Senate Bill 43 in San Mateo County
SB43 will begin in San Mateo County on January 1, 2026.
Senate Bill 43 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. All Counties are required to “implement” this law no later than January 1, 2026.
Upcoming Community Learning/Q & A Sessions will be held in late January and in February to be able to hear from professionals and the public about SB43 implementation so that any issues can be addressed and to provide for learning in order to continue to build SB43 within San Mateo County.
SB43 Training Resources
San Mateo County First Responders (Required)
This training covers the background of the law and the changes made to the LPS Act. It explains the purpose and intent of the legislation, the implementation timeline, and the implication of the changes to the law. It generally explains the approach taken by San Mateo County to implement the law.
This training is non-clinical and covers changes to the LPS Act, including the expanded definition of gravely disabled and inclusion of Severe Substance Use Disorders and Co-Occurring Severe Substance Use and Mental Health Disorders. Potential Observable Indicators for personal safety and necessary medical care are covered, as is Severe Substance Use Disorders and probable cause, and practices applying the new criteria to 5 scenarios.
Both of the above training courses are a prerequisite to use of the 5150 Evaluation & SB43 Quick Reference Field Guide for First Responders.
SB43 Consultation Services
Most persons that meet SB43 criteria will enter services upon discharge from one of two local Psychiatric Emergency Services Units (San Mateo Medical Center and Mills-Peninsula). Family members and service providers are invited to preplan SB43 services provided voluntarily or upon a 72-hour hold if eminent, through the SB43 Consultation Process. You can also use this process if you are a provider and wish to have a consultation about a current case you are carrying that is complex and may or may not be SB43 eligible. Please note that use if the consultation process is optional and not required. Psychiatric emergencies should be addressed by dialing 911 for response by law enforcement or the San Mateo County Crisis Line at (650) 579-0350.
BHRS Welcoming Framework
SB43 is not a program, it is a culture shift of the behavioral health system and network in San Mateo County. One of the first actions taken by the SB43 Community Steering Committee was to rewrite the BHRS policy on being welcoming and hopeful through the spread of co-occurring approaches to care. The Welcoming Framework principles require implementation by BHRS, its partners, and all BHRS providers by conducting an assessment of Co-Occurring Capability, developing an Action Plan based on the gaps identified by the assessment, and update the action plan annually. BHRS will conduct audits to determine compliance with the requirement and the clinical training courses listed above reflect a commitment to the co-occurring approach to treatment.
- HRS Policy 25-05: Welcoming Framework
- BHRS Policy 25-05: Attachment A – A Companion Guide to Implementation of a Welcoming Environment
SB43 Program Evaluation
American Institutes for Research (AIR) has been retained to conduct an evaluation of the implementation of SB43 in San Mateo County in order to have an opinion of program success by an independent evaluator. The evaluation will first cover the 2024 SB43 Pilot to gain knowledge of the success of the pilot and lessons learned. Subsequently, the evaluation will review implementation of SB43 post implementation.
Other Resources
Implementation Learnings from Previous Listening Sessions
The County held three listening sessions in May 2024 which included a wide range of stakeholders, ranging from people with lived experience, to inpatient, residential, and outpatient service providers, to hospital systems, and first responders. The input from these listening sessions has informed our approach to this planning process by identifying gaps in the current system and ideas for the future. Gaps identified in the current system include:
1. Coordinating between MH and SUD with follow up tracking of high need individuals; coordination with physical health.
2. Develop a culture of improving welcoming, hopeful engagement for SUD individuals in crisis.
3. Expand access to unused residential SUD capacity, consider adding mechanisms for increased MH support to those settings to help engage more complex clients.
4. Improve co-occurring capability in mobile crisis, outpatient MH services, and all SUD services.
Potential implementation ideas generated by the listening sessions include:
1. Success is engagement in a relationship, movement through stages of change over time, and reduction of poor outcomes; success is not measured only by entry into formal SUD treatment or by sobriety alone.
2. Expanding development and deployment of SUD peer support workers.
3. Building on existing crisis and first responder collaboration meetings to include helpful SUD responses.
4. Developing models for “damp” housing, where people who wish to continue substance use can be helped to use safely.
5. Expand rapid access to Buprenorphine in EDs/EMS, and plan for more rapid follow up.
6. Consider what is the most useful role for crisis beds in addressing the needs of individuals with SUD in crisis. Design a seamless continuum between inpatient, detox, crisis beds, and sobering drop in.
7. Using Care Court as a resource for selected individuals with SUD/COD.
Contact Information
SB43 Implementation Lead – Scott Gruendl, BHRS Assistant Director, sgruendl@smcgov.org.
SB43 Ongoing Oversight – Alex Hagnere, BHRS Clinical Services Manager, ahagnere@smcgov.org.