County says few detained under new definition of grave disability

Under Senate Bill 43, a new law that recently took effect in San Diego County, law enforcement officers and medical professionals can detain a person with a diagnosed mental illness or substance use disorder if there is evidence they are gravely disabled.

However, one month in, it appears this law has had little effect on the number of detained individuals showing up in local hospitals and other facilities.

Luke Bergmann, the county’s director of behavioral health, said last week that his department scrutinized internal records for January, the first month that the new law was in effect throughout the region, and found little evidence that detention rates were any higher than they were previously.

“We’re seeing no impact in our emergency departments, no impact in our crisis stabilization units, no impact in MCRT, no impact in PERT,” Bergmann said, using the acronyms for specially trained teams of medical and law enforcement personnel designated to respond to mental health care emergencies. “The changes from the last couple of months of 2024 to the first month of 2025 are not statistically significant.”

State law has long allowed law enforcement officers, and certain other medical professionals, to detain a person if they meet a standard of grave disability.

In the past, this definition was restricted to those with diagnosed mental illnesses who appeared to be unable to provide for their food, shelter or clothing. But SB 43 added a second reason — severe substance use disorder — to the list of reasons why a resident could be detained for grave disability.

But the existence of a diagnosed mental disorder or severe drug or alcohol problem is not enough for a police officer or social worker to order a person detained and transported to a medical facility for evaluation. There also must be evidence that a person is so affected by their condition that their personal safety is in jeopardy. Previously, the criteria was a person’s inability to provide for their own food, shelter or clothing. SB 43 adds two additional reasons: an inability to ensure their personal safety or effectively access medical care.

The county’s assertions that there has been no big increase in the number of people picked under this expanded definition does not mean that local medical providers report zero diagnoses under the broader meaning of grave disability. UC San Diego Health said its facilities in La Jolla and Hillcrest documented 13 patients who met the criteria in January, and Scripps Health, with hospitals from Chula Vista north to Encinitas, said it recorded 20 such patients.

Bergmann said that when these cases are set against the overall number of involuntary mental health and substance use-related detentions, they just do not move the needle.

“We’re just not seeing substantial enough volume to have an overall impact on health care,” Bergmann said.

In January, for example, there were 1,595 issions to crisis-stabilization units, the location where those detained for substance use disorder under SB 43 would be taken if they did not have a severe medical condition that needed attention from a doctor or other health care professional. That’s right in the normal range of what crisis centers have seen on a monthly basis. According to a county report, crisis center units reported between 1,145 and 1,714 visits per month in 2024. Inpatient hospital units saw 525 issions in January, lower than any single month in 2024, which ranged from 640 to 750 per month.

Dr. Steve Koh, chief of clinical psychiatry at UC San Diego Health, said that some people were brought in with injuries such as out-of-control diabetes or an untreated foot ulcer and, once they arrived, were listed as being gravely disabled under the new definition. But these folks, he said, would not have been ignored before the law change.

“No police officer or ambulance medic would see someone with an open wound on the streets, talking gibberish, and not bring that patient in on a hold,” Koh said.

And, he added, some of the patients who end up being counted as gravely disabled holds may sort into that category while they are at a hospital based on the behavior that caregivers observe while they are present. But many of those may not necessarily have been detained on the streets on suspicion of grave disability.

And, as a recent ride-along with San Diego Police Officer Megan Pavinca showed, deciding who should be detained as gravely disabled comes down to individual interpretation. During a 10-hour shift patrolling downtown San Diego, a beat that includes 17th Street, an area that is the epicenter of the unhoused crisis in the city, one man could be seen pushing a shopping cart in the roadway muttering to himself and, just a block further along, another could be seen moving in and out of traffic in a way that certainly looked dangerous.

Asked why these folks didn’t prompt a response, Pavinca looked in her rear-view mirror, noting that the individuals eventually made it to the sidewalk.

“A lot of people downtown, they walk in the street; it doesn’t necessarily mean they’re a danger to themselves,” she said. “They’re just going where they need to go.”

Now, had it looked different in the moment, she added, the result would have been different.

“If someone is in immediate danger, if cars are having to swerve to avoid them or if they’re laying down on the street, then absolutely we’re going to get out and talk to them, try to help them out,’ she said.

Picking someone up for grave disability, a decision that necessitates putting them in handcuffs per department safety policy, is not an activity that is taken lightly, especially when doing so will take an officer out of their assigned patrol route, meaning they will not be available to respond to other calls while a patient is transported to the nearest hospital with capacity to do a mental health or substance use evaluation.

But it’s early. Expanded detention powers are still very new, and Bergmann said he expects the situation to change in the coming year as those on the front lines have more time to settle into the new rules.

“I do anticipate that there will be an evolution in the numbers,” Bergmann said.