A 2023 law meant to push more people with severe mental illness or addiction into involuntary treatment has barely changed conservatorship caseloads in most of California’s largest counties, CalMatters found in data obtained from 19 counties.

Senate Bill 43, signed by Gov. Gavin Newsom, broadened the nearly 60-year-old Lanterman-Petris-Short Act definition of “gravely disabled” so it can include people who cannot provide for their safety or medical care, and people incapacitated by a severe substance-use disorder — not only those unable to provide food, clothing or shelter because of mental illness or chronic alcoholism. Counties were allowed to wait until January 2026 to start using the new standard, and many did. Of the 19 counties that gave comparable point-in-time counts, 12 reported increases of less than 5% or declines in one-year conservatorships after the law took effect there. On average, caseloads rose less than 6%, and the overall number of cases in the counties analyzed increased by 4%, CalMatters reported. Only three counties said they had conserved anyone solely for a substance-use disorder, a total of six people statewide in the data.

Bay Area results were mixed. San Francisco attributed a 7% increase in conservatorship cases at least in part to the new law, the San Francisco Human Services Agency told CalMatters, saying it strengthened the city’s ability to help people at high risk of fatal overdose or repeated self-harm. In San Mateo County, 72-hour psychiatric holds rose by more than a quarter in the six months after the law took effect, compared with the six months before — a jump in short-term holds that does not automatically lead to a year-long conservatorship. Contra Costa County, where Walnut Creek officers shot and killed Joaquin Anthony “Tony” Pereyra in February during a mental-health crisis, saw one-year conservatorships rise 13%, from 98 cases to 111, more than many other counties. His mother, Annis Pereyra, told CalMatters she had been asking the county to use the new law to compel him back onto an antipsychotic that had worked for him; she believes it could have saved his life. Sonoma County had braced for 20 or 30 additional cases a year, Chief Deputy Public Administrator-Guardian-Conservator Jasdeep Singh said; instead, cases are down slightly, and a court rejected a recent petition brought under the new safety standard.

County behavioral-health directors told CalMatters the law has improved collaboration between mental-health and addiction programs, even if it has not produced a surge in conservatorships. Disability Rights California’s Samuel Jain said it is too soon to judge, and that more involuntary treatment may follow once more facilities are built. Sen. Roger Niello, a Republican co-author, said funding and treatment capacity remain the binding constraints. The figures are CalMatters’ county-by-county survey, not a state dashboard, and many counties still do not track which cases used the law’s expanded criteria.