Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. Existing law establishes a process by which a defendants mental competency is evaluated. Existing law, in the case of a misdemeanor charge in which the defendant is found incompetent, requires the court to hold a hearing to determine if the defendant is eligible for diversion. Existing law requires, if the defendant is not eligible for diversion, the court to hold a hearing to determine whether the defendant will be referred to outpatient treatment, conservatorship, or the CARE program, or if the defendants treatment plan will be modified. Existing law requires the court to dismiss the case if a defendant does not qualify for the above-described services.

Existing law prohibits, except as specified, a person confined in a county jail from being administered any psychiatric medication without prior informed consent. Existing law authorizes a county department of mental health, or other designated county department, to involuntarily administer psychiatric medication to an inmate on a nonemergency basis only after the inmate is provided, among other things, a hearing before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer. Existing law also provides for the involuntary administration of psychiatric medication to an inmate in an emergency situation. Existing law limits the duration during which an inmate can be involuntarily administered psychiatric medication on an emergency basis and requires that, except as specified, the inmate be provided the same due process protections they would be entitled to when psychiatric medication is involuntarily administered on a nonemergency basis. Existing law specifies that an emergency exists for these purposes when there is a sudden and marked change in an inmates mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others and it is impractical, due to the seriousness of the emergency, to first obtain informed consent.

This bill would, if an individual has been found incompetent to stand trial after having been charged with a misdemeanor, additionally authorize the administration of antipsychotic medication to the individual without their prior informed consent on an emergency basis when treatment is necessary to address the emergency condition and the medication is administered in the least restrictive manner, as specified. The bill would specify that a determination made pursuant to these provisions is valid for up to 72 hours if the medication is necessary to address the emergency condition, except as provided. The bill would require the court, prior to issuing an involuntary medication order after hearing, to find by clear and convincing evidence that, among other things, a psychiatrist or psychologist has determined that the individual has a serious mental health disorder that can be treated with antipsychotic medication, and there is no less intrusive alternative to the involuntary administration of antipsychotic medication, and involuntary administration of the medication is in the individuals best interest. The bill would require the court to review that order at least every 60 days and would require the psychiatrist to file an affidavit at that review, as specified. By expanding the crime of perjury, the bill would create a state-mandated local program. The bill would also enumerate certain rights for individuals, prior to the administration of involuntary medication pursuant to these provisions. The bill would make these provisions inoperative and would repeal them on January 1, 2030, subject to a later enacted statute.

Existing law provides that if a person in charge of a county jail, city jail, or juvenile detention facility, or a judge, as specified, believes that a person in custody may have a mental health disorder, that person or judge may cause the prisoner to be taken to a facility for 72 hours of treatment and evaluation.

The bill would prohibit certain factors, including the persons temporary access to food, clothing, and shelter, while transferred to a 72-hour facility for treatment and evaluation, from being a basis to conclude that the person is able to provide for their basic personal needs.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. Existing law establishes a process by which a defendants mental competency is evaluated. Existing law, in the case of a misdemeanor charge in which the defendant is found incompetent, requires the court to hold a hearing to determine if the defendant is eligible for diversion. Existing law requires, if the defendant is not eligible for diversion, the court to hold a hearing to determine whether the defendant will be referred to outpatient treatment, conservatorship, or the CARE program, or if the defendants treatment plan will be modified. Existing law requires the court to dismiss the case if a defendant does not qualify for the above-described services.

Existing law prohibits, except as specified, a person confined in a county jail from being administered any psychiatric medication without prior informed consent. Existing law authorizes a county department of mental health, or other designated county department, to involuntarily administer psychiatric medication to an inmate on a nonemergency basis only after the inmate is provided, among other things, a hearing before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer. Existing law also provides for the involuntary administration of psychiatric medication to an inmate in an emergency situation. Existing law limits the duration during which an inmate can be involuntarily administered psychiatric medication on an emergency basis and requires that, except as specified, the inmate be provided the same due process protections they would be entitled to when psychiatric medication is involuntarily administered on a nonemergency basis. Existing law specifies that an emergency exists for these purposes when there is a sudden and marked change in an inmates mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others and it is impractical, due to the seriousness of the emergency, to first obtain informed consent.

This bill would, if an individual has been found incompetent to stand trial after having been charged with a misdemeanor, additionally authorize the administration of antipsychotic medication to the individual without their prior informed consent on an emergency basis when treatment is necessary to address the emergency condition and the medication is administered in the least restrictive manner, as specified. The bill would specify that a determination made pursuant to these provisions is valid for up to 72 hours if the medication is necessary to address the emergency condition, except as provided. The bill would require the court, prior to issuing an involuntary medication order after hearing, to find by clear and convincing evidence that, among other things, a psychiatrist or psychologist has determined that the individual has a serious mental health disorder that can be treated with antipsychotic medication, and there is no less intrusive alternative to the involuntary administration of antipsychotic medication, and involuntary administration of the medication is in the individuals best interest. The bill would require the court to review that order at least every 60 days and would require the psychiatrist to file an affidavit at that review, as specified. By expanding the crime of perjury, the bill would create a state-mandated local program. The bill would also enumerate certain rights for individuals, prior to the administration of involuntary medication pursuant to these provisions. The bill would make these provisions inoperative and would repeal them on January 1, 2030, subject to a later enacted statute.

Existing law provides that if a person in charge of a county jail, city jail, or juvenile detention facility, or a judge, as specified, believes that a person in custody may have a mental health disorder, that person or judge may cause the prisoner to be taken to a facility for 72 hours of treatment and evaluation.

The bill would prohibit certain factors, including the persons temporary access to food, clothing, and shelter, while transferred to a 72-hour facility for treatment and evaluation, from being a basis to conclude that the person is able to provide for their basic personal needs.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. Existing law establishes a process by which a defendants mental competency is evaluated. Existing law, in the case of a misdemeanor charge in which the defendant is found incompetent, requires the court to hold a hearing to determine if the defendant is eligible for diversion. Existing law requires, if the defendant is not eligible for diversion, the court to hold a hearing to determine whether the defendant will be referred to outpatient treatment, conservatorship, or the CARE program, or if the defendants treatment plan will be modified. Existing law requires the court to dismiss the case if a defendant does not qualify for the above-described services.

Existing law prohibits, except as specified, a person confined in a county jail from being administered any psychiatric medication without prior informed consent. Existing law authorizes a county department of mental health, or other designated county department, to involuntarily administer psychiatric medication to an inmate on a nonemergency basis only after the inmate is provided, among other things, a hearing before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer. Existing law also provides for the involuntary administration of psychiatric medication to an inmate in an emergency situation. Existing law limits the duration during which an inmate can be involuntarily administered psychiatric medication on an emergency basis and requires that, except as specified, the inmate be provided the same due process protections they would be entitled to when psychiatric medication is involuntarily administered on a nonemergency basis. Existing law specifies that an emergency exists for these purposes when there is a sudden and marked change in an inmates mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others and it is impractical, due to the seriousness of the emergency, to first obtain informed consent.

This bill would, if an individual has been found incompetent to stand trial after having been charged with a misdemeanor, additionally authorize the administration of antipsychotic medication to the individual without their prior informed consent on an emergency basis when treatment is necessary to address the emergency condition and the medication is administered in the least restrictive manner, as specified. The bill would specify that a determination made pursuant to these provisions is valid for up to 72 hours if the medication is necessary to address the emergency condition, except as provided. The bill would require the court, prior to issuing an involuntary medication order after hearing, to find by clear and convincing evidence that, among other things, a psychiatrist or psychologist has determined that the individual has a serious mental health disorder that can be treated with antipsychotic medication, and there is no less intrusive alternative to the involuntary administration of antipsychotic medication, and involuntary administration of the medication is in the individuals best interest. The bill would require the court to review that order at least every 60 days and would require the psychiatrist to file an affidavit at that review, as specified. By expanding the crime of perjury, the bill would create a state-mandated local program. The bill would also enumerate certain rights for individuals, prior to the administration of involuntary medication pursuant to these provisions. The bill would make these provisions inoperative and would repeal them on January 1, 2030, subject to a later enacted statute.

Existing law provides that if a person in charge of a county jail, city jail, or juvenile detention facility, or a judge, as specified, believes that a person in custody may have a mental health disorder, that person or judge may cause the prisoner to be taken to a facility for 72 hours of treatment and evaluation.

The bill would prohibit certain factors, including the persons temporary access to food, clothing, and shelter, while transferred to a 72-hour facility for treatment and evaluation, from being a basis to conclude that the person is able to provide for their basic personal needs.

Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. Existing law establishes a process by which a defendants mental competency is evaluated. Existing law, in the case of a misdemeanor charge in which the defendant is found incompetent, requires the court to hold a hearing to determine if the defendant is eligible for diversion. Existing law requires, if the defendant is not eligible for diversion, the court to hold a hearing to determine whether the defendant will be referred to outpatient treatment, conservatorship, or the CARE program, or if the defendants treatment plan will be modified. Existing law requires the court to dismiss the case if a defendant does not qualify for the above-described services.

Existing law prohibits, except as specified, a person confined in a county jail from being administered any psychiatric medication without prior informed consent. Existing law authorizes a county department of mental health, or other designated county department, to involuntarily administer psychiatric medication to an inmate on a nonemergency basis only after the inmate is provided, among other things, a hearing before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer. Existing law also provides for the involuntary administration of psychiatric medication to an inmate in an emergency situation. Existing law limits the duration during which an inmate can be involuntarily administered psychiatric medication on an emergency basis and requires that, except as specified, the inmate be provided the same due process protections they would be entitled to when psychiatric medication is involuntarily administered on a nonemergency basis. Existing law specifies that an emergency exists for these purposes when there is a sudden and marked change in an inmates mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others and it is impractical, due to the seriousness of the emergency, to first obtain informed consent.

