On October 10, 2023, California Governor, Gavin Newsom, signed Senate Bill 43, which expands the Lanterman-Petris-Short (“LPS”) Act’s definition of “gravely disabled” to include individuals who are unable to care for themselves because of a severe substance use disorder, a co-occurring substance use disorder, or chronic alcoholism. The law also adds “personal safety and necessary medical care” as the types of care one must be able to provide for themselves to avoid an involuntary hold or conservatorship.
Proponents of the new law regard it as an important step to address the homelessness and mental health crises plaguing California, and they hope that the expanded definition will serve as a means of funneling some of California’s most at-risk individuals into the continuum of care. Opponents regard it as a severe impingement on civil rights and argue that involuntary holds and conservatorships often cause more harm than good.
The new law does not address how counties are expected to deal with the influx of new patients in already overburdened psychiatric facilities. As a result of the acute shortage of inpatient psychiatric beds, patients on a 72-hour LPS holds are often left to linger in emergency room departments without proper psychiatric care. This practice of boarding patients in emergency departments often consumes limited emergency beds, creates unnecessary security risks, and illegally transfers the cost of caring for these patients from the counties to hospitals.
Unfortunately, in the absence of a sufficient behavioral health safety net, hospitals are left with unreimbursed costs, as many county mental health plans will not provide payment to general acute care hospitals who treat LPS hold outpatients in their emergency departments. Athene Law, LLP has worked with numerous providers and trade associations to hold payors accountable for the unreimbursed obligations imposed as a result of the LPS Act. This issue may be ameliorated to some degree if California voters pass Proposition 1, which would provide a $6.38 billion bond to fund 11,150 new behavioral health beds and housing and 26,700 outpatient treatment slots.
SB 43 will go into effect on January 1, 2024, although counties can postpone implementation until 2026.
 Athene Law, LLP thanks Rawan Khalili for her contribution to this blog post.