Marin County delays intervention for gravely disabled

Senate Bill 43 requires counties to either implement a change in the definition of the disability in January 2024 or adopt a board-approved resolution to delay it no later than January 2026.

Marin will delay implementing a new state law that would make it easier to detain and place into conservatorship people deemed “gravely disabled.”

Senate Bill 43, which was signed into law by Gov. Gavin Newsom on Oct. 10, requires counties to either implement a change in the definition of the disability in January 2024 or adopt a board-approved resolution to delay it to no later than January 2026.

“It is our recommendation that Marin County take that option and defer implementation,” Todd Schirmer, forensic division director at Marin County Behavioral Health and Recovery Services, told county supervisors on Tuesday.

Currently, gravely disability is defined as a condition in which a person is unable to provide for his or her basic personal needs for food, clothing, or shelter due to a mental disorder.

The legislation expands the definition to include “severe substance use disorder, or a co-occurring mental health and severe substance use disorder, and also includes those who are unable to provide for their personal safety or necessary medical care,” Schirmer said.

Schirmer said he was grateful to the governor and the Legislature for creating additional tools to provide treatment to people with serious mental illness and substance use disorders.

“However, the 82 days between signing of the law and the implementation date of Jan. 1 of 2024 was simply not enough time given the scope and magnitude of the changes required, especially since this legislation contained no funding or infrastructure resources necessary to ensure its success,” he said.

Schirmer said he and former Health and Human Services director Benita McLarin formulated the recommendation prior to her recent retirement.

In the Bay Area, Contra Costa, Napa, Santa Clara and Solano counties are also deferring implementation of the law.

On Friday, Newsom criticized counties that are delaying implementation, saying, “They have to understand people are dying on their watch.”

Newsom said that he was consulting with legislators regarding ways to pressure counties to proceed more quickly. He indicated that future state funding for homeless accountability programs might hinge on adoption of the law.

“We are aware of Gov. Newsom’s comments last Friday expressing concern that counties are requesting delays in implementation,” Schirmer said.

One county that isn’t waiting is San Francisco. Mayor London Breed announced the day after Newsom signed the bill that San Francisco would implement SB 43 on “day one.”

In her executive directive to implement the law, Breed wrote, “The previously outdated Lanterman-Petris-Short Act conservatorship laws failed to include certain people who are at great risk of harm due to their inability to live safely in the community.”

Breed noted that 50% of San Francisco’s unhoused residents self-reported having substance use challenges.

“It is not progressive, nor humane,” Breed wrote, “to allow people to deteriorate in our streets.”

There was no public comment at Tuesday’s meeting but in an email, Monica Rosenberg of San Rafael, wrote, “The board should not vote to postpone the implementation of the bill.” Rosenberg has been writing to the supervisors since May trying to get help for a woman who has been living at a bus stop near her home.

“She is clearly unhoused and has a mental health challenge,” Rosenberg wrote.

Schirmer said to effectively implement SB 43 the county will need to build and expand its local treatment workforce, treatment settings, and housing capacity.

This is not the first program of this kind that the county has developed.

In 2018, after much debate, the county adopted Assembly Bill 1421, known as Laura’s Law, which gave judges the authority to order severely mentally ill people to undergo outpatient treatment in counties that adopted it. The law passed in 2002 after a mentally ill man fatally shot Laura Wilcox, a 19-year-old volunteer at a Nevada County mental health clinic.

Marin supervisors adopted the law over the objections of Grant Colfax, who was the county’s director of Health and Human Services at the time. Colfax insisted there was insufficient evidence to prove that programs such as Laura’s Law were more effective than non-compulsory treatment approaches already in use.

SB 43 has been criticized by disability and civil liberties groups who assert that the law will threaten the civil rights of mentally ill people.

In her written report to supervisors, Jessica Paran, Marin’s interim director of Health and Human Services, wrote, “Black, indigenous and people of color individuals are more likely than white individuals to be subject to involuntary psychiatric treatment. Expansion of the definition of gravely disabled without a thoughtful planned approach risks exacerbating this inequity.”

Colfax, who is now San Francisco’s health director, wrote in a statement, “While there is still more work needed to meet the needs of adults unable to care for their own basic needs due to mental illness or a severe substance use disorder, this is a major step forward in supporting this vulnerable population.”

Regarding Laura’s Law, Schirmer wrote in an email, “Our data indicates a total of 101 referrals from 2018 onward, of which 33 met eligibility criteria. Of those, 20 connected to services voluntarily after outreach and engagement.”

Schirmer said fewer than 10 cases have gone before a judge. He wouldn’t say how many cases have been heard in court, saying that doing so would violate his department’s privacy rules.

Schirmer said in December 2024, the county will implement another related program, Senate Bill 1338, Newsom’s Care Court initiative.

The law is designed to ensure that people suffering from untreated schizophrenic and psychotic disorders receive treatment and housing. If people refuse treatment or fail to complete a care plan, the law authorizes an investigation to determine whether they should be involuntarily committed for the purpose of treatment and evaluation.

In June 2022, county supervisors allocated $500,000 for implementation of Care Court.

Despite the overlap of these initiatives, Schirmer said the county remains unprepared to implement SB 43.

“This is different,” he said, “because this focuses on severe substance use disorder whereas Care Court and Laura’s Law do not.”

Lou Enge, director of the Marin chapter of the Mental Alliance on Mental Illness, said, “It is a new piece of legislation. We definitely think it is smart to have your plans in place before you start to implement it.”