This bill would, if a defendant an individual has been found incompetent to stand trial after having been charged with a misdemeanor, additionally authorize a psychiatrist to administer psychiatric the administration of antipsychotic medication to the defendant individual without their prior informed consent on an emergency basis when treatment is immediately necessary for the preservation of life or the prevention of serious bodily harm and it is impracticable to first gain consent. necessary to address the emergency condition and the medication is administered in the least restrictive manner, as specified. The bill would specify that a determination made pursuant to these provisions is valid for one year after the date of the initial determination of the emergency, 90 days after the date the defendant is referred to one of the programs described above, or upon order of any court with jurisdiction over the defendant, whichever occurs first. The bill would also authorize a psychiatrist to involuntarily administer psychiatric medication to those defendants upon a courts determination that the defendant does not have the capacity to refuse treatment and is gravely disabled on the basis that they, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, are unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care. The bill would establish various procedures to be followed when psychiatric medication is involuntarily administered pursuant to these provisions. up to 72 hours if the medication is necessary to address the emergency condition, except as provided. The bill would require the court, prior to issuing an involuntary medication order after hearing, to find by clear and convincing evidence that, among other things, a psychiatrist or psychologist has determined that the individual has a serious mental health disorder that can be treated with antipsychotic medication, and there is no less intrusive alternative to the involuntary administration of antipsychotic medication, and involuntary administration of the medication is in the individuals best interest. The bill would also enumerate certain rights for individuals, prior to the administration of involuntary medication pursuant to these provisions.

Existing law prohibits a person from being tried or adjudged to punishment while that person is mentally incompetent. Existing law establishes a process by which a defendants mental competency is evaluated. Existing law, in the case of a misdemeanor charge in which the defendant is found incompetent, requires the court to hold a hearing to determine if the defendant is eligible for diversion. Existing law requires, if the defendant is not eligible for diversion, the court to hold a hearing to determine whether the defendant will be referred to outpatient treatment, conservatorship, or the CARE program, or if the defendants treatment plan will be modified. Existing law requires the court to dismiss the case if a defendant does not qualify for the above-described services.

Existing law prohibits, except as specified, a person confined in a county jail from being administered any psychiatric medication without prior informed consent. Existing law authorizes a county department of mental health, or other designated county department, to involuntarily administer psychiatric medication to an inmate on a nonemergency basis only after the inmate is provided, among other things, a hearing before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer. Existing law also provides for the involuntary administration of psychiatric medication to an inmate in an emergency situation. Existing law limits the duration during which an inmate can be involuntarily administered psychiatric medication on an emergency basis and requires that, except as specified, the inmate be provided the same due process protections they would be entitled to when psychiatric medication is involuntarily administered on a nonemergency basis. Existing law specifies that an emergency exists for these purposes when there is a sudden and marked change in an inmates mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others and it is impractical, due to the seriousness of the emergency, to first obtain informed consent.

This bill would, if a defendant has been found incompetent to stand trial after having been charged with a misdemeanor, additionally authorize a psychiatrist to administer psychiatric medication to the defendant without their informed consent on an emergency basis when treatment is immediately necessary for the preservation of life or the prevention of serious bodily harm and it is impracticable to first gain consent. The bill would specify that a determination made pursuant to these provisions is valid for one year after the date of the initial determination of the emergency, 90 days after the date the defendant is referred to one of the programs described above, or upon order of any court with jurisdiction over the defendant, whichever occurs first. The bill would also authorize a psychiatrist to involuntarily administer psychiatric medication to those defendants upon a courts determination that the defendant does not have the capacity to refuse treatment and is gravely disabled on the basis that they, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, are unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care. The bill would establish various procedures to be followed when psychiatric medication is involuntarily administered pursuant to these provisions.

 UNFINISHED BUSINESS 

Bill No: SB 820

Author: Stern (D)

Amended: 7/7/25

Vote: 21

SENATE PUBLIC SAFETY COMMITTEE: 6-0, 4/29/25

AYES: Arreguín, Seyarto, Caballero, Gonzalez, Pérez, Wiener

SENATE FLOOR: 39-0, 5/27/25

AYES: Allen, Alvarado-Gil, Archuleta, Arreguín, Ashby, Becker, Blakespear, Cabaldon, Caballero, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, Limón, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Valladares, Wahab, Weber Pierson, Wiener

NO VOTE RECORDED: Reyes

ASSEMBLY FLOOR: 70-0, 9/10/25 - See last page for vote

SUBJECT: Inmates: mental health

SOURCE: Author

DIGEST:

This bill authorizes, until January 1, 2030, a separate process to involuntarily medicate individuals charged with a misdemeanor who have been found to be incompetent to stand trial (IST), as specified.

Assembly Amendments

of 7/7/25

1. Revise the procedures and specify an individual’s rights before an order authorizing the administration of involuntary medication may be issued.
2. Specify that an individual is not precluded from filing a petition for habeas corpus to challenge the continuing validity of an order authorizing the administration of antipsychotic medication.
   
3. Sunset its provisions on January 1, 2030, unless a later enacted statute deletes or extends the date.

ANALYSIS:

Existing law:

1. Provides that a person shall not be tried or adjudged to punishment while mentally incompetent. (Penal (Pen.) Code, § 1367, subd. (a).)
2. Specifies procedures for inquiring into and determining mental competence, including suspending criminal proceedings, as specified. (Pen. Code, § 1368, subd. (b) & (c).)
3. Requires, if the defendant is found mentally competent, the criminal process to resume, and the trial on the offense charges to proceed. (Pen. Code, §§ 1370; 1370.01.)
4. Establishes the procedures for the treatment of individuals found IST and charged with a misdemeanor, as follows:
   1. The trial, judgment, or hearing on the alleged misdemeanor is suspended and the court must conduct a hearing on whether the defendant is eligible for mental health diversion;
   2. If the court finds that the defendant is not eligible for diversion, the court must hold a hearing to determine which of the following actions to take:
      1. Order modification of an existing mental health diversion treatment plan in accordance with a recommendation from a treatment provider;
      2. Refer the defendant to outpatient treatment;
      3. Refer defendant for possible conservatorship proceedings;
      4. Refer the defendant to the Community Assistance, Recovery and Empowerment (CARE) program; or
      5. Dismiss the charges if the defendant does not qualify for these services; and,
   3. If the misdemeanor charges are dismissed, and the individual is not receiving the above-described services, the court must notify the defendant of their need for mental health services. The court shall additionally provide the individual with contact information of specified mental health services. (Pen. Code, §§ 1370.01, 1370.2; Welf. & Inst. Code, § 5623.6, subd. (b); Cal. Rules of Court, rule 4.130, subds. (f)(1) & (3).)
5. States the Legislature's intent that the court consider all treatment options, as provided, prior to dismissing criminal charges but allows the court to dismiss any misdemeanor charges pending against a defendant found IST in the interests of justice. (Pen. Code, §§ 1370.01, subd. (e), 1385.)
6. States the Legislature's intent that a defendant subject to the misdemeanor IST procedures receive mental health treatment in a treatment facility and not a jail. (Pen. Code, § 1370.01, subd. (c).)
7. Allows the court to dismiss any misdemeanor charges pending against a defendant found IST. (Pen. Code, § 1370.2.)
8. Requires the court to dismiss the criminal charges at the end of the diversion period if the individual performs satisfactorily on diversion. (Pen. Code, § 1370.01, subd. (e).)
9. Establishes mental health diversion for misdemeanor and felony offenses and sets forth eligibility requirements. (Pen. Code, §§ 1001.35 & 1001.36.)
10. Authorizes the administration of psychotropic medication on an involuntary basis to a defendant confined in the county jail if a psychiatrist determines that they should be treated with psychiatric medication, specified procedures are followed, and the treatment is consistent with the standard of care. (Pen. Code, § 2603, subd. (b).)
11. Specifies that, on a non-emergency basis, a county department of mental health, or other designated county department, may administer involuntary psychiatric medication to a defendant confined in the county jail only if all of the following conditions have been met:
    1. A psychiatrist or psychologist has determined that the inmate has a serious mental disorder;
    2. A psychiatrist or psychologist has determined that, as a result of that mental disorder, the inmate is gravely disabled and does not have the capacity to refuse treatment with psychiatric medications, or is a danger to self or others;
    3. A psychiatrist has prescribed one or more psychiatric medications for the treatment of the inmate's disorder, has considered the risks, benefits, and treatment alternatives to involuntary medication, and has determined that the treatment alternatives to involuntary medication are unlikely to meet the needs of the patient;
    4. The inmate has been advised of the risks and benefits of, and treatment alternatives to, the psychiatric medication and refuses, or is unable to consent to, the administration of the medication;
    5. The jail has made a documented attempt to locate an available bed for the inmate in a community-based treatment facility in lieu of seeking to administer involuntary medication. The jail shall transfer that inmate to such a facility only if the facility can provide care for the mental health needs, and the physical health needs, if any, of the inmate and upon the agreement of the facility;
    6. The inmate is provided a hearing before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer:
       1. If the inmate is in custody awaiting trial, including an inmate whose criminal proceedings are suspended for competency proceedings, the hearing and any ex parte orders shall be submitted to a judge in the superior court where the criminal case is pending; and,
       2. A superior court judge may consider whether involuntary medication would prejudice the incarcerated person's defense;
    7. The inmate is provided counsel at least 21 days prior to the hearing, unless emergency medication is being administered, in which case the inmate would receive expedited access to counsel, as specified;
    8. The inmate and counsel are provided with written notice of the hearing at least 21 days prior to the hearing, unless emergency or interim medication is being administered, in which case the inmate would receive an expedited hearing;
    9. In the hearing, the superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer determines by clear and convincing evidence that the inmate has a mental illness or disorder, that as a result of that illness, the inmate is gravely disabled and lacks the capacity to consent to or refuse treatment with psychiatric medications or is a danger to self or others if not medicated, that there is no less intrusive alternative to involuntary medication, and that the medication is in the inmate's best medical interest;
    10. The historical course of the inmate's mental disorder, as determined by available relevant information about the course of the inmate's mental disorder, shall be considered when it has direct bearing on the determination of whether the inmate is a danger to self or others, or is gravely disabled and incompetent to refuse medication as the result of a mental disorder; and,
    11. An inmate is entitled to file one motion for reconsideration following a determination that they may receive involuntary medication, and may seek a hearing to present new evidence, upon good cause shown. This does not prevent a court from reviewing, modifying, or terminating an involuntary medication order for an inmate awaiting trial if there is a showing that the involuntary medication is interfering with the inmate's due process rights in the criminal proceeding. (Pen. Code, § 2603, subd. (c).)
12. Provides that a physician may take appropriate action in an emergency. (Pen. Code, § 2603, subd. (d).)
13. States that an emergency exists when there is a sudden and marked change in an inmate's mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others, and it is impractical, due to the seriousness of the emergency, to first obtain informed consent. (Pen. Code, § 2603, subd. (d)(1)(A).)
14. Specifies that if psychiatric medication is administered to a person incarcerated in the county jail on an emergency basis, the medication shall only be that which is required to treat the emergency condition and shall be administered for only so long as the emergency continues to exist. (Pen. Code, § 2603, subd. (d)(1)(B).)
15. States that if the clinicians of the county department of mental health, or other designated county department, identify a situation that jeopardizes the inmate's health or well-being as the result of a serious mental illness, and necessitates the continuation of medication beyond the initial 72 hours pending the full mental health hearing, the county department may seek to continue the medication by giving notice to the inmate and their counsel of its intention to seek an ex parte order to allow the continuance of medication pending the full hearing. If an order is issued, the psychiatrist may continue the administration of the medication until the hearing is held. (Pen. Code, § 2603, subd. (d)(2)(A).)
16. Specifies that in any case in which it appears to the person in charge of a jail, or juvenile detention facility, or to a judge, that a person in custody in that jail or juvenile detention facility may be mentally disordered, they may cause the prisoner to be taken to a facility for 72-hour treatment and evaluation and they shall inform the facility in writing, which shall be confidential, of the reasons that the person is being taken to the facility. (Pen. Code, § 4011.6; Welf. & Inst. Code, § 5150.)
17. Provides that an order by the court authorizing involuntary medication of an inmate shall be valid for no more than one year. In the case of an incarcerated person awaiting arraignment, trial or sentencing, the order shall be valid for no more than 180 days and the court shall review the order at intervals of not more than 60 days to determine whether the ground for the order remains. At each review, the psychiatrist shall file an affidavit with the court that ordered the involuntary medication affirming that the person who is the subject of the order continues to meet the criteria for involuntary medication. A copy of the affidavit shall be provided to the defendant and the defendant's attorney. (Pen Code, § 2603, subd. (e)(1).)
18. States that in determining whether the criteria for involuntary medication still exist, the court shall consider the affidavit of the psychiatrist or psychiatrists and any supplemental information provided by the defendant's attorney. The court may also require the testimony from the psychiatrist, if necessary. The court, at each review, may continue the order authorizing involuntary medication, vacate the order, or make any other appropriate order. (Pen Code, § 2603, subd. (e)(1).)
19. States that if a determination has been made to involuntarily medicate a county jail inmate, the medication shall be discontinued one year after the date of that determination, unless the inmate gives their informed consent to the administration of the medication, or unless a new determination is made pursuant to the procedures set forth above. (Pen. Code, § 2603, subd. (f).)

