment services, including substance use disorder, mental health, or new physical health providers necessary to evaluate grave disability on the basis of failing to meet basic medical needs. The only expansion of funding for substance use disorder treatment has been written into SB 326, or Proposition 1, set to go to the voters in March 2024, which would reallocate funds from existing mental health services currently needing treatment for substance use disorder treatment.
ALTERNATIVES:
The Board could choose not to adopt this resolution. This is not recommended because attempting to implement SB 43 too quickly without proper adjustment in training and policy will be detrimental to client care.
OTHER AGENCY INVOLVEMENT:
Health and Social Services, Behavioral Health Division, will be working the Public Guardian, the courts, advisory boards, community members, managed care plans, hospitals, and law enforcement partners for SB 43 implementation.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION