SB 43: Revised definition now includes severe substance use disorders and expanded criteria

In California, the Lanterman-Petris-Short (LPS) Act provides for involuntary detention of individuals who, as a result of a mental health disorder, are a danger to themselves or others, or who are gravely disabled. Such detention can only happen pursuant to strict procedures and for limited amounts of time periods for evaluation and treatment and potentially additional intensive treatment in designated facilities. The LPS Act also permits appointment of a conservator for individuals who are gravely disabled as a result of a mental health disorder. Senate Bill (SB) 43 expands the circumstances under which an individual is considered gravely disabled, and therefore may be involuntarily detained or conserved under the LPS Act.

Prior to Jan. 1, 2024, the LPS Act defined gravely disabled as a condition in which a person, as a result of a mental health disorder, is unable to provide for their personal needs for food, clothing, or shelter. SB 43 expands this definition to include individuals with a severe substance use disorder (SUD) and with a co-occurring mental health disorder and severe SUD, as well as individuals who, due to a mental health disorder, a severe SUD, or a co-occurring mental health disorder and a severe SUD, are unable to provide for their personal safety or necessary medical care.

In full, the new definition reads: A condition in which a person, as a result of a mental health disorder, a severe SUD, or a co-occurring mental health disorder and a severe SUD, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.

“Severe SUD” is defined as “a diagnosed substance-related disorder that meets the diagnostic criteria of ‘severe’ as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.”

“Personal safety” is defined as “the ability of one to survive safely in the community without involuntary detention or treatment…”

“Necessary medical care” is defined as “care that a licensed health care practitioner …determines to be necessary to prevent serious deterioration of an existing physical medical condition which, if left untreated, is likely to result in serious bodily injury…”

(SB 43 similarly amends an immunity statute which applies to non-LPS designated hospitals under an alternative process.)

Related to the conservatorship process, SB 43 also adds Welfare and Institutions Code section 5122, expanding the evidence admissible in LPS conservatorship proceedings. This new provision creates a limited exception to the rule against hearsay by allowing expert witnesses to rely upon statements of specified health practitioners made in the medical record of the individual subject to the conservatorship proceeding, under certain circumstances.

Finally, SB 43 also adds to DHCS’s data collection requirements for involuntary detentions the number of involuntary detentions subject to the expanded definition of gravely disabled.

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SB 43 expands the number of individuals who will potentially be eligible for involuntary treatment, but does not address funding or infrastructure for providing services. Thus, while providers are preparing to care for individuals who may meet the expanded definition of gravely disabled, issues such as resources for providing this care will be important as SB 43 is implemented.

SB 43 will go into effect Jan. 1, 2024, but counties may defer implementation of the changes to the definition of gravely disabled until Jan. 1, 2026. As of the date of publication, many counties have already delayed implementation for varying lengths of time, up to two years.