Saving Lives Or Warehousing The Sick? Debate Continues Over New Law That Expands Criteria For Involuntary Treatment

Los Angeles is one of several counties in the state that delayed implementation of a new law that would open up treatment to more people living with serious mental illness and substance use issues.

Last month, the Board of Supervisors voted to postpone enacting the law, noting that the county was not yet ready to provide the facilities and services to make it work.

“Our health care facilities are not prepared for the magnitude of what this response could look like,” Board Chair Lindsey Horvath said before the vote to delay until January 2026.

But some mental health advocates and family members of people struggling with mental illness argue that waiting years to move forward with the new law would continue to keep those who are sickest out of lifesaving treatment.

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“We can’t accept the status quo any longer,” said Teresa Pasquini, a longtime mental health advocate whose son lives with a serious mental illness.

“It’s killing our loved ones.”

The delay highlights the ongoing debate about what the new law, when in effect, will likely accomplish. Will it pave the way for counties to provide consistent, “last resort” behavioral health care for people who can’t provide it on their own? Or will it strip people of their individual rights, leading to people being warehoused under the guise of treatment?

What the new law does

Senate Bill 43, which was signed by Gov. Gavin Newsom in October, changed state law to allow people living with a serious mental illness or severe substance use disorder — who are also unable to provide for their personal safety or medical care — to be deemed “gravely disabled” and held against their will.

According to Newsom’s office, SB 43 provided the first significant changes to existing conservatorship law in 50 years by broadening who is eligible, updating situations for which conservatorship can be considered and creating “the first-ever meaningful transparency” into data on conservatorships.

“The mental health crisis affects us all, and people who need the most help have been too often overlooked,” the governor said in a news release. “We are working to ensure no one falls through the cracks, and that people get the help they need and the respect they deserve.”

The bill gave counties the option of implementing the law at the start of this year or waiting until 2026. A majority of the counties opted to wait.

That choice is distressing to many families dealing with severe mental illness and who have seen their loved ones cycle from treatment facilities they say are inadequate to the streets and, in some cases, jail.

Mark Gale, criminal justice chair for the National Alliance on Mental Illness of Greater L.A. County said families of loved ones living with serious mental illness have been waiting too long for changes to the law that they believe will open up more options for care. He said advocates like himself are “exhausted” and “disappointed” at counties’ decision to delay.

“Some people with mental illness are gonna continue to make catastrophic decisions for themselves until they’re found dead… ,” Gale said. “I’m not waiting for that.”

Opponents fear return to 'warehousing'

Others see SB 43 not as a way forward, but means of reverting to the past, when people living with mental illness were too often warehoused in inhumane conditions across the country.

They worry that the new law will ultimately lead to more locked facilities that will provide a prison-like setting rather than a therapeutic one.

Vanessa Ramos of Disability Rights California has been diagnosed with schizoaffective disorder and substance use issues. She has been sober for nearly 12 years. She told LAist she is concerned that under SB 43, California will be on a path to creating more locked facilities that are easier to enter than they are to exit.

“SB43 has the ingredients to banish poor, non-white and white and, for sure, disabled people for the lack of community-based mental health and harm reduction services that people need,” Ramos said.

Of particular concern for Ramos are people living with severe substance-use issues. The new law allows them to be placed on an involuntary hold and make them possibly eligible for conservatorship if they are unable to provide for their personal safety or necessary medical care.

Gary Tsai, director of Substance Abuse Prevention and Control at the county Department of Health, pointed out last month that right now there is no involuntary care model for people living with substance use issues. Tsai told the Board of Supervisors that infrastructure would need to be built out in order for the county to provide appropriate care under the new law.

But even if that infrastructure were available, some local health advocates still don’t think it’s a good idea.

Carolina Valle, senior policy director for the California Pan-Ethnic Health Network, said Angelenos already have enough information from history to be suspicious of locking people up with substance use disorders.

“It’s called the War on Drugs,” Valle said. “We had models of involuntary substance use treatment, it was called jails and prisons and we continue to have those today.”

Valle said she’d like to see SB 43 not only delayed, but repealed.

Newsom wants more urgency

Newsom has said that he’s not happy with counties that have chosen to postpone SB 43 implementation.

“We cannot wait until 2026... on the conservatorship reform,” Newsom told reporters during a virtual news conference last month. “People literally will lose their lives. And people are losing confidence and trust in government.”

Newsom’s demands for urgency on the part of counties comes just as the most populous areas of the state launch CARE Court, a new program he championed that aims to get more people living with serious mental illness into treatment.

And the governor wants voters to agree to open up new funding to pay for the mental health care and housing infrastructure needed to make all of these legislative moves successful.

Earlier this month, Newsom was joined in L.A. by Mayor Karen Bass and others to drum up support for Proposition 1, the measure on the ballot in March which his office says would raise more than $6 billion for mental health treatment facilities and housing.