Posted February 6, 2026

What Every Family Member Should Know

California’s new Lanterman-Petris-Short (LPS) Act legislation, SB 43, significantly expands how the law defines “gravely disabled.” This change directly affects families, loved ones, and advocates seeking help for individuals who are unable to care for themselves due to serious mental health or substance-related conditions.

o New emphasis is added on unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care. WIC § 5008(h)(1)(A).

SB 43 gives families a clearer legal pathway to seek protective intervention when a loved one is unable to care for themselves due to a severe mental illness, a severe drug use disorder, or both. By protective intervention, this designation allows for involuntary admission in an inpatient psychiatric hospital (5150 holds).

Knowing what qualifies as grave disability under SB 43, and how to document it, is often the difference between a loved one receiving protective care or being released back into unsafe conditions…again.

What SB 43 Changes

SB 43 expands the legal definition of “gravely disabled” to include individuals who, as a result of one or more of the following, are unable to provide for their own basic personal needs:

• A severe mental health disorder or mental illness
• A severe drug usage
• A severe mental health disorder and severe s drug usage

A person may now be considered gravely disabled if they cannot provide for one or more of the following:

• Food
• Clothing
• Shelter
• Personal safety
• Necessary medical care

This expanded definition is codified in Welfare and Institutions Code § 5008(h)(1)(A).

What Is “Necessary Medical Care”?

SB 43 clarifies the meaning of necessary medical care.

“Necessary medical care” means care that a licensed health care practitioner—acting within the scope of their professional practice—determines is required to prevent serious deterioration of an existing physical medical condition. If left untreated, that condition would likely result in serious bodily injury. I remember one case where a man, suffering from symptoms of schizophrenia, kept refusing immediate medical care to prevent the amputation of his ring finger. The “voices” was telling him to let his ring cut into his finger and become one with his finger; thus he kept refusing medical attention to remove the ring. This is would qualify as necessary medical care.

This definition is found in Welfare and Institutions Code § 5008(q).

How Family Members Can Participate

Under California’s Welfare and Institutions Code, family members may participate in certification (5250) hearings in two primary ways:

1. Written Statements

Family members may submit a written statement or letter to the Patient’s Rights Advocate or the hearing officer. Written statements are often more effective than oral testimony because they become part of the permanent medical record. When your loved one is placed on a 5150 involuntary hold, automatically a certification review hearing with the Superior Court is scheduled within four business days. It is called the 5250 certification review (or probable cause hearing).

2. In-Person or Virtual Testimony

Family members may request to attend the hearing. Hearing officers typically allow family members to speak or answer questions regarding the individual’s grave disability, particularly their inability to care for themselves safely.

What to Include in Your Statement

To be effective at a 5250 certification hearing, written statements should focus on grave disability, not simply severe drug usage.

Hearing officers must see evidence that the individual cannot provide for their own basic needs, including:

Food, Clothing, or Shelter

• Inability to eat regularly or maintain housing due to substance use
• Inability to manage hygiene or basic self-care

Personal Safety

• Repeated placement in life-threatening situations, such as:
  • Walking into traffic
  • Passing out in unsafe locations
  • Frequent overdoses
  • Repeated victimization or assaults

Necessary Medical Care

• Ignoring serious medical conditions (e.g., infections, diabetes, heart disease)
• Refusing treatment despite clear risk of serious bodily harm or death

Key SB 43 Evidence Categories

When writing your statement, focus on direct observations, not admitting diagnoses or opinions.
Use phrases such as “I observed” or “I heard” rather than “I feel.”

Category

What to Document

Personal Safety

Walking into traffic, passing out in dangerous areas, frequent injuries or assaults while intoxicated

Medical Care

Untreated infections, abscesses, severe weight loss, refusal to manage chronic medical conditions

Severe Substance Use Disorder

Repeated overdoses, failed attempts to stop, severe withdrawal symptoms (e.g., seizures, uncontrollable vomiting, disorganized speech)

SB 43 is changing the rules; but the rights of patients are staying the same. The focus is always - least restrictive and appropriate and effective treatment.