Hospitals and emergency departments are going to “fail miserably” if Santa Barbara County implements new state legislation without giving the county’s health systems enough time to set up the support needed to manage a potential influx of patients, Denise McDonald told the Board of Supervisors on Dec. 12.
“There’s nothing harder for an ER [emergency room] nurse than not being able to help a patient,” said McDonald, the director of emergency and trauma services at Cottage Hospital.
McDonald and several other medical professionals spoke to supervisors during a discussion on Senate Bill 43: a new piece of state legislation that expands the criteria for involuntary detention, treatment, and conservatorship to now include people with severe substance abuse disorders along with those who have serious mental illnesses.
According to the Santa Barbara County Behavioral Wellness Department’s presentation, this policy change means that the number of people subject to detention and conservatorship will increase from 1 percent of the population to about 10 percent.
However, the state isn’t providing funding to implement its new requirement. With SB 43 scheduled to go into effect on Jan. 1, 2024, the county’s behavioral wellness team requested a two-year extension to give the team time to increase capacity, establish new evaluation criteria, and hire additional staff.
“I can assure you, if we fail to roll this out correctly, these patients are going to default to my departments. They are going to linger for days, hours, weeks because we have no place to send them,” McDonald said. “What is the point of creating or starting a program prematurely when we don’t have anything to offer these patients?”
Supervisors voted 4-1 to approve the extension, with 4th District Supervisor Bob Nelson dissenting because he wanted to see it rolled out earlier for the sake of those who need help now.
“I’m concerned that we are sending people out into the streets to suffer and to not be treated while we try to figure out our systems,” Nelson said during the meeting. “Knowing if they don’t get help now, they may have other consequences down the line.”
While the supervisors acknowledged that it was an urgent need, the majority agreed that it was important to set up the new systems to meet the potential increase in demand.
“If you have a tool, but not the infrastructure in place … it’s not going to work well. We want to test this approach, and it’s not fair if we don’t have the systems in place to make it work,” 3rd District Supervisor Joan Hartmann said during the meeting. “We need to take the time to do it right.”
Behavioral Wellness Department Director Toni Navarro told the Sun that the department wants to execute this before the two-year deadline of Jan. 1, 2026, but the granted extension will have a positive impact on her team. The department will return to the Board of Supervisors in July with an update and a timeline for when the bill’s requirements can be implemented.
“It’s an extremely complex issue. As you can see, there are practical realities like … staffing, beds for treatments and placement, and sites to get the care they need,” Navarro said. “But [there’s] a highly personal and emotional component to this because it really is directly about taking care of those who are the most vulnerable and debilitated by mental illness and addiction in our state.”
The Lanterman-Petris-Short Act is the original piece of legislation that provides evaluation and treatment for a person who is severely disabled—which means the individual cannot meet their basic personal needs like food, clothing, and shelter because of their mental illness, according to the staff report. The person then undergoes an involuntary psychiatric hospitalization and involuntary medication.
SB 43, signed by Gov. Gavin Newsom on Oct. 10, adds personal safety and necessary medical care to the list of basic personal needs and adds severe substance use to the issues that could be considered severely disabling.
“It’s going to be a whole new population added to the rosters and it could increase the amount of people we see on the front end significantly, and we have to plan for that,” Navarro said.
In the 2022-23 fiscal year, Santa Barbara County wrote 425 involuntary holds, which Navarro said could increase tenfold with SB 43. However, the county doesn’t have a definition for what it means to have a severe substance use disorder, nor has it established the evaluation criteria to understand if someone can’t meet their personal medical care or safety needs.
“This is a very serious act. Any time we hospitalize someone, we take that very seriously,” Navarro said. “We always want to help people maintain their civil rights and integrity of freedom, but in some cases we can’t, so we need to have clear, expert-vetted policies, procedures, and implementations outside of our expertise.”
SB 43 was one of 269 mental health-related bills that went through the legislative process in 2023. While not every bill passed, there was still a significant increase in the number of new laws about mental health—signaling that behavioral wellness “is front and center,” she said.
“COVID … has brought awareness to how vital it is to have mental health and thriving communities, and we as a society need to destigmatize mental health and destigmatize addiction,” Navarro said. “The double-edged sword is we have a lot of changes to make and things to do. We’re pedaling faster, and across the state, we are working collaboratively and doing a good job of identifying what works.”
Marian Regional Medical Center President and CEO Sue Andersen told the Sun that there also aren’t enough locations to treat people with substance use disorder in the county.
“Our county is really lacking in facilities to send these people to; our concern is these people will stay in our emergency departments, they will stay in our emergency units,” Andersen said. “What needs to happen over the next two years is the county needs to take a hard look at mental health resources in the county, the one specifically SB 43 is directed to.”
She said she’s hoping the county will find the answer for where patients in involuntary treatment will go outside of the hospital or emergency departments. North County doesn’t have an inpatient care facility nor psychiatric health facility beds to transfer individuals in severe crises to, and the area only has two outpatient care facilities—with another coming online—for substance use disorders.
“Every psychiatric company that evaluates this area says we are gravely under-bedded for any kind of mental health services,” Andersen said. “I think the hard part for us at hospitals is we’re not psychiatric hospitals, we’re not trained in that. We handle a lot of people who need detox and coming off a drug overdose and alcohol issues.”
While Marian handles patients experiencing these issues every day, the long-term services those patients need aren’t something the hospital is licensed to provide.
“We agree with the county that a lot of work needs to be done to implement the ability to improve our substance use disorder treatment programs and … adding new programs, training, education—I really think that’s what the county needs to do to make it implemented properly in the next two years,” Andersen said.
Reach Staff Writer Taylor O’Connor at toconnor@santamariasun.com.
This article appears in Dec 21-31, 2023.