California Senate Bill 43: A Turning Point in Behavioral Health Policy

In October 2023, California enacted Senate Bill 43 (SB 43)—a quietly transformative law that will reshape how we respond to individuals living with serious mental illness and substance use disorders. While the bill may not have made national headlines, its implications for behavioral health providers, systems of care, and—most importantly—those we serve are profound.

Redefining "Gravely Disabled"

For decades, the Lanterman-Petris-Short (LPS) Act has governed California’s criteria for involuntary psychiatric holds and conservatorships. Until now, the standard for intervention was narrow: a person had to be “gravely disabled” due to mental illness and unable to provide for their food, clothing, or shelter.

SB 43 expands this definition in a long-overdue way. Beginning January 1, 2024, counties may opt into a broadened framework that recognizes a person as gravely disabled if, due to severe substance use disorder or a co-occurring mental health and substance use condition, they are unable to care for their own personal safety or necessary medical care.

This is more than a semantic shift. It represents an acknowledgment that untreated addiction can be just as impairing—and life-threatening—as any psychiatric disorder. By aligning legal standards with what neuroscience and clinical practice have long understood, SB 43 begins to close a critical gap in care.

Substance Use Disorders Are Now Explicitly Included

One of the most significant changes SB 43 introduces is the explicit inclusion of substance use disorders in the criteria for involuntary intervention. Historically, substance use alone was excluded from these statutes, even when it resulted in grave harm. Providers have long been challenged by this legal blind spot, especially when treating individuals cycling through emergency rooms, jails, and the streets without access to sustained care.

SB 43 affirms what we already know: addiction is a medical condition—often chronic, progressive, and fatal without treatment—and deserves the same systemic responses we bring to other serious illnesses.

County-Level Implementation and Safeguards

Implementation of SB 43 is being phased in. Counties may choose to adopt the expanded criteria starting in 2024, with statewide adoption required by 2026. This timeline allows systems to adapt thoughtfully, build capacity, and ensure that legal protections remain strong.

Critically, the bill retains robust safeguards for individual rights, including access to legal representation and judicial review. It also requires counties to report data on implementation, supporting transparency and accountability.

Implications for Providers

As providers of behavioral health and addiction treatment, we’re preparing for what this shift will mean in practice. SB 43 opens the door to earlier and more appropriate intervention for individuals who have long fallen through the cracks—those with co-occurring disorders, living unsheltered, and at high risk of repeated crisis or incarceration.

At the same time, this policy shift reinforces the need for evidence-based, person-centered care—the kind that engages individuals compassionately, treats the whole person, and integrates mental health and addiction treatment as inseparable components of recovery.

We believe this legislation offers a meaningful opportunity to improve outcomes and reduce suffering. But realizing its promise will depend on how we, as a field, implement it—with clinical integrity, cultural humility, and deep respect for the dignity of those we serve.