Agenda Item AGENDA STAFF REPORT ASR Control 23-000990
MEETING DATE:	12/05/23
legal entity taking action:	Board of Supervisors
board of supervisors district(s):	All Districts
SUBMITTING Agency/Department:	Health Care Agency (Approved)
Department contact person(s):	Veronica Kelley (714) 834-7024
	Annette Mugrditchian (714) 834-5026

Subject: Senate Bill 43 Resolution

ceo CONCUR

County Counsel Review

Clerk of the Board

Concur

Approved Resolution to Form

Discussion

3 Votes Board Majority

Budgeted: N/A

Current Year Cost: N/A

Annual Cost: N/A

Staffing Impact:

# of Positions:

Sole Source: N/A

Current Fiscal Year Revenue: N/A

Funding Source: N/A	County Audit in last 3 years: N/A
Levine Act Review Completed: N/A

Prior Board Action: N/A

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