45 counties, including Kern, to delay launch of major mental health law

Dec. 2—Nearly every county across California will share an unfortunate resolution in the coming year: They each will delay their launch of a new mental health law expected to change the face of involuntary treatment.

At a city of Bakersfield Homelessness and Housing Committee meeting last Tuesday, Alison Burrowes, the interim director of Kern Behavioral Health and Recovery Services, gave city officials the news that they won't be ready anytime soon.

And neither will most of California.

Senate Bill 43 expands the state's conservatorship law and rules for involuntary mental health holds — also known as 5150s — by expanding the legal definition of "gravely disabled." This is when a third party — typically a county public guardian, physician or police officer — places someone in a psychiatric facility and compels them to take medicine and get treatment.

Under the new law, conservatorships can be allowed if it's found that a mental illness or substance use disorder is placing — or will place — a person's physical or mental health at "substantial risk of serious harm."

The bill is a significant overhaul of the state's 1967 behavioral health law, and comes as lawmakers are desperate to solve a mounting homelessness and mental illness crisis worsened by illicit drugs, such as fentanyl and methamphetamine.

Early estimates, Burrowes said, show the number of those in Kern who would now qualify would increase "tenfold." In 2022, it was estimated that 34% of homeless people in the county deal with substance abuse issues, with many more affected by poor health and physical disabilities.

"This is quite a big deal, because we've never had that opportunity," Burrowes said. "I've seen so many missed opportunities and lives lost for individuals who, because of a substance use disorder, were stuck."

Signed into law in October, the first deadline is Jan. 1, 2024, with the option for counties to delay up to 2026.

But an obvious need and historic, bipartisan support in Sacramento that includes the League of California Cities, behavioral health advocates and the Big City Mayors Coalition proved not enough to ensure a proper launch. Burrowes confirmed 45 of the state's 58 counties, Kern included, expect to postpone.

"Our intention is to make a recommendation to the (Board of Supervisors) to delay with the option to implement as soon as we are ready," Burrowes said.

Offices across the state, from San Diego to Sacramento, each confirmed to The Californian on Friday that they plan to take this issue before their respective boards of supervisors, with the intention to ask to delay.

Christee Rivas, the assistant director of behavioral health in Kings County, said she expects no county in the state to be ready on time, citing an inability to have the right infrastructure in place.

In a prepared statement, San Diego's behavioral health department reasoned its delay as "there will likely be future fiscal impacts identified by the department including new costs and staff years associated with the implementation of SB 43."

Burrowes said a lot of infrastructure and staffing is needed before the program can start. This includes evaluation centers for individuals to go to before they are hospitalized; a locked, medical detox facility where they then can be hospitalized; and then a locked outpatient residential treatment center.

Without the infrastructure in place, there are concerns that broadening the number of people deemed gravely disabled at the start of the year could result in a stark increase in the number of 5150 holds that occur, especially among unhoused residents, who will likely end up cycling through arrests and emergency rooms before being sent back onto the street.

There's also the issue of staffing: "We've never evaluated people like this before," Burrowes said. "We don't even have the standard set up yet. Nobody does." At a 4-1 ratio, the county would need to hire medical doctors including psychiatrists, nurses and behavioral health staff.

In the report they plan to unveil before their respective supervisors on Tuesday, officials with the Los Angeles Department of Mental Health said that "due to the complexity of this endeavor, DMH anticipates it will need at least one year to develop the parameters, write new policies, develop new training and testing materials and redesignate individuals and hospitals."

While amending contracts or expanding services may take "months," they said, building new facilities could take "several years."

Sources for funding are also not known at this time. In the same report, Los Angeles DMH officials said that "funding for these new treatment services will need to be identified as SB 43 did not provide any additional funding for these new mandated services." According to an analysis of the bill, Medi-Cal is expected to reimburse county programs between $11 billion and $12.2 billion a year. But it's unclear when that will start.

"We're waiting to see how the reimbursement would work for that," Burrowes said.

This comes as a controversial package of mental health reforms, including SB 363, enter the March 2024 docket. If passed, the bill would overhaul — and arguably disrupt — county mental health budgets. The funding source attached is a $6.4 billion bond, known as Proposition 1, which includes some money for unlocked facilities and psychiatric beds.

Prior to the bill's passage, the California State Association of Counties raised concerns, saying that an expansion of the definition "does not expand placements in a system already stretched thin," meaning the law did not include the assurance of proper bed space and treatment providers for those under a conservatorship.

"Additional investments are needed for treatment, including locked facilities, workforce, housing and step-down care options," association Chief Policy Officer Jacqueline Wong-Hernandez said in October. "Substance use disorder in California is widespread, and we currently lack the infrastructure to properly address this worsening epidemic."

Burrowes said there's only one county she knows of that is ready to start: San Francisco.

"We're not quite sure how they're doing it without the designations and the resources," she said.

Officials with San Francisco County's Public Health Department did not respond to a request for comment. In an Oct. 10 statement, San Francisco Mayor London Breed said that since the law was signed, city and county officials have been "working immediately to implement these changes at a local level."

"I am directing all of our departments to work closely with the City Attorney's Office to ensure that there are no barriers to us getting this program into place and that we pursue all cases as aggressively as possible," she said. "There are too many people who are unwilling or unable to accept the help they need, and we need to get them into care immediately."

When asked for a follow-up conversation to the comments Kern County's Burrowes made at the city of Bakersfield's committee meeting, Kern Behavioral Health and Recovery Services spokesman Louis Groce declined, saying that the department won't comment before it makes a presentation before the Kern Board of Supervisors on Dec. 19.

"Typically, we do not comment on stories prior to that presentation," Groce wrote.

At Tuesday's meeting, Bakersfield Ward 2 Councilman Andrae Gonzales recommended that the county enter through a phased approach, beginning implementation on a smaller scale "as soon as possible."

"Because frankly waiting two years is not acceptable for the public," Gonzales said. "And for any of us in the room, we need to have this mechanism in place sooner than later."