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Involuntary treatment expansion could be delayed in San Diego County

San Diego County supervisors will vote on a proposal to delay an expansion of involuntary treatment, part of Senate Bill 43. The law expands the legal definition of "gravely disabled" to include people with "a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder" who can't provide basic personal needs like food, clothing and shelter or for their own safety and medical care.

San Diego County Board of Supervisors Chair Nora Vargas proposed delaying implementation for a year, to 2025. She said the rollout of CARE Court required more than a year of planning, including working with stakeholders.

"This will ensure that the County of San Diego and the greater provider community can adequately build the infrastructure needed for intervention and support in behavioral health services, housing, staffing and judicial spaces," Vargas said in a letter to the Board of Supervisors.


Why it matters

Gov. Gavin Newsom signed SB 43 into law in October. Newsom's office touted it as legislation that "significantly updates California’s conservatorship laws for the first time in more than 50 years."

San Diego Mayor Todd Gloria has also been supportive of SB 43, saying it will help a "segment of our homeless population who up until now have been allowed to languish on the streets, often dying alone and forgotten by society."

Local hospitals, through the Hospital Association of San Diego and Imperial Counties, have pushed for a delay in the law's implementation. A letter to Vargas from Hospital Association CEO Dimitrios Alexiou said: "If SB 43 goes into effect on Jan. 1, 2024, there will be insufficient services in place for people who are deemed to meet the new requirements of gravely disabled."

Scripps Health CEO Chris Van Gorder said the region did not have the facilities necessary to temporarily treat more people.

"The year really gives this county time to plan and prepare and coordinate so that we all know what we’re going to be doing and how we’re going to manage this," Van Gorder said. "Remember this law is supposed to go into effect in less than a month now — and nobody has any discussion on coordination and how we’re going to do that."


Gloria said there was too much at stake to delay implementation for a year, arguing that lives could be lost.

"This is one of the key ways that we can get some of the most difficult cases — not folks who lost a job or who are struggling to pay rent — I’m talking about people who have severe mental illness: bipolar, schizophrenia, and often co-occuring situations with extreme substance abuse disorder, methamphetamine, fentanyl. That’s why I say that this could result in more people dying because these are the people we need to get into care," Gloria said.

Van Gorder said there was already a lack of behavioral health beds in San Diego and hospital emergency rooms are busy.

'"I'm concerned that it might cost people's lives because we don't have emergency rooms — that they’ll be full of patients," he said. "We’re supportive of what the mayor would like to accomplish, but we’re also worried about our capability and capacity to be able to do this safely for them and other patients."

Gloria said any change at this point was better than the status quo, and he worries that, if supervisors agree to delay implementation for a year, it could turn into two years, as SB 43 allows counties to push implementation off until 2026.

Supervisor Terra Lawson-Remer agrees that SB 43 should not be delayed.

"I recognize the lead time on SB 43 ramp-up for the County, hospital partners, services providers and city-partners is short, but we all should be moving as fast as possible to help the people we serve," Lawson-Remer said in an emailed statement. "I know if we move fast there will be challenges and gaps to overcome, but our response to public health emergencies like the COVID-19 emergency showed our region is capable and resilient. We should implement SB 43 in January.”

Closer look

San Diego County Sheriff Kelly Martinez supports delayed implementation because she said the proper training and infrastructure needed to be in place. In a letter to Vargas, Martinez said the law required a diagnosis of “severe substance-use disorder” and there is no system for law enforcement to verify that diagnosis.

"More work needs to be done to put a safe, efficient, and effective system into place, so law enforcement has the necessary resources to ensure that only those individuals who have been diagnosed with a severe substance-use disorder are properly detained as gravely disabled under the statutory amendments," Martinez wrote. "There is a real potential for risk and confusion regarding whether the individual encountered in the field qualifies under the statute."

County supervisors will vote on whether to delay implementing SB 43 on Tuesday.