California SB 43
California SB 43 (effective in most counties as of January 1, 2026) expands the definition of “gravely disabled” under the Lanterman-Petris-Short (LPS) Act (Welfare & Institutions Code § 5008 and § 5150). This allows peace officers to initiate a 5150 hold for a 72-hour mental health/substance use evaluation when a person, due to a mental health disorder, severe substance use disorder, chronic alcoholism, or co-occurring mental health disorder and severe substance use disorder, cannot provide for their basic personal needs—including food, clothing, shelter, personal safety, or necessary medical care.
The tools below are designed specifically for field use by officers. They help document probable cause for calling a mental evaluation team (e.g., mobile crisis, designated LPS clinician, or direct transport for 5150 assessment). These focus on the expanded grave-disability criteria from SB 43 while also covering danger-to-self/others where relevant. Use them to gather information quickly, support your report, and decide whether to request evaluation.
10 Questions an Officer Can Ask (the Person, Family, or Witnesses)
Ask these conversationally to assess inability to meet basic needs due to a qualifying disorder/SUD. Document responses verbatim when possible.
1. Food/Nutrition: “When was the last time you ate a full meal, and what did you have? How do you usually get food each day?”
2. Clothing/Hygiene: “Do you have clean, weather-appropriate clothes right now? How do you keep yourself clean or get new clothes?”
3. Shelter: “Where have you been sleeping the last few nights? Is it safe and dry?”
4. Personal Safety: “Do you feel safe where you are right now? Have you been in any dangerous situations lately because you weren’t able to protect yourself?”
5. Necessary Medical Care: “Do you have any injuries, illnesses, or pain right now? When was the last time you saw a doctor or got medicine for it?”
6. Daily Self-Care Routine: “Walk me through what a normal day looks like for you—how do you take care of eating, sleeping, and staying healthy?”
7. Mental Health Symptoms: “Have you been hearing voices, seeing things that aren’t there, or having thoughts that scare you or don’t make sense?”
8. Substance Use (SB 43 expansion): “Have you been using drugs or alcohol lately? How much, and how does it affect your ability to eat, sleep, or stay safe?”
9. Awareness of Needs: “If you needed food, a safe place to stay, or medical help right now, what would you do and who would you call?”
10. Recent Changes: “Has anything changed in the last few weeks with your thinking, your health, or how you’re able to take care of yourself?”
Observation Checklist (Document What You See)
Check all that apply and note specifics (location, time, witnesses). These observations help establish that the inability to meet needs is caused by a mental health disorder or severe SUD, per SB 43.
• Appearance/Hygiene: Malnourished, dehydrated, extremely dirty, or wearing inappropriate clothing for weather/conditions.
• Living Environment: No shelter or unsafe/unsanitary shelter (e.g., living in trash, feces, exposed to elements, fire hazards).
• Food/Shelter Access: No visible food, water, or means to obtain them; evidence of not eating for days (e.g., empty stomach on exam, reports of weight loss).
• Medical Needs: Visible untreated injuries, infections, open wounds, severe withdrawal symptoms, or obvious medical distress (e.g., difficulty breathing, seizures).
• Personal Safety: Engaging in or unable to avoid high-risk behavior (e.g., walking into traffic, standing in roadway, handling dangerous objects without awareness).
• Behavior/Thinking: Disorganized speech, confusion, disorientation to time/place/person, paranoia, hallucinations, or inability to answer basic questions.
• Substance-Related (SB 43): Clear signs of severe intoxication, repeated overdose history, or withdrawal (e.g., tremors, vomiting, agitation) impairing self-care.
• Danger Indicators (if present): Recent threats or attempts to harm self/others, or reckless actions showing impaired judgment due to mental health/SUD.
• Overall Functioning: Unable to articulate or demonstrate a plan for meeting basic needs (food, safety, medical care) even when prompted.
• Collateral/History: Family, bystanders, or records confirm repeated inability to care for self over time due to mental health or severe SUD symptoms.
How to use these tools in the field:
• Run through the questions and checklist on scene.
• If multiple checks apply and you have reasonable cause to believe a qualifying mental health disorder or severe SUD is the cause, request the mental evaluation team (or initiate 5150 transport).
• Include your observations and question responses in the 5150 application form—the expanded SB 43 criteria make it easier to document grave disability when personal safety or medical care is also compromised.
These are practical, officer-friendly aids aligned directly with SB 43’s updated grave-disability standard. Always follow department policies and consult the on-scene mental health designee when available.