New Conservatorship Law May Burden Facilities in San Diego

A new law that is now effective aims to grant more conservatorships, especially for people who are homeless or struggling with addiction. Lawmakers wanted to make it easier to force Californians with severe substance use disorders into treatment. However, critics say they have created a law that will further overburden current resources without funding new sources for drug treatment, especially here in San Diego.

SB 43 broadens eligibility for both conservatorships and shorter-term involuntary holds in hospitals. This means people whose addiction is a danger to themselves or others. It also includes people who are neglecting their own medical care.

San Diego's Addiction Recovery Challenges

The challenges in accessing addiction recovery facilities in San Diego and the burden on addiction treatment programs are well-known and have several causes. There is a high demand for addiction treatment due to the prevalence of substance abuse disorder in the region. However, the capacity of addiction recovery facilities has not kept pace with the growing demand, resulting in a shortage of available beds and wait lists that have not yet been resolved.

Financial constraints and limited resources also contribute to the overburdened nature of addiction treatment programs. Many facilities operate with tight budgets, limiting their ability to expand and offer more comprehensive services within San Diego County.

Government funding and support for addiction treatment may not be sufficient to meet the rising demand, exacerbating the strain on existing programs. The stigma associated with addiction can hinder community support and financial backing for these programs, making it challenging to secure the necessary resources. For example, many people object to having recovery homes or sober living programs in their neighborhood, saying clients become a danger to the community if they relapse.

SB 43's Impact on Addiction in San Diego: Will It Work?

Despite the discussions surrounding SB 43 suggesting a focus on extended conservatorships, San Diego County's behavioral health director and others anticipate that the law's primary immediate impact will involve an increase in cases where law enforcement brings people struggling with addiction to hospitals for short-term holds.

Barriers, however, definitely remain when it comes to treatment. Currently, on-demand care is often unavailable for individuals with Medi-Cal insurance. This can potentially cause more low-income and homeless San Diegans to cycle through hospital emergency rooms without accessing the necessary care unless there is a swift influx of new treatment options and systemic reforms. This will also cause a burden for ERs that have not yet recovered from the surges related to the COVID-19 pandemic.

Many people who suffer from severe addiction issues are indigent and can only get health insurance through Medicaid, limiting their treatment options.

The lobbying group representing San Diego's hospitals advises county supervisors to utilize a provision in the state law allowing for a maximum two-year delay to prepare for a potential surge of individuals entering emergency rooms and to ensure treatment availability. County supervisors, including Chairwoman Nora Vargas, declined to comment on whether they would pursue this action.

Mayor Todd Gloria and other proponents of the conservatorship reform law argue that vulnerable San Diegans and their families cannot afford to wait for this controversial tool, asserting that lives are at risk and the mandate is necessary to expand access to care.

Some Barriers Will Be Removed with SB 43, But What's Next Remains Murky

Individuals with substance use disorders have historically faced unequal treatment when admitted to hospitals, especially during short-term holds lasting up to 72 hours. Once medical staff identifies that a person's primary symptoms are linked to substance use, they often discharge them once they are no longer intoxicated. Addicted patients are typically deemed ineligible for longer-term conservatorships, as hospital workers do not consider them gravely disabled or a threat to themselves or others once sober.

SB 43 alters the dynamics of temporary holds for severe substance use disorder patients by making the condition eligible for conservatorship, potentially leading to extended hospital stays. It also broadens the definition of gravely disabled to encompass a person's inability to ensure their own personal safety or necessary medical care beyond basic needs like food, clothing, or shelter.

Luke Bergmann, San Diego County's behavioral health services director, believes SB 43 is unlikely to result in a surge of longer-term conservatorships for those with addiction challenges but anticipates a rise in individuals ending up in the ER on temporary holds for this condition. He acknowledges that the short ER stay could present an opportunity for swift care delivery. He also recognizes the potential for disruption and disillusionment if these patients are not promptly linked to ongoing care. Often, there still won't be a bed in a facility, and they will be discharged back to the streets of San Diego.

"I think the broader opportunity is how do we collectively try to shift the likelihood of connection to care being greater than the likelihood of disruption in well-being," Bergmann said. "And the context for that is the overwhelming majority of people with substance use disorder never get access to care – ever, in their lives."