The county Board of Supervisors voted 3-2 on Tuesday to delay for one year enactment of a state law that expands mental health holds, based in part on concerns over training and the additional strain on hospital emergency departments.
In October, Gov. Gavin Newsom signed Senate Bill 43, which expands the definition of "gravely disabled" in terms of who can be involuntarily held in facilities and receive treatment.
Under the previous law, mental health conservatorships can be used only when a person is a danger to themselves or others, or cannot provide for their food, shelter or clothing.
SB 43, which goes into effect Jan. 1, 2024, expands eligibility for conservatorship to situations where people cannot manage their medical care or personal safety. It also adds substance-use disorders in addition to mental illness as an applicable condition, according to San Diego Mayor Todd Gloria's office.
Gloria has long-supported SB 43. He spoke with reporters before the vote Tuesday and said he understands hospitals are busy, but change is needed now.
“I have to feel like San Diegans feel as though a hospital setting is a better place for very sick people than the sidewalk which is where they’re ending up now,” Gloria said about some unsheltered residents. “We’ve got to figure this out. Delaying isn’t going to help us figure it out, it’s delay us having to make the tough choices we know are ahead.”
California’s involuntary treatment policy hasn’t changed much since it was written and signed into law in 1967, said Luke Bergmann, the director of San Diego County’s behavioral health services department.
“So this change of SB 43 — I think we’ve established — is a big deal,” he said.
Before the vote, Bergmann told supervisors this expansion would be far reaching.
“SB 43 will almost certainly result in many more folks being brought into emergency departments … But SB 43 comes with no new resources,” Bergmann said.
More crowded emergency rooms and a lack of out-patient beds are a concern for the region’s hospital systems, which supported delayed implementation.
“We’re simply not ready today to start the system,” said Dimitrios Alexiou, CEO of the Hospital Association of San Diego and Imperial Counties. “None of our hospitals disagree with the context of how to help — it’s more about having a system in place so we can be successful.”
Under the new law, a county government can delay implementation for up to two years. Supervisors on Tuesday passed a resolution that calls for implementing SB 43 by January 2025. A report on the county's efforts to enact the state law will be presented to supervisors sometime in March. Board Chairwoman Nora Vargas, who proposed the delay, voted yes along with Supervisors Jim Desmond and Monica Montgomery Steppe, who took her seat after being sworn in earlier.
Supervisors Joel Anderson and Terra Lawson-Remer voted no. Vargas said while the county has been a leader behavior health treatment and unafraid to carry out smart policies, it was also important to be careful about the new law and how it could impact residents.
"We're talking about real families," she said, adding the county needs to ensure that it has enough beds to accommodate patients, the correct type of treatment, and properly trained medical health professionals and first responders. "Involuntary treatment is a significant action," Vargas said.
Supervisor Monica Montgomery Steppe said before SB 43 is implemented, there needs to be a hiring plan, feedback from hospitals and the new law's connection with CARE Court, a state-approved program that allows individuals to petition a court to order treatment and housing for people suffering from severe mental illness.
Montgomery Steppe also said she was concerned about the county enacting SB 43 requirements if law enforcement officers hadn't received proper training.
"We really have to ensure we're doing the absolute most that we can to meet this mandate," she added. "This is on us now. We cannot pass the buck."
Vice Chair Lawson-Remer said she couldn't support the delay, given the county didn't prepare for SB 43 even though it was unveiled earlier this year.
In a statement, Lawson-Remer said that "significant time and energy were spent finding the best ways to delay implementing Senate Bill 43 ... but our region and most importantly the people in dire need of treatment, would have been better served if all those same people worked on an implementation strategy. "Many people tried all types of excuses to make me feel better about going along with the delay," Lawson-Remer added. "I don't care if other counties delayed their implementation for two years. I represent the people of San Diego County, and we should be striving to be better than the rest."
Lawson-Remer said she would be open to supporting Vargas' proposal after the 90-day review, with hopes the county "pedals to the metal" on accommodating SB 43.
Anderson in a statement said he voted no on delaying the new law because "the status quo is not working."
"Every delay hurts my constituents and the communities I represent, and they cannot afford to wait any longer," Anderson said. "I put `fix homelessness' on my campaign signs, and I meant it."
Desmond said he was "really encouraged that the state has finally given us the kick in the rear to get the help we need," in terms of expanded treatment options, but agreed with Vargas about a lack of resources.
"We gotta do this the right way," he said. "We can't overrun over emergency rooms." Desmond added that he won't support any future delays of the state law.
During public comment, supervisors heard from hospital and mental health professionals who urged a delay.
Cathryn Nacario, CEO of National Alliance on Mental Illness of San Diego, said the "intentional and purposeful planning process ensures successful programs in our county," such as mobile crisis response teams and crisis stabilization units.
With hospital emergency departments already impacted by flu, COVID-19 and RSV cases, a delay in SB 43 will "allow time to address the gaps that we already know," she added.
A representative with Cal Fire Local 2881 said a one-year delay would allow all stakeholders to develop a plan and ensure that first responders have needed resources.
"We should not overload an already stressed system until we can fully prepare that system," he added.
Others said there was no reason to hold off on carrying out the new law.
Colin Stowell, chief of the San Diego Fire-Rescue Department, urged the board not to delay implementation. He noted that last year, SDFD responded to 53,000 calls on behavioral health-related problems, equivalent to 38 first responders working 10 hours every day.
One woman who called in said SB 43 will extend life-saving care to more people. She said her son was diagnosed as a schizophrenic in 2019, and she has spent years trying to get him proper care.
"The bottom line is this: We're not doing enough for mental health," she said. "There are people like my family in this county, like my son, who need this intervention now. The delay could cost people their lives."