This bill:

1. States, notwithstanding existing procedures for involuntary medication of pretrial county jail inmates, if an individual charged with a misdemeanor and who is confined in county jail has been found IST, antipsychotic medication may be administered without the defendant’s informed consent in either an emergency, as defined, or upon a court’s determination that the defendant is gravely disabled, as defined, and does not have the capacity to consent to or refuse treatment with antipsychotic medication.
2. Provides that in case of an emergency, the following procedures apply:
   1. Antipsychotic medication may, despite the individual’s objection, be administered before a capacity hearing if the medication is necessary to address the emergency condition and is administered in the least restrictive manner, only for the duration of the emergency, and in no case for more than 72 hours, except as provided below.
   2. If a psychiatrist determines that continued administration of antipsychotic medication is necessary beyond the initial 72 hours and the individual does not consent to take the medication voluntarily, the psychiatrist may petition the superior court in the county where the individual is confined to order continued treatment with antipsychotic medication.
   3. The petition and written notice describing the diagnosis, the factual basis for the diagnosis, the expected benefits of the medication, any potential side effects and risks of the medication, and any alternatives to treatment with the medication shall be filed within the initial 72-hour period that the antipsychotic medication is administered and served on the individual and their counsel.
3. Defines an “emergency” by way of reference to existing provisions of law, as either:
   1. A situation in which action to impose treatment over the person’s objection is immediately necessary for the preservation of life or the prevention of serious bodily harm to the patient or others, and it is impracticable to first gain consent. It is not necessary for harm to take place or become unavoidable prior to treatment; or,
   2. When there is a sudden and marked change in an inmate’s mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others, and it is impractical, due to the seriousness of the emergency, to first obtain informed consent.
4. Defines “gravely disabled” by way of reference to existing law as a condition in which a person, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.
5. Provides that upon a court’s determination that an individual is gravely disabled and that the individual does not have the capacity to consent to or refuse treatment with antipsychotic medication, the court shall consider opinions in the reports prepared by a licensed psychologist or psychiatrist evaluating the individual’s competency as applicable to the issue of whether the individual lacks the capacity to make decisions regarding the administration of antipsychotic medication, and shall proceed as follows:
   1. The court shall conduct a hearing, which may occur at the same time as the competency hearing, before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer to determine whether any of the following is true:
      1. Based upon the opinion of the psychiatrist or licensed psychologist offered to the court, the individual lacks the capacity to make decisions regarding antipsychotic medication, the individual’s mental disorder requires medical treatment with antipsychotic medication, and, if the individual’s mental disorder is not treated with antipsychotic medication, it is probable that serious harm to the physical or mental health of the individual will result. Probability of serious harm to the physical or mental health of the individual requires evidence that the individual is presently suffering adverse effects to their physical or mental health, or the individual has previously suffered these effects as a result of a mental disorder and their condition is substantially deteriorating. The fact that an individual has a diagnosis of a mental disorder does not alone establish probability of serious harm to the physical or mental health of the individual.
      2. Based upon the opinion of the psychiatrist or licensed psychologist offered to the court, the individual is a danger to others, in that the individual has inflicted, attempted to inflict, or made a serious threat of inflicting substantial physical harm on another while in custody, or the individual had inflicted, attempted to inflict, or made a serious threat of inflicting substantial physical harm on another that resulted in the individual being taken into custody, and the individual presents, as a result of mental disorder or mental defect, a danger of inflicting substantial physical harm to others.
   2. If the court finds the conditions described above to be true, and has considered the requisite conditions as specified in 8) below, and if pursuant to the opinion offered to the court on the individual’s competency, a psychiatrist or licensed psychologist has opined that treatment with antipsychotic medication may be appropriate for the individual, the court may issue an order authorizing the administration of antipsychotic medication as needed, including on an involuntary basis, to be administered under the direction and supervision of a licensed psychiatrist.
6. Provides the following rights to an individual before an order authorizing involuntary medication:
   1. To receive written notice of the diagnosis, the factual basis for the diagnosis, the expected benefits of the medication, any potential side effects and risks of the medication, and any alternatives to treatment with the medication;
   2. To be represented by counsel at all stages of the proceedings;
   3. To receive timely access to their medical records and files;
   4. To be present at all stages of the proceedings; and,
   5. To present evidence and cross-examine witnesses.
7. States that after the hearing, a court may order involuntary medication to be administered if the court finds by clear and convincing evidence that all of the following conditions are met:
   1. A psychiatrist or psychologist has determined that the individual has a serious mental health disorder that can be treated with antipsychotic medication;
   2. A psychiatrist or psychologist has determined that, as a result of that mental health disorder, the individual is gravely disabled and lacks the capacity to consent to, or refuse treatment with, antipsychotic medications;
   3. That serious harm to the physical or mental health of the individual is likely to result absent treatment with antipsychotic medication;
   4. A psychiatrist has prescribed one or more antipsychotic medications for the treatment of the individual’s disorder, has considered the risk, benefits, and treatment alternatives to involuntary medication, and has determined that the treatment alternatives to involuntary medication are unlikely to meet the needs of the individual;
   5. The individual has been advised of the expected benefits of any potential side effects and risks to the individual, any alternatives to treatment with antipsychotic medication, and refuses, or is unable to consent to, the administration of the medication;
   6. The jail has made a documented attempt to locate an available bed for the individual in a community-based treatment facility in lieu of seeking to administer involuntary medication. If a community-based alternative is not available, medication shall only be administered by noncustody, health care staff and individuals will be monitored at least every 15 minutes for at least one hour after administration of medication; and,
   7. There is no less intrusive alternative to the involuntary administration of antipsychotic medication, and involuntary administration of the medication is in the individual’s best medical interest.
8. Prohibits the individual’s confinement form being extended to provide treatment to the individual with antipsychotic medication.
9. States that an order authorizing administration of antipsychotic medication shall be valid until the first of the following events occurs:
   1. 90 days from the date the individual is found IST;
   2. 90 days after the date when the individual is referred to Community Assistance, Recovery, and Empowerment (CARE) court, assisted outpatient treatment or county conservatorship;
   3. Upon order of any court with jurisdiction over the individual including the programs listed above; or,
   4. The individual is released from custody.
10. Requires the court to review the order no more than 60 days after an involuntary medication order is issued to determine whether the grounds for the order remains.
11. States that a person who is subject to the court’s order to involuntarily receive medication has the legal and civil rights set forth in the Lanterman-Petris-Short Act.
12. Specifies that an individual is not precluded from filing a petition for habeas corpus to challenge the continuing validity of an order authorizing the administration of antipsychotic medication.
13. Provides that when a person in custody is transferred from a jail to a 72-hour facility for treatment and evaluation, the fact that the person has temporary access to food, clothing, shelter, personal safety, and necessary medical care while incarcerated is not a basis to conclude that the person is able to provide for their basic personal needs, which shall be evaluated based upon the person’s ability to provide for those needs outside the jail setting.
14. Sunsets its provisions on January 1, 2030 unless a later enacted statute deletes or extends the date.

