Julia Holladay holds on to a letter from her daughter — a handwritten note of gratitude — as a reminder of who she used to be. Before the meth addiction. Before the cycle of psychiatric hospital stays.
“I have been challenged by my loved one — my daughter — for 20 years,” Julia said. “She was diagnosed at 16 with bipolar disorder and auditory complications.”
Julia and her husband, Kirk, are among many families navigating what’s known as dual diagnosis — when someone lives with both a mental illness and a substance use disorder. Their daughter, now 36, has cycled in and out of treatment facilities for years, often leaving against medical advice.
“You turn 18, things change fast,” Julia said. “You don't even realize the significance of that until you're faced with trying to get information and support. And then she's as well, getting smarter and smarter about the system.”
As their daughter grows older, intervening has gotten harder.
“The most challenging part for me is grappling with the idea that she's beyond hope,” Kirk said.
Recently evicted and now living in a motel, their daughter was hospitalized again just a few weeks ago. But despite a major change in California law, Julia said no one mentioned her daughter could be eligible for involuntary treatment during her daughter’s most recent stay.
Senate Bill 43, which took effect earlier this year, expands the definition of “grave disability” in California’s mental health law. It allows individuals with severe substance use disorders to be placed under an involuntary psychiatric hold, something that wasn’t previously possible unless they posed an immediate danger to themselves or others.
When Julia read about the law in the newspaper, she was hopeful.
"I was so excited,” she said. “I thought, 'oh, this could actually be it.'"
But when she brought it up with her daughter’s care team, the response was lukewarm.
“They had kind of a wait-and-see attitude,” she said.
The county had a year to prepare for the law’s rollout in January. Luke Bergmann, San Diego County's outgoing behavioral health director, said they’ve trained hospital staff, peace officers and first responders on how to apply the changes to the law under Senate Bill 43. They also partnered with the National Alliance on Mental Illness to educate families.
“I would say implementation has gone pretty well,” Bergmann said Wednesday. “Primarily in that we haven’t seen huge numbers of people detained and transported for care under the terms SB 43 establishes.”
The county said they plan to release numbers in June on how many people have been detained under the new law.
At Sharp Grossmont Behavioral Health, lead social worker Candy Elson helps families navigate these situations every day. She said even with Senate Bill 43 in place, getting someone involuntarily held is difficult.
“It’s very difficult to help them stay in the hospital for a long period of treatment if they don’t want to be there,” Elson said . “So I spend a lot of time explaining the nature of mental health law in California and the limitations of the resources.”
While SB 43 is well-intentioned, it’s not a cure-all, she said.
“I sometimes say it’s like false hope,” she said. “Because if your family member still says, ‘I’m not going to get treatment,’ nothing’s going to happen.”
Involuntary treatment is possible, but it requires court intervention.
For now, the Holladays are left waiting and hoping that the next time their daughter ends up in crisis, the system might work differently.
“I just hope people who have family members, friends, or other people in their lives who suffer from mental illness and diagnosis don’t abandon those people,” Kirk said.
