New mental health and conservatorship laws come at a cost to Sonoma County

Written by: Noah Abrams

When calendars turn over to January 1st each year, a slate of new state laws go into effect.

One of those, Senate Bill 43, is going to mean tradeoffs for Sonoma, and the rest of California's 58 counties.

'Grave disability' is one of the main focus points of Senate Bill 43.

Signed by Governor Gavin Newsom in 2024, the law expands the definition.

Now 'grave disability' means a severe substance use disorder, and an inability to provide for one’s personal safety or necessary medical care

Both are now reason for involuntary mental health holds as well.

Sonoma County Health Services' David Evans provided an example scenario.

"We all know and see sometimes people wandering in traffic," Evans said. "You wonder to yourself, 'how can we get that person to a higher level of care?' That person can now be placed into an involuntary setting because of the change in this law."

SB 43 also changes California's conservatorship laws.

The 1967 Lanterman-Petris-Short Act reshaped the mental health care landscape in California; ending the era of indefinite and involuntary commitment for those with mental health issues.

The LPS Act created what's called 5150's. Those are 72 hour mental health holds.

It also created LPS conservatorships. That's a legal mechanism in which a court appoints a "conservator" to make legal decisions for an incapacitated individual.

197 Sonoma County residents are currently under LPS conservatorships, many of them are being cared for at mental health facilities outside the county.

There an additional 12 individuals from Sonoma County under Murphy conservatorships, meant for individuals who are deemed 'gravely disabled' and have often committed violent felonies.

While the new SB43 rules open up more opportunities to place mentally unstable or incapacitated individuals into treatment, the law doesn't have any state funding attached to it, and that's a worry said Supervisor David Rabbitt.

"Unfunded mandates are way too easy to pass," Rabbitt said at the October 28th Board of Supervisors meeting. "There's nuggets in there that would be great if we could have the resources in there to go forward with that."

Sonoma County health staff estimate the new rules under SB 43 could add another 50 individuals into conservatorships, bringing the county's total to around 250.

County health staff said they are concerned they will need to cut costs in some areas of the county's healthcare system to cover the increased costs associated with the likely new conservatorships. 

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New mental health and conservatorship laws come at a cost to Sonoma County 

San Francisco Turns to Conservatorship in Drug Crisis: A Study of Diana Staros’ Case

By: Sakchi Khandelwal

In the face of an escalating drug crisis, San Francisco city leaders are reconsidering conservatorship as more than a last resort in treating individuals with severe drug addictions. A powerful illustration of the potential efficacy of this approach is the heartbreaking case of Diana Staros. Staros, a young woman who lost her life to the ravages of meth and fentanyl addiction, might have been saved by the forceful intervention that conservatorship provides, according to her grieving mother, Alison Monroe.

California’s Conservatorship Law Expansion
On January 1, California expanded its conservatorship law via Senate Bill 43. Previously, the law only covered individuals suffering from mental illnesses or alcoholism who were incapable of looking after themselves. The recent amendment includes those battling drug addictions. The San Francisco Department of Disability and Aging is in the process of preparing for the implementation of this change, increasing staffing and coordinating with partners.

Response from City Leadership
Mayor London Breed has been vocal in her advocacy for swift action to alleviate the plight of those ensnared in the grip of addiction. “We must act now,” says Breed, a statement reflecting the urgency of the situation. But despite the mayor’s fervent push, the approach has its detractors.
Opposition and Challenges

Critics argue that involuntary treatment is not the answer. In their view, resources would be better directed towards improving mental health services and providing housing. The Bay Area counties of Contra Costa, Marin, and Santa Clara, are either delaying the implementation of the expanded conservatorship law or have yet to establish a clear timetable. These counties face their own unique challenges in grappling with the drug crisis, reflecting the complexity of the issue at hand.

In the midst of these debates, the memory of Diana Staros serves as a stark reminder of what is at stake. As the city gears up to apply the new law, the question remains: Can conservatorship be the lifeline for those teetering on the brink of self-destruction due to drug addiction?

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San Francisco Turns to Conservatorship in Drug Crisis: A Study of Diana Staros’ Case