If any year is looked back on as pivotal in California’s fight to curb mental illness, homelessness and drug-related deaths, 2023 could be the one. Gov. Gavin Newsom pushed major — and at times controversial — reforms of the state’s mental and behavioral health systems through the Legislature, but a mere two months after signing the laws, Newsom accused counties of moving too slowly to adopt them.
Newsom on Friday at a press conference took local governments to task, publicly pressuring them to take action on the state’s new conservatorship law.
“The state has done its job. It’s time for the counties to do their job,” Newsom said.
In October, lawmakers significantly loosened long-standing rules limiting who can be placed in involuntary treatment. The change to the state’s conservatorship rules allows people who can’t take care of their own medical needs or personal safety to be deemed “gravely disabled” and placed in treatment facilities without consent. This includes people struggling with addiction.
But the vast majority of counties have opted to delay implementing the conservatorship expansion, putting them at odds with the governor’s timeline. They play a critical role in the law because they administer the state’s social services and mental health programs.
County leaders say they need more guidance and resources. They argue they lack the staff and funding to move this new policy forward. The law goes into effect in 2024, but allows counties to defer implementation until 2026.
Fifty-six counties out of the state’s 58 are requesting permission to delay implementing the law, Tony Vartan, Stanislaus County’s Behavioral Health Director, told his Board of Supervisors this week.
Only San Luis Obispo and San Francisco counties plan on beginning implementation next month, Vartan said.
Newsom said during Friday’s press call that the “lack of urgency” at the local level was disappointing.
“You have a crisis out there. There’s a crisis on the streets and people are talking about delaying the conservatorship efforts till 2026. We can’t afford to wait,” he said.
Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California, said in a statement behavioral health departments are “already stretched” thin and need time to coordinate such a complex change. In the past two years, they’ve been hit by increased demand for services, widespread provider shortages, and a series of new state mandates.
“County boards of supervisors across California have heard clearly from hospitals, law enforcement officials, and county behavioral health professionals that infrastructure capacity, staffing and training must be in place to make the law successful,” Cabrera said.
California counties singled out
The change comes on the heels of another major Newsom mental health initiative. CARE Court, which passed last year and began rolling out in October, allows people with untreated mental illness to be placed in court-mandated treatment programs and housing.
So far, eight counties are operating a CARE court. Now, most of those early adopters have chosen to delay the conservatorship expansion.
One of the counties that is operating a CARE Court, Riverside, is taking more time to adopt the conservatorship law. Newsom singled it out at his press conference.
“Riverside County (is) doing great work on CARE Court, but decided not to move forward with the implementation of conservatorship,” Newsom said.
Riverside County officials said they’re not ready to carry out changes to the conservatorship law, which carries “significant responsibilities.” The county’s behavioral health department, hospitals and law enforcement need time to expand treatment facilities, increase housing capacity, develop new protocols and train staff, Dr. Matthew Chang, behavioral health director of Riverside University Health System, said to the Riverside County Board of Supervisors.
“Setting an implementation date in 2026 would signal our commitment to getting it right for our community,” Chang said during board remarks.
Mayors back Newsom’s timeline
Several California mayors, by contrast, are urging counties to move faster. Mayors often bear the brunt of residents’ complaints about homelessness, but they tend to have little influence over social services and mental health spending.
San Diego Mayor Todd Gloria, who supported a majority of Newsom’s mental health reforms, urged his county’s board of supervisors to implement the conservatorship expansion immediately.
“While the law allows for counties to delay implementation until 2026, our county is experiencing an unacceptable behavioral health crisis – one all of us see clearly every day in our communities. Putting implementation off will cost people their lives,” Gloria and other San Diego County mayors wrote in a letter to the board this month.
Nora Vargas, chair of the board of supervisors, initially proposed delaying implementation to 2025 after hospital and behavioral health leaders argued more people would cycle in and out of the emergency room without proper support.
“San Diego County will implement (the conservatorship law) in a way that is methodical and equitable because these are real people and real families seeking care,” Vargas said in a statement to CalMatters.
Tim McClain, a spokesperson for San Diego County Health and Human Services Agency, said the county is moving as quickly as possible despite receiving no support from the state.
The law “comes with no new resources for hospitals, substance use disorder treatment providers, or county run public conservator offices. It doesn’t establish clinical assessment criteria that will incline clinicians to extend holds. And it doesn’t do anything to create the operational tools that will actually get people with substance use disorder from (emergency departments) into ongoing addiction treatment,” McClain said in a statement to CalMatters.
Demand on mental health system
Among the concerns raised by counties is a dramatic influx in the number of people needing treatment.
In Kern and Santa Barbara counties, behavioral health officials have said they expect the number of people who would qualify for involuntary treatment to increase tenfold, The Bakersfield Californian and Santa Barbara Independent have reported.
Behavioral health officials in Stanislaus County told their board of supervisors that because the expanded definition of “gravely disabled” will now include people with drug use disorders, the number of conservatees will likely go up. They say they need additional staff and coordination to handle a larger population. There are also very few treatment settings for people with severe substance use disorders in the county, health officials said.
The Stanislaus County Board of Supervisors agreed to push back implementation, but supervisors said they would like to enact the law sometime before 2026.
In neighboring San Joaquin County, supervisors this week also voted to delay the law’s implementation.
“We need the state to provide us with guidance on how we can best apply this law to help the vulnerable and protect people’s civil rights while ensuring their treatment,” Supervisor Robert Rickman said in a press release.
All of the recent changes at the state level target serious mental illness among the state’s growing homeless population, which has ballooned by more than 30% to 170,000 people since Newsom took office in 2019.
In March, voters will be asked to approve or reject yet another major overhaul of the state’s mental and behavioral health system. Proposition 1 includes two key provisions: a $6.4 billion bond to pay for 10,000 treatment beds and supportive housing, and a revamp of the state’s 20-year-old law that funds mental health services through a tax on personal income over $1 million.