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Resources for Law Enforcement
Coordinate with the CSU (415) 473-6666 for 5150 drop offs and consults.
Follow department protocols for documentation and grave disability observations (food, clothing, shelter, personal safety, necessary medical care).
Request BHRS Mobile Crisis for field support when appropriate (415) 473-6392.
Department specific training and forms are disseminated through agency command and BHRS liaison channels.
Resources for Emergency Departments
Ensure timely advisement of patient rights and access to advocacy.
Document criteria related to danger to self/others and/or grave disability elements.
Reference updated DHCS forms which now include SB 43 language
Review linked training video for hospitals/EDs
Overview of SB 43 implementation in Marin County
SB 43 was signed into law by Governor Newsom in 2023, and Marin County will officially launch SB 43 on January 1, 2026. County agencies are preparing policies, training, and cross system workflows (hospitals, courts, Public Guardian, law enforcement) to support safe and effective implementation.
Marin County initiated the following implementation activities: Bi-weekly planning meetings with a cross-divisional workgroup; engagement with Xanthos Health consultants to support implementation; coordination and engagement with impacted partners and service providers; development and delivery of trainings and updates to policies and procedures; and creation of an internal and external communications strategy to ensure the community has access to relevant information related to SB 43.
Marin County conducted 15 stakeholder meetings with a variety of participants including internal BHRS clinical teams tasked with writing holds and/or connecting clients to crisis, mental health or substance use services, Law Enforcement, Public Guardian, local hospitals and medical providers, community-based organizations, Social Services, and advocacy groups.
Stakeholder feedback directly informed how Marin proceeded with implementation activities and training including the development and distribution of a variety of trainings and supportive materials, intercept mapping of LPS holds in Marin County, and access to ongoing information related to SB 43 implementation, including data reporting.
What is SB 43?
Senate Bill 43 updates California’s Lanterman–Petris–Short (LPS) Act. Among other changes, it modernizes the criteria for when an adult may be considered “gravely disabled” for evaluation, short term involuntary holds, and (in some cases) conservatorship—while emphasizing least restrictive care and due process protections.
Key Changes to the Definition of Grave Disability Under SB 43
Gravely Disabled (Previous)
A condition in which a person, due to a mental health disorder, cannot provide for basic needs such as food, clothing, or shelter.
Gravely Disabled (Updated)
(note: this language only applies to adults)
A condition in which a person, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health 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.
Additional Provisions
Broader testimony options in conservatorship proceedings; Counties must consider less‑restrictive alternatives during investigations; and expanded state data reporting by facilities and counties.
Definitions
Severe Substance Use Disorder: A substance use disorder of a severity that substantially impairs a person’s functioning, judgment, and ability to care for basic needs.
Personal Safety: The ability to avoid serious harm to self-due to an inability to understand and meet immediate hazards.
Necessary Medical Care: Medical or psychiatric care needed to prevent imminent and serious deterioration of health.
Co‑occurring Disorders: The presence of both a mental health disorder and a substance use disorder.
What is a 5150 hold?
A 5150 is an involuntary psychiatric hold—up to 72 hours—for evaluation and treatment when an authorized professional believes a person, due to a mental health disorder, or Co-Occurring disorder, is a danger to self, a danger to others, and/or gravely disabled under the LPS criteria. For grave disability criteria only, severe substance use disorder is now a qualifying diagnostic causation of the grave disability condition.
Who can initiate a 5150?
Law enforcement officers and designated mental health professionals (including certain clinicians) may initiate a 5150 when legal criteria are met.
Patients’ Rights
Individuals placed on a 5150 are entitled to information about their rights, advocacy support, and due process reviews if further detention (such as a 5250—up to 14 days) is sought.
What happens after a 5150 involuntary hold?
Discharge if criteria are no longer met with referrals and safety planning
Voluntary Services if the individual agrees to treatment.
Extended Hold (e.g., 5250) if criteria continue to be met, with a Certification Review Hearing. This is done on LPS inpatient units
Conservatorship Evaluation in limited cases when grave disability persists; least restrictive options are considered first.
Facilities & Locations (Marin County)
County Operated
Crisis Stabilization Unit (CSU): 24/7 psychiatric crisis evaluation and stabilization for voluntary and involuntary (W&I 5150) presentations
250 Bon Air Road, Greenbrae, CA 94904
Phone: (415) 473-6666
Mobile Crisis Response Team: 24/7 community-based response, coordination with law enforcement and EMS as needed.
Phone: (415) 473-6392
Hospitals & Partners
Marin Health Medical Center Emergency Dept and Unit A (17 Bed Inpatient Unit)
Kaiser San Rafael Terra Linda Emergency Department
Novato Community Hospital Emergency Department
Training
Marin BHRS coordinates SB 43 related and LPS/Crisis training with hospitals, courts, law enforcement, and community partners. To request training or technical assistance for your agency, please contact Todd Paler, BHRS Program Manager via email at Todd.Paler@MarinCounty.gov.
Training Videos
Frequently Asked Questions
SB 43 allows grave disability to be based on a severe substance use disorder (or co‑occurring disorder) when it results in an inability to provide for basic needs, personal safety, or necessary medical care. Evaluations remain individualized and emphasize least‑restrictive care.
Marin is preparing for implementation and will fully implement no later than January 1, 2026. In the interim, existing LPS criteria and county protocols remain in effect.
People have the right to be informed of the reason for detention, to access patients’ rights advocacy, to receive timely evaluations, and to a hearing if a 5250 (up to 14 days) is sought.
Call the CSU at (415) 473‑6666 for 24/7 crisis support, or the Access & Assessment Line at (888) 818‑1115 for referrals and information. If there is immediate danger, call 911. You can also dial 988 for the Suicide & Crisis Lifeline.