California SB 43: Expanded Grave Disability Holds and Conservatorship

California SB 43 rewrites who counts as “gravely disabled” under state law, making it easier to place someone in involuntary mental health treatment or an LPS conservatorship. The law adds personal safety and necessary medical care to the list of basic needs a person must be able to meet, and it allows a severe substance use disorder alone to support a finding of grave disability.¹ Signed in October 2023, it took effect as state law on January 1, 2024, and every California county has to enforce it as of January 1, 2026.²

What Changed in the Grave Disability Standard

Before SB 43, “gravely disabled” under Welfare and Institutions Code Section 5008 meant one thing: a person who, because of a mental health disorder or chronic alcoholism, could not provide for their own food, clothing, or shelter. A person who managed to eat and find any kind of roof, however briefly, generally fell outside the reach of involuntary treatment.

SB 43 changes that definition in two concrete ways.³

First, it adds two new basic needs. Alongside food, clothing, and shelter, a person must also be able to provide for their personal safety and their necessary medical care. Los Angeles County’s guidance describes personal safety situations like walking into traffic, being unable to recognize ongoing victimization, or severely impaired judgment that creates life-threatening situations.⁴ Necessary medical care covers physical health problems likely to cause serious injury or death if untreated, such as untreated infections, unmanaged diabetes, or wounds a person cannot care for.¹

Second, it makes severe substance use disorder a standalone basis. Under the old statute, substance-related conservatorships were effectively limited to chronic alcoholism; a person with a devastating fentanyl or methamphetamine addiction could not be conserved unless they also had a separate psychiatric diagnosis. SB 43 removes that requirement. A severe substance use disorder, by itself, now qualifies.¹

Put together, the amended statute says a person is gravely disabled if, because of a mental health disorder, a severe substance use disorder, or both occurring together, they cannot provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.³

Who Can Now Be Held or Conserved

The practical reach of the new standard is wider than the old one in a specific way: it brings in people who are surviving at a minimal physical level but whose condition still exposes them to death or serious harm. Someone who eats and finds shelter but cannot manage a life-threatening medical condition can now be found gravely disabled. So can someone whose addiction has stripped their ability to recognize imminent physical danger.

For the substance use pathway, severity is not a lay judgment. Clinicians apply the DSM-5-TR, under which a substance use disorder is “severe” when a person meets six or more of eleven diagnostic criteria. Those criteria include using far more of the substance than intended, failed attempts to stop, spending most of one’s time obtaining or recovering from the substance, continued use despite serious physical or social consequences, and increased tolerance.⁵ Tolerance and withdrawal tied to legitimate prescribed medical treatment do not count toward the diagnosis.

How Someone Gets Into the System

SB 43 did not create a new detention process. It widens who qualifies for the existing Lanterman-Petris-Short pathway, which has three escalating stages.

72-Hour Hold

Under Section 5150, a peace officer, the professional in charge of a county-designated treatment facility, attending staff at such a facility, a mobile crisis team member, or a county-designated professional may detain a person for up to 72 hours on probable cause that they are gravely disabled, a danger to themselves, or a danger to others.⁶ Family members cannot start a hold themselves, but they can provide information to someone who is authorized. Intentionally providing false information for this purpose carries civil liability.

14-Day Certification

If the person still meets the criteria at the end of 72 hours and has not accepted voluntary treatment, the facility can certify them for up to 14 more days of intensive treatment under Section 5250.⁷ The person is entitled to a certification review hearing within four days.⁸

LPS Conservatorship

For people who remain gravely disabled after the shorter holds, the county may petition for an LPS conservatorship under Section 5350, giving a conservator authority over the person’s care, their estate, or both.⁹ A conservatorship lasts one year and expires automatically unless the county files a new petition to renew it, generally two to three months before it ends.¹⁰ Referrals for conservatorship evaluation come from hospitals, designated treatment facilities, and community clinics, not directly from individuals or family members.

