Starting January 1, 2026, many California counties will implement Senate Bill 43 (SB 43), which significantly expands the criteria for involuntary psychiatric holds (5150 holds) and conservatorships. This law marks the first major update to the Lanterman-Petris-Short (LPS) Act in over 50 years.
Key Changes to 5150 Hold Criteria
The primary change is the broadening of the definition of “gravely disabled,” one of the three legal reasons a person can be held against their will (alongside being a danger to self or a danger to others).
New Diagnoses Included: Involuntary holds can now be initiated for individuals with severe substance use disorder or chronic alcoholism, even without a co-occurring mental health disorder.
Expanded “Basic Needs”: Previously, “gravely disabled” only referred to an inability to provide for food, clothing, or shelter. The new definition adds:
Personal Safety: The inability to survive safely in the community.
Necessary Medical Care: The inability to access care needed to prevent serious bodily injury or deterioration of a physical condition.
Removal of Family Care Exception: Previously, individuals were not considered “gravely disabled” if they received help from family or friends. The new law allows holds even if third-party support is available, provided the individual cannot meet their own needs.
Implementation and 2026 Timeline
While SB 43 was signed in 2023, most counties used a legal provision to delay implementation to ensure they had the necessary infrastructure and staff training.
Counties starting Jan 1, 2026: This include major jurisdictions such as Los Angeles, Orange, Riverside, Alameda, Ventura, San Mateo, and Merced.
Earlier Adopters: San Francisco and San Luis Obispo implemented the law in 2024; San Diego and Sacramento followed in 2025.
Patient Rights and Legal Safeguards
Despite the expansion, individuals on a 5150 hold (up to 72 hours) or extended holds (such as a 14-day 5250 hold) retain specific rights:
Legal Representation: Access to court-appointed counsel and regular case reviews.
Riese Hearings: The right to refuse psychiatric medication unless a judge determines they lack the capacity to make that decision, or in immediate emergencies.
Least Restrictive Care: Counties are required to consider voluntary treatment or less restrictive alternatives before pursuing conservatorship.