Background

This bill creates an alternative process to allow involuntarily medication of persons who are confined in the county jail and have been found IST after being charged with a misdemeanor. The bill provides for the ability to involuntarily medicate in an emergency situation, as defined, or where a court has found a defendant to be gravely disabled and without the capacity to refuse treatment with psychiatric medication.

According to information provided by the author’s office, this bill is necessary because when SB 317 (Stern), Chapter 99, Statutes of 2021, made significant updates to the IST system for misdemeanor offenses, streamlining access to treatment and reducing jail time, it inadvertently limited the ability of psychiatrists to utilize all available tools at their disposal, including involuntary medication. “Regardless of medical necessity, the severity of an individual’s condition, or how negatively it impacts their wellbeing and treatment access, there is no mechanism to compel individuals to take prescribed medication if they refuse.”

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Assembly Appropriations Committee:

Cost pressures (Trial Court Trust Fund, General Fund) of an unknown but likely significant amount, possibly in the low millions of dollars annually, to the courts to conduct additional hearings and for medical evaluations and expert testimony. Judicial Council estimates costs of $1.77 million to $4.25 million annually ongoing to fulfill these responsibilities. Within that estimate, Judicial Council attributes approximately half of the costs to additional hearings that may not occur in conjunction with a competency hearing, and additional hearing time to consider involuntary medication orders. Judicial Council attributes the other half of the costs to psychiatric evaluations and for court-appointed evaluators’ testimony at hearings. Judicial Council notes there is currently a shortage in psychiatric evaluators in many parts of the state and there may be delays in scheduling these hearings due if, due to the shortage, courts are unable to timely obtain the required evaluation.

Although courts are not funded on the basis of workload, increased pressure on the Trial Court Trust Fund may create a demand for increased funding for courts from the General Fund. The fiscal year (FY) 2025-26 state budget provides $82 million ongoing General Fund to the Trial Court Trust Fund for court operations. Judicial Council notes that beginning in FY 2025-26, the trial courts are handling an ongoing $55 million reduction to their operational funding, which impacts their ability to provide core services. Judicial Council reports this bill will result in new, unfunded workload for the trial courts, putting additional pressure on their limited resources.

SUPPORT: (Verified 9/10/25)

California State Association of Psychiatrists (Sponsor)

Alameda County Families Advocating for the Seriously Mentally Ill

California Big City Mayors Coalition

California Medical Association

California State Sheriffs' Association

City of San Diego

Family Advocates for Individuals With Serious Mental Illness of Sacramento

National Alliance on Mental Illness

Steinberg Institute

Treatment Advocacy Center

Private Individual

OPPOSITION: (Verified 9/10/25)

ACLU California Action

Cal Voices

California Coalition for Women Prisoners

California Peer Watch

Courage California

Disability Rights California

Justice2jobs Coalition Sacramento

Initiate Justice

LA Defensa

Survived & Punished

ARGUMENTS IN SUPPORT:

According to the California State Association of Psychiatrists, the sponsor of this bill:

SB 820 . . . ensures that a defendant found incompetent to stand trial (IST) for a misdemeanor offense is provided the appropriate medical treatment and supportive services needed for them to achieve wellness.

In the event of a defendant lacking mental competency to understand court proceedings, a judge may find them incompetent to stand trial (IST). In such cases, they are then offered alternatives, such as mental health diversion and assisted outpatient treatment (AOT). However, many defendants do not access these alternatives due to the severity of their symptoms and the fact that these programs remain voluntary. Should they be found ineligible or refuse to participate, their cases are typically dismissed with no further requirements of behavioral health services. This gap in care has severe consequences on recidivism rates and homelessness for this population despite them having been identified by the court as exceedingly vulnerable.

SB 317 (Stern, 2021) made significant updates to the IST system for misdemeanor offenses. However, it inadvertently limited the ability of psychiatrists to utilize all available tools at their disposal, including involuntary medication. Regardless of medical necessity, there is currently no mechanism to compel these individuals to take prescribed medication – a crucial tool in stabilizing patients.

California faces a significant and ongoing shortage of bed space. Because of this, these individuals often spend extended periods in jail while their mental health declines, ultimately making successful reintegration even more difficult. Until infrastructure catches up to demand, it is vital that the ability to provide involuntary medication during the crucial period between the IST hearing and the proffer of services be reinstated – exactly what SB 820 aims to do while retaining existing protections. Doing so will improve their chances of accepting and benefiting from treatment while reducing recidivism and homelessness.

ARGUMENTS IN OPPOSITION:

According to California Peer Watch:

SB 820 would authorize a psychiatrist to administer psychiatric medication to a defendant without their informed consent. While the bill indicates that this would be only on an emergency basis when it is impracticable to first gain consent, this criterion has been regularly abused to justify inappropriate forced treatment over the years, and increasingly in the past three years.

The bill would authorize a psychiatrist to involuntarily administer psychiatric medication to those defendants upon a court’s determination that the defendant does not have the capacity to refuse treatment and is gravely disabled on the basis that they, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, are unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care. These criteria also constitute boilerplate language used to justify forced treatment.

While we understand that many freedoms are denied to inmates, their basic human and constitutional rights should not be violated.

ASSEMBLY FLOOR: 9/10/25 70-0

AYES: Addis, Aguiar-Curry, Ahrens, Alanis, Alvarez, Arambula, Ávila Farías, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Calderon, Caloza, Carrillo, Castillo, Chen, Connolly, Davies, DeMaio, Dixon, Elhawary, Ellis, Fong, Gabriel, Garcia, Gipson, Jeff Gonzalez, Mark González, Hadwick, Haney, Harabedian, Hart, Hoover, Irwin, Jackson, Johnson, Krell, Lackey, Lowenthal, Macedo, McKinnor, Muratsuchi, Nguyen, Ortega, Pacheco, Papan, Patel, Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Ransom, Michelle Rodriguez, Rogers, Blanca Rubio, Sanchez, Schiavo, Schultz, Sharp-Collins, Solache, Soria, Stefani, Ta, Valencia, Wallis, Wicks, Wilson, Rivas

NO VOTE RECORDED: Bonta, Bryan, Flora, Gallagher, Kalra, Lee, Celeste Rodriguez, Tangipa, Ward, Zbur

Prepared by: Cheryl Anderson / PUB. S. / (916) 651-4118

7/23/26 11:58:56

**** END ****

 UNFINISHED BUSINESS  

Bill No: SB 820

Author: Stern (D)

Amended: 7/7/25 in Assembly

Vote: 21

SENATE PUBLIC SAFETY COMMITTEE: 6-0, 4/29/25

AYES: Arreguín, Seyarto, Caballero, Gonzalez, Pérez, Wiener

SENATE FLOOR: 39-0, 5/27/25

AYES: Allen, Alvarado-Gil, Archuleta, Arreguín, Ashby, Becker, Blakespear, Cabaldon, Caballero, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, Limón, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Valladares, Wahab, Weber Pierson, Wiener

NO VOTE RECORDED: Reyes

ASSEMBLY FLOOR: 51-1, 9/10/25 – Roll call not available.

SUBJECT: Inmates: mental health

SOURCE: Author

DIGEST:

This bill authorizes, until January 1, 2030, a separate process to involuntarily medicate individuals charged with a misdemeanor who have been found to be incompetent to stand trial (IST), as specified.

Assembly Amendments

of 7/7/25

1. Revise the procedures and specify an individual’s rights before an order authorizing the administration of involuntary medication may be issued.
2. Specify that an individual is not precluded from filing a petition for habeas corpus to challenge the continuing validity of an order authorizing the administration of antipsychotic medication.
   
3. Sunset its provisions on January 1, 2030, unless a later enacted statute deletes or extends the date.

ANALYSIS:

Existing law:

