Only six people conserved for substance use alone under the new criteria
California braced for upheaval three years ago when Gov. Gavin Newsom signed a law meant to bring people with severe mental illness and addiction off the street and into involuntary treatment. Families hoped it would finally compel loved ones into care through conservatorship, while disability rights advocates warned it would traumatize large numbers of people by forcibly medicating them and removing their right to make decisions about their own care. County behavioral health officials expected a torrent of new referrals, and leaders of already overcrowded emergency rooms and psychiatric facilities expected an influx of new patients. So far, according to data obtained by CalMatters, little of that has happened: in most of the state’s largest counties, one-year mental health conservatorships have barely budged.
Senate Bill 43, signed in 2023, broadened the Lanterman-Petris-Short Act, the nearly 60-year-old framework governing when someone is so “gravely disabled” that they can no longer care for themselves. That standard previously meant a person could not provide for the basic needs of food, clothing or shelter because of severe mental illness or chronic alcoholism. The new law added people who cannot provide for their own safety or medical care, and people incapacitated by severe substance use disorder. It touches the full range of involuntary treatment options, from a 72-hour psychiatric hold — known as a 5150 hold — to a one-year conservatorship, in which a judge orders a conservator to take over a person’s treatment, often in a locked psychiatric facility. The state let counties wait until January 2026 to begin using the new parameters, and many did; some experts say the law’s real effect will not be apparent in those counties until more time has passed.
CalMatters requested data from the state’s 25 most populous counties comparing one-year conservatorship caseloads just before the law took effect with current counts. Of the 19 counties that provided point-in-time figures, 12 reported increases of less than 5% or declines. On average, counties saw an increase of less than 6%, and the overall caseload in the counties analyzed rose 4%.
Addiction, one of the main expanded criteria of the legislation, has so far produced almost no conservatorships. Only three counties reported conserving anyone solely because of a substance use disorder, for a total of six people, and most counties that provided data are not tracking whether people qualified under the law’s other expanded criteria. County behavioral health directors say the law tried to fit addiction treatment into a mental health conservatorship framework that does not necessarily suit it. The first step toward involuntary care is a 72-hour hold; someone held for drug use typically regains the ability to care for themselves once the drugs wear off within that window and no longer qualifies. Michelle Cabrera, executive director of the County Behavioral Health Directors Association, said many counties also have little appetite for using lengthy involuntary holds to treat substance use. Research, she said — citing work out of Massachusetts — suggests forced addiction treatment does not work and can reduce people’s drug tolerance, making them more likely to overdose when they return to use. “We can’t ignore that there isn’t a tremendous amount of evidence to support this treatment model,” Cabrera said.
Another possible reason the numbers have not shown a dramatic increase: several counties reported improving their voluntary mental health services around the same time the new conservatorship law went into effect, and as a result more people chose care and fewer people were forced into conservatorships — something widely considered a positive outcome. Santa Barbara County, where the law took effect in July 2025, has seen conservatorships drop 1%. “It was not at all as big an impact as we thought it could be,” said Toni Navarro, the county’s behavioral health director. Orange County’s caseload is up 2% since January. “It has given us quite a lot of positive things that I think that no one is looking at,” said Veronica Kelley, director of the Orange County Health Care Agency. “But I think the end that everyone’s interested in: Did we get everyone now into (a Lanterman-Petris-Short) conservatorship? No, that hasn’t happened.”
Sonoma County prepared for an expected 20 to 30 additional cases a year when it began using the law at the start of 2026 — an influx that would have taxed the mid-sized county’s already scarce resources, said Jasdeep Singh, its chief deputy public administrator-guardian-conservator. Cases are down slightly instead. When the county recently petitioned to conserve someone under the new law, arguing the person’s personal safety was at risk, the court rejected the petition, Singh said — an outcome he said frustrated staff who thought the person needed more time in treatment. “Just going off of that, what feels like a recent experience, it wasn’t helpful,” Singh said.
Where caseloads did climb, tying the increase to the new law is difficult. San Luis Obispo County, which began using it as soon as it could in January 2024, has seen one-year conservatorships rise by more than a quarter — but none of those cases involved substance use alone, and the county is not tracking the law’s other expanded parameters. Tulare and Placer counties, each up nearly 17%, are in the same position. San Francisco, by contrast, attributes its 7% increase at least in part to the new law, saying in a statement from its Human Services Agency that the law strengthened the city’s ability to help people most at risk of fatal overdose and those repeatedly harming themselves.
Some counties saw larger movement in short-term holds. San Mateo County’s 72-hour psychiatric holds increased by more than a quarter in the six months after the law took effect compared with the six months before. Los Angeles County wrote more than 500 such holds for severe substance use disorder — newly allowed under the legislation — between January and June 2026. But short-term holds do not always lead to lasting treatment: people placed on 5150 holds often cycle repeatedly between the hospital and the street.
Kelley said the law has accomplished work the public debate has overlooked. Adding substance use to the conservatorship criteria has pushed counties’ separately run mental health and addiction treatment departments to collaborate more, she said — a shift she called helpful, since about 60% of the patients with serious mental illness her Orange County department sees also have a substance use disorder, and the facilities serving people on conservatorships are now better equipped to treat addictions. “We’ve been trying to merge those systems, because it’s the same brain, for decades,” Kelley said.
