More on the Few

This morning, at the meeting of the Sonoma County Board of Supervisors, a discussion was held which illuminated the near future of communication between state and local government. After years of managed anguish over the growing impact of unfunded mandates required of local government by the State Legislature, our Board seems to have reached a boiling point. In particular, the expansion of authority given local government concerning who can be deemed “gravely disabled”. Gravely disabled now means a condition in which a person, as a result of a mental health disorder, severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.

The bill expands the definition of “basic needs” to include not just food, shelter, and clothing, but also access to necessary medical care and personal safety. 

Counties have until January 1, 2026, to implement Senate Bill 43 (SB 43). Six counties are currently implementing SB 43; however, limited data is publicly available. Preliminary data from a similar size county reflects a 25% increase in conservatorships from January 2024 – August 2025. Sonoma County has 200 people on conservatorship; a 25% increase would see the conservatee population grow to 250.

Over the last five years, the county’s Lanterman-Petris-Short conservatee caseload has ranged from 186-207 clients. To address the existing deficits and anticipated increases, the Human Services Department will require two Full Time Equivalent allocations. Similarly, the Department of Health Services will require two Full Time Equivalent allocations.

To prepare for SB 43, the county has taken several actions. A series of informational meetings are planned through 2025 with community, public, and private stakeholders, an SB 43 training will be held in November 2025, and a limited number of substance use disorder beds have been identified for conservatees meeting certain withdrawal management criteria. In Spring 2025, the county secured a $67.8 million Bond Behavioral Health Continuum Infrastructure Program award from the California Department of Health Care Services. Long-term, this will allow the county to add more treatment beds for substance use disorder and conservatee clients. No additional funding has been provided to counties to implement SB 43.

Data

As of September 2025, Sacramento, San Bernardino, San Diego, San Francisco, San Luis Obispo, and Stanislaus County are implementing SB 43. Approximately 52 counties opted to begin implementation on January 1, 2026. Data on the impact of SB 43 will be available in 2026 as counties comply with data reporting requirements. In the interim, limited data is publicly available. Initial estimates indicate the number of conservatees in San Luis Obispo County increased 25% and 29% in San Francisco County. Similar increases in Sonoma County would see the number of conservatees increase from 200 to 250 – 258. Over the last five years, the county’s LPS conservatees caseload has ranged from 186-207 clients as illustrated on page 10 of Attachment 3 – Presentation.

Placement and Treatment Considerations

In FY 2024/2025, the Department of Health Services (DHS) spent approximately $11.7 million placing 197 conserved individuals. Placement is determined by the individual’s least restrictive placement order and includes locked settings such as Institutions for Mental Disease, skilled nursing facilities, and mental health rehabilitation centers.  It also includes unlocked settings like residential care facilities or other transitional or supportive housing settings.  DHS contracts with a number of providers both locally and regionally in an effort to ensure individuals are not being held unnecessarily in locked settings such as psychiatric hospitals, emergency departments, or Sonoma County Jail. 

DHS places strong emphasis on utilizing local placements so individuals have the ability to be near their primary support networks. Costs for each facility varies by its type and level of care needs the individual presents with upon admission. The average cost for placing an LPS conservatee is $60K annually. Alternatively, the annual cost to place a murphy conservatee is approximately $150K to $300K depending on type of placement and acuity level of the individual being placed.

Sonoma County currently has 65% of clients placed out of county to receive mental health treatment. Many facilities are over 100 miles away from Sonoma County. This can create obstacles with arranging for in-person court appearances, for county staff to complete periodic visits, and for families to see their loved ones. Being placed out of county can also create challenges when the client no longer meets criteria for LPS conservatorship and needs to be reintegrated back into the Sonoma County Mental Health services system. In the short term, the county has identified up to ten (10) SUD withdrawal management beds that are available for conservatees meeting certain criteria. This temporary option is intended to provide some relief while longer-term measures are being developed (e.g. Bond Behavioral Health Continuum Infrastructure Program construction).

In anticipation of future placement needs for individuals conserved under the enhanced grave disability SB 43 criteria, it is estimated that DHS will need an additional $1.4 – $2.9 million in new placement costs.  Costs are subject to type of facility, length of stay, and treatment needs of the conserved individual.

Staffing

The LPS conservatee population has grown by 7% over the last five (5) years without a corresponding staffing increase. To address the existing 2025 deficits, the Human Services Department (HSD) will require two Full Time Equivalent allocations (FTE) and DHS will require two FTEs. To address the 2026 deficits as a result of SB 43 implementation, DHS will require two FTEs. A total of six FTEs (2025 needs and 2026 SB 43 implementation needs) are needed to provide services to conservatees for both HSD and DHS.

“Funding expected to be utilized will come from Measure O, and a scattering of other DHS program cuts.” explained Nolan Sullivan, DHS Director, in response to Board questioning.

The Board of Supervisors responded by asking its staff to explore legal and advocacy initiatives with all state counties to increase state compensation for the impacts of SB43.