1. Provides that a person shall not be tried or adjudged to punishment while mentally incompetent. (Penal (Pen.) Code, § 1367, subd. (a).)
2. Specifies procedures for inquiring into and determining mental competence, including suspending criminal proceedings, as specified. (Pen. Code, § 1368, subd. (b) & (c).)
3. Requires, if the defendant is found mentally competent, the criminal process to resume, and the trial on the offense charges to proceed. (Pen. Code, §§ 1370; 1370.01.)
4. Establishes the procedures for the treatment of individuals found IST and charged with a misdemeanor, as follows:
   1. The trial, judgment, or hearing on the alleged misdemeanor is suspended and the court must conduct a hearing on whether the defendant is eligible for mental health diversion;
   2. If the court finds that the defendant is not eligible for diversion, the court must hold a hearing to determine which of the following actions to take:
      1. Order modification of an existing mental health diversion treatment plan in accordance with a recommendation from a treatment provider;
      2. Refer the defendant to outpatient treatment;
      3. Refer defendant for possible conservatorship proceedings;
      4. Refer the defendant to the Community Assistance, Recovery and Empowerment (CARE) program; or
      5. Dismiss the charges if the defendant does not qualify for these services; and,
   3. If the misdemeanor charges are dismissed, and the individual is not receiving the above-described services, the court must notify the defendant of their need for mental health services. The court shall additionally provide the individual with contact information of specified mental health services. (Pen. Code, §§ 1370.01, 1370.2; Welf. & Inst. Code, § 5623.6, subd. (b); Cal. Rules of Court, rule 4.130, subds. (f)(1) & (3).)
5. States the Legislature's intent that the court consider all treatment options, as provided, prior to dismissing criminal charges but allows the court to dismiss any misdemeanor charges pending against a defendant found IST in the interests of justice. (Pen. Code, §§ 1370.01, subd. (e), 1385.)
6. States the Legislature's intent that a defendant subject to the misdemeanor IST procedures receive mental health treatment in a treatment facility and not a jail. (Pen. Code, § 1370.01, subd. (c).)
7. Allows the court to dismiss any misdemeanor charges pending against a defendant found IST. (Pen. Code, § 1370.2.)
8. Requires the court to dismiss the criminal charges at the end of the diversion period if the individual performs satisfactorily on diversion. (Pen. Code, § 1370.01, subd. (e).)
9. Establishes mental health diversion for misdemeanor and felony offenses and sets forth eligibility requirements. (Pen. Code, §§ 1001.35 & 1001.36.)
10. Authorizes the administration of psychotropic medication on an involuntary basis to a defendant confined in the county jail if a psychiatrist determines that they should be treated with psychiatric medication, specified procedures are followed, and the treatment is consistent with the standard of care. (Pen. Code, § 2603, subd. (b).)
11. Specifies that, on a non-emergency basis, a county department of mental health, or other designated county department, may administer involuntary psychiatric medication to a defendant confined in the county jail only if all of the following conditions have been met:
    1. A psychiatrist or psychologist has determined that the inmate has a serious mental disorder;
    2. A psychiatrist or psychologist has determined that, as a result of that mental disorder, the inmate is gravely disabled and does not have the capacity to refuse treatment with psychiatric medications, or is a danger to self or others;
    3. A psychiatrist has prescribed one or more psychiatric medications for the treatment of the inmate's disorder, has considered the risks, benefits, and treatment alternatives to involuntary medication, and has determined that the treatment alternatives to involuntary medication are unlikely to meet the needs of the patient;
    4. The inmate has been advised of the risks and benefits of, and treatment alternatives to, the psychiatric medication and refuses, or is unable to consent to, the administration of the medication;
    5. The jail has made a documented attempt to locate an available bed for the inmate in a community-based treatment facility in lieu of seeking to administer involuntary medication. The jail shall transfer that inmate to such a facility only if the facility can provide care for the mental health needs, and the physical health needs, if any, of the inmate and upon the agreement of the facility;
    6. The inmate is provided a hearing before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer:
       1. If the inmate is in custody awaiting trial, including an inmate whose criminal proceedings are suspended for competency proceedings, the hearing and any ex parte orders shall be submitted to a judge in the superior court where the criminal case is pending; and,
       2. A superior court judge may consider whether involuntary medication would prejudice the incarcerated person's defense;
    7. The inmate is provided counsel at least 21 days prior to the hearing, unless emergency medication is being administered, in which case the inmate would receive expedited access to counsel, as specified;
    8. The inmate and counsel are provided with written notice of the hearing at least 21 days prior to the hearing, unless emergency or interim medication is being administered, in which case the inmate would receive an expedited hearing;
    9. In the hearing, the superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer determines by clear and convincing evidence that the inmate has a mental illness or disorder, that as a result of that illness, the inmate is gravely disabled and lacks the capacity to consent to or refuse treatment with psychiatric medications or is a danger to self or others if not medicated, that there is no less intrusive alternative to involuntary medication, and that the medication is in the inmate's best medical interest;
    10. The historical course of the inmate's mental disorder, as determined by available relevant information about the course of the inmate's mental disorder, shall be considered when it has direct bearing on the determination of whether the inmate is a danger to self or others, or is gravely disabled and incompetent to refuse medication as the result of a mental disorder; and,
    11. An inmate is entitled to file one motion for reconsideration following a determination that they may receive involuntary medication, and may seek a hearing to present new evidence, upon good cause shown. This does not prevent a court from reviewing, modifying, or terminating an involuntary medication order for an inmate awaiting trial if there is a showing that the involuntary medication is interfering with the inmate's due process rights in the criminal proceeding. (Pen. Code, § 2603, subd. (c).)
12. Provides that a physician may take appropriate action in an emergency. (Pen. Code, § 2603, subd. (d).)
13. States that an emergency exists when there is a sudden and marked change in an inmate's mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others, and it is impractical, due to the seriousness of the emergency, to first obtain informed consent. (Pen. Code, § 2603, subd. (d)(1)(A).)
14. Specifies that if psychiatric medication is administered to a person incarcerated in the county jail on an emergency basis, the medication shall only be that which is required to treat the emergency condition and shall be administered for only so long as the emergency continues to exist. (Pen. Code, § 2603, subd. (d)(1)(B).)
15. States that if the clinicians of the county department of mental health, or other designated county department, identify a situation that jeopardizes the inmate's health or well-being as the result of a serious mental illness, and necessitates the continuation of medication beyond the initial 72 hours pending the full mental health hearing, the county department may seek to continue the medication by giving notice to the inmate and their counsel of its intention to seek an ex parte order to allow the continuance of medication pending the full hearing. If an order is issued, the psychiatrist may continue the administration of the medication until the hearing is held. (Pen. Code, § 2603, subd. (d)(2)(A).)
16. Specifies that in any case in which it appears to the person in charge of a jail, or juvenile detention facility, or to a judge, that a person in custody in that jail or juvenile detention facility may be mentally disordered, they may cause the prisoner to be taken to a facility for 72-hour treatment and evaluation and they shall inform the facility in writing, which shall be confidential, of the reasons that the person is being taken to the facility. (Pen. Code, § 4011.6; Welf. & Inst. Code, § 5150.)
17. Provides that an order by the court authorizing involuntary medication of an inmate shall be valid for no more than one year. In the case of an incarcerated person awaiting arraignment, trial or sentencing, the order shall be valid for no more than 180 days and the court shall review the order at intervals of not more than 60 days to determine whether the ground for the order remains. At each review, the psychiatrist shall file an affidavit with the court that ordered the involuntary medication affirming that the person who is the subject of the order continues to meet the criteria for involuntary medication. A copy of the affidavit shall be provided to the defendant and the defendant's attorney. (Pen Code, § 2603, subd. (e)(1).)
18. States that in determining whether the criteria for involuntary medication still exist, the court shall consider the affidavit of the psychiatrist or psychiatrists and any supplemental information provided by the defendant's attorney. The court may also require the testimony from the psychiatrist, if necessary. The court, at each review, may continue the order authorizing involuntary medication, vacate the order, or make any other appropriate order. (Pen Code, § 2603, subd. (e)(1).)
19. States that if a determination has been made to involuntarily medicate a county jail inmate, the medication shall be discontinued one year after the date of that determination, unless the inmate gives their informed consent to the administration of the medication, or unless a new determination is made pursuant to the procedures set forth above. (Pen. Code, § 2603, subd. (f).)

This bill:

