What is Senate Bill 43?
Senate Bill (SB) 43 was recently signed by the Governor and expands the definition of Grave Disability. Grave Disability is one of the criteria used to place people with disabilities on involuntary holds.
Overview
Senate Bill (SB) 43 updates the Lanterman-Petris-Short (LPS) Act – a California law governing involuntary detention, treatment, and conservatorship of people with behavioral health conditions. This new statute updates California’s civil detention and conservatorship laws for the first time in more than 50 years by establishing new diagnostic criteria and by broadening the definition of “grave disability.” The criteria by which people may be civilly detained under the LPS Act includes:
- Danger to self,
- Danger to others, or
- Grave disability.
Existing law, for purposes of involuntary commitment, defines “gravely disabled” as either a condition in which a person, as a result of a mental health disorder, is unable to provide for their basic personal needs for food, clothing, or shelter.
New law as indicated by bold text, SB 43 expands the definition “gravely disabled” to include:
- people with a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder,
- and, who are unable to provide for their basic needs for food, clothing, shelter, access to necessary medical care, or personal safety.
SB 43 Changes the Definition of Grave Disability in TWO ways:
1. Adds severe substance use disorder as a reason someone could be placed on an involuntary hold.
2. Adds inability to provide for one’s personal safety or necessary medical care as reasons that a person could be placed
Grave Disability Definitions
| Old Definition | New Definition (Under SB 43) |
|---|---|
| A condition in which a person, as a result of a mental health disorder, is unable to provide for his or her basic personal needs for food, clothing, or shelter. | A condition in which a person, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care. |
SB 43 also makes the following changes:
- Expands the array of testimony that can be submitted into conservatorship proceedings without requiring in-person cross examination.
- Requires counties consider less restrictive alternatives in conducting conservatorship investigation.
- Expands State reporting requirements.
Watch this 45-minute training video for information about Senate Bill 43. Update: SB 43 to be implemented in San Bernardino County on April 1, 2025.
Definition of terms in SB 43
| Severe Substance Use Disorder | Personal Safety | Necessary Medical Care |
|---|---|---|
| A diagnosed substance-related disorder that meets the diagnostic criteria of ‘severe’ as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM defines “severe” as meeting 6 or more of the 11 criteria for the disorder. | The ability of one to survive safely in the community without involuntary detention or treatment. | Care that a licensed health care practitioner, while operating within the scope of their practice, determines to be necessary to prevent serious deterioration of an existing physical medical condition which, if left untreated, is likely to result in serious bodily injury. |
What is a 5150?
- A 5150 is a Welfare and Institutions Code Section in state law that allows a person to be held involuntarily for 72 hours. A 5150 is not a criminal arrest.
- Grave Disability is one of the criteria which can be used to place you on a 5150. The other criteria are danger to self and danger to others.
- A 5150 can be initiated by either a police officer or other peace officer or by a person approved by the county behavioral health department.
- Under a 5150, law enforcement, ambulance, or other authorized persons can detain the person and transport them to a facility for the purpose of mental health assessment and evaluation.
- 5150s do not authorize involuntary medication or medical treatment.
- During this hold, the hospital will evaluate you to determine next steps. They do not need to keep you hospitalized for the full 72 hours if they believe you do not need to be there.
What happens after a 5150 hold?
After the 72 hours end, you can either be
- discharged from the 5150 hold and the hospital,
- admitted as a voluntary patient for continued treatment, or continue to be held involuntarily under a different type of hold.
Where will people be held if SB 43 criteria is met?
- SB 43 will not change where individuals are held for mental health treatment. However, SB 43 expands the definition of grave disability to include severe substance use disorder.
- There are currently no facilities for involuntary substance use disorder treatment in California.
Request a Virtual Training
The Department of Behavioral Health offers virtual 1-hour trainings to learn more about Senate Bill 43. When requesting a training, please choose one of the options below.
- 5150 LPS Designation Non-Certification Training (no test/no certified hold writer status) pre-recorded training available
- Grave Disability (Voluntary/Involuntary) & Behavioral Health Resources pre-recorded training available
- AB 2275 (Non-Designated Facilities – Emergency Departments Only) virtual only
If you are interested in one of the trainings listed above (groups of 10 or more), please email [email protected] and list the training(s) name.
Community Resources
5150 Certification Training Registration Information
Registrants must meet the eligibility criteria within the Department of Behavioral Health (DBH) Authorization and Designation Pursuant to the Lanterman-Petris-Short (LPS) Act Policy. The policy can be found in the DBH Standard Practice Manual.
Trainings are virtual, see below for upcoming dates and times:
- April 23, 8 a.m.- Noon
- April 23, 1-5 p.m.
- July 23, 8 a.m.- Noon
- July 23, 1-5 p.m.
- October 22, 8 a.m.- Noon
- October 22, 1-5 p.m.
Law Enforcement Resources
Emergency Department Resources
New Legislation – AB2275
AB2275 Patients’ Rights
AB2275 Questions and Answers
Letter to Non-LPS Hospitals
Guidance for 5150 Detainment
Notice of Patients Entitlement
AB2275 Flow Chart
Approved Hearing Officer List
Frequently Asked Questions
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Placeholder until FAQ questions are finalized.
