For three years, Southern California families with loved ones trapped in cycles of severe mental illness and addiction have waited to see whether a sweeping state law would deliver on its promise to get more people into treatment — even against their will. New data suggests that, so far, the answer in most places is no.
Gov. Gavin Newsom signed Senate Bill 43 in 2023, expanding the legal definition of who can be deemed “gravely disabled” and therefore eligible for conservatorship — a court process that strips someone of the right to make their own medical decisions and places them under a guardian’s care. Supporters hoped the change would finally give families a tool to force treatment on relatives lost to psychosis or addiction. Critics feared it would trample civil rights on a massive scale. County officials worried it would overwhelm already-strained behavioral health systems.
Three years later, data obtained by CalMatters from the state’s 25 largest counties shows the law has done neither. In most counties that provided figures, the number of people under long-term mental health conservatorships has barely changed.
“It was not at all as big an impact as we thought it could be,” said Toni Navarro, who directs behavioral health services for Santa Barbara County, where conservatorship numbers actually dipped slightly after the law took effect there in mid-2025.
Of 19 counties that shared data, 12 reported either a small increase of under 5% or an outright decline in one-year conservatorship cases since the law kicked in locally. On average, the increase across those counties was less than 6%, and the overall caseload rose just 4%. Only three counties said they had used the law’s new substance-abuse provisions to conserve anyone — a combined total of six people statewide among those that responded.
For families who pushed hard for the law’s passage, the muted results are a bitter disappointment, echoing frustrations many already felt with Newsom’s CARE Court initiative and delayed mental health housing projects funded through a state bond measure.
Among those families is Annis Pereyra of Walnut Creek, whose son, Joaquin Anthony “Tony” Pereyra, was shot and killed by police in February during a mental health crisis. Pereyra says she begged Contra Costa County for months to force her son back onto an antipsychotic medication that had once given him 15 stable years — holding a job, living independently, helping around the family home. When he stopped taking it after his mother suffered a medical scare in 2024, the voices he’d long kept at bay returned, and his condition spiraled. Despite a violent episode in which he attacked his parents and a subsequent temporary conservatorship, he was released without resuming the medication, his mother said.
“His needs were ignored at every turn that happened,” Pereyra said. “He wasn’t put on the only medication that saved him from the horrors of his illness.”
Contra Costa County, where Tony lived, is one of the counties that has seen a more notable rise in conservatorships — up 13%, from 98 cases to 111. County behavioral health officials declined to discuss the case or speak with CalMatters about the law’s local rollout.
Behavioral health directors elsewhere say the modest numbers don’t necessarily mean the law has failed — just that it hasn’t worked the way anyone expected. In Orange County, which saw just a 2% uptick in conservatorships, health agency director Veronica Kelley said the legislation has nonetheless pushed mental health and addiction treatment systems — long operated separately — to work together far more closely, which she considers a meaningful improvement.
“It has given us quite a lot of positive things that I think no one is looking at,” Kelley said. “But the end that everyone’s interested in: Did we get everyone now into a conservatorship? No, that hasn’t happened.”
Part of the issue, several county officials said, is structural. The law tried to fold substance use disorder into a conservatorship system built around mental illness, and the fit has been awkward. Someone held for 72 hours because of drug impairment typically sobers up before the hold ends, no longer meeting the threshold for further involuntary care. Research also suggests forcing people into addiction treatment can backfire, reducing their tolerance and raising overdose risk once they resume using — a concern echoed by Michelle Cabrera, executive director of the County Behavioral Health Directors Association.
Some counties have seen a bigger jump in short-term, 72-hour psychiatric holds rather than long-term conservatorships. San Mateo County, for instance, saw those holds increase more than 25% in the six months after adopting the new law, compared with the prior six months. Los Angeles County issued more than 500 holds tied specifically to severe substance use disorder between January and June of this year. But such short holds often just mean people cycle repeatedly between hospitals and the street, rather than receiving lasting care.
Disability rights advocates, who fought the law’s passage, argue it’s simply too early to judge its full effect. Samuel Jain, a senior policy attorney with Disability Rights California, said he expects to see far more people forced into treatment once the state builds out more psychiatric facilities and treatment capacity.
State Sen. Roger Niello, a Roseville Republican and one of the bill’s co-authors, agreed the verdict is still out — but he pointed to a more basic obstacle than time: money. Without major new investment in treatment capacity, he said, the law may never produce the results its backers envisioned.
“First we need funding,” Niello said. “If we’re not going to increase the capacity for treatment, then I’m not sure there’s any amount of time that would show success.”
In Sonoma County, officials had braced for 20 to 30 additional conservatorship cases a year under the new rules — a number that would have strained the mid-sized county’s limited resources. Instead, caseloads dipped slightly. When the county recently tried to conserve someone by arguing their personal safety was at risk, a judge rejected the petition, leaving staff frustrated.
“Just going off of that, what feels like a recent experience, it wasn’t helpful,” said Jasdeep Singh, the county’s chief deputy public administrator-guardian-conservator.
San Francisco stands out as one of the few counties crediting the law directly for a meaningful increase — a 7% rise in conservatorships, which officials there say has helped the city intervene with people at high risk of fatal overdose or repeated self-harm.
Back in Contra Costa County, Annis Pereyra continues pressing officials to use the law more aggressively. Earlier this month, she joined roughly 40 people outside the county administration building in Martinez for a vigil marking National Mental Health Day of Prayer, dedicated to her son’s memory. Gigi Crowder, who leads the local National Alliance on Mental Illness chapter, told the gathering she believes Tony’s death could have been prevented.
“This was a totally avoidable death,” Crowder said.
Supervisors Board Chair Diane Burgis, who attended the vigil, acknowledged the system still falls short for families desperate for help.
“As someone that has personally experienced the frustrations of trying to help someone that you love get the care they need, the system still has so much that it needs to do to be better,” she said.
Later that morning, Pereyra stood before the board of supervisors, a button bearing her son’s photo pinned to her lapel, and described the moment a bullet struck his chest and the pavement where he died. She ran out of time before finishing her prepared remarks, but the words she didn’t get to read captured her message all the same: implement the law to its fullest extent, she had written, to save others.
Original source: CalMatters
