San Mateo County is soliciting input and collaboration for implementation of Senate Bill (SB) 43. Behavioral Health & Recovery Services, a division of County Health, will be hosting two Listening Sessions to collect information about relevant experiences: 

First Listening Session (San Mateo)
Thursday, May 9, 2024
9:00AM – 11:00AM
Central County Adult Outpatient Clinic
Room A51 – Multi-Purpose Room
1950 Alameda de las Pulgas
San Mateo, CA 94403

Second Listening Session (Redwood City)
Tuesday, May 21, 2024
2:00PM – 4:00PM
South County Adult Outpatient Clinic
Room 100 – Multi-Purpose Room
802 Brewster Avenue
Redwood City, CA 94603

What is SB 43?

SB 43, which became effective on January 1, 2024, expands the authority of the law governing mental health commitment (the Lanterman-Petris-Short or LPS Act) to include application to individuals with severe substance use disorders (SUD).  The law states that individuals with severe SUD who meet criteria, including inability to take care of medical needs to prevent serious harm, can be placed on involuntary holds of 72-hours or longer, and can also potentially be placed on conservatorship for multiple years.

What is San Mateo County’s responsibility under this law?

All Counties are required to “implement” this law no later than January 1, 2026.  However, each County at present has flexibility regarding how this law should be implemented. Because implementation is challenging, San Mateo County has decided to begin the process as soon as possible, and engage stakeholders in a collaborative process to determine how this law would be best applied in San Mateo.  We are inviting you to join us in providing your input at the beginning of that process.

Why is implementation of SB 43 challenging?

The reason this law was passed is because many people with severe SUD are dying tragically because of out-of-control addictions and appear to be unable to voluntarily access the help they need that could save their lives.  Examples include, but are certainly not limited to, people dying of opioid overdoses.  Before this law was passed, the LPS Act restricted involuntary treatment to individuals who were at risk of harm due to mental illness, including mental illness with co-occurring SUD, but not to people with SUD alone.  The intent of this law therefore is to allow involuntary intervention as a tool to save lives.

However, this is not as simple as it may seem. First, involuntary treatment interventions are always challenging because they are – by definition – involuntary.  How do we implement this law in a way that ensures that we only intervene in a way that is truly necessary and lifesaving?

Second, involuntary interventions for SUD should be associated with receiving treatment that is truly helpful and recovery-oriented, not merely confinement.  However, we do not have a base of understanding and evidence for how to do this effectively. Further, at present, there are no licensed facilities in California, nor is there even a licensing category in California, that permits involuntary commitment of persons with severe SUD conditions beyond a brief hold in an emergency room.  It is important therefore not to initiate involuntary interventions for SUD that do not have a reasonable likelihood to result in better outcomes for the people who receive them.

This is why we need your help.

San Mateo County Health, Behavioral Health & Recovery Services seeks to work collaboratively with a wide variety of stakeholder representatives during 2024 and 2025 to develop the best possible approach to implementing this law.  We want to identify populations that are most at risk and interventions that are likely to be successful for those populations, within what the current licensing regulations and current resources allow. Our goal is to try to utilize involuntary interventions for SUD in a targeted way that balances the benefit of lifesaving help against the risks of inappropriate loss of liberty.  And, over time, we want to do this in a way that allows us to continually learn and improve so that we can better save lives and minimize harm.

The Listening Sessions are just the beginning of this collaboration.  One of the goals of these Listening Sessions is not just to hear your input, but to identify representative partners to join us in forming an SB 43 Steering Committee.  This Steering Committee will include representatives of key stakeholder groups (individuals and families with lived experience, first responders, treatment providers, emergency departments, hospitals, etc.) to work in partnership with BHRS leadership and consultants to identify priorities and potential interventions that help us to achieve our goals.

Therefore, in these Listening Sessions we are not only looking for individual input, we are also looking for ideas for which stakeholder groups should be represented on this Steering Committee, and who their representatives should be.   Based on the input we receive in the first Listening Session, we may focus discussion in the Second Listening Session more on how to best plan for the launch of that Steering Committee.

The County wants to hear from stakeholders that are interested in this issue:

1. Describing situations you encounter where involuntary interventions might be helpful?
2. Listening to what your needs and priorities are in relation to the target population.
3. Would placing persons with out-of-control high risk SUD on involuntary holds be beneficial? Or harmful? Why or why not?
4. What are your thoughts about what types of involuntary interventions for people with SUD would be helpful, or unhelpful?
5. What role might your program play in implementing SB 43 interventions? What would you want to avoid?
6. Anything else or experience that you would like us to know that would be useful to develop effective responses?

Who should attend?

Persons and family members with lived experience of addiction, first responders of all kinds, Emergency Room representatives, law enforcement, street medicine teams, homeless outreach teams, homeless services providers, mental health and SUD treatment providers of all kinds, providers of medication treatment for addiction, residential treatment facility representatives, hospital representatives, university faculty and researchers, county employees and private sector employees that engage the population, and others interested in how the County can better respond to people in crisis due to a severe SUD.

If you are already in a role as a designated representative of a key constituency, we are particularly interested in your participation. 

Ways to provide input: 

• Come to one of the listening sessions in person and provide testimony.
• Submit  written comments at either session or email to sgruendl@smcgov.org.
• Fill out and submit our online Input Form.
• Text your comments or recorded testimony to 650-586-2162.
• US Mail your written comments to SB 43 Input, 2000 Alameda de las Pulgas, Suite 235, San Mateo, CA 94403. 

If you are unable to attend, but have suggestions for representation on the Steering Committee, please submit those to us as well.

Contact Scott Gruendl at sgruendl@smcgov.org or 650-573-2491 for more information.