Lanterman-Petris-Short (LPS) Act for gravely-disabled individuals

This page provides information for Marin County residents, families, providers, hospitals, and law enforcement about Senate Bill 43 (SB 43) and updates to California’s Lanterman-Petris-Short (LPS) Act.

SB 43 updates the definition of grave disability for adults and affects evaluation, short-term involuntary holds, and in some cases conservatorship, while emphasizing least restrictive care and due process protections.

This service is for:

• Marin County residents and families seeking information about SB 43
• Providers, hospitals, and emergency departments involved in evaluation and treatment
• Law enforcement and first responders coordinating crisis response and 5150 holds
• Adults who may be subject to evaluation under updated grave disability criteria
• Community partners, advocates, and agencies involved in crisis, conservatorship, or behavioral health response systems

Overview of SB 43 implementation in Marin County

SB 43 was signed into law by Governor Newsom in 2023, and Marin County officially launched SB 43 on January 1, 2026. County agencies prepared policies, training, and cross-system workflows with hospitals, courts, the Public Guardian, and law enforcement to support implementation.

Implementation activities included bi-weekly planning meetings with a cross-divisional workgroup, engagement with Xanthos Health consultants, coordination with impacted partners and service providers, training and policy updates, and an internal and external communications strategy to ensure the community has access to relevant information related to SB 43.

Marin County also conducted 15 stakeholder meetings with participants including BHRS clinical teams tasked with writing holds and/or connecting clients to crisis, mental health, or substance use services, law enforcement, the Public Guardian, local hospitals and medical providers, community-based organizations, Social Services, and advocacy groups. Stakeholder feedback informed trainings, supportive materials, intercept mapping of LPS holds in Marin County, and ongoing information related to 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

Additional changes include broader testimony options in conservatorship proceedings, requirements that counties 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 of 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 cause 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 hold of 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, such as a 5250, if criteria continue to be met, with a Certification Review Hearing
• Conservatorship evaluation in limited cases when grave disability persists, with least restrictive options considered first

Facilities and 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, with coordination with law enforcement and EMS as needed
  Phone: 415-473-6392

Hospitals and partners

• Marin Health Medical Center Emergency Department and Unit A (17 Bed Inpatient Unit)
• Kaiser San Rafael Terra Linda Emergency Department
• Novato Community Hospital Emergency Department

Resources for law enforcement

• Coordinate with the CSU for 5150 drop offs and consults at 415-473-6666
• Follow department protocols for documentation and grave disability observations, including food, clothing, shelter, personal safety, and necessary medical care
• Request BHRS Mobile Crisis for field support when appropriate at 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, danger to others, and/or grave disability elements
• Reference updated DHCS forms that now include SB 43 language
• Review linked training video for hospitals and emergency departments

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, contact Todd Paler, BHRS Program Manager, at Todd Paler and Jenn Cameron

Frequently asked questions

• Does SB 43 mean someone can be held for substance use alone?
  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.
• What rights do individuals have on a 5150/5250?
  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 is sought.
• How do families get help if they are worried about a loved one?
  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.