Newsom signs mental health bill expanding definition for conservatorship in California

Gov. Gavin Newsom signed Senate Bill 43, which updates California’s conservatorship laws for the first time in more than 50 years.

The new law, authored by Susan Eggman (D-Stockton), updates the definition for conservatorship to include people who are unable to provide for their personal safety or medical care due to severe substance use disorder or serious mental illnesses.

The bill stems from a decades-long fight to amend the Lanterman-Petris-Short Act (LPS Act), passed when Ronald Reagan was governor. Under the LPS Act, a person could be detained against their will if they were “gravely disabled” or posed a danger to themselves or others.

Proponents of SB 43 argued that LPS Act is inadequate and often leads to criminalization and jail rather than treatment.

“(LPS Act) established strong and important civil liberty protections to ensure individual rights are protected," Eggman said. "Like many things that are decades old, it has long been time to make some adjustments to the law to address the realities we are seeing today on our streets."

California lawmakers have been working to overhaul the state's mental health system in order to better treat those who pose a risk to themselves and others.

"The mental health crisis affects us all, and people who need the most help have been too often overlooked," Newsom said. "We are working to ensure no one falls through the cracks, and that people get the help they need and the respect they deserve.”

What is conservatorship?

The options to treat a severely mentally ill person, who refuses treatment, are limited in California.

Eggman, a clinical social worker, has worked to expand the number of counties offering assisted outpatient treatment and improve wraparound programs for those with the greatest needs.

Some counties have adopted Laura's Law — court-mandated, wraparound care. Under Laura's Law, patients must have a serious mental illness plus a recent history of psychiatric hospitalizations, jail time, and threats or attempts of serious violent behavior toward themselves or others, according to the Treatment Advocacy Center.

Tulare County has court-ordered voluntary treatment such as mental health court, mental health diversion, drug and recovery court treatment, and an Assertive Community Team (ACT). ACT works with patients who are unsuccessful with voluntary outpatient services. Case managers help patients with medication, self-care, individual therapy, group therapy and rehabilitative skills.

However, most forms of treatment require a person to seek and follow through with services.

For many families, the only option to get their loved ones consistent, life-saving care is conservatorship.

Conservatorship is a form of treatment only used for people who have a mental health disorder so severe that it prevents them from providing for their own basic needs. These people may also pose a public safety risk.

This form of treatment is used to stop the cycle of repeated arrests, psychiatric hospitalization, homelessness, and even death. The goal is to get a person into treatment so they can manage their mental health on their own and end the conservatorship.

The process begins with a county mental health department petitioning a court to appoint a third party, often a family member, to direct the person’s care for a limited time. Family members cannot start a mental health conservatorship.

Under SB 43, a conservatorship investigation is done to ensure that all available alternatives to conservatorship are not suitable for the patient. The investigator will then give their report to the court for review. The report include the patient's medical, psychological, financial, family, vocational, and social condition. It also contains information from family members, close friends, a social worker, or therapist.

The judge will then render a decision.

A conserved patient loses legal authority to make medical, financial and placement decisions. The practice is considered restrictive and disempowering by some mental health workers and disability rights advocates.

However, due process protections provided in the LPS Act are still in place under SB 43.

The person for whom conservatorship is being requested has the right to demand a court or jury trial to decide if they are "gravely disabled." The person must prove that they can survive safely without being forced into a treatment facility, according to SB 43 text.

Conservatorships typically last up to six months but can be extended up to two years. Patients are often housed at state mental health facilities where their medications are monitored. Counseling is also provided, but not mandatory.

How will SB 43 impact local services?

Tulare County Behavioral Health staff say they have been tracking the bill's progress.

"We understand and are in support of the need to connect individuals with co-occurring substance use disorders and other mental health conditions to higher levels of care as intended with this bill," stated Dr. Natalie Bolin, Tulare County's mental health director.

The agency already provides services to this population with its mobile crisis and forensic assertive community treatment (FACT) teams. This form of treatment preserves the patient's civil liberties whenever possible and provides wrap around services and community resources.

A team of forensic psychologists was also hired by the agency.

Even with these programs and additions to behavioral health staffing, the need for psychiatric beds is projected to be largest in the northern and southern San Joaquin Valley, according to a 2021 RAND report on adult psychiatric bed capacity, need, and shortage estimates in California.

Bolin said her agency has seen a rise in conservatorship referrals and cases over previous years. Currently, there are 135 clients under LPS conservatorship in Tulare County.

Many of the people being referred for conservatorship have stand-alone or co-occurring substance use disorders and other mental health conditions, Bolin said.

"With this new legislation we will continue to pursue opportunities to grow our services while also working with local and state partners to address widespread shortages in placements and higher level of care facilities, such as mental health rehabilitation centers, augmented board and cares, and inpatient psychiatric hospitals," she said.

Tulare County Behavioral Health has been working on growing local higher level of care placement opportunities. The county has added an augmented board and care in Visalia (previously known as Casa Grande) and a crisis residential facility in Tulare (Jackson House).

SB 43 also requires that counties provide the state public health department with local data on conservatorship, including the number of people transferred to mental health facilities, the number of conservatorships established in the county, and patient outcomes.

The California Department of Health Care Services will make this information public on its website.

The law could be implemented starting in January, but under SB 43, counties have the option to extend implementation to January 2026.

This article originally appeared on Victorville Daily Press: Newsom signs mental health bill expanding definition for conservatorship