Santa Clara County prepares to implement conservatorship changes

Santa Clara County is expediting the implementation of new conservatorship rules for people suffering from severe mental illness and substance use disorders—the process will be complicated and costly.

The Board of Supervisors on Tuesday unanimously approved establishing a timeline toward implementing changes to Senate Bill 43, a state law that expands the definition of “gravely disabled” under the existing Lanterman Petris Short (LPS) conservatorship. The bill provides no state funding, which will force Santa Clara County to shift dollars in its general fund. The county is looking at a potential $158 million deficit for the 2024-25 fiscal year.

“Significant assets will be needed to implement SB 43 and the state has not yet made additional resources available,” Deputy County Executive Ky Le said at the meeting.

The law, which Gov. Gavin Newsom signed in October, becomes effective Jan. 1. It requires counties to establish a timeline to fully implement the changes by January 2026.

A portion of the law can be enacted at the start of the year under the new definition of “gravely disabled.” The prior definition of “gravely disabled” meant having a severe mental illness such as schizophrenia or other psychotic disorders, where the individual is unable to provide for their basic personal needs such as food, clothing or shelter. The amended law adds the inability to manage medical care and personal safety, and includes individuals with substance use disorders.

Other requirements going into effect include making sure that CARE Court and Assisted Outpatient Treatment options are considered before a conservatorship. Public guardians also have to prove medical records are from a health practitioner and behavioral health and LPS facilities have increased reporting requirements.

Those under a conservatorship are involuntarily placed in a locked facility for treatment. SB 43 requires those with a substance use disorder to also be in a locked facility for treatment. During the county behavioral health presentation, Le explained that there are no locked facilities for individuals with substance use disorders, as this population seeks help voluntarily.

Le added that new facilities are needed to support the increase in LPS conservatorships, and funds from the Mental Health Services Act (MHSA) can’t be applied to toward involuntary commitment programs.

County Executive James Williams said the potential passage of Prop. 1, which would reallocate money in MHSA, might make infrastructure funds available. But no MHSA funding can be used for services, operations or administrative costs.

SB 43 comes on the heels of the CARE Act, which Santa Clara County is required to implement on Dec. 1, 2024. These combined needs will require a significant increase in the number of beds; constructing new facilities for involuntary placement for those with substance use disorders and those with severe mental illnesses; retraining and implementation of new policies and procedures for hospital staff, public guardians and law enforcement; and hiring to meet the expansion demands.

Together these laws will mandate a dramatic reallocation of funds into the behavioral health department and force cuts to other departments and programs, Williams said.

“The costs for (SB 43) will likely come out of the general funds to increase the need for beds at the acute and subacute level,” he said. “There are limited funding sources to help counties pay for these enhanced services.”

During public comment, four lawyers from the Silicon Valley Law Foundation implored supervisors to delay the timeline start date. The foundation wanted time to hire more people and train staff to help those who want treatment, but not through involuntary measures.

The majority of speakers favored the board’s position, but asked for transparency and quarterly updates from the county.

Supervisor Susan Ellenberg posted on her blog how this approval is another important step in the long and complicated process of mental health reform.

“The law also includes a sensible provision to provide Counties with TIME to put in place all the other pieces that will be needed to implement the remaining portions of the new law. That work is underway,” she wrote.

Contact Moryt Milo at [email protected] or follow her at @morytmilo on Twitter.