California SB 43: Grave Disability, Substance Use, and Holds

California SB 43 rewrites the legal standard for involuntary psychiatric and addiction treatment by expanding what it means to be “gravely disabled” under the Lanterman-Petris-Short Act. Signed in 2023 and fully in effect statewide as of January 1, 2026, the law adds two new ways a person can meet the standard (inability to maintain personal safety, and inability to get necessary medical care) and, for the first time, allows severe substance use disorder on its own to support involuntary holds and conservatorship.

The New Definition of Gravely Disabled

For more than fifty years, “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 disorder. Someone who was visibly deteriorating on the street but could still find a meal and a doorway often fell outside that definition.

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

The personal safety prong reaches people whose behavior or living conditions expose them to serious physical harm even if food and shelter are technically available. The medical care prong is narrower than it sounds. 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 would otherwise likely cause serious bodily injury.² Untreated infections, uncontrolled diabetes, or wounds that will worsen without care fit. A general failure to eat well or see a doctor does not.

One boundary matters for anyone reading the law with homelessness in mind: SB 43 does not treat being unhoused as grave disability on its own. The inability to secure shelter, safety, or medical care must be caused by a qualifying mental health or substance use condition. Homelessness without an underlying qualifying disorder does not meet the standard.²

Severe Substance Use Disorder as a Standalone Basis

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

A mental health disorder.
A severe substance use disorder.
A mental health disorder combined with a severe substance use disorder.

The addition of severe substance use disorder as a standalone basis is the most consequential policy change in the law. Before SB 43, a person with disabling drug addiction who did not also carry a diagnosable mental illness was effectively outside the LPS system. Now that same person can be evaluated, held, and, if the criteria are met, placed under conservatorship on addiction alone.¹

Chronic alcoholism sits in a different slot. Under WIC Section 5008(h)(2), impairment by chronic alcoholism qualifies for extended certification holds and conservatorships, but not for the initial 72-hour evaluation hold. The statute also excludes intellectual disability as a standalone basis. A person cannot be involuntarily held solely because of an intellectual disability.¹

How the New Standard Applies at Each Stage

The broader definition flows through every level of involuntary intervention under the LPS Act.

The 72-Hour Hold

An involuntary commitment usually begins with a 72-hour evaluation hold, widely called a 5150 hold. A peace officer, a clinician in charge of a county-designated facility, an attending staff member, a mobile crisis team member, or another county-designated professional can initiate the hold based on probable cause that the person is, because of a qualifying condition, a danger to themselves, a danger to others, or gravely disabled.³

The 72-hour clock starts the moment the person is first detained, not when they arrive at a facility. Staff must evaluate the person on an ongoing basis and offer voluntary treatment if the person can be properly served without detention.³ Under SB 43, that evaluation now includes whether the person can maintain personal safety and obtain necessary medical care, and it can rest on severe substance use disorder as the underlying condition.

The 14-Day Certification

If staff determine after 72 hours that the person still meets the criteria, the facility can certify the individual for up to 14 additional days of intensive treatment under WIC Section 5250. The certification requires that the person was advised of 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 the right to judicial review by writ of habeas corpus and the right to counsel, appointed if they cannot afford an attorney.⁵

LPS Conservatorship

When someone remains gravely disabled after shorter-term holds, the county may petition for an LPS conservatorship under WIC Section 5350. A conservatorship appoints a legal guardian with authority over the person’s housing, medical care, and daily needs, and the initial term runs one year.⁶

The proposed conservatee can demand a court or jury trial on the question of grave disability. The demand must be made within five days of the conservatorship hearing, the trial must begin within 10 days of the demand, and the court can extend that by up to 15 days at the request of the conservatee’s attorney. If the trial does not start within these deadlines, the proceedings must be dismissed.⁶

To renew the conservatorship for another year, the conservator must submit opinions from two physicians or licensed psychologists confirming continuing grave disability and must certify that alternatives, including assisted outpatient treatment and the CARE Act program, have been considered and are not suitable.⁷

The Written Third-Party Assistance Rule

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. This limit appears in both the 14-day hold statute and the conservatorship statute.⁶

The rule has a strict formality: a verbal promise is not enough. Unless a family member or other person has specifically stated in writing that they can and will provide for the person’s food, clothing, shelter, personal safety, or medical care, the court will not consider the offer.⁴ Help from a jail or prison does not count as third-party assistance.

Rights During an Involuntary Hold

The person taking someone into custody on a 5150 hold must immediately identify themselves, explain that this is not a criminal arrest, and say where the person is being taken. If the detention happens at the person’s home, they must be allowed to make a phone call, leave a note for family or friends, and bring approved personal items.³

At the facility, staff must give written notice of core rights: how long the person can be held, that they may request a specific facility or mental health professional, that they may be given treatment including medication, and that if held beyond 72 hours they have a right to counsel (appointed at no cost if needed) and a hearing before a judge. The notice must include contact information for the county patients’ rights advocate.³

A detained person can challenge the hold through a writ of habeas corpus by telling a staff member or the person who delivered the certification notice that they want to be released. The staff member must promptly notify the professional in charge, who must inform the local superior court as soon as possible. Ignoring or obstructing that request is a criminal misdemeanor.⁸

When SB 43 Took Effect

SB 43 officially took effect on January 1, 2024, but the legislature let each county’s board of supervisors pass a resolution delaying local implementation by up to two years, with a final statewide deadline of January 1, 2026.⁹ Most large counties, including Los Angeles, took the maximum delay to build treatment capacity, hire staff, and train judicial officers.

With the 2026 deadline now passed, the broader definition applies in every county. Behavioral health systems statewide must evaluate people against a standard that includes personal safety, necessary medical care, and severe substance use disorder as an independent basis for involuntary intervention.¹ How aggressively that plays out in practice depends on local treatment bed capacity, trained staff, and how 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