Existing law, for purposes of involuntary commitment, defines gravely disabled as :

• A condition in which a person, as a result of a mental health disorder, is unable to provide for their basic personal needs for food, clothing, or shelter

New law, as indicated by bold text, under SB 43 expands the definition of gravely disabled to include: 

• People with a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and severe substance use disorder, and who are unable to provide for their basic needs for food clothing, shelter, access to necessary medical care, or personal safety

SB 43 changes the definition of grave disability in two ways: 

• Adds severe substance use disorder as a reason someone could be placed on an involuntary 5150 hold
• Adds inability to provide for one's person safety or necessary medical care as reasons that a person could be placed on an involuntary 5150 hold

SB 43 also makes the following changes: 

• Expands the array of testimony that can be submitted into conservatorship proceedings without requiring in-person cross examination
• Requires counties to consider less restrictive alternatives in conducting conservatorship investigations
• Expands state reporting requirements

Due to a mental health disorder, severe substance use disorder, or a co-occurring mental health and severe substance use disorder:  

• Their caretaker is failing to provide the necessary care of the individual or is stating that they cannot provide help for the individual without distressing hardship (AB 1194).
• Refuses third-party help or unable to utilize the third-party help when it's provided (food, clothing, shelter, necessary medical care).
• Their impaired thought process is hindering their personal safety and/or is causing them to be unable to safely care for themselves.

• A 5150 is a Welfare and Institutions Code Section in state law that allows a person to be held involuntarily for up to 72 hours. A 5150 hold is not a criminal arrest.
• Grave Disability is one of the criteria which can be used to place a person on a 5150 hold. The other criteria are danger to self and danger to others. 
• A 5150 hold can be initiated by either a police officer or other peace officer or by a person approved by the county behavioral health department.
• Under a 5150 hold, law enforcement, or other authorized persons can detain the person and transport them to a facility for the purpose of mental health assessment and evaluation. 
• 5150 holds do not authorize involuntary medication or medical treatment. 

Individuals on a 5150 hold are assessed and evaluated by trained behavioral health professionals. This process may include, but is not limited to:

• information gathering from the individual on the hold
• information gathering from reliable third parties (family, friends, support persons, etc.)
• review of historical information
• observation of behavior

Prior to the 72-hour expiration of the hold, one of the following will occur: 

• 5150 hold is discontinued, and the individual is discharged to the community with services
• 5150 hold is discontinued, and the individual is admitted as a voluntary patient to an inpatient hospital for continued treatment
• 5150 hold is upheld, and the individual is admitted to an inpatient hospital for continued treatment

SB 43 will not change where individuals are held for mental health treatment. However, SB 43 expands the definition of grave disability to include severe substance use disorder.

• Individuals on a 5150 hold for severe substance use disorder will be taken to the same LPS designated 5150 evaluation and treatment facilities as those on a hold for mental health treatment.

• KernBHRS Psychiatric Evaluation Center / Crisis Stabilization Unit
  • Voluntary/Involuntary Services
    • 2151 College Ave., Bakersfield, CA 93305
    • (661) 868-8010
    • Open seven days a week, 24 hours a day
    • www.kernbhrs.org/services/crisis-services
• Telecare Ridgecrest Crisis Stabilization Unit
  • Voluntary/Involuntary Services
    • 1141 Chelsea St., Ridgecrest, CA 93555
    • (760) 463-2880
    • Open seven days a week, 24 hours a day
    • www.telecarecorp.com/ridgecrest-csu
• Telecare Recovery Station (Voluntary Sobering Program)
  •  312 Kentucky St., Bakersfield, CA 93305
  • (661) 336-6400
  • Open seven days a week, 24 hours a day
  • No walk-ins, admissions coordinated through KernBHRS and Telecare
  • www.telecarecorp.com/bakersfield-recovery-station
• 988 Crisis Hotline
  • Call for crisis counseling, suicide prevention and intervention and Mobile Crisis Response dispatch 
  • Open seven days a week, 24 hours a day
  • www.988lifeline.org
• Local Emergency Departments throughout Kern County
• Behavioral Health Inpatient Treatment Facilities
  • Kern Medical Hospital
  • Good Samaritan Hospital
  • Bakersfield Behavioral Healthcare Hospital
  • Crestwood Psychiatric Health Facility 
  • Telecare Kern Psychiatric Health Facility
  • Central Star Kern Youth Psychiatric Health Facility

