San Diego, California – In the bustling streets of San Diego County, law enforcement and first responders are gearing up for a significant shift in their approach to mental health crises. Beginning January 1, these frontline professionals will be thrust into the role of making critical health assessments under a new law that broadens the criteria for involuntary detention due to grave disability.
The change comes with the implementation of Senate Bill 43, signed by Governor Gavin Newsom. The law aims to address the need for government conservatorship among the unhoused population, who are often the most visibly affected by severe mental health and substance use disorders.
Attorney Mike Phillips, co-chair of the region’s SB 43 readiness committee, detailed the adjustments at a gathering at the Psychiatric Hospital of San Diego County. To an audience of mental health care professionals, Phillips described the expansion of the definition of grave disability to now include those with severe substance use disorders or a combination of mental health and substance abuse disorders.
Under the existing framework, primarily set down by the state’s 1967 community mental health laws, grave disability was confined to those who, due to mental illness or chronic alcoholism, could not tend to their basic needs such as food, clothing, or shelter. The new legislation extends these criteria to include personal safety and necessary medical care.
“For the first time, a Californian can be detained without committing a crime if they are believed to have a severe substance use disorder or appear to be gravely disabled by living conditions or untreated medical issues,” Phillips explained.
The challenge for first responders, according to Phillips, is substantial. They are tasked with making on-the-spot decisions that could lead to someone being detained and transported for psychiatric evaluation — a decision that traditionally falls under the purview of trained medical professionals.
Phillips admitted that the implementation process would involve “trial and error,” as responders adapt to their augmented responsibilities. Over the past several months, he said, his team has conducted upwards of 200 training sessions, emphasizing the nuanced understanding required by SB 43. Feedback and questions have been varied, coming from diverse community sectors concerned over the implications for civil liberties and medical ethics.
Critics and supporters alike are wary of the potential for increased detentions and the stress it might place on medical facilities. Hospitals across California have expressed concerns about the feasibility of implementing SB 43 so swiftly, worried about the bottleneck effects in emergency rooms ill-equipped to handle severe addiction cases.
San Diego County has taken these concerns into account by setting a local implementation date of January 1, 2025—a compromise that gives authorities and healthcare providers more time to prepare.
Moreover, the county plans to bolster its resources. By early 2025, a new psychiatric health facility will open at Tri-City Medical Center, enhancing capacity to treat individuals with complex diagnoses. Additionally, the county has expanded opioid treatment programs and is finalizing plans to increase residential treatment beds and specialized care facilities.
Predicting the impact of SB 43 remains complex. Dr. Nicole Esposito, the county’s chief population health officer, noted that while San Diego County might see about 1,500 additional detentions annually under the expanded definition, the adaptation process by first responders will gradually shape actual numbers. She pointed out that discussions with other counties victim to early implementation suggest that a significant portion of new detentions involve individuals with co-occurring disorders, necessitating treatment in secure psychiatric settings.
As with any novel policy, county to county variations in implementation are expected and the additional burdens placed on local health systems remain a significant concern. Observations from early adopters like San Francisco and San Luis Obispo counties indicate that the real test will be in maintaining a balance between protecting public safety and respecting individual rights—a fine line that SB 43 walks with cautious ambition.
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