Newsom tells counties to move faster in enacting new conservatorship law

Governor Gavin Newsom is urging county leaders to take advantage of new state law that makes it easier to place people with severe mental health issues or substance use disorders in conservatorships — a step he believes will help prevent people unable to care for themselves from winding up on the streets, in jail or dead.

County health departments must enact the new rules contained in Senate Bill 43 before a Jan. 1, 2026 deadline, but can opt to do so sooner. So far only San Francisco and San Luis Obispo counties have started implementation.

Leaders in Los Angeles and Orange County say they say they need time to fund and build more mental health facilities and train practitioners on the changes to conservatorship law.

 

That isn’t good enough for Newsom, who recently sent a letter to the chairs of the state’s 58 county boards of supervisor urging them to immediately implement SB 43.

“I am disappointed that only two counties in California have implemented this critical, lifesaving work to date,” he wrote in a July 27 letter. “Despite having unprecedented tools at your disposal to start helping our state’s most vulnerable people right now, you are still waiting to implement this element of the work to improve our conservatorship system until the absolute deadline.”

Prior to SB 43, people could be placed under the court-appointed care of a conservator if they met the definition of “gravely disabled,” meaning they were unable to provide their own food, shelter or clothing.

SB 43, which passed in 2023, expanded that definition to include people who are unable to provide for their own safety or medical care. It also expanded the cause of conservatorships to include substance use disorders, not just mental health issues.

The Los Angeles County Board of Supervisors voted unanimously in December 2023 to delay implementation until 2026 and this week the L.A. County Department of Mental Health issued a statement in response to Newsom’s letter saying, “the new law was rolled out without consideration for the infrastructure, resources or supports, financial and otherwise, needed for this massive and complex undertaking.”

“L.A. County has more than 4,200 individuals at 40 hospitals who need to be trained on the changes to the law so that they can make clinically consistent decisions about what constitutes ‘grave disability’ while protecting individual civil rights,” the statement said. “New bed capacity needs to be built to accommodate a population of patients who will require locked facilities when held for treatment involuntarily.”

The Orange County Board of Supervisors voted 4-1 to delay implementation until 2026 in December 2023. At the time, O.C. Chief of Medical Services Veronica Kelley pointed out that the county did not have the necessary infrastructure to treat people who are conserved due to substance use.

“That means if I were to put somebody today on a hold, because they had a severe substance use disorder and were unable find food, clothing or shelter, tend to their safety or make medical decisions, I would bring them to one of our current designated facilities that is not able to lock a door and treat a substance use disorder,” Kelley said. “That facility would release the hold and the person would be out on the street.”

Orange County Supervisor Katrina Foley was the only supervisor to vote against the delay as she believes SB 43 could save lives.

“Individuals who are chronically homeless and need medical care because they cannot take care of themselves, they are deteriorating on the street or in the parks because of severe substance abuse or severe mental illness, some caused by the other,” Foley said in an interview on Thursday, Aug. 1. “This would allow us to move people into treatment without the person we’re trying to treat having to be competent enough to say, ‘I need help,’ which they are not able to do so.”

While SB 43 did not come with accompanying funding to build mental health and substance use facilities, Newsom is now urging county’s to take advantage of the pot of money made available by Prop. 1.

The $6.38 billion bond measure was passed by voters in March and will be used to build new behavioral health housing and treatment settings across the state.

State Sen. Susan Talamantes Eggman, D-Stockton, authored SB 43 and said she understands the points raised by both Newsom and county leaders.

“I think what the governor is frustrated with is that for so long, people have said, ‘We can’t do anything because of this (conservatorship law).’ Well, now we’ve removed all those barriers so you can,” she said. “At the same time, I have empathy for the counties because we made all these massive changes and there are facilities that need to come with it and a workforce that needs to be built up.”

Eggman’s impetus for reforming conservatorship laws come from having an aunt who struggled with bipolar disorder and who her family repeatedly tried and failed to place under a conservatorship. Ultimately Eggman’s aunt ended up living on the streets where she was assaulted and later died from AIDs.

“Here’s a family who’s trying so hard to help somebody they love and the system is saying she’s not sick enough (to enter a conservatorship),” said Eggman. “I grew up with that tragedy and my cousin always saying ‘you’ve got to fix this’.”

For the first two-thirds of the 21st century Californians who were unable to care for themselves due to mental illness were locked up in state hospitals that gained a reputation for human rights abuses like those depicted in Ken Kesey’s novel “One Flew Over the Cuckoo’s Nest.”

In 1967, California Gov. Ronald Reagan signed the Lanterman-Petris-Short (LPS) Act to end the involuntarily commitment of people with mental illness and replace it with the conservatorship system.

While the LPS Act ended a lot of abuse, it did not create an adequate system to cater to the needs of people with mental illness, said Eggman. This problem become more severe with the rise in homelessness and spread of highly addictive drugs like fentanyl, she added.

Now Newsom wants counties to use the SB 43 to provide a court-appointed conservator to care for people experiencing serious mental illness or severe substance use disorder.

“Every day, I hear about the life-and-death urgency of our behavioral health crisis. I see people languishing on our streets, often forgotten by their own communities,” Newsom said. “This is wholly unacceptable.”

Some disability and civil rights advocates, however, fear that Newsom’s push for more conservatorships will take the state back to the dark days of the mental health asylum system.

“Disability Rights California opposes Governor Newsom’s behavioral health system reforms which expand forced treatment. Using Proposition 1 money to build locked facilities will harm people with mental illness and substance use disorders,” the organization stated in May. “Treatment is more likely to succeed when people are invested in their own recovery. Force and coercion are not the answer.”

Another new tool Newsom has created to address the twin crises of mental health and homelessness is the CARE Court system.

Under the program, family members, first responders, social workers, mental health professionals and other qualified people can petition a CARE Court to come up with a plan to address the needs of people experiencing severe mental illness and/or substance use.

People who enroll in CARE Court can receive services such as mental health care, housing and other support for a maximum of two years, with periodic review hearings scheduled to go over their case. In severe cases, CARE Court can be used to refer people to conservatorship proceedings. Those who enter the program can leave any time and won’t face any civil or criminal penalties for rejecting treatment.

All counties are required to launch a CARE Court system by Dec. 1, 2024, and L.A. County joined seven other counties in moving ahead of schedule by launching its CARE Court program on Jan. 1, 2024.

Since then L.A. County’s CARE Court has received 190 petitions to connect people with court-ordered treatment plans, according to the Department of Mental Health. Of these cases, 45 have been dismissed by a Superior Court judge, 145 remain active and 15 have resulted in a treatment agreement.