Three years after California lawmakers promised a sweeping expansion of involuntary mental health treatment, the numbers tell a far more modest story. Among 19 of the state's most populous counties that supplied point-in-time data, most reported that conservatorship caseloads had not increased significantly since Senate Bill 43 took effect — a quiet outcome for a law that was billed as a turning point for people living with untreated psychosis and addiction on California's streets.
Senate Bill 43, signed into law in 2023, broadened a nearly 60-year-old framework under the Lanterman-Petris-Short Act, according to CalMatters. The law expanded eligibility for involuntary treatment beyond the old gravely disabled standard — inability to provide food, clothing or shelter due to severe mental illness or chronic alcoholism — to also include people unable to provide for their own safety or medical care, and people incapacitated by severe substance use disorder. The state let counties phase in the expanded criteria on their own timelines, with adoption dates ranging from January 2024 to January 2026.
CalMatters requested conservatorship data from 25 of California's most populous counties; 19 provided point-in-time figures. The figures showed little overall change in conservatorship caseloads. Toni Navarro told the outlet the law's impact had been smaller than expected, while Dr. Veronica Kelley offered a more measured verdict: “Did we get everyone now into (a Lanterman-Petris-Short) conservatorship? No, that hasn't happened,” she said, per the same report, even as she credited the law with some positive outcomes.
A Patchwork of Results Across Counties
The county-by-county picture is uneven. Santa Barbara County's conservatorship count had dropped 1% since the law took effect there in July 2025, while Orange County's conservatorship cases rose 2% since the law went into effect there in January, according to its health care agency. Contra Costa County's one-year conservatorships climbed 13%, rising from 98 to 111 cases, and Tulare and Placer counties each reported increases of nearly 17%.
San Francisco saw a 7% increase in conservatorship cases, which its Human Services Agency attributed partly to SB 43. A 2025 San Francisco Standard report also found the city budgeted for 18 deputy conservator positions, but five sat vacant — leaving remaining staff responsible for upwards of 60 conservatees at a time.
Funding Gaps and Lingering Doubts
Roger Niello, a Republican state senator from Roseville and one of SB 43's co-authors, said the law's fate hinges on resources. “If we're not going to have funding, 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,” he told CalMatters. The bill was authored by Sen. Susan Talamantes Eggman and had 23 co-authors.
Skeptics point to the limits of what a 72-hour hold — the maximum duration of a 5150 detention — can actually accomplish. Per Disability Rights California, such holds do not authorize involuntary medication or medical treatment, though a hold can progress to a one-year conservatorship if a person remains unable to care for themselves. Advocates with Disability Rights California, per Samuel Jain, had expected the law's impact to grow more significant once more treatment facilities were built.
A Family's Loss Behind the Statistics
Joaquin Anthony “Tony” Pereyra was diagnosed with schizophrenia and experienced his first psychotic break during his sophomore year of high school, after which he dropped out, according to CalMatters. He later took clozapine, which transformed his life; his mother, Annis Pereyra, described 15 good years.
Pereyra was shot and killed by Walnut Creek police on February 26 during a mental health crisis, after he was holding a pellet gun when officers opened fire; he died at the scene. Annis Pereyra said she believes SB 43, fully implemented, could have saved her son's life by compelling him to stay on his medication, and she has urged officials to implement the law fully so others are spared the same fate.
