What is SB 43?

SB 43, which became effective on January 1, 2024, expands the authority of the law governing mental health commitment (the Lanterman-Petris-Short or LPS Act) to include application to individuals with severe substance use disorders (SUD).  The law states that individuals with severe SUD who meet criteria, including inability to take care of medical needs to prevent serious harm, can be placed on involuntary holds of 72-hours or longer, and can also potentially be placed on conservatorship for multiple years.

What is San Mateo County’s responsibility under this law?

All Counties are required to “implement” this law no later than January 1, 2026.  However, each County at present has flexibility regarding how this law should be implemented. Because implementation is challenging, San Mateo County decided to begin the process as soon as possible, and engage stakeholders in a collaborative process to determine how this law would be best applied in San Mateo. 

Why is implementation of SB 43 challenging?

The reason this law was passed is because many people with severe SUD are dying tragically because of out-of-control addictions and appear to be unable to voluntarily access the help they need that could save their lives.  Examples include, but are certainly not limited to, people dying of opioid overdoses.  Before this law was passed, the LPS Act restricted involuntary treatment to individuals who were at risk of harm due to mental illness, including mental illness with co-occurring SUD, but not to people with SUD alone.  The intent of this law therefore is to allow involuntary intervention as a tool to save lives.

However, this is not as simple as it may seem. First, involuntary treatment interventions are always challenging because they are – by definition – involuntary.  How do we implement this law in a way that ensures that we only intervene in a way that is truly necessary and lifesaving?

Second, involuntary interventions for SUD should be associated with receiving treatment that is truly helpful and recovery-oriented, not merely confinement.  However, we do not have a base of understanding and evidence for how to do this effectively. Further, at present, there are no licensed facilities in California, nor is there even a licensing category in California, that permits involuntary commitment of persons with severe SUD conditions beyond a brief hold in an emergency room.  It is important therefore not to initiate involuntary interventions for SUD that do not have a reasonable likelihood to result in better outcomes for the people who receive them.

This is why we need your help.

San Mateo County Health, Behavioral Health & Recovery Services seeks to work collaboratively with a wide variety of stakeholder representatives during 2024 and 2025 to develop the best possible approach to implementing this law.  We want to identify populations that are most at risk and interventions that are likely to be successful for those populations, within what the current licensing regulations and current resources allow. Our goal is to try to utilize involuntary interventions for SUD in a targeted way that balances the benefit of lifesaving help against the risks of inappropriate loss of liberty.  And, over time, we want to do this in a way that allows us to continually learn and improve so that we can better save lives and minimize harm.

SB 43 Implementation Timeline

Learnings from Listening Sessions

The County held three listening sessions in May 2024 which included a wide range of stakeholders, ranging from people with lived experience, to inpatient, residential, and outpatient service providers, to hospital systems, and first responders. The input from these listening sessions has informed our approach to this planning process by identifying gaps in the current system and ideas for the future. Gaps identified in the current system include:

1. Coordinating between MH and SUD with follow up tracking of high need individuals; coordination with physical health.

2. Develop a culture of improving welcoming, hopeful engagement for SUD individuals in crisis.

3. Expand access to unused residential SUD capacity, consider adding mechanisms for increased MH support to those settings to help engage more complex clients.

4. Improve co-occurring capability in mobile crisis, outpatient MH services, and all SUD services.

Potential implementation ideas generated by the listening sessions include:

1. Success is engagement in a relationship, movement through stages of change over time, and reduction of poor outcomes; success is not measured only by entry into formal SUD treatment or by sobriety alone.

2. Expanding development and deployment of SUD peer support workers.

3. Building on existing crisis and first responder collaboration meetings to include helpful SUD responses.

4. Developing models for “damp” housing, where people who wish to continue substance use can be helped to use safely.

5. Expand rapid access to Buprenorphine in EDs/EMS, and plan for more rapid follow up.

6. Consider what is the most useful role for crisis beds in addressing the needs of individuals with SUD in crisis.  Design a seamless continuum between inpatient, detox, crisis beds, and sobering drop in.

7. Using Care Court as a resource for selected individuals with SUD/COD.

The County wants to continue to hear from stakeholders that are interested in this issue:

1. Describing situations you encounter where involuntary interventions might be helpful?
2. Listening to what your needs and priorities are in relation to the target population.
3. Would placing persons with out-of-control high risk SUD on involuntary holds be beneficial? Or harmful? Why or why not?
4. What are your thoughts about what types of involuntary interventions for people with SUD would be helpful, or unhelpful?
5. What role might your program play in implementing SB 43 interventions? What would you want to avoid?
6. Anything else or experience that you would like us to know that would be useful to develop effective responses?

Ways to provide input: 

• Come to one of the listening sessions in person and provide testimony.
• Submit  written comments at either session or email to sgruendl@smcgov.org.
• Fill out and submit our online Input Form.
• Text your comments or recorded testimony to 650-586-2162.
• US Mail your written comments to SB 43 Input, 2000 Alameda de las Pulgas, Suite 235, San Mateo, CA 94403. 

Contact Scott Gruendl at sgruendl@smcgov.org or 650-573-2491 for more information.