What is the Lanterman-Short-Petris Act (LPS)?
The LPS Act is a California law signed in 1967 related to involuntary detention and conservatorship of people with behavioral health conditions. The LPS Act established a system of short-term holds as well as a path to temporary and “permanent” conservatorships.
What is conservatorship?
LPS Conservatorship is for the most severely impaired individuals and involves a court-appointed conservator who can make decisions related to treatment and placement for individuals when they are unable to care for themselves.
- People on a conservatorship receive case management and often reside in congregate care settings such as mental health rehabilitation centers, skilled nursing facilities, and board and care facilities.
- Conservatorship may last for up to one year and is evaluated for renewal annually.
What is considered a “severe” substance use disorder under this new law?
Clinically, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) allows clinicians to specify how severe or how much of a problem a substance use disorder is. Out of eleven criteria outlined in the DSM-5-TR, a person would need to have six or more symptoms to indicate a “severe” substance use disorder.
In practice under SB 43, a peace officer will need to determine in the field whether a person appears to have a severe substance use disorder and would qualify for an initial 5150 hold under the new expanded criteria.
What happens if someone is placed on an LPS detention due to severe substance use disorder?
The person would be transported to an LPS-designated facility – likely an emergency room or hospital (or an alternative site designated as LPS by the County) – for evaluation and treatment for up to 72 hours. After the 72 hours expires, a few different things could happen:
- The person could be released if the person does not continue with treatment; (e.g., they are no longer considered “gravely disabled”);
- The person is released from the hold and enters voluntary treatment; or
- The person continues to receive treatment by being placed on a 5250 hold for up to 14 days.
If a person is brought in intoxicated, does the clearance of their intoxication mean that they will be released?
Severe substance use disorder is a diagnosis made independent of intoxication. Someone brought in on a 5150 detainment suspected of severe substance use disorder may continue to be detained even after intoxication clears.
How does SB 43 intersect with the CARE Act program?
The Community Assistance, Recovery, and Empowerment (CARE) Act creates a new pathway to deliver mental health and substance use services to people who are diagnosed with schizophrenia or other psychotic disorders and are not engaged in treatment. The intention of the CARE Act is to connect people to voluntary treatment through a civil court process.
With SB 43, the CARE Act will be considered as a less restrictive path to treatment for people who are referred for LPS conservatorship.
What if my loved one needs treatment now?
Please contact the Screening Assessment and Referral Center (SARC) for a free, confidential assessment at (800) 968-2636. If a loved one is experiencing a psychiatric emergency, community-based mobile response teams are available in English and Spanish 24/7 – Call (800) 398-0018 or text (909) 420-0560.
What types of facilities can accept a person for assessment, evaluation, and crisis intervention or placement for evaluation and treatment (up to 72 hours, per W&I Code § 5150) for grave disability due to a severe substance use disorder only?
Any facility that can provide assessment, evaluation, and crisis intervention, as these services are defined in W&I Code § 5008 and § 5150.4, can accept a person on a 5150 hold for grave disability due to a severe substance use disorder only. Examples include, but are not limited to, emergency departments, certified crisis stabilization units, and hospital medical units. Facilities do not need to be designated by a county, or have the designation approved by DHCS, to provide assessment, evaluation, and crisis intervention services as described in this question.
What types of facilities can admit a person for intensive treatment (up to 14 days, per W&I Code § 5250, or for up to two additional 30-day periods per W&I Code § 5270.15 and 5270.55) for grave disability due to a severe substance use disorder only?
The following facility types – after designation by counties and approval by DHCS – may admit people who are gravely disabled due to a severe substance use disorder only:
- General acute care hospitals (GACHs) with distinct part units providing chemical dependency recovery services as a supplemental service (as defined
in HSC § 1250(a) and HSC § 1250.3(e)-(g)); - Acute psychiatric hospitals (APHs) with distinct part units providing chemical dependency recovery services as a supplemental service (as defined in HSC §
1250(b) and HSC § 1250.3(e)-(g)); and - Certified crisis stabilization units (CSUs) in accordance with § 1840.338 and § 1840.348 of Title 9 of the California Code of Regulations. Hospitals can apply to provide chemical dependency recovery services as a supplemental service. Please visit the California Department of Public Health’s facility licensing and certification page to learn more; questions may be directed to [email protected]. To be approved by DHCS, county-designated facilities must meet the requirements set forth in § 821 of Title 9 of the California Code of Regulations. SB 43 did not change the facility designation requirements that exist in state law.
What types of facilities can admit a person for treatment of a co-occurring mental health disorder and a severe substance use disorder?
The following facility types – after designation by counties and approval by DHCS – are allowed to treat people with co-occurring mental health disorder and severe substance use disorder:
- Acute Psychiatric Hospitals
- General Acute Care Hospitals
- Skilled Nursing Facilities with Special Treatment Programs
- Certified Crisis Stabilization Units
- Psychiatric Health Facilities
- Mental Health Rehabilitation Centers
When will DHCS update advisement forms 1801, 1802, and 1808 and post them on its website?
DHCS has updated forms 1801, 1802, and 1808 to incorporate changes made by SB. These optional forms are available on the DHCS Website under Mental Health Certification Forms.