Senate Bill 43 Overview

Senate Bill (SB) 43 expands California’s criteria for involuntary detention and conservatorship which is based on a person’s mental health disorder or severe substance use disorder (SUD) resulting in the person’s inability to provide for their basic needs for food, clothing shelter, personal safety or necessary medical care. A key change in law is an expanded definition of Grave Disability as shown below. SB 43 expands the definition of basic personal needs to include not just food, shelter, and clothing, but also access to necessary medical care and personal safety.

*The bolded text reflects the new/expanded definition of Grave Disability.

Below are examples of observable functional impairments one might see in the community when determining grave disability criteria based on a mental health disorder and/or severe substance use disorder (SUD) related to Necessary Medical Care or Personal Safety. The listed examples are not meant to be exhaustive and may evolve over time.

*Observable Factors: Necessary Medical Care

Signs of malnourishment (loss of weight or dehydration).
Unwillingness to eat when food is provided.
Irrational beliefs about food that is available (e.g., it is poisoned).
Inability to articulate a plan for getting food.
Unwillingness to clothe oneself when clothing is provided.
Unable to utilize shelter when provided or to formulate a reasonable plan for shelter.
Inability to engage in personal hygiene to the extent that it creates risk of harm.
Inability to utilize medical care when needed and available.
Wound care and infection issues that are likely to lead to loss of limb or life if not treated.
Untreated comorbidities such as HIV, diabetes, or cancer liver / kidney disease that is life threatening.
Extreme physical pain.

*Observable Factors: Personal Safety

Running in and out of traffic.
An individual incapable of defending themselves against ongoing victimization.
Being assaulted, abused, exploited or victim of crime.
Unhygienic / uninhabitable conditions at home or other home safety issues such as arson.
Inability to care for hygiene, cleanliness, needles, which leads to illness.
Failure to thrive (may be a crossover with medical care).
Multiple near-fatal overdoses requiring inpatient hospitalization (note: Narcan reversals alone would not meet this criteria).

*Observable Factors: Substance Use Disorder

Overwhelming odor of alcohol or marijuana.
Dilated or constricted pupils/bloodshot or watery eyes.
Eyes wide open or droopy, heavy lidded, nodding off.
Unsteady gait/slurred speech/unable to walk or stand by oneself/fumbles simple tasks.
Scratching, picking or clawing at skin (e.g., noticeable sores on face, hands or arms).
Unintelligible speech: loud, yelling, slurring words.
Multiple/pattern of contacts for similar presentation (intoxication) in 12-month period.

*NOTE: One incident alone may not automatically meet the standard to detain a person. The incident must be significant and severe enough to cause bodily injury or death and must be related to a mental health disorder and/or severe SUD.

SB 43 also adds new requirements and defines key terms; a non-exhaustive illustration of these changes is provided below:

Requirements:

Terms and Definitions:

Additional information about SB 43 is provided in the California Department of Health Care Services, Behavioral Health Information Notice (BHIN) Number 24-011. Please use the following link to access more information: BHIN-24-011.pdf.