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About Mental Health

Senate Bill 43 is to be implemented by 2026.

As efforts continue to integrate care for those with severe substance use disorders, San Mateo County Health is in the planning stages of implementing Senate Bill 43.

The bill expands the Lanterman-Petris-Short Act, a conservatorship law, to include defining “gravely disabled” due to impacts of a severe substance use disorder alone. Previously, the law only had authority over those who were at risk of harm due to mental illness, or mental illness co-occurring with substance use disorder.

The law went into effect Jan. 1, but counties have two years to “implement” this expanded definition — and flexibility in what that means. Initial implementation efforts from County Health have so far included three listening sessions held by the Behavioral Health and Recovery Services devision to begin gathering input on best methods and practices to be considered going forward.

Kenneth Minkoff, a psychiatrist and consultant on clinical services and systems design for individuals with co-occurring disorders for County Health, said the county is in its “pre-launch” phase at the third and final listening session held Wednesday.

“We have to proceed on the assumption that we’re going to be working within the resources we have,” Minkoff said. “We want to do things that are hopeful, not harmful.”

Involuntary treatment is a difficult thing to implement because of the sheer fact that it is involuntary.

Michael Lim, a member of the Behavior Health Commission, said that although he can’t speak for everyone, he has experience with a family member who was detained — or 5150’d — and his work with the client community shows vehement opposition to this bill or anything involving involuntary services.

He said many who are detained for psychiatric hospitalization share frustration with the experience and belief that their autonomy is stripped away, sometimes unnecessarily so.

“A lot of the reaction is basic grief from the quality of services when they were 5150’d,” Lim said. “A good part of that comes from inadequate service and requiring each county to do this task without assigning additional resources is concerning.”

Improvements to current facilities, although may seem superficial, can be a good starting point to making clients feel truly supported though.

“If I’m being treated for my physical medical condition and I’m hospitalized, I’m usually in a nice environment,” Lim said. “If I’m in detox or rehab, my environment is pretty drab. It shouldn’t be any different.”

Peter Dell, County Health deputy medical director, said it’s important to understand that using this law and involuntarily detaining someone is the last thing physicians hope to do. He said his major concern relates to exacerbating already established health care inequities between racial demographics and socioeconomic class in particular.

The discrepancy in readily available treatment for those on Medi-Cal as compared to private health insurance is also at the forefront of health care worker concerns.

Minkoff said through his research on this subject matter, many states have legislation similar to this, but don’t use it, and those who use it can’t seem to demonstrate that what they’re doing is beneficial.

“We really need to just make sure what we’re doing actually helps people,” he said.

County Health will be paying attention to San Francisco and San Luis Obispo counties, Minkoff said, who are both implementing the new definition early in the two-year grace period.

“We’re hoping to learn from their adventures,” he said.

At a press conference earlier this month, County Executive Officer Mike Callagy announced the county’s early implementation of Community Assistance, Recover and Empowerment Court, or CARE Court. The state-mandated court is designed to provide resources and treatment to unhoused people with mental health and substance use disorders who may not seek the help voluntarily. He said the county looks to fully implement SB 43 “as soon as possible,” which will make it easier to get someone into a conservatorship and get them the help they need.

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