Alameda County health officials outline SB 43 preparations, recommend adopting W&I sections 5270 and 5121

Alameda County behavioral health leaders on Tuesday presented a multi-pronged plan to prepare for SB 43, the state law that expands the criteria for involuntary psychiatric holds and adds standalone substance-use conditions to grave-disability determinations.

"SB 43 is required, and we will be required to implement no later than January 1 this coming '20 '26," said Dr. Karen Tribble, Alameda County behavioral health director, summarizing the department's timeline and two near-term policy requests to the Board of Supervisors.

Tribble said county staff will return to the board with two board letters asking the county to align local practice with two parts of state law: adopting Welfare and Institutions Code section 5270 (which provides an additional 30-day certification-review hold) and section 5121 (which authorizes the behavioral health director to designate and train professionals who may initiate involuntary holds). "We will be coming to you with a request that Alameda County adopt 5270," she said.

Vanessa Baker, deputy director (presenting remotely), described stakeholder engagement, translation needs and equity-focused planning. "This law still does require the opportunity to explore less restrictive alternatives, namely assisted outpatient treatment and care court," Baker said, emphasizing the county’s effort to expand outpatient and peer services before implementation.

Dr. Aaron Chapman, chief medical officer, urged adopting 5270 to allow a 30-day stabilization period that can reduce unnecessary conservatorships, citing San Francisco's post-adoption decline in conservatorship referrals. "5,270 allows us an additional 30 days to work with an individual in a hospital setting to try to stabilize them before we go down the path of conservatorship," Chapman said.

Officials told the board the county has secured substantial capital awards — staff referred to roughly $130,000,000 in BCHIP grants — to expand treatment and facility capacity, including a locked facility and several interim sites intended to increase bed supply for people who may be subject to involuntary holds.

County presenters emphasized workforce, clinician designation, training of first responders and translation for non‑English speakers. Baker said the county expects to provide materials in at least 11 threshold languages and to partner with the state and local providers for training and certification.

The presenters also linked SB 43 readiness to other local initiatives, including the county's Care Court program and an expanded Community Assessment and Transport Team (CATT), saying those systems will help offer less restrictive alternatives and smoother transitions into care.

Supervisors pressed staff on geographic distribution of BCHIP-funded projects, timelines for construction, and whether other Bay Area counties have adopted the proposed local code changes. Staff said most Bay Area counties have adopted the 5270 authority and that several BCHIP-funded sites are in construction or near completion, with staggered openings beginning this summer.

The department said it will return with board letters in the coming weeks to request formal local adoption of sections 5270 and 5121 and to seek direction on implementation priorities. No formal board action was taken at Tuesday’s meeting; staff asked for feedback and signaled they will present formal board letters with more details and proposed text.