Conservatorship law exists to protect some of the most vulnerable citizens, such as those experiencing cognitive decline or facing other debilitating health challenges. Thus, proposed policy changes often invite a high degree of scrutiny. The recent Senate Bill 43, which sought to "modernize" California's conservatorship law, is no exception.1
On October 10, 2023, Governor Gavin Newsom updated California's conservatorship law for the first time since the 1967 Lanterman-Petris-Short Act (LPS) by signing SB 43.2 Understanding the issues at stake requires some historical background. Consistent with the spirit of deinstitutionalization in the 1950s and 1960s, LPS's purpose was to protect the rights of individuals with mental health problems by establishing clear criteria for involuntary commitment. Deinstitutionalization refers to the process of transitioning mental health care from long-term psychiatric hospitals and asylums to community-based mental health services. It was partly spurred by social movements that called for more human treatment of people with mental health challenges and for governments to protect the civil liberties of vulnerable populations by ending the practice of inappropriate and sometimes indefinite involuntary commitment of individuals.
Thus, LPS set out some strict criteria for involuntary mental health treatment, such as whether the patient is a danger to self or others, or "gravely disabled," defined as not being able to access essential life necessities such as food, clothing, and shelter. Since 1967, however, LPS has suffered mounting criticism from clinicians and policy-makers alike for failing to meet the growing mental health needs of people experiencing homelessness and incarcerated people.3 While many have praised the process of shifting mental health care from mental asylums toward community-based interventions, clinicians and researchers have long lamented the lack of collective investment in viable community mental health alternatives, leading to many people falling through the cracks of the current system. 4
It is within this historical context that advocates of SB 43, such as the National Alliance on Mental Illness (a co-sponsor of the bill), hope that the new bill would make it easier for those who are suffering from severe mental illness to access care.5 However, the policy change is not without controversy. One hotly debated aspect of the bill is that it substantially expands the definition of "gravely disabled" to include those who are unable to provide for their safety and medical care due to a substance use disorder or a co-occurring mental health problem.6
Critics point out that the new definition is too broad and could thus lead to new abuses of state power.7 For instance, in an open letter, Human Rights Watch contends that the new definition of "gravely disabled" would lead to the unjust detainment of vulnerable people and human rights violations.8 The same letter also points out that the new law fails to address structural issues, such as the lack of investment in evidence-based intervention programs. In a similar vein, Disability Rights California criticized the bill for neglecting the issue of access to proven community interventions like Assertive Community Treatment and warns that people of color and the unhoused population would be most vulnerable to involuntary detainment. 9
In short, SB 43 marks a significant attempt to address the state's mental health crisis. While the supporters of SB 43 anticipate improved access to care for those with severe mental illnesses, the controversy surrounding the bill highlights the complexities of policy changes in conservatorship law. The expanded definition of "gravely disabled" has triggered debates over potential abuses of state power, with critics expressing concerns about human rights violations and the lack of attention to structural issues within the mental health care system. As the new law's implementation unfolds, it is essential to closely monitor its impact and advocate for necessary adjustments to strike an appropriate balance between safeguarding individual rights and ensuring access to quality mental health care.
Co-Author Bios:
Yi-Shen Ma, PhD
Dr. Ma is an Associate Director of the Center for Christian Bioethics. He is also an Assistant Professor of Ethics in the School of Religion. His research interests include the practice and ethics of psychosocial accompaniment in healthcare and the ethics of solidarity.
Joud Chamchikh, BS
Joud Chamchikh is a student in the Masters of Bioethics Program at the Loma Linda University School of Religion. His research interests also include biotech and biomedical equipment development in the field of ophthalmology.
References
- https://www.gov.ca.gov/2023/10/10/modernizing-conservatorship-law-sb43/
- https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202320240SB43
- https://www.latimes.com/archives/la-xpm-1987-03-22-op-14759-story.html
- Novella, E. J. (2010). Mental health care in the aftermath of deinstitutionalization: A retrospective and prospective view. Healthcare Analysis, 18(3), 222–238.
- https://namica.org/advocacy/
- https://www.latimes.com/california/story/2023-04-09/sb-43-gravely-disabled-mental-illness-bill
- https://www.hrw.org/news/2023/08/07/human-rights-watchs-opposition-sb-43#_ftnref7
- https://www.disabilityrightsca.org/latest-news/drc-and-coalition-opposition-letter-to-sb-43-assembly-health-committee