Disability rights advocates who opposed the law caution that it is too soon to measure its impact, which they still expect to be significant. Samuel Jain, a senior policy attorney at Disability Rights California, said he and others anticipate seeing a lot more people forced into involuntary treatment once more facilities are built. Former Sen. Susan Talamantes Eggman, the Stockton Democrat who authored the legislation, did not respond to multiple calls requesting an interview. Sen. Roger Niello, a Roseville Republican and one of the legislation’s 23 co-authors, said he worries that society’s reluctance to overrule someone’s civil rights and compel treatment is jeopardizing the law’s effectiveness — while cautioning that the jury is still out because the law is so new. Money, he said, is the other obstacle. “First we need funding,” Niello said. “If we’re not going to have funding, if we’re not going to increase the capacity for treatment, then I’m not sure there’s any (amount) of time that would show success.”
The early results land amid wider disappointment among some families, who say the law is the latest in a series of unmet promises by the Newsom administration. A CalMatters investigation of CARE Court, Newsom’s signature effort to use the courts to move people into mental health treatment, found the program has helped fewer people than anticipated and left many families disappointed. CalMatters also found that all the projects slated to open last year under a mental health bond the governor backed — one that has doled out billions of dollars for treatment beds and treatment slots — were delayed or canceled. “It’s scary, the gaps are scary,” said Teresa Pasquini, a longtime mental health advocate whose son lives with mental illness. The biggest failure Pasquini knows of under the new conservatorship law, she said, is the case of her friend Annis Pereyra’s son.
Joaquin Anthony “Tony” Pereyra was shot and killed by Walnut Creek police on Feb. 26 while in the middle of a mental health crisis, less than two months after the new law rolled out in Contra Costa County, where he lived. In the months before, his mother, Annis Pereyra, had been begging county officials to force him back onto the antipsychotic medication that had quieted his schizophrenia — and had asked local leaders whether the new law could be used to do it, even before it took effect in the county.
Tony Pereyra was, by his mother’s account, a cheerful and brilliant child. Irrational thoughts began in fifth grade; by junior high he was hearing voices. He had his first psychotic break during his sophomore year of high school, dropped out, and was soon diagnosed with schizophrenia. The county repeatedly placed him under temporary conservatorships and sent him to locked facilities. In his early 30s, after other medications failed to produce lasting success, he landed on clozapine, which his mother said transformed him: for 15 years he held down a job, lived independently and helped her with projects around the family home. In the summer of 2024, after his mother suffered a medical emergency, Tony — by then in his 40s — became terrified by her frailty and took himself off the drug. The voices, long quieted, grew louder.
On March 24, 2025, a distressed Tony Pereyra appeared at his parents’ home and violently attacked them, according to his mother. The couple told police they did not want to press charges — they wanted someone to help their son. He spent several months in locked facilities under a temporary conservatorship but was released to his apartment without being put back on clozapine, his mother said. The county’s attempt to reach him through CARE Court also failed, she said. She believed her son — dangerous to himself and others, unable to care for himself, unable to recognize he needed medication — would qualify for a longer-term conservatorship under the new law.
Early on the morning of Feb. 26, Walnut Creek police responded to a report of a man in dark clothing shining a flashlight into people’s cars and homes and found Tony Pereyra around the corner from his parents’ house. Body-worn camera footage released by the department shows officers issuing multiple commands for him to show his hands and drop to the ground. “I ain’t messing with you, man,” one officer shouted. After shooting him, officers discovered he had been holding a pellet gun. He died at the scene. Afterward, his mother went to the apartment where he had lived, she said: garbage was piled to the railings on the back patio, and Tony had ripped up the flooring, dismantled the plumbing, pulled out the light switches and used racks from the refrigerator to block off the kitchen cabinets. She believes he was trying to make the voices stop, she said. How, she asked, did the county not consider him sick enough to use the new law to force him to restart clozapine? “His needs were ignored at every turn that happened. Every single turn,” Annis Pereyra said. “He wasn’t put on the only medication that saved him from the horrors of his illness.”
Contra Costa County’s one-year conservatorship caseload has risen 13% since the law took effect there, from 98 cases to 111 — more than many other counties. Its behavioral health department declined to make anyone available for an interview. Diane Burgis, chair of the county Board of Supervisors, did not weigh in on Tony Pereyra’s case but said county leaders were aware of the high expectations families held as the law rolled out and are “so committed to this work.” “It wasn’t as far-reaching as expected, we kind of saw that coming,” she said. “As someone that has personally experienced the frustrations of trying to help someone that you love get the care you need, the system still has so much that it needs to do to be better.”
Just before 9 a.m. on a Tuesday in early October, 40 people formed a circle near the steps of the Contra Costa County Board of Supervisors chambers in downtown Martinez, holding a vigil for the National Mental Health Day of Prayer dedicated to Tony Pereyra’s memory. “I’m tired of getting the phone calls that police have shot and killed another person with mental illness,” Gigi Crowder, chief executive of the local NAMI affiliate, told the group. Crowder is among those who believe the new conservatorship law could have been invoked to save his life. “This was a totally avoidable death,” she said. Burgis emerged from the chambers and stood quietly off to one side. “Sometimes, sitting up at the dais, people can get the impression that we don’t care,” she told CalMatters later. “I just wanted to be with those folks because I understand that experience. I share their frustrations. I understand there is a lot more work that needs to be done.”
During the board meeting’s public comment period, Annis Pereyra approached the microphone wearing a button with her son’s picture pinned to her lapel and clutching a double-spaced printout of her message to the board. She described the bullet tearing through her son’s chest and the cold asphalt where he died. “Treatment before tragedy works,” she said. Her two minutes ran out before she could read the final line she had written on the paper: “Implement SB 43 to the fullest extent possible to save others.”