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County sets date for involuntary treatment for ‘gravely disabled’
• Bill aims to help mentally ill on streets
Del Taco homeless dude
A significant number of homeless persons who are dealing with crippling mental illness or substance abuse can be forced to undergo treatment under a new law which Stanislaus County will put into place on Jan. 1, 2025. This man was seen sleeping outside Del Taco on Mitchell Road in Ceres. - photo by JEFF BENZIGER/ Courier file photo

Starting Jan. 1, 2025, Stanislaus County will embark on a new program to begin involuntary treatment for select individuals with substance abuse and mental health issues.

Last week the Stanislaus County Board of Supervisors approved the start date for the program which is a mandate on counties under Senate Bill 43 authored by state Senator Susan Eggman, D-Stockton and signed by Gov. Gavin Newsom last October. The bill represents the first major changes to the state’s landmark 1967 Lanterman-Petris-Short Act. Signed by Gov. Ronald Reagan, the legislation upended how California dealt with the “gravely disabled” and ended the state’s previous practice of warehousing those with mental illnesses in state hospitals or psychiatric facilities.

Under the 1967 law, only those deemed “gravely disabled” were required to be placed in involuntary mental health care or conservatorship, including 5150 holds initiated by law enforcement or health providers that detain people in psychiatric facilities for 72 hours.

The new law expands that definition to include “severe substance use disorder” without any accompanying mental illness. It also broadens the criteria for those with existing mental health disorders to include those who cannot provide for their “personal safety or necessary medical care.” Previously only those who could not provide for their own food, clothing and shelter could be eligible for involuntary care.

Stanislaus County Behavioral Health and Recovery Services Director Tony Vartan was successful in getting supervisors for more time to implement the changes. Concerns over insufficient capacities at county behavioral health facilities, area emergency rooms and drug treatment facilities were among the reasons for the delay.

In December Vartan told supervisors that the changes would have an impact beyond his department. Law enforcement, courts, hospitals and other mental health providers in the region must grapple with the new expanded definition of “gravely disabled.” He also noted that without sufficient existing treatment programs or care facilities, it would force “hospitals to be stuck with a lot of patients in an involuntary hold,” which could mean fewer beds for other sick or injured patients.

The passage of SB 43 follows the state’s implementation of the CARE Act, which established specialized courts (called CARE Courts) in each county. County mental health providers, first responders, family members and others can petition the court to give individuals with mental illness voluntary services and treatment.

Stanislaus County is part of a seven-country pilot program that launched its CARE Court last October. The rest of the state has until December 2024 to finalize the new courts.

While the two laws are not related, they both represent significant changes to how the state handles those with severe mental health disorders in an effort to address California’s ongoing homeless crisis. 

In December Supervisor Terry Withrow pronounced the new law as “a godsend” and said “We’re talking about saving lives…I can’t think of a better way for us to spend our time and resources than to try to get this thing up and running as quickly as possible.”

Gov. Newsom has also been vocal in his displeasure in what he called the “slow-walking” of the new conservatorship criteria. Most counties have opted to delay implementation, which was allowed in the act, with San Francisco and San Luis Obispo counties the only ones so far indicating they’d be ready for the changes by Jan. 1, 2024.

Vartan said the county has been meeting with officials at Doctors Medical Center, Emanuel Medical Center and Doctors Behavioral Health Center as well as Ceres, Modesto and Turlock police to discuss ways to implement the program by the end of this year. Vartan’s department has also been consulting behavioral health professionals, public guardians, court officials, patient’s rights advocates to accommodate the mandates of the new law.

Vartan said the county will need to hire additional staff, build programs and train first-responders to identity when a person needs to be placed into the program. Still to be determined is where treatment programs will be offered or when treatment should end for patients.

The new law will have financial impacts on counties and will not provide extra funding for the program. Those costs are expected to be addressed in June with the adoption of the budget for Fiscal Year 2024-25.

While groups like the NAMI (National Alliance on Mental Illness) California and California State Association of Psychiatrists have supported the bill, its signing was not without controversy. Disability Rights California, Human Rights Watch and other disability and mental health organizations have argued it would infringe on the civil rights of an already vulnerable population, and could lead to more mass involuntary conservatorships. 

– Marijke Rowland, the senior health equity reporter for the Central Valley Journalism Collaborative, a nonprofit newsroom based in Merced, contributed to this report.