Gavin Newsom slams Sacramento County for delaying mental illness conservatorship reforms
California Gov. Gavin Newsom admonished Sacramento County on Friday for slow-walking a new law easing the path to conservatorships for those with severe mental illness or addiction — but officials said they are not equipped to provide the care it requires.
In a press call, Newsom called out the county for a “lack of urgency” around implementing Senate Bill 43 from Sen. Susan Talamantes Eggman, D-Stockton, which the governor signed in October.
The bill changes California’s involuntary mental health care regulations to make it less challenging to put those struggling with severe mental health or addiction issues in conservatorships, which give medical and financial decision-making power to family members or other parties.
The call was meant to discuss his CARE Court program. The initiative creates special mental health courts to compel treatment for those with severe mental illness.
California’s 58 counties are implementing CARE Court in phases, and eight have already started the process. Sacramento County is among the remaining 50 that must launch by Dec. 1, 2024.
But it was conservatorship reform that drew his most pointed comments.
“You have a crisis out there,” Newsom said. “There’s a crisis on the streets, and people are talking about delaying the conservatorship efforts till 2026. We can’t afford to wait. The state has done its job. It’s time for the counties to do their job.”
A Sacramento County spokeswoman, Samantha Mott, said Friday that the county has no locked treatment capacity for people with substance use disorders. Step-down facilities outside hospitals currently have incredibly limited capacity for involuntary substance use treatment, she said. With nowhere else to go, those placed into conservatorships under the law could end up trapped in hospital beds for long periods of time if the county rushed to implement the law in January.
SB 43 expands the definition of “gravely disabled,” the criteria by which mentally ill Californians can be involuntarily hospitalized or placed in a conservatorship. The previous standard was whether a person could “provide for his or her basic personal needs for food, clothing, or shelter” or was a danger to themselves or others.
The new definition adds “the inability of providing for personal safety or necessary medical care” to the criteria. It also allows those who have not directly treated patients to testify at conservatorship hearings without having their statements considered hearsay.
Sacramento County delays conservatorship reform
Under SB 43, counties can delay implementation of the law until Jan. 1, 2026. But Newsom made it clear he does not want to see that happen, specifically reprimanding Sacramento County alongside several others that plan to extend their timelines in response to concerns about taking on an influx of new patients.
“We need to see a sense of urgency,” Newsom said. “We cannot wait till 2026, can’t wait till 2025 on the conservatorship reform. People literally will lose their lives. And people are losing confidence and trust in government that can deliver on the promises that we promote. People don’t want to hear about how much money we’re spending anymore. They want to know that we’re actually producing results.”
The Sacramento County Board of Supervisors voted unanimously Tuesday to push the implementation to January 2025. County staff recommended January 2026, saying that the county did not have the systems in place to provide adequate care for the people who would be newly eligible for conservatorships.
County spokeswoman Mott said in a written statement that the county simply did not have the treatment infrastructure or any of the policies or procedures in place to start placing people with severe substance use disorders into conservatorships in January. The county does not have enough spots for them, she said, nor does it have the staffers needed to assess people, investigate cases or process petitions.
“Rushed implementation could lead to unintended consequences,” she said.
Supervisor Phil Serna, who represents the district that covers much of the city of Sacramento, spoke in favor of the delay at Tuesday’s board meeting. If the law were implemented too quickly, he said, “This county may be hit with a wave of constitutional violations.”
“We recognize the importance of this law, which focuses on serving those we have had challenges engaging in voluntary treatment and housing supports, and as such, we intend to act with urgency to implement,” said Chevon Kothari, the deputy county executive for social services.
But, as she advocated for the delay, she said that because the state did not plan to issue guidance on implementation, “Counties and our partners will need to develop an extensive array of new policies, procedures, workforce, residential placements and treatment capacity to implement SB 43.”
Kothari said that certain parts of the law will still go into effect in the new year. In January, Sacramento County will adopt the new hearsay evidentiary standards in SB 43, as well as the requirement to explore assisted outpatient treatment or CARE Court prior to conservatorship — though the county does not yet have CARE Court. In May, the county will begin complying with new reporting requirements.
Eric Harris, director of public policy at Disability Rights California, urged the board to delay.
“The county needs time to prepare for forthcoming implementation challenges caused by SB 43, which will greatly increase the number of people being treated in the County’s already overburdened emergency rooms, hospitals, and behavioral health systems,” he wrote in a letter. “In addition, the county should prioritize efforts to reduce unnecessary institutionalization.”
Newsom dismisses concerns
When asked about counties’ concerns, Newsom waved them away, saying, “Let’s fix it. We’ll move in real time.”
The governor is betting heavily on mental health reform initiatives to address the state’s homelessness crisis. In addition to CARE Court and conservatorship reform, his administration is pushing March 5 ballot initiatives to change the state’s Mental Health Services Act and pursue $6.4 billion in bond money to add behavioral health treatment beds.
It is clear Newsom sees CARE Court and SB 43 as a tandem effort, with the success of one potentially affecting the outcome of the other.
“It’s going after the most chronic,” Newsom said on Friday, when asked whether he views his mental health programs as part of his homelessness strategy.
“I want to see those encampments cleaned up,” he said. “I want to see CARE Court prioritizing encampments.”
California has a homeless population of more than 181,000, according to the U.S. Department of Housing and Urban Development. The Newsom administration expects only 7,000 to 12,000 people will meet CARE Court criteria.
“At the end of the day, we have to be held to account,” Newsom said. “All of us, at every level of government. Let’s go. And if you’ve got issues, every one of these folks has my cell phone. They call me. We’ll try to fix it. That’s what we’ve been doing the last five years. Look at all these reforms.”
“I heard the exact same excuses five, 10 years ago,” he added. “You’ll hear them the next five, 10 years. It will never be good enough. It will never be perfect. Let’s do our job. Let’s go, let’s iterate.”
