Obstacles delay new conservatorship law
Kern’s mental health providers have begun to brainstorm with interested parties across the county to form a plan on how to implement Senate Bill 43, legislation that passed last October that greatly expands the state’s conservatorship law.
Since last month, Kern County has convened twice with all involved parties — law enforcement, hospitals, city officials — to keep them apprised of any changes, while also building out a map of how the expanded conservatorship system will enter a continuum of care model for the at least 1,600 people they expect to enter their care.
Senate Bill 43 expands the state’s conservatorship law and rules for involuntary psychiatric 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 medication and get treatment.
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.
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.”
Early estimates show the number of those in Kern who would now qualify would increase “tenfold,” to possibly include more than a third of Kern’s homeless population that struggles with substance abuse issues, according to 2022 statistics.
Alison Burrowes, the director of Kern Behavioral Health and Recovery Services, said this continuum of care, while incomplete at the moment, will look like a big flow chart, starting at the moment someone enters a psychiatric hold to their point of conservatorship, with different routes depending on one’s case.
“Somebody with high medical needs — what does the flow look like for them?” Burrowes said. “Because their treatment and care will look very different (from) somebody who was just
intoxicated.”
The group’s third meeting will be held Friday, at the Kern Behavioral Health and Recovery Services office.
But there’s only so much planning officials can do, as they await instructions from the state.
“This moved over very quickly,” Burrowes said. “Legislation like this has been attempted to be passed for many years and I don’t know (if) anybody anticipated this moving forward.”
Specific training is needed for staff to confidently initiate an involuntary hold, a point of contention during the bill’s time in the state Legislature over the possibility forced treatment could trigger lawsuits as an impingement of people’s civil rights.
Yet the law requires yetto-be identified facilities and a workforce that may likely require licensing and training that does not yet exist in California.
“There’s a lot still unknown for us as well,” Burrowes said.
In its first and only notice, the state said they won’t expect counties to build new facilities.
Many counties, including Kern, have few facilities capable of accepting those with medical, substance use and mental health needs. Some, like Los Angeles County, have none. Without additional bed space, a mass influx of people deemed gravely disabled could result in many cycling through arrests and emergency rooms before being sent back onto the street.
Regardless of the notice, Burrowes said it’s likely that Kern will need to build detoxification facilities and treatment centers as Burrowes expects the county will see at least double the number of incoming 5150 holds.
Kern County’s crisis stabilization unit sees 600 to 800 people per month, she added.
“I don’t even know how we would reach that,” Burrowes said on the tenfold increase. “We’re hoping that is not the capacity needed but we’re planning for maybe doubling whatever the needs are now.”
Psychiatric facilities usually cost several million dollars to build and take years to construct. Two new psychiatric facilities, able to handle a combined 36 patients, took eight years before they reached Kern County Board of Supervisors approval Tuesday.
Another issue is insurance. Burrowes said only some services at psychiatric facilities would be reimbursed through Medi-Cal.
“If an individual was to go into our crisis stabilization unit right now and just had a substance use disorder and that was their diagnosis, we have no way to be reimbursed for that service,” Burrowes said. “That is the part of the licensing and payment piece that needs to be updated.”
Beyond that, Kern County is assigned one of the lowest Medi-Cal reimbursement rates in the state. Burrowes said she’s not sure why.
“Whatever is not reimbursed from the state, then the behavioral health department and the county needs to supplement that to make sure organizations and businesses can keep running,” she said.
The state has offered little to no guidance on how counties must implement the law and has so far not approved any additional funding for hospitals, treatment providers or county conservators offices.
And it remains unlikely the state Legislature will be swayed otherwise as California faces up to a $70 billion deficit in next year’s budget, according to the Legislative Analyst’s Office.
Burrowes said in her December presentation that implementation could cost upward of $50 million and another $25 million each year to operate.
Despite the problems ahead, Burrowes said the county is weighing out whether it will implement pieces of the new law, such as the expanded definition of the “hearsay rule,” which allows an expert witness, such as a health practitioner or licensed clinical social worker included in the medical record, to offer an opinion that sways a conservatorship ruling.
Previously, only families or psychiatrists who witnessed a behavior could testify, Burrowes said.
This comes months after the Kern County Board of Supervisors unanimously voted in December to delay participation in the program, joining a majority of counties across California to do so, despite continued pressure from Gov. Gavin Newsom’s administration to speed up the pace.
“You have a crisis out there,” Newsom said at a news conference in December. “There is a crisis on the streets, and people are talking about delaying the conservatorship efforts until 2026. We can’t afford to wait… It’s time for the counties to do their job.”
This also comes as Proposition 1, a controversial package of mental health reforms included in the March 5 primary election, officially passed Wednesday. The bill will overhaul — and arguably disrupt — parts of county mental health budgets while including a $6.4 billion bond for unlocked facilities and psychiatric beds as well as affordable housing.