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San Francisco City Hall


Thursday, December 7, 2023   

Contact: Mayor’s Office of Communications,    


Under Mayor Breed’s Executive Directive issued in October, City Departments are prepared to begin implementing SB 43 law changes at the beginning of January 2024  

 SB 43 expands the definition of “grave disability” to include those who live with severe substance use disorder and those who are unable to provide for their own personal safety or necessary medical care  

San Francisco, CA – Mayor London N. Breed today announced that San Francisco will be ready at the beginning of January to operationalize Senate Bill 43, a change in State mental health conservatorship laws that expands the eligibility requirements to compel people struggling with severe substance use disorder to get the care and support they need.  

Signed by Governor Newsom last October, SB 43 goes into effect on January 1, 2024. Immediately after the bill was signed into law, Mayor Breed issued an Executive Directive to City Departments to ensure that San Francisco was ready to implement this new policy at the beginning of January.  

Senate Bill 43 expands California’s Lanterman–Petris–Short (LPS) conservatorship law by updating the criteria for determining if a person is “gravely disabled,” the standard for LPS conservatorship eligibility.  

SB43 expands the definition of Grave Disability in two important ways:  

  • The law provides a legal basis for conserving individuals who are Gravely Disabled due to the impacts of a severe substance use disorder alone. This adds to the current definition that only allows for conservatorships based on serious mental illness or chronic alcoholism.  
  • The expanded definition adds inability to provide for necessary medical care, and/or personal safety to the current definition of food, clothing, and shelter that is related to their mental illness or substance use disorder.  

This will address a situation where psychiatric emergencies involve the use of multiple substances (e.g. methamphetamines and opioids including fentanyl).    

Mayor Breed’s Executive Directive coordinates and gives direction to departments, including the Department of Disability and Aging Services (DAS), the City Attorney’s Office, and the San Francisco Department of Public Health (SFDPH) to implement SB 43. The Executive Order provides oversight and coordination, sets implementation timelines, and requires departments to train staff on the expanded definition of grave disability with an improved collaborative workflow.  

The Departments are prepared for the law to go into effect on January 1, 2024. At that time, the Public Conservator will begin to receive referrals under the newly established criteria set forth by SB 43. If deemed eligible after an assessment, the Public Conservator will file petitions with the court to conserve those individuals. For additional information on SB 43 and its implementation in San Francisco, visit this link.  

“People are struggling with severe substance use and mental health challenges in our City to the point where they cannot help themselves. When we have an opportunity to put a new solution into place, we must work quickly to do everything we can to implement it,” said Mayor Breed. “Conservatorship is a complex and long legal process, which is why moving quickly to put the pieces into place is imperative. I want to thank the staff at the various City agencies who have been working hard to ensure that, come January, we are ready to start helping people and changing lives.”  

As part of the conservatorship process, the Superior Court appoints a public conservator to authorize psychiatric treatment of a person who meets the legal definition of grave disability. If the Court determines a person meets the criteria, they can be placed under conservatorship for up to one year, and the conservatorship can be renewed annually if the individual continues to meet the criteria. Only psychiatrists and clinical psychologists may make referrals for conservatorship and only the Public Conservator may file petitions. After appointment, the Conservator works with other City departments to ensure conservatees are receiving proper treatment.    

“Conservatorship is the intervention of last resort. We hope that by working in close collaboration with our City partners to implement the expansion of SB 43, it will help people who need it most,” said Kelly Dearman, Executive Director of the Department of Disability and Aging Services. “Although SB 43 does not change the procedures of existing conservatorships, it will allow us to help people who are not able to provide for their basic needs for food, clothing, shelter, personal safety or necessary medical care due to a severe substance use disorder and/or mental health disorder.”  

“The Department of Public Health continues to expand our portfolio of treatment options for those in need while offering a range of services including early intervention, crisis response, as well as inpatient and outpatient care,” said Director of Health, Dr. Grant Colfax. “SB 43 provides us another opportunity in our larger system of care and support to help those with the most acute behavioral health needs.”  

“The previous definition of grave disability was written in the 1970s. Today’s societal challenges are different than they were 50 years ago,” said City Attorney David Chiu. “I am proud of the work our attorneys did to shape and advocate for this expansion of state law. We are ready to assist our clients in ensuring SB 43 is implemented effectively in San Francisco.”  

Over the last several years, Mayor Breed has advocated for a broad range of statewide conservatorship reform, working closely with State Senator Scott Wiener and other State and City leaders, including State Senator Susan Talamantes Eggman, to successfully pass and implement mental health conservatorship process improvements.