  *All admissions of individuals on involuntary holds are coordinated through KernBHRS and the LPS designated facility

LPS Conservatorship is for the most severely impaired individuals and involves a court-appointed conservator who can make decisions related to treatment and placement for individuals when they are unable to care for themselves

• People on a conservatorship receive case management and often reside in congregate care settings such as mental health rehabilitation centers, skilled nursing facilities and board and care facilities. 
• Conservatorship may last for up to one year and is evaluated for renewal annually. 
• For more information on conservatorship, please go to:

  • https://www.kerncounty.com/government/aging-adult-services/services/lps-conservatorship

Clinically, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) allows clinicians to specify how severe or how much of a problem a substance use disorder is. Out of 11 criteria outlined in the DMS-5-TR, a person would need to have six or more symptoms to indicate a "severe" substance use disorder. 

In practice under SB 43, a peace officer will need to determine in the field whether a person appears to have a severe substance use disorder and would qualify for an initial 5150 hold under the new expanded criteria. 

The person would be transported to a LPS-designated facility, likely an emergency room or hospital (or an alternative site designated as LPS by the County), for an evaluation and treatment for up to 72 hours. After the 72 hours expires, a few different things could happen: 

• The person could be released if the person does not continue with treatment; (e.g., they are no longer considered gravely disabled)
• The person is released from the hold and enters voluntary treatment
• The person continues to receive treatment by being placed on a 5250 hold for up to 14 days. 

The Community Assistance, Recovery, and Empowerment (CARE) Act creates a new pathway to deliver mental health and substance use services to people who are diagnosed with schizophrenia or other psychotic disorders and are not engaged in treatment. The intention of the CARE Act is to connect with people to voluntary treatment through a civil court process. 

With SB 43, the CARE Act will be considered as less restrictive path to treatment for people who are referred for LPS conservatorship. 

To access ongoing behavioral health treatment services, please contact the Access and Assessment Center to schedule a screening at (661) 868-8123. Access and Assessment services are available Monday through Friday, 8:00 a.m. to 5:00 p.m.

For urgent behavioral health concerns, Mobile Crisis Response and Hotline services are available 24 hours a day, seven days a week, 365 days a year by dialing 988. For life threatening emergencies, please contact 911. 

To access ongoing substance use disorder treatment services, please contact the SUD Access Line at 1-866-266-4898. The call center is available 24 hours a day, seven days a week, providing screenings and referrals to our network of community substance use providers across Kern County. 

The following facility types, after designation, by counties and approval by DCHS, may admit people who are gravely disabled due to a severe substance us disorder only: 

• General acute care hospitals (GACHs) with distinct part units providing chemical dependency recovery services as a supplemental service
• Acute psychiatric hospitals (APHs) with distinct part units providing chemical dependency recovery services as a supplemental service
  • Hospitals can apply to provide chemical dependency recovery services as a supplemental service approved by CDPH
    • Please visit the California Department of Public Health's (CDPH) facility licensing and certification page to learn more
    • Questions may be directed to CAB@cdph.ca.gov
• Psychiatric Health Facilities with DHC approved substance use treatment services and in accordance with licensing and regulations under Title 9 of the California Code of Regulations. 
• Certified Crisis Stabilization Units (CSUs) with DHCS approved substance use treatment services and in accordance with certifications and regulations of Title 9 of the California Code of Regulations.

To be approved by DHCS, county-designated facilities must meet the LPS designation requirements set forth in § 821 of Title 9 of the California Code of Regulations and any supplemental Behavioral Health Information notices or LPS designation protocols released by DHCS. 

The following facility types, after designation by counties and approval by DHCS, are allowed to treat people with co-occurring mental health disorder and severe substance use disorder: 

• General Acute Care Hospitals 
• Acute Psychiatric Hospitals
• Psychiatric Health Facilities
• Certified Crisis Stabilization Units
• Mental Health Rehabilitation Centers  
• Skilled Nursing Facilities with Special Treatment Programs