1. States, notwithstanding existing procedures for involuntary medication of pretrial county jail inmates, if an individual charged with a misdemeanor and who is confined in county jail has been found IST, antipsychotic medication may be administered without the defendant’s informed consent in either an emergency, as defined, or upon a court’s determination that the defendant is gravely disabled, as defined, and does not have the capacity to consent to or refuse treatment with antipsychotic medication.
2. Provides that in case of an emergency, the following procedures apply:
   1. Antipsychotic medication may, despite the individual’s objection, be administered before a capacity hearing if the medication is necessary to address the emergency condition and is administered in the least restrictive manner, only for the duration of the emergency, and in no case for more than 72 hours, except as provided below.
   2. If a psychiatrist determines that continued administration of antipsychotic medication is necessary beyond the initial 72 hours and the individual does not consent to take the medication voluntarily, the psychiatrist may petition the superior court in the county where the individual is confined to order continued treatment with antipsychotic medication.
   3. The petition and written notice describing the diagnosis, the factual basis for the diagnosis, the expected benefits of the medication, any potential side effects and risks of the medication, and any alternatives to treatment with the medication shall be filed within the initial 72-hour period that the antipsychotic medication is administered and served on the individual and their counsel.
3. Defines an “emergency” by way of reference to existing provisions of law, as either:
   1. A situation in which action to impose treatment over the person’s objection is immediately necessary for the preservation of life or the prevention of serious bodily harm to the patient or others, and it is impracticable to first gain consent. It is not necessary for harm to take place or become unavoidable prior to treatment; or,
   2. When there is a sudden and marked change in an inmate’s mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others, and it is impractical, due to the seriousness of the emergency, to first obtain informed consent.
4. Defines “gravely disabled” by way of reference to existing law as a condition in which a person, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.
5. Provides that upon a court’s determination that an individual is gravely disabled and that the individual does not have the capacity to consent to or refuse treatment with antipsychotic medication, the court shall consider opinions in the reports prepared by a licensed psychologist or psychiatrist evaluating the individual’s competency as applicable to the issue of whether the individual lacks the capacity to make decisions regarding the administration of antipsychotic medication, and shall proceed as follows:
   1. The court shall conduct a hearing, which may occur at the same time as the competency hearing, before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer to determine whether any of the following is true:
      1. Based upon the opinion of the psychiatrist or licensed psychologist offered to the court, the individual lacks the capacity to make decisions regarding antipsychotic medication, the individual’s mental disorder requires medical treatment with antipsychotic medication, and, if the individual’s mental disorder is not treated with antipsychotic medication, it is probable that serious harm to the physical or mental health of the individual will result. Probability of serious harm to the physical or mental health of the individual requires evidence that the individual is presently suffering adverse effects to their physical or mental health, or the individual has previously suffered these effects as a result of a mental disorder and their condition is substantially deteriorating. The fact that an individual has a diagnosis of a mental disorder does not alone establish probability of serious harm to the physical or mental health of the individual.
      2. Based upon the opinion of the psychiatrist or licensed psychologist offered to the court, the individual is a danger to others, in that the individual has inflicted, attempted to inflict, or made a serious threat of inflicting substantial physical harm on another while in custody, or the individual had inflicted, attempted to inflict, or made a serious threat of inflicting substantial physical harm on another that resulted in the individual being taken into custody, and the individual presents, as a result of mental disorder or mental defect, a danger of inflicting substantial physical harm to others.
   2. If the court finds the conditions described above to be true, and has considered the requisite conditions as specified in 8) below, and if pursuant to the opinion offered to the court on the individual’s competency, a psychiatrist or licensed psychologist has opined that treatment with antipsychotic medication may be appropriate for the individual, the court may issue an order authorizing the administration of antipsychotic medication as needed, including on an involuntary basis, to be administered under the direction and supervision of a licensed psychiatrist.
6. Provides the following rights to an individual before an order authorizing involuntary medication:
   1. To receive written notice of the diagnosis, the factual basis for the diagnosis, the expected benefits of the medication, any potential side effects and risks of the medication, and any alternatives to treatment with the medication;
   2. To be represented by counsel at all stages of the proceedings;
   3. To receive timely access to their medical records and files;
   4. To be present at all stages of the proceedings; and,
   5. To present evidence and cross-examine witnesses.
7. States that after the hearing, a court may order involuntary medication to be administered if the court finds by clear and convincing evidence that all of the following conditions are met:
   1. A psychiatrist or psychologist has determined that the individual has a serious mental health disorder that can be treated with antipsychotic medication;
   2. A psychiatrist or psychologist has determined that, as a result of that mental health disorder, the individual is gravely disabled and lacks the capacity to consent to, or refuse treatment with, antipsychotic medications;
   3. That serious harm to the physical or mental health of the individual is likely to result absent treatment with antipsychotic medication;
   4. A psychiatrist has prescribed one or more antipsychotic medications for the treatment of the individual’s disorder, has considered the risk, benefits, and treatment alternatives to involuntary medication, and has determined that the treatment alternatives to involuntary medication are unlikely to meet the needs of the individual;
   5. The individual has been advised of the expected benefits of any potential side effects and risks to the individual, any alternatives to treatment with antipsychotic medication, and refuses, or is unable to consent to, the administration of the medication;
   6. The jail has made a documented attempt to locate an available bed for the individual in a community-based treatment facility in lieu of seeking to administer involuntary medication. If a community-based alternative is not available, medication shall only be administered by noncustody, health care staff and individuals will be monitored at least every 15 minutes for at least one hour after administration of medication; and,
   7. There is no less intrusive alternative to the involuntary administration of antipsychotic medication, and involuntary administration of the medication is in the individual’s best medical interest.
8. Prohibits the individual’s confinement form being extended to provide treatment to the individual with antipsychotic medication.
9. States that an order authorizing administration of antipsychotic medication shall be valid until the first of the following events occurs:
   1. 90 days from the date the individual is found IST;
   2. 90 days after the date when the individual is referred to Community Assistance, Recovery, and Empowerment (CARE) court, assisted outpatient treatment or county conservatorship;
   3. Upon order of any court with jurisdiction over the individual including the programs listed above; or,
   4. The individual is released from custody.
10. Requires the court to review the order no more than 60 days after an involuntary medication order is issued to determine whether the grounds for the order remains.
11. States that a person who is subject to the court’s order to involuntarily receive medication has the legal and civil rights set forth in the Lanterman-Petris-Short Act.
12. Specifies that an individual is not precluded from filing a petition for habeas corpus to challenge the continuing validity of an order authorizing the administration of antipsychotic medication.
13. Provides that when a person in custody is transferred from a jail to a 72-hour facility for treatment and evaluation, the fact that the person has temporary access to food, clothing, shelter, personal safety, and necessary medical care while incarcerated is not a basis to conclude that the person is able to provide for their basic personal needs, which shall be evaluated based upon the person’s ability to provide for those needs outside the jail setting.
14. Sunsets its provisions on January 1, 2030 unless a later enacted statute deletes or extends the date.

Background

This bill creates an alternative process to allow involuntarily medication of persons who are confined in the county jail and have been found IST after being charged with a misdemeanor. The bill provides for the ability to involuntarily medicate in an emergency situation, as defined, or where a court has found a defendant to be gravely disabled and without the capacity to refuse treatment with psychiatric medication.

According to information provided by the author’s office, this bill is necessary because when SB 317 (Stern), Chapter 99, Statutes of 2021, made significant updates to the IST system for misdemeanor offenses, streamlining access to treatment and reducing jail time, it inadvertently limited the ability of psychiatrists to utilize all available tools at their disposal, including involuntary medication. “Regardless of medical necessity, the severity of an individual’s condition, or how negatively it impacts their wellbeing and treatment access, there is no mechanism to compel individuals to take prescribed medication if they refuse.”

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Assembly Appropriations Committee:

Cost pressures (Trial Court Trust Fund, General Fund) of an unknown but likely significant amount, possibly in the low millions of dollars annually, to the courts to conduct additional hearings and for medical evaluations and expert testimony. Judicial Council estimates costs of $1.77 million to $4.25 million annually ongoing to fulfill these responsibilities. Within that estimate, Judicial Council attributes approximately half of the costs to additional hearings that may not occur in conjunction with a competency hearing, and additional hearing time to consider involuntary medication orders. Judicial Council attributes the other half of the costs to psychiatric evaluations and for court-appointed evaluators’ testimony at hearings. Judicial Council notes there is currently a shortage in psychiatric evaluators in many parts of the state and there may be delays in scheduling these hearings due if, due to the shortage, courts are unable to timely obtain the required evaluation.

Although courts are not funded on the basis of workload, increased pressure on the Trial Court Trust Fund may create a demand for increased funding for courts from the General Fund. The fiscal year (FY) 2025-26 state budget provides $82 million ongoing General Fund to the Trial Court Trust Fund for court operations. Judicial Council notes that beginning in FY 2025-26, the trial courts are handling an ongoing $55 million reduction to their operational funding, which impacts their ability to provide core services. Judicial Council reports this bill will result in new, unfunded workload for the trial courts, putting additional pressure on their limited resources.

SUPPORT: (Verified 9/10/25)

California State Association of Psychiatrists (Sponsor)

Alameda County Families Advocating for the Seriously Mentally Ill

California Big City Mayors Coalition

California Medical Association

California State Sheriffs' Association

City of San Diego

Family Advocates for Individuals With Serious Mental Illness of Sacramento

National Alliance on Mental Illness

Steinberg Institute

Treatment Advocacy Center

Private Individual

OPPOSITION: (Verified 9/10/25)

ACLU California Action

Cal Voices

California Coalition for Women Prisoners

California Peer Watch

Courage California

Disability Rights California

Justice2jobs Coalition Sacramento

Initiate Justice

LA Defensa

Survived & Punished

ARGUMENTS IN SUPPORT:

According to the California State Association of Psychiatrists, the sponsor of this bill:

SB 820 . . . ensures that a defendant found incompetent to stand trial (IST) for a misdemeanor offense is provided the appropriate medical treatment and supportive services needed for them to achieve wellness.

In the event of a defendant lacking mental competency to understand court proceedings, a judge may find them incompetent to stand trial (IST). In such cases, they are then offered alternatives, such as mental health diversion and assisted outpatient treatment (AOT). However, many defendants do not access these alternatives due to the severity of their symptoms and the fact that these programs remain voluntary. Should they be found ineligible or refuse to participate, their cases are typically dismissed with no further requirements of behavioral health services. This gap in care has severe consequences on recidivism rates and homelessness for this population despite them having been identified by the court as exceedingly vulnerable.

SB 317 (Stern, 2021) made significant updates to the IST system for misdemeanor offenses. However, it inadvertently limited the ability of psychiatrists to utilize all available tools at their disposal, including involuntary medication. Regardless of medical necessity, there is currently no mechanism to compel these individuals to take prescribed medication – a crucial tool in stabilizing patients.

California faces a significant and ongoing shortage of bed space. Because of this, these individuals often spend extended periods in jail while their mental health declines, ultimately making successful reintegration even more difficult. Until infrastructure catches up to demand, it is vital that the ability to provide involuntary medication during the crucial period between the IST hearing and the proffer of services be reinstated – exactly what SB 820 aims to do while retaining existing protections. Doing so will improve their chances of accepting and benefiting from treatment while reducing recidivism and homelessness.

ARGUMENTS IN OPPOSITION:

According to California Peer Watch:

SB 820 would authorize a psychiatrist to administer psychiatric medication to a defendant without their informed consent. While the bill indicates that this would be only on an emergency basis when it is impracticable to first gain consent, this criterion has been regularly abused to justify inappropriate forced treatment over the years, and increasingly in the past three years.

The bill would authorize a psychiatrist to involuntarily administer psychiatric medication to those defendants upon a court’s determination that the defendant does not have the capacity to refuse treatment and is gravely disabled on the basis that they, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, are unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care. These criteria also constitute boilerplate language used to justify forced treatment.

While we understand that many freedoms are denied to inmates, their basic human and constitutional rights should not be violated.

Prepared by: Cheryl Anderson / PUB. S. /

9/10/25 19:23:16

**** END ****

SENATE THIRD READING

STR Bill Id:SB 820

Author:(Stern)

As Amended Ver:July 7, 2025

Majority vote

SUMMARY

Authorizes, until January 1, 2030, a separate process to involuntarily medicate individuals charged with a misdemeanor who have been found to be incompetent to stand trial (IST), as specified.

