County supervisors postponed implementation of a conservatorship state law in response to fears that hospitals could be inundated with new patients.
by Lisa Halverstadt
County supervisors postponed implementing a state conservatorship expansion law after hospitals warned it could overwhelm San Diego emergency rooms.
Yet there hasn’t been a dramatic influx of patients in the months since the county implemented the state law in January, just over a year after supervisors considered whether to immediately implement it or hold off.
SB 43 aimed to make it easier to force people with severe substance use disorders into treatment. It also allowed holds or conservatorships in instances where someone failed to access needed medical care. The 2023 law gave counties the option to postpone implementation until 2026. San Diego County decided to move forward this January to allow more time to institute training and new services to meet an expected spike in demand for them. The decision drew praise from advocates concerned about patients’ civil liberties and criticism from others including San Diego Mayor Todd Gloria, who argued the region needed another tool to aid people languishing on the streets.
But a recent county report showed a small drop in involuntary 72-hour holds that many expected to spike after SB 43 took effect in the first three months of 2025 compared with the prior three quarters in 2024. Temporary and longer-term term conservatorships also appeared to be trending down after January, though the county noted its March numbers were incomplete.
“The fear we had that there was going to be this huge increase just really hasn’t materialized,” said Steve Koh, chief of clinical psychiatry at UC San Diego Health.
The county reports that contracted crisis stabilization units it had prepared to take in more patients who might otherwise flood local hospitals also haven’t seen a surge in demand despite the county’s efforts to redirect patients there.
The county’s now-former behavioral health director had predicted at least a 10 percent spike in short-term holds tied to the new law in its first year based on feedback from police and others. Some activists and behavioral health providers – like hospitals – expected and in some cases, even hoped for, a more dramatic increase.
County officials are hesitant to pinpoint the reasons for the mismatch between the predictions and reality, noting that it’s been just seven months since the county implemented the expansion.
“While the county has recently observed decreases in holds and fluctuations in permanent conservatorships, it is still early to clearly understand the impacts of the SB 43 legislation,” county spokesperson Tim McClain wrote in an email. “The county continues to monitor these trends closely.”
In the county memo, the leader of the county’s Health and Human Services Agency wrote that involuntary holds could “increase over time as providers become more familiar with the revised criteria and adapt operational and clinical practices accordingly.”
Deputy Chief Administrative Officer Kim Giardina also wrote that upcoming state updates on insurance reimbursements could also “increase demand for local inpatient (substance use disorder) treatment.”
The Hospital Association of San Diego & Imperial Counties, the lobbying group for San Diego’s hospitals that urged supervisors to postpone SB 43 implementation, declined to comment for this story.
Other San Diegans on multiple sides of the issue have similar theories on why SB 43 hasn’t swiftly increased involuntary holds or conservatorships.
Though the county has inked new contracts to supply more post-hospital options and treatment beds, there’s broad agreement that there still aren’t enough resources – and that police and hospital staff who make the call on holds and conservatorships are still getting up to speed on the new law.
Koh and others said some clinicians and police officers have been unclear on whether patients meet the new criteria, leaving some to stick with longstanding protocols rather than use new ones under SB 43.
“I think it’s a complicated thing,” Koh said. “I know there are some folks who don’t want to use it because they don’t think it will lead to anything.”
Post-hospital placements for patients on temporary holds and longer-term conservatorships remain hard to come by, Koh said, and clinicians can be reluctant to take away patients’ rights to choose their own treatment path without a clear end game.
San Diego National Alliance on Mental Illness CEO Cathryn Nacario agreed.
“We still have some infrastructure that needs to be brought online to really support and place people in appropriate facilities and programs,” Nacario said.
Michelle Routhieaux, who leads San Diego’s Depression and Bipolar Support Alliance and regularly assists people in crisis, was concerned about how SB 43 could be misused before it took effect in San Diego County.
She’s also not surprised by how it’s played out initially.
After all, Routhieaux said, even patients who want hospital care have long struggled to get it in San Diego County.
“Either there’s no space for them or the hospital says, ‘You don’t meet criteria,’” she said.
Linda Mimms, a longtime mental health advocate who rallied behind SB 43, is frustrated and also unsurprised. She thinks more education is needed on the law and that local government agencies, including the county, need to heed it – and supply the services necessary to support people who could be connected to treatment under the expanded law.
“They just don’t want to bring people in because they don’t have the resources to help them,” Mimms said.
Full Article & Source:
Forced Treatment Hasn’t Flooded Hospital Emergency Rooms – Yet
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