Agenda Item AGENDA STAFF REPORT ASR
Control 23-000990 |
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MEETING
DATE: |
12/05/23 |
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legal entity taking action: |
Board
of Supervisors |
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board of supervisors district(s): |
All
Districts |
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SUBMITTING Agency/Department: |
Health
Care Agency (Approved) |
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Department contact person(s): |
Veronica
Kelley (714) 834-7024 |
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Annette
Mugrditchian (714) 834-5026 |
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Subject: Senate Bill 43 Resolution
ceo CONCUR |
County Counsel Review |
Clerk of the Board |
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Concur |
Approved
Resolution to Form |
Discussion |
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3
Votes Board Majority |
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Budgeted: N/A |
Current Year
Cost: N/A |
Annual Cost: N/A |
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Staffing Impact: |
No |
# of Positions: |
Sole Source: N/A |
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Current Fiscal Year Revenue: N/A
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Prior Board Action: N/A |
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RECOMMENDED
ACTION(S):
Adopt by Resolution to defer to January 1,
2026, implementation of the changes made to the definition of gravely disabled
in Welfare and Institutions Code Section 5008 by Senate Bill 43.
SUMMARY:
Adoption of this Resolution to defer
implementation of the changes made to the definition of gravely disabled in
Welfare and Institutions Code Section 5008 by Senate Bill 43 will allow the
County to better prepare for addressing the needs of the expanded population
that will meet the grave disability criteria.
BACKGROUND
INFORMATION:
The Lanterman-Petris-Short Act (Welfare
& Institutions Code (WIC) § 5000 et seq.) (LPS Act) establishes a uniform,
statewide civil commitment scheme for the involuntary detention of individuals
with a mental health disorder. The LPS
Act provides for a process to involuntary hold (detain) a person for varying
lengths of time for the purpose of providing treatment and evaluation,
progressing from an initial 72-hour hold to conservatorship. Typically, the first interaction with the LPS
Act is through what is commonly referred to as a 5150 hold where a peace
officer, or an individual or facility authorized by the county Behavioral
Health Director (i.e., “LPS-designated”), may involuntarily detain a person for
up to 72 hours for evaluation and treatment if the person is determined to be,
because of a mental health disorder, a threat either to themselves or to
others, or gravely disabled. Following a 72-hour hold, the person may be
involuntarily detained for an additional 14 days of intensive treatment if
found to still be, because of a mental health disorder, a threat to themselves
or others, or gravely disabled (WIC § 5250). If the person is still found to
remain gravely disabled and unwilling or unable to accept voluntary treatment
following the (WIC § 5250) 14-day hold, the person may be involuntarily
detained for an additional period of not more than 30 days of intensive
treatment (WIC § 5270). On the other hand, if the person is deemed imminently
dangerous (based on several statutory enumerated conditions) following the (WIC
§ 5250) 14-day hold, the person may be involuntarily detained for treatment for
an additional period, not to exceed 180 days (WIC § 5300). Finally, the LPS Act
provides for a conservatorship of the person, of the estate, or of both, for a
person who is gravely disabled because of a mental health disorder so the
person is provided individualized treatment, supervision, and appropriate
placement (WIC § 5350).
Currently under the LPS Act, the term,
“gravely disabled,” means a condition in which an adult person, as a result of
a mental health disorder, is unable to provide for his or her basic personal
needs for food, clothing, or shelter (WIC § 5008(h)). Gravely disabled does not
include persons with intellectual disabilities by reason of that disability
alone.
Senate Bill (SB) 43
expands the definition of “gravely disabled” in (the revised) WIC § 5008(h) as
a condition in which an adult person, as a result of a severe substance use disorder, or
a co-occurring mental health disorder and or a severe substance use
disorder, is unable to provide for basic
personal needs for food, clothing, shelter, personal safety, or necessary
medical care.
It defines “severe
substance use disorder” in (the newly added) WIC § 5008(o) 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, which is based on the number of symptoms assessed by
clinician that meet this criteria.”
It also requires counties under (the
revised) WIC § 5350(a) to consider less restrictive alternatives such as
assisted outpatient treatment (AOT) and CARE Court in conducting
conservatorship investigations.
SB 43 does not currently come with
dedicated state funding to support the expanded obligations. Delaying
implementation until January 2026 will allow Orange County to develop an
extensive array of new policies, procedures, workforce, and treatment capacity
to implement SB 43 and identify the staffing and resources necessary to support
implementation. Additionally, with the changes in SB 43, Orange County will be
required to obtain new licensing that has not yet been identified by the State.
Expanding the definition of “gravely
disabled” to include persons with severe substance use disorder significantly
expands the portion of the population currently subject to detention and
conservatorship under the LPS Act from approximately 1 percent to around 10
percent of the population.
SB 43 allows counties to elect to
defer implementation of the changes made to the definition of “gravely
disabled” (and other pertinent changes) in WIC § 5008 to January 1, 2026, by
way of a resolution adopted by their Board of Supervisors.
The Health Care Agency requests the Board
of Supervisors to defer the implementation of the changes made to the
definition of “gravely disabled” (and other pertinent changes) in WIC § 5008 to
January 1, 2026.
FINANCIAL
IMPACT:
N/A
STAFFING
IMPACT:
N/A
ATTACHMENT(S):
Attachment
A - Senate Bill 43 - Behavioral Health
Attachment B - WIC 5150
Attachment C - WIC 5250
Attachment D - Resolution to Defer Implementation
Attachment E – WIC 5270
Attachment F – WIC 5300
Attachment G – WIC 5350
Attachment H – WIC 5008