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Health and Human Services Agency (HHSA) recommending the Board adopt and authorize the Chair to sign Resolution 176-2023, to defer implementation of Senate Bill (SB) 43, Statutes 2023, Chapter 637, which expands the definition of “gravely disabled person,” under the Lanterman-Petris-Short Act, to include persons with substance abuse as well as currently included mental health disorders, from January 1, 2024, until January 1, 2026 to provide HHSA adequate time to identify the treatment expansions, funding impacts, and staffing needs required to implement this bill.
FUNDING: N/A
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DISCUSSION / BACKGROUND:
The Lanterman-Petris-Short (LPS) Act, enacted in 1967, provides for the treatment of an individual who is a danger to themselves or others or who is found to be gravely disabled. The LPS Act authorizes the involuntarily commitment of such individual to be taken into custody on a temporary hold or a series of holds leading to a determination of their conservatorship, for an individual’s own protection.
Current law defines “gravely disabled” as a person who, as a result of a mental health disorder, is unable to provide for his or her basic personal needs for food, clothing or shelter. The LPS Act allows individuals who are gravely disabled to be appointed a conservator to arrange for mental health treatment and residential placement. A gravely disabled individual will receive an assessment and crisis intervention as necessary and may be placed in a psychiatric health facility or specialized hospital facility such as an institution for mental disease (IMD) in order to meet their treatment needs.
SB 43, Statutes 2023, Chapter 637, signed by the Governor on October 10, 2023, expands the definition of “gravely disabled” to include a person who, as a result of a mental health disorder, a severe substance use disorder (SUD), or a co-occurring mental health disorder and a severe SUD, or as a result of impairment by chronic alcoholism, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care. This expanded definition for “gravely disabled” becomes effective on January 1, 2024.
The expansion of the definition of gravely disabled will require the County to review and expand available treatments, workforce, delivery networks, housing capacity and models for locked treatment settings or models of care for involuntary substance use disorder treatment to successfully meet the conservatorship needs of the population. The County will additionally need to implement criteria and processes to allow for both the initiation and removal of such involuntary commitment should the individual demonstrate recovery from their gravely disabled condition. This process will require more time than SB 43’s effective date of January 1, 2024.
California Welfare and Institutions Code (WIC) section 5008 subdivision (h)(4), as enacted by SB 43, provides that a county, by adoption of a resolution of its governing body, may elect to defer implementation of the changes made until January 1, 2026, thereby postponing implementation of the new definition of gravely disability.
Due the expansion of mandates imposed by SB 43, HHSA’s Behavioral Health Division (BHD) is recommending the Board authorize the Chair to execute this Resolution to elect to postpone the implementation of SB 43’s changes until January 1, 2026. Said postponement will provide HHSA BHD time to identify the treatment expansions, funding impacts, and staffing needs required to implement this bill.
ALTERNATIVES:
The only form of involuntary treatment for SUD that exists in El Dorado County and in California is incarceration. As a result, El Dorado County has no established system of care for involuntary SUD treatment outside of County jails. SB 43 establishes the option for involuntary treatment, and should a conservatee require a locked treatment setting, those are non-existent for SUD treatment services outside of carceral settings. Should the Board decline to approve this Resolution, the County would be unable to meet the new obligations in the timeline prescribed by SB43 and would be required to meet these obligations in a manner that is unfunded and without proper facilities.
PRIOR BOARD ACTION:
N/A
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Approved by County Counsel.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this Agenda item. If the Resolution is not approved, the SB 43 treatment option would be mandated in El Dorado County effective January 1, 2024with significant and unknown financial impacts to local government through expansion of existing involuntary treatment requirements without any assigned source of State or Federal revenue.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1) Clerk of the Board to obtain signature of Chair on the adopted resolution; and
2) Clerk of the Board to return one (1) certified copy of the adopted Resolution to hhsa-contracts@edcgov.us.
STRATEGIC PLAN COMPONENT:
Good Governance, Healthy Communities
CONTACT
Olivia Byron-Cooper, MPH, Director, Health and Human Services Agency