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Newsom Signs Law Expanding Conservatorships for Those Experiencing Severe Mental Illness, Substance Abuse

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A profile of Gov. Gavin Newsom looking very serious.
Gov. Gavin Newsom during a press conference where he signed new gun legislation into law at the Capitol Annex Swing Space in Sacramento on Sept. 26, 2023. (Miguel Gutierrez Jr./CalMatters)

Gov. Gavin Newsom on Tuesday signed the first of a series of bills that aims to transform California’s mental health system by loosening long-standing rules that dictate who can be forced into treatment.

Senate Bill 43, which changes the state’s conservatorship laws for the first time in more than 50 years, broadens the standards for involuntary medical treatment to include people who are considered unable to keep themselves safe because of severe substance-use disorders or mental health issues.

Depending on who you ask, this transformation represents a long overdue humanitarian response — or a worrisome step backward on civil liberties.

“California is undertaking a major overhaul of our mental health system,” Newsom said in a statement. “The mental health crisis affects us all, and people who need the most help have been too often overlooked. We are working to ensure no one falls through the cracks, and that people get the help they need and the respect they deserve.”

Newsom is also expected to sign legislation that sends two key ballot measures to voters next March: a $6.4 billion bond to pay for 10,000 new treatment beds and expand supportive housing options, and an update to a 20-year-old law that provides funding for mental health services. Both measures would need approval from a majority of voters.

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All of this comes just as CARE Court — Newsom’s signature mental health legislation from last year aimed at addressing treatment options for people suffering from severe mental illness — begins rolling out in an initial cohort of seven counties. Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus and Tuolumne counties opened their Community Assistance, Recovery, and Empowerment (CARE) courts earlier this month; Los Angeles County will open its court in December. The rest of the state’s counties will follow suit next year.

Addressing serious mental illness among the state’s growing unhoused population is a major focus of all of these initiatives.

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A recent survey of people experiencing homelessness by the UCSF Benioff Homelessness and Housing Initiative, found that the majority had experienced serious mental health conditions (PDF) at some point in their lives, but also found that high housing costs and low incomes were the main reasons most actually entered homelessness.

CARE Court allows family, close friends, first responders and behavioral health workers to petition a court to compel a person with untreated schizophrenia or other psychotic disorders into a court-ordered treatment plan. The proposed ballot initiative to redesign the Mental Health Services Act would require that 30% of tax dollars brought in under the plan go toward housing programs, with half of that reserved for people who are chronically homeless or living in encampments.

The prospective changes mark a significant departure from the decades in which civil liberties protections for Californians with mental illness seemed virtually untouchable because of the landmark 1967 Lanterman-Petris-Short Act.

The authors of that law sought to end the inappropriate and often indefinite institutionalization of people with mental illnesses and developmental disabilities. At the time, it had been relatively easy for family members to force people into mental health treatment, often locking them away for long stretches in state hospitals where conditions were often abhorrent.

New standard for involuntary treatment

The law established strict criteria to determine who was eligible for involuntary treatment as well as specific timeframes that limited how long people could be held against their will. This included the 72-hour hold period, known as a 5150. But concurrent promises to build up community-based support programs did not materialize.

Susan Talamantes Eggman, a social worker turned Democratic state senator from Stockton, has become one of the Legislature’s main authors of mental health policies, and is among those who feel the state went too far back then.

“For fear of doing something wrong we did something even worse,” said Eggman, who authored SB 43 and co-authored last year’s CARE Act.

She told CalMatters she has tried five times in recent years to introduce legislation amending the Lanterman-Petris-Short Act, but was stymied by stiff resistance from disability rights groups and some legislators concerned with the civil liberties implications.

But this year’s attempt sailed through the Legislature with little opposition.

She called the current constellation of policy changes “the most significant thing we’ve done in the mental health, behavioral health workspace easily within the last 50 years.”

Why some families want involuntary treatment

Many families of seriously mentally ill individuals say they are thrilled with Eggman’s bill and other recent policy shifts, after long feeling sidelined in their efforts to get treatment for loved ones who refuse it.

“I think personally that the tide is finally turning, that we are on our way to really doing something to help these very sick people get the treatment that they need,” said Linda Mimms, vice chair of the national Schizophrenia & Psychosis Action Alliance.

She lauded Newsom’s interview with 60 Minutes last month, in which he called out critics of the changes.

“Change has its enemies. I get it,” Newsom said. “But one thing you cannot argue for — with all due respect to all the critics out there — is the status quo. You can’t. And in the absence of alternatives, what the hell are we going to do to address this crisis?”

But those critics say they aren’t defending the status quo at all. Rather, they point to other critical parts of the system — including affordable housing and an array of voluntary treatment services — that have suffered after decades of underinvestment.

“We’re never having the right conversation,” said Kelechi Ubozoh, a mental health advocate and author of We’ve Been Too Patient: Voices from Radical Mental Health. “It is a conversation around poverty. We’re still saying, ‘Let’s blame it on mental health and the mental health system.’”

Many who live with mental illness have had traumatic experiences with involuntary treatment, Ubozoh said, and are “really scared” by the current direction the state is headed.

“For no one to oppose this huge erosion of civil rights is just a really concerning change in the state Legislature,” said Samuel Jain, senior attorney with Disability Rights California. He believes that state leaders, feeling pressure to address the state’s spiraling homelessness crisis, are conflating homelessness and mental illness.

“We don’t feel that this is going to change anything on the streets,” he said. “This strategy seems to be to take people with mental health disabilities and put them into institutions.”

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In the meantime, he said, his organization’s clients often find themselves stuck in emergency departments and locked psychiatric settings because there are no community-based beds available for them.

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