California lawmakers late Thursday gave final approval to a sweeping overhaul of the 1967 behavioral health law, part of an ongoing effort to address a statewide mental illness crisis exacerbated by homelessness and illegal drugs, such as fentanyl and methamphetamines.

Senate Bill 43, introduced this year by Senator Susan Talamantes Eggman (D-Stockton), expands the criteria for the detention, treatment and guardianship of people with serious mental illness. The bill is passed by the General Assembly and the Senate and goes to the government. Gavin Newsom, who worked until October. 14 to sign or veto the measure.

The bill is one of three passed by the Legislature before Thursday night’s deadline aimed at transforming California’s behavioral health landscape. The others, championed by Newsom, place two measures on the March 2024 ballot to fund an increase in psychiatric beds and services across the state.

Eggman’s bill represents a decades-long legislative effort to amend the Lanterman Petris Short Act, or LPS, which was passed when Ronald Reagan was governor. That law states that someone can be held against their will if he or she is “severely disabled” or poses a danger to themselves or others.

“This is the year that got us there,” said Eggman, who sees SB 43 as one of a series of legislative victories that have transformed mental health care.

care in the state. “These have been the five most important years for behavioral health care in California, if not in the state’s history, then certainly since the 1960s.”

The measure was endorsed by a coalition of mayors, psychiatrists, doctors and the National Alliance on Mental Illness California, who said it gives counties a new tool to address an epidemic of mental illness. From January it can be implemented per province.

Reforming LPS has been a goal since the 1980s, so this has been a long time coming, said Rod Shaner, former medical director of the Los Angeles County Department of Mental Health. SB 43 is the culmination of many bills and efforts to modernize the core language of the LPS. Eggman has taken this bill further than many people probably thought.

Critics, including human rights and disability rights advocates, argue that SB 43 could undermine the civil liberties of Black, Indigenous and other communities of color, given the demographics of

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the state’s homeless population. Others say the measure risks overwhelming an already stretched-capacity mental health system.

Deb Roth, a leading advocate for disability rights in California, said the bill “will lead to increased use of conservatorship, which takes away people’s rights.” Roth testified against the bill in the Assembly Judiciary Committee.

Along with the CARE Act and Newsom’s initiatives calling for mental health financing reform, SB 43 is part of a wave of changes in California’s behavioral health laws.

SB 43 adds severe substance use disorders to the definition of severely disabled, which was previously defined as the inability to provide food, clothing and shelter. In addition to these categories, the law adds “personal safety and necessary medical care” as basic personal needs to force people into treatment.

Under SB 43, if evidence is found that a mental disorder or substance use disorder places or will place an individual’s physical or mental health at significant risk of serious harm, crisis teams and mental health providers can initiating an involuntary hold that can lead to conservatorship.

The focus on substance use disorders, which adds to LPS’s focus on “chronic alcoholism,” takes into account the “overlap of substance abuse and mental illness,” Shaner said. “Treatment of mental illness cannot be successful without addressing substance abuse.”

Additionally, the new law gives the conservatorship court more leeway in allowing testimony from expert witnesses, who may not have firsthand knowledge of a case. For example, medical records are often reviewed in court on the basis of hearsay and are inadmissible unless the doctor who wrote the report testifies.

SB 43 would take effect in 2024, but counties could delay implementation until 2026 over concerns about the burden it could place on already overcrowded psychiatric facilities.

NAMI California, a co-sponsor of SB 43, said in a statement that the bill is essential for people with serious mental illness and their families by modernizing the definition of the severely disabled.

LA County Supervisor Kathryn Barger said she hopes the Department of Health and its Substance Abuse Prevention and Control Division will take urgent action to put SB 43 into practice.

“We want to be methodical, but we don’t have that luxury,” she said. People in communities are frustrated and people are languishing on the streets.

But the province’s Ministry of Health, which runs three hospitals with locked psychiatric emergency departments and inpatient psychiatric units, expressed concerns about resources, saying:

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in a statement that the law would pressure facilities to “discharge patients to sub-acute beds that do not exist.”

The California State Assn. of provinces expressed similar concerns. “Expanding the definition does not expand the number of placements in a system that is already thin. To truly achieve an expansion of LPS, additional investments are needed for treatment, including locked facilities, staffing, housing and scale-down care options,” the report said. rack.

An estimated 171,000 people are homeless in California, and nearly 70,000 live in Los Angeles County. In 2019, it was estimated that as many as 76% of the county’s homeless population could be affected by mental illness, substance abuse, poor health and physical disabilities.

Dr. Margot Kushel, director of the Center for Vulnerable Populations at UC San Francisco, she said

doesn’t believe the bill will be as effective as lawmakers hope.

Eggman is right to draw attention to a major problem, but I don’t think changing the definition of severe disability will meaningfully address the problem it is trying to solve,” she said. “We already have very strong laws that allow us to detain people against their will, but that system doesn’t work because ultimately we don’t have adequate housing or support for those people.

Rachel Bhagwat, legislative advocate for the ACLU California Action, said involuntary blocks don’t work in advancing treatment and instead end up pushing people into the most restrictive and expensive corners of the system.

We want to ensure people get the services they need, and while SB 43 was written with good intentions, it extends an approach that has failed and harmed our communities, Bhagwat said.

The other major measures approved by the Legislature would amend the state’s mental health law. AB 531 is a nearly $6.4 billion bond measure to build mental health campuses, housing and permanent supportive housing. SB 326 would reallocate $1 billion from the law to operate the facilities. These high-profile bills will reform a primary funding stream for behavioral health care in California.

When Eggman introduced SB 43 in March, she cited the progress lawmakers had made in addressing the escalation of homelessness and mental illness, which had overtaken the state’s ability to provide meaningful treatment. But that work, she added, had “not made a big dent in helping the sickest.” An unwillingness to adapt LPS stood in the way. That legislation, which became law in 1972, served as a model for similar bills authored by other states interested in adopting a more progressive approach to behavioral health care, and for years its landmark status made it difficult for the California Legislature to reform. with SB 43 on Newsom’s desk, that allegiance to the past is gone. None too soon, says Eggman. “We were the most steadfast in sticking to LPS and not our honor,” she said. “We played a part in not helping people and letting it take too long.”