California SB 43: Gravely Disabled Standard, Holds, and Conservatorship

California SB 43 rewrites the standard for when the state can place someone in involuntary psychiatric or substance use treatment. Signed in 2023 and fully in effect statewide as of January 1, 2026, the law expands the Lanterman-Petris-Short Act’s definition of “gravely disabled” to reach people who cannot maintain their own personal safety or obtain necessary medical care, and for the first time it allows severe substance use disorder on its own to trigger involuntary holds and conservatorship.

What SB 43 Changed in the “Gravely Disabled” Definition

For more than five decades, “gravely disabled” under the LPS Act meant one thing: a person could not provide their own food, clothing, or shelter because of a mental health condition. Someone who was unhoused but could find a meal and a doorway often fell outside the definition, no matter how dangerous their situation looked.

SB 43 adds two new prongs to Welfare and Institutions Code Section 5008. A person can now be found gravely disabled if, because of a qualifying condition, they cannot provide for their own personal safety or necessary medical care.¹

The personal safety prong reaches situations where behavior or living conditions expose someone to serious physical harm even when they technically have access to food and shelter. The medical care prong reaches people who refuse or neglect treatment for a physical condition that will cause serious injury or death if left alone.

The California Department of Health Care Services defines “necessary medical care” as treatment a licensed practitioner determines is needed to prevent serious deterioration of an existing physical condition that, without treatment, is likely to cause serious bodily injury.² That means untreated infections, unmanaged diabetes, or worsening injuries can qualify. A general failure to eat well or exercise does not.

Which Conditions Now Qualify

Under prior law, only a mental health disorder could support a finding of grave disability. SB 43 lists three qualifying bases under WIC Section 5008(h)(1)(A):

A mental health disorder, the original basis.
A severe substance use disorder, now standing on its own without a co-occurring mental health diagnosis.
A mental health disorder together with a severe substance use disorder.

All three apply across every stage of involuntary intervention, from the initial 72-hour hold through conservatorship.¹ Adding severe substance use disorder as a standalone basis is the most consequential policy change in the bill. Before, a person with crippling addiction and no diagnosable mental illness was effectively outside the LPS system.

Chronic alcoholism sits in a narrower spot. Under WIC Section 5008(h)(2), impairment by chronic alcoholism qualifies as a basis for grave disability in extended certification holds and conservatorships, but not for the initial 72-hour evaluation hold.¹ In practice, a person initially detained on another basis could be held longer because of chronic alcoholism’s effects on self-care.

What SB 43 Does Not Cover

Homelessness by itself is not grave disability. The inability to provide for shelter, safety, or medical care must be caused by a qualifying mental health or substance use condition; being unhoused without an underlying qualifying disorder does not meet the standard.²

Intellectual disability is also excluded as a standalone basis. The statute is explicit that a person cannot be involuntarily held solely because of an intellectual disability.¹

How the Expanded Standard Flows Through Holds and Conservatorship

SB 43 did not create new types of holds. It changed the criteria clinicians and courts apply at each existing step.

The 72-Hour Hold

Involuntary treatment typically starts with a 72-hour evaluation hold under WIC Section 5150, placed when a peace officer or designated clinician has probable cause to believe the person is, because of a qualifying condition, a danger to self, a danger to others, or gravely disabled.³ A clinician on a 5150 can now consider personal safety and medical care, not just food, clothing, and shelter, and can rely on severe substance use disorder as the underlying cause.

The 14-Day Certification Hold

If staff determine after the 72-hour evaluation that the person still meets the criteria, the facility can certify the individual for up to 14 more days of intensive treatment under WIC Section 5250. Certification requires that the person was offered voluntary treatment and was unable or unwilling to accept it.⁴ The person is automatically entitled to a certification review hearing at the facility and must be informed of their right to judicial review by writ of habeas corpus and to appointed counsel.⁵

LPS Conservatorship

When grave disability persists, the county can petition for an LPS conservatorship under WIC Section 5350, which appoints a legal guardian with authority over housing, medical care, and daily needs. The initial term is one year. The proposed conservatee can demand a court or jury trial on the question of grave disability. That demand must come within five days of the hearing, and trial must start within 10 days of the demand, extendable up to 15 days at the attorney’s request. If those deadlines are missed, the proceedings must be dismissed.⁶

A conservator seeking a renewed one-year term must submit opinions from two physicians or licensed psychologists confirming continued grave disability and must certify that alternatives, including assisted outpatient treatment and the CARE Act program, were considered and are not suitable.⁷

Protections That Still Apply

SB 43 did not change the procedural protections built into the LPS Act. A person cannot be found gravely disabled if they can survive safely with help from family, friends, or others who are responsible, willing, and able to provide for their basic needs. The rule appears in both the 14-day hold statute and the conservatorship statute.⁶

There is a condition. Verbal promises are not enough. Family or others willing to help must state in writing that they can and will provide for the person’s food, clothing, shelter, personal safety, or medical care; otherwise the court will not consider the offer.⁴ Help from a jail or prison does not count. An incarcerated person receiving food and shelter from a correctional facility is not “surviving safely” in the sense the statute requires.

A person detained under the LPS Act can challenge the hold at any time by filing a writ of habeas corpus. To start the process, the person only needs to tell a staff member or the person who delivered the certification notice that they want to be released. Staff must promptly notify the professional in charge, who must then notify the superior court. Obstructing that request is a criminal misdemeanor.⁸

When the Law Takes Effect in Your County

SB 43 officially took effect on January 1, 2024, but the legislature allowed each county’s board of supervisors to delay local implementation by up to two years, setting a final statewide deadline of January 1, 2026.⁹ Most large counties, Los Angeles among them, took the full delay. A few moved earlier.

With the January 2026 deadline past, the expanded definitions apply statewide. Every county’s behavioral health system must now evaluate people against the broader standard that includes personal safety, necessary medical care, and severe substance use disorder as a standalone basis for involuntary intervention.¹ How much the change produces in practice will depend on treatment bed capacity, staffing, and how aggressively local clinicians and courts apply the new criteria.

1
California Legislative Information. California Welfare and Institutions Code 5008
2
California Department of Health Care Services. Senate Bill (SB) 43, Changes to Gravely Disabled Behavioral Health Information Notice: 24-011 Frequently Asked Questions
3
California Legislative Information. California Welfare and Institutions Code 5150
4
California Legislative Information. California Welfare and Institutions Code 5250
5
California Legislative Information. California Welfare and Institutions Code WIC 5254.1
6
California Legislative Information. California Welfare and Institutions Code 5350
7
California Legislative Information. California Welfare and Institutions Code 5361
8
California Legislative Information. California Welfare and Institutions Code 5275
9
Los Angeles County Department of Mental Health. LPS Act and SB 43