SB43 allows hospital emergency departments to involuntarily hold those with severe substance use disorder who refuse necessary medical treatment.
As an emergency physician in San Francisco, I’m currently seeing more patients with mental health and substance use crises than ever before in my two-decade career. Our emergency department and others like it across the region are overwhelmed.
Last year, the governor signed SB43, which promised to help. It took existing conservatorship rules for those with extreme mental health conditions and applied them to those with substance use disorders alone. Advocates for this bill said it would save the lives of those with severe addiction issues, especially those living on the streets, by forcing them into care. The legislation envisioned such individuals being detained on involuntary holds in emergency departments like mine until they can eventually be transferred to a longer-term treatment facility and conserved — after which treatment for substance use can be mandated.
The law has been in effect since Jan. 1. But it won’t work if it relies on emergency departments.
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Before SB43’s enactment, patients considered a danger to themselves or others, or “gravely disabled” — meaning they could not feed, clothe or shelter themselves — were brought to emergency departments and placed on 72-hour involuntary psychiatric holds that prevented them from leaving. If their condition persisted, they could be held longer, brought before a judge and eventually conserved.
SB43 expanded the definition of “gravely disabled” to include individuals with severe substance use disorders alone — if they are refusing necessary medical treatment. Nearly every shift, I already see the patients SB43 aims to help.........