What is SB 43?
Since 1972, Welfare and Institutions Code (WIC) § 5008 (h)(1) (A) has defined the term “gravely disabled” as a condition in which a person, as a result of a mental disorder, is unable to provide for their basic personal needs for food, clothing, or shelter.
In Orange County, effective 01/01/2026, the definition of grave disability will expand to include the following:
- A condition in which a person, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care. WIC § 5008(h)(1)(A) (emphasis added):
- “Severe substance use disorder” means a diagnosed substance-related disorder that meets the diagnostic criteria of “severe” as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. WIC § 5008(o) o
- “Personal safety” means the ability of one to survive safely in the community without involuntary detention or treatment pursuant to this part. WIC § 5008(p) o
- “Necessary medical care” means care that a licensed health care practitioner, while operating within the scope of their practice, determines to be necessary to prevent serious deterioration of an existing physical medical condition which, if left untreated, is likely to result in serious bodily injury as defined in Section 15610.67. WIC § 5008(q)
Grave Disability Observations
Observable considerations for grave disability (GD) due to mental health symptoms (or a co-occurring severe substance use disorder):
- Unable to articulate a plan for food, clothing, shelter
- Irrational beliefs about food that is available or offered (e.g. poisoned)
- Inability to engage in personal hygiene due to mental health symptoms
- Refusal to utilize food, clothing, shelter when offered resources
- Urinating or defecating on oneself
- Impacted speech: tangential, rambling, difficult to understand (e.g. “word salad”)
- Violent or threatening statements
- Fluctuation between calm and agitation
- Creating a public disturbance
- Yelling obscenities, screaming
- Paranoid or delusional thought content
- Disorganized thought content
- Catatonic/blank stare
- Hallucinating (talking to, hearing voices, responding to unseen others)
In accordance with SB-43, additional observable factors to consider for GD determinations:
Severe Substance Use
- Overwhelming odor of alcohol or marijuana
- Dilated or constricted pupils/bloodshot or watery eyes
- Eyes wide open or droopy, heavy lidded, nodding off
- Unsteady gait/slurred speech/unable to walk or stand by oneself/fumbles simple tasks
- Scratching, picking or clawing at skin (e.g. noticeable sores on face, hands or arms)
- Unintelligible speech: loud, yelling, slurring words
- Multiple/pattern of contacts for similar presentation (intoxication) in 12-month period
Necessary Medical Care
- Not seeking or obtaining necessary medical care due to substance use or mental health symptoms
- Uncontrollable vomiting
- Diminished responsiveness or loss of consciousness
- Potential loss of limb(s) due to untreated condition
- Uncontrolled bleeding
- Coughing or vomiting blood
- Cold/clammy skin
- Seizure/convulsions
- Complaint of severe pain or severe injury
- Non-healing wound, wound care or potential infection
- Extreme or profuse sweating
- Disclosure of untreated co-morbidities
Personal Safety:
- Not tending to personal safety due to substance use or mental health symptoms
- Wandering, walking or running in and out of traffic
- Unhygienic/uninhabitable conditions at home or other home safety issues such as not attending to appliances (e.g., leaving the stove on) due to intoxication or mental health symptoms
- Inability to care for hygiene and cleanliness which could or has led to illness
- Hoarding to an extreme causing safety concerns or hazardous (dangerous) conditions
This information is intended to provide support and guidance while a community standard is being developed. The law does not provide this level of specificity. These examples may change over time and are not exhaustive or dispositive. An individualized assessment must be completed. Determination for when to call 911 for EMS coordination are unchanged with SB-43 and should never be delayed.
Frequently Asked Questions (FAQ)
Resources:
Senate Bill 43 (bill text)
Training videos are being developed. Please check back in the future for additional support and tools regarding this initiative.
DISCLAIMER: The information on this page is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information contained in this document should be construed as legal advice from Patient Advocacy or the individual author, nor it is intended to be a substitute for legal counsel on any subject matter.