Major Provisions

1. States, notwithstanding existing procedures for involuntary medication of pretrial county jail inmates, if an individual charged with a misdemeanor and who is confined in county jail has been found IST, antipsychotic medication may be administered without the defendant′s informed consent in either an emergency, as defined, or upon a court′s determination that the defendant is gravely disabled, as defined, and does not have the capacity to consent to or refuse treatment with antipsychotic medication.
2. Provides that in case of an emergency, the following procedures apply:
   1. Antipsychotic medication may, despite the individual′s objection, be administered before a capacity hearing if the medication is necessary to address the emergency condition and is administered in the least restrictive manner, only for the duration of the emergency, and in no case for more than 72 hours, except as provided below.
   2. If a psychiatrist determines that continued administration of antipsychotic medication is necessary beyond the initial 72 hours and the individual does not consent to take the medication voluntarily, the psychiatrist may petition the superior court in the county where the individual is confined to order continued treatment with antipsychotic medication.
   3. The petition and written notice describing the diagnosis, the factual basis for the diagnosis, the expected benefits of the medication, any potential side effects and risks of the medication, and any alternatives to treatment with the medication shall be filed within the initial 72-hour period that the antipsychotic medication is administered and served on the individual and their counsel.
3. Defines an ″emergency″ by way of reference to existing provisions of law, as either:
   1. A situation in which action to impose treatment over the person′s objection is immediately necessary for the preservation of life or the prevention of serious bodily harm to the patient or others, and it is impracticable to first gain consent. It is not necessary for harm to take place or become unavoidable prior to treatment; or,
   2. When there is a sudden and marked change in an inmate′s mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others, and it is impractical, due to the seriousness of the emergency, to first obtain informed consent.
4. Defines ″gravely disabled″ by way of reference to existing law as a condition in which a person, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.
5. Provides that upon a court′s determination that an individual is gravely disabled and that the individual does not have the capacity to consent to or refuse treatment with antipsychotic medication, the court shall consider opinions in the reports prepared by a licensed psychologist or psychiatrist evaluating the individual′s competency as applicable to the issue of whether the individual lacks the capacity to make decisions regarding the administration of antipsychotic medication, and shall proceed as follows:
   1. The court shall conduct a hearing, which may occur at the same time as the competency hearing, before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer to determine whether any of the following is true:
      1. Based upon the opinion of the psychiatrist or licensed psychologist offered to the court, the individual lacks the capacity to make decisions regarding antipsychotic medication, the individual′s mental disorder requires medical treatment with antipsychotic medication, and, if the individual′s mental disorder is not treated with antipsychotic medication, it is probable that serious harm to the physical or mental health of the individual will result. Probability of serious harm to the physical or mental health of the individual requires evidence that the individual is presently suffering adverse effects to their physical or mental health, or the individual has previously suffered these effects as a result of a mental disorder and their condition is substantially deteriorating. The fact that an individual has a diagnosis of a mental disorder does not alone establish probability of serious harm to the physical or mental health of the individual.
      2. Based upon the opinion of the psychiatrist or licensed psychologist offered to the court, the individual is a danger to others, in that the individual has inflicted, attempted to inflict, or made a serious threat of inflicting substantial physical harm on another while in custody, or the individual had inflicted, attempted to inflict, or made a serious threat of inflicting substantial physical harm on another that resulted in the individual being taken into custody, and the individual presents, as a result of mental disorder or mental defect, a danger of inflicting substantial physical harm to others.
   2. If the court finds the conditions described above to be true, and has considered the requisite conditions as specified in 8) below, and if pursuant to the opinion offered to the court on the individual′s competency, a psychiatrist or licensed psychologist has opined that treatment with antipsychotic medication may be appropriate for the individual, the court may issue an order authorizing the administration of antipsychotic medication as needed, including on an involuntary basis, to be administered under the direction and supervision of a licensed psychiatrist.
6. States that the fact that an individual has temporary access to food, clothing, shelter, personal safety, and necessary medical care while incarcerated is not a basis to conclude that the individual is able to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care, which shall be evaluated based upon the individual′s ability to provide for those needs while not incarcerated.
7. Provides the following rights to an individual before an order authorizing involuntary medication:
   1. To receive written notice of the diagnosis, the factual basis for the diagnosis, the expected benefits of the medication, any potential side effects and risks of the medication, and any alternatives to treatment with the medication;
   2. To be represented by counsel at all stages of the proceedings;
   3. To receive timely access to their medical records and files;
   4. To be present at all stages of the proceedings; and,
   5. To present evidence and cross-examine witnesses.
8. States that after the hearing, a court may order involuntary medication to be administered if the court finds by clear and convincing evidence that all of the following conditions are met:
   1. A psychiatrist or psychologist has determined that the individual has a serious mental health disorder that can be treated with antipsychotic medication;
   2. A psychiatrist or psychologist has determined that, as a result of that mental health disorder, the individual is gravely disabled and lacks the capacity to consent to, or refuse treatment with, antipsychotic medications;
   3. That serious harm to the physical or mental health of the individual is likely to result absent treatment with antipsychotic medication;
   4. A psychiatrist has prescribed one or more antipsychotic medications for the treatment of the individual′s disorder, has considered the risk, benefits, and treatment alternatives to involuntary medication, and has determined that the treatment alternatives to involuntary medication are unlikely to meet the needs of the individual;
   5. The individual has been advised of the expected benefits of any potential side effects and risks to the individual, any alternatives to treatment with antipsychotic medication, and refuses, or is unable to consent to, the administration of the medication;
   6. The jail has made a documented attempt to locate an available bed for the individual in a community-based treatment facility in lieu of seeking to administer involuntary medication. If a community-based alternative is not available, medication shall only be administered by noncustody, health care staff and individuals will be monitored at least every 15 minutes for at least one hour after administration of medication; and,
   7. There is no less intrusive alternative to the involuntary administration of antipsychotic medication, and involuntary administration of the medication is in the individual′s best medical interest.
9. Prohibits the individual′s confinement form being extended to provide treatment to the individual with antipsychotic medication.
10. States that an order authorizing administration of antipsychotic medication shall be valid until the first of the following events occurs:
    1. 90 days from the date the individual is found IST;
    2. 90 days after the date when the individual is referred to Community Assistance, Recovery, and Empowerment (CARE) court, assisted outpatient treatment or county conservatorship;
    3. Upon order of any court with jurisdiction over the individual including the programs listed above; or,
    4. The individual is released from custody.
11. Requires the court to review the order no more than 60 days after an involuntary medication order is issued to determine whether the grounds for the order remains.
12. States that a person who is subject to the court′s order to involuntarily receive medication has the legal and civil rights set forth in the Lanterman-Petris-Short Act.
13. Specifies that an individual is not precluded from filing a petition for habeas corpus to challenge the continuing validity of an order authorizing the administration of antipsychotic medication.
14. Provides that when a person in custody is transferred from a jail to a 72-hour facility for treatment and evaluation, the fact that the person has temporary access to food, clothing, shelter, personal safety, and necessary medical care while incarcerated is not a basis to conclude that the person is able to provide for their basic personal needs, which shall be evaluated based upon the person′s ability to provide for those needs outside the jail setting.
15. Sunsets its provisions on January 1, 2030 unless a later enacted statute deletes or extends the date.

COMMENTS

According to the Author

″California is facing mental health and homelessness crises, where vulnerable individuals are cycling in and out of our jails without getting adequate treatment. While the state has made massive investments in behavioral health infrastructure, it′s going to take time for new beds to come online. In the meantime, demand is urgent and growing. Jails have become de facto treatment facilities, leaving vulnerable Californians who need treatment with minimal support and resources. The problem is acute for those declared incompetent to stand trial (IST) for a misdemeanor, who are experiencing severe mental health crises and have particularly high rates of recidivism. SB 820 builds on efforts to keep these individuals safe, out of the criminal justice system, and getting the help they need by granting doctors the discretion to use the medical treatment they deem most appropriate, including involuntary medication. By allowing involuntary medication orders during the crucial period between the IST hearing and the proffer of services, including mental health diversion and assisted outpatient treatment, this bill will prevent further deterioration while these individuals are in custody, bringing targeting resources to an already identified, impacted population to improve the likelihood that they are accepted into and consent to diversion options. SB 820 keeps existing protections while enabling these vulnerable individuals to access the treatment they need to stabilize, reintegrate into society, and achieve recovery.″

Arguments in Support

According to California State Association of Psychiatrists, the sponsor of this bill, ″In the event of a defendant lacking mental competency to understand court proceedings, a judge may find them incompetent to stand trial (IST). In such cases, they are then offered alternatives, such as mental health diversion and assisted outpatient treatment (AOT). However, many defendants do not access these alternatives due to the severity of their symptoms and the fact that these programs remain voluntary. Should they be found ineligible or refuse to participate, their cases are typically dismissed with no further requirements of behavioral health services. This gap in care has severe consequences on recidivism rates and homelessness for this population despite them having been identified by the court as exceedingly vulnerable.

″SB 317 (Stern, 2021) made significant updates to the IST system for misdemeanor offenses. However, it inadvertently limited the ability of psychiatrists to utilize all available tools at their disposal, including involuntary medication. Regardless of medical necessity, there is currently no mechanism to compel these individuals to take prescribed medication – a crucial tool in stabilizing patients.

″California faces a significant and ongoing shortage of bed space. Because of this, these individuals often spend extended periods in jail while their mental health declines, ultimately making successful reintegration even more difficult. Until infrastructure catches up to demand, it is vital that the ability to provide involuntary medication during the crucial period between the IST hearing and the proffer of services be reinstated – exactly what SB 820 aims to do while retaining existing protections. Doing so will improve their chances of accepting and benefiting from treatment while reducing recidivism and homelessness.″

Arguments in Opposition

According to Initiate Justice, ″SB 820 would create a new mechanism for issuing involuntary medication orders for incarcerated persons in county jail who face misdemeanor charges and have been deemed incompetent to stand trial. The author states this is necessary because there are insufficient treatment facilities. We oppose SB 820 for the following reasons.

I. Administering involuntary medication without sufficient clinical oversight is dangerous.

″SB 820 would expand the authority of county jails to administer involuntary psychiatric medications in general population units rather than in clinical settings. Administering such medications without proper oversight can have fatal consequences. Antipsychotic medications, for example, carry a black box warning because they can be lethal for individuals with dementia-related psychosis. Determining the underlying cause of psychosis is particularly challenging in jail settings, where correctional officers often lack the necessary training to recognize medication side effects. Moreover, incarcerated individuals may have limited ability to report concerns to medical staff.