Protections That Still Apply

SB 43 widened the definition of grave disability but left the procedural safeguards in place. At every stage where liberty is at stake, the LPS framework still requires:

Proof beyond a reasonable doubt that the person is gravely disabled, the same standard used in criminal trials.¹⁰
Appointment of a public defender or other attorney within five days of a conservatorship petition, and the right to counsel or a county patients’ rights advocate at certification review hearings.¹¹⁸
The right to a court or jury trial on grave disability. The demand must be made within five days of the conservatorship hearing, and the trial must begin within ten days of the demand.⁹
Annual expiration of any conservatorship, which requires a fresh petition to continue.¹⁰
A willing-caretaker exception: a person is not gravely disabled if a family member, friend, or other responsible person confirms in writing that they are willing and able to help the person meet their basic needs in the community.⁷

That last protection matters in practice. If you are a family member and you are prepared to help, your written commitment to assist can keep a loved one out of a conservatorship.

When Each County Has to Enforce It

SB 43 became state law on January 1, 2024, but the statute let counties defer enforcement by resolution of their governing body. That deferral runs out on January 1, 2026, after which every county must apply the expanded standard.³² Los Angeles and San Francisco moved earlier; other counties used the extra time to add treatment capacity, train staff, and update evaluation protocols.

What SB 43 Does Not Change

A few boundaries are worth stating directly, because they are easy to misread.

SB 43 is not the same as CARE Court. CARE Court, created by SB 1338, is a separate civil court process limited to adults diagnosed with schizophrenia spectrum disorders, other psychotic disorders, or bipolar I disorder with psychotic features who are deteriorating in the community.¹² SB 43 operates through LPS holds and conservatorships and reaches a broader group, including people whose only qualifying condition is a severe substance use disorder.³

SB 43 also did not change how treatment is paid for. Medi-Cal continues to cover medically necessary services for eligible beneficiaries at existing rates, and counties absorb costs that fall outside Medi-Cal or other insurance.¹³ The financial burden of locked psychiatric or residential placement falls on county behavioral health departments, not on the conservatee’s family.

And family members still cannot place a loved one on a hold themselves. They can give information to someone who is authorized to act.

Criticism and Open Questions

Civil liberties and disability rights groups have pushed back on SB 43 on several grounds.

The first is capacity. A broader definition of grave disability only produces treatment if there are enough psychiatric beds, residential placements, and trained clinicians to receive the people it reaches. Early implementation in counties that adopted the law in 2024 showed shortages of locked subacute beds and long-term residential placements, raising the risk that people found to meet the standard end up detained without meaningful treatment.

The second is disparate impact. Given the demographics of California’s unhoused population and documented disparities in psychiatric diagnosis, critics argue the expanded standard will fall disproportionately on Black and Latino Californians.

The third is whether coercion works. Some researchers point to mixed outcomes from court-ordered substance use treatment and evidence that coerced treatment can raise overdose and relapse risk compared with voluntary alternatives, and argue that SB 43 directs resources toward a coercive track at the expense of voluntary programs.

The fourth is evidentiary. The law includes a new hearsay exception allowing an expert witness to discuss health practitioner statements from medical records at conservatorship hearings, which loosens normal evidence rules in a proceeding where liberty is on the line.

Supporters argue the previous standard left people dying on the street while the system had no legal path to intervene, and that broadening the definition was the only way to reach the most vulnerable residents. SB 43 moves the line; where exactly it settles in practice will depend on how counties staff, place, and litigate the cases that come through.

1
Office of Governor Gavin Newsom. Modernizing Conservatorship Law: SB 43
2
San Mateo County Health. Senate Bill 43 Launches, CARE Court Expands in San Mateo County
3
California Legislative Information. California Welfare and Institutions Code WIC 5008
4
Los Angeles County Department of Mental Health. Senate Bill 43 (SB 43) FAQ
5
National Center for Biotechnology Information. DSM-5-TR Criteria for Diagnosing and Classifying Substance Use Disorders
6
California Legislative Information. California Welfare and Institutions Code WIC 5150
7
California Legislative Information. California Welfare and Institutions Code WIC 5250
8
California Legislative Information. California Welfare and Institutions Code WIC 5256
9
California Legislative Information. California Welfare and Institutions Code WIC 5350
10
Superior Court of California, County of Santa Clara. LPS (Mental Health) Conservatorship
11
Justia Law. California Code WIC 5350-5371
12
California Courts Newsroom. Eligibility
13
Department of Health Care Services. SB 43 FAQs