″Individuals administered involuntary medication are under close observation in clinical settings. Designated behavioral health treatment centers maintain 24-hour clinical staff who conduct regular rounds and closely monitor patients. Under existing law, many individuals subject to involuntary medication in county jails are taken to designated mental health Correctional Treatment Centers (CTCs). CTCs have similar requirements for staffing ratios, staff licensure, treatment planning, and discharge planning as designated behavioral health treatment centers in the community. SB 820 would allow jails to involuntary medicate individuals without transferring them to designated behavioral health treatment centers or CTC units. By expanding the ability of county jails to administer involuntary medications outside clinical settings, SB 820 undermines existing safeguards and increases the risk of serious harm or death.

II. SB 820 will incentivize counties to hold individuals in jail for treatment, backsliding efforts to divert people with serious mental illness from jail.

″Individuals with serious mental illness quickly deteriorate in jail and are at heightened risk of abuse and neglect. State and local efforts are underway to divert individuals with mental illness from jail and provide treatment in the community. By creating a new mechanism for involuntary medication orders, SB 820 risks incentivizing counties to rely on jails for mental health treatment rather than investing in community-based care.″

FISCAL COMMENTS

According to the Assembly Appropriations Committee, ″Cost pressures (Trial Court Trust Fund, General Fund) of an unknown but likely significant amount, possibly in the low millions of dollars annually, to the courts to conduct additional hearings and for medical evaluations and expert testimony. Judicial Council estimates costs of $1.77 million to $4.25 million annually ongoing to fulfill these responsibilities. Within that estimate, Judicial Council attributes approximately half of the costs to additional hearings that may not occur in conjunction with a competency hearing, and additional hearing time to consider involuntary medication orders. Judicial Council attributes the other half of the costs to psychiatric evaluations and for court-appointed evaluators′ testimony at hearings. Judicial Council notes there is currently a shortage in psychiatric evaluators in many parts of the state and there may be delays in scheduling these hearings due if, due to the shortage, courts are unable to timely obtain the required evaluation.

″Although courts are not funded on the basis of workload, increased pressure on the Trial Court Trust Fund may create a demand for increased funding for courts from the General Fund. The fiscal year (FY) 2025-26 state budget provides $82 million ongoing General Fund to the Trial Court Trust Fund for court operations. Judicial Council notes that beginning in FY 2025-26, the trial courts are handling an ongoing $55 million reduction to their operational funding, which impacts their ability to provide core services. Judicial Council reports this bill will result in new, unfunded workload for the trial courts, putting additional pressure on their limited resources.″

VOTES

SENATE FLOOR: 39-0-1

YES: Allen, Alvarado-Gil, Archuleta, Arreguín, Ashby, Becker, Blakespear, Cabaldon, Caballero, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, Limón, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Valladares, Wahab, Weber Pierson, Wiener

ABS, ABST OR NV: Reyes

ASM PUBLIC SAFETY: 9-0-0

YES: Schultz, Alanis, Mark González, Haney, Harabedian, Lackey, Nguyen, Ramos, Sharp-Collins

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Sanchez, Arambula, Calderon, Caloza, Dixon, Elhawary, Fong, Mark González, Ahrens, Pacheco, Pellerin, Solache, Ta, Tangipa

UPDATED

VERSION: July 7,2025

CONSULTANT: Stella Choe / PUB. S. / (916) 319-3744 FN: 0001330

Date of Hearing: August 20, 2025

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

SBPCA Bill Id:SB 820

Author:(Stern) – As Amended Ver:July 7, 2025

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill creates a process for a court to authorize administration of involuntary medication for a misdemeanor defendant who has been found incompetent to stand trial (IST).

Specifically, among other provisions, this bill:

1. Permits administration of antipsychotic medication for a defendant who has been charged with a misdemeanor, who is confined in county jail, and who has been found IST, without the defendant’s informed consent, in an emergency or upon a court’s determination that the defendant is gravely disabled and does not have the capacity to consent to or refuse treatment with antipsychotic medication.
2. Defines an “emergency” and establishes parameters for administration of involuntary medication during an emergency.
3. Defines “gravely disabled” and establishes procedures a court must follow to order involuntary medication for a defendant who is gravely disabled, including considering the opinion of a licensed psychologist or psychiatrist and conducting a hearing to determine whether the defendant lacks the capacity to make decisions about antipsychotic medication, whether serious harm will result to the defendant if they are not treated with antipsychotic medication, and whether the defendant is a danger to others, among other considerations.
4. Provides specified rights to a defendant before the court may issue an order authorizing involuntary medication, including the right to be represented by counsel at all stages of the proceedings and to receive timely access to the defendant’s medical records and files.
5. Makes an order authorizing administration of antipsychotic medication valid until one of the following occurs:
   1. 90 days elapse from the date the individual is found IST.
   2. 90 days elapse from the date when the individual is referred to Community Assistance, Recovery, and Empowerment (CARE) court, assisted outpatient treatment, or county conservatorship.
   3. A court with jurisdiction over the defendant, including for the programs listed above, issues an order.
   4. The defendant is released from custody.
6. Requires the court to review an order authorizing involuntary medication no more than 60 days after the order is issued to determine whether the grounds for the order remains.
7. States that a defendant who is subject to a court’s involuntary medication order has the legal and civil rights set forth in the Lanterman-Petris-Short Act.
8. Sunsets its provisions on January 1, 2030.

FISCAL EFFECT:

Cost pressures (Trial Court Trust Fund, General Fund) of an unknown but likely significant amount, possibly in the low millions of dollars annually, to the courts to conduct additional hearings and for medical evaluations and expert testimony. Judicial Council estimates costs of $1.77 million to $4.25 million annually ongoing to fulfill these responsibilities. Within that estimate, Judicial Council attributes approximately half of the costs to additional hearings that may not occur in conjunction with a competency hearing, and additional hearing time to consider involuntary medication orders. Judicial Council attributes the other half of the costs to psychiatric evaluations and for court-appointed evaluators’ testimony at hearings. Judicial Council notes there is currently a shortage in psychiatric evaluators in many parts of the state and there may be delays in scheduling these hearings due if, due to the shortage, courts are unable to timely obtain the required evaluation.

Although courts are not funded on the basis of workload, increased pressure on the Trial Court Trust Fund may create a demand for increased funding for courts from the General Fund. The fiscal year (FY) 2025-26 state budget provides $82 million ongoing General Fund to the Trial Court Trust Fund for court operations. Judicial Council notes that beginning in FY 2025-26, the trial courts are handling an ongoing $55 million reduction to their operational funding, which impacts their ability to provide core services. Judicial Council reports this bill will result in new, unfunded workload for the trial courts, putting additional pressure on their limited resources.

COMMENTS:

1. Background. State and federal law require that a person charged with a crime must be mentally competent enough to help with their own defense for a case to proceed against them. If a defendant has been deemed IST, their trial may not move forward. For a felony defendant deemed IST, statute authorizes an extensive evaluation, hearing, and treatment process to assess the defendant and help them attain competence so they can stand trial. Depending on their circumstances, antipsychotic medication can be part of a treatment plan for a person deemed IST, but people with serious behavioral health conditions may not consent to taking medication. As discussed in more detail in the analysis of this bill by the Assembly Committee on Public Safety, the government forcibly medicating a person implicates their constitutional rights and is justified only in certain circumstances.

Existing law allows a court to authorize involuntary medication for a person charged with a felony and deemed IST. Existing law also allows for involuntary medication of certain incarcerated people, including a person who has been sentenced and is in county jail custody. In 2017, the Legislature expanded the courts’ authority to order involuntary medication to include a person confined in county jail who has not yet been sentenced, including a person housed in jail during or awaiting trial proceedings or a person who was booked into jail and is awaiting arraignment, transfer, or release.

Generally, the distinctions between the above circumstances and a misdemeanor defendant deemed IST are the less serious nature of the crime with which the defendant is charged and the fact that the defendant has not yet been convicted of a crime. In light of these distinctions, existing law generally takes a less intensive and potentially invasive approach to misdemeanor defendants deemed IST. When a misdemeanor defendant is deemed IST, the court may grant the defendant mental health diversion, or if the court determines the defendant is not eligible or suitable for diversion, the court must hold a hearing to determine the appropriate action, including referring the defendant to assistant outpatient treatment if treatment is available, referring the defendant for possible conservatorship proceedings, or referring the defendant to CARE court. If a defendant does not qualify for any of these services, the court may dismiss the charges against the defendant. Under existing law, the courts do not have authority to order administration of involuntary medication for a misdemeanor defendant deemed IST.

1. Purpose. The author believes authority for court-ordered involuntary medication for misdemeanor defendants deemed IST is needed to stabilize such defendants so they can accept and participate more fully in behavioral health services. According to the author:

By allowing involuntary medication orders during the crucial period between the IST hearing and the proffer of services, including mental health diversion and assisted outpatient treatment, this bill will prevent further deterioration while these individuals are in custody, bringing targeting resources to an already identified, impacted population to improve the likelihood that they are accepted into and consent to diversion options.

Analysis Prepared by: Annika Carlson / APPR. / (916) 319-2081

 THIRD READING  

Bill No: SB 820

Author: Stern (D)

Introduced: 2/21/25

Vote: 21

SENATE PUBLIC SAFETY COMMITTEE: 6-0, 4/29/25

AYES: Arreguín, Seyarto, Caballero, Gonzalez, Pérez, Wiener

SUBJECT: Inmates: psychiatric medication: administration

SOURCE: California State Association of Psychiatrists

DIGEST:

This bill creates an alternative process for involuntarily medicating defendants confined in the county jail who are found incompetent to stand trial (IST) and charged with a misdemeanor.

ANALYSIS:

Existing law:

1. States that a defendant is IST if, as a result of a mental health disorder or developmental disability, they cannot understand the nature of the criminal proceedings or assist counsel in their defense in a rational manner. Provides that a person shall not be tried or adjudged to punishment while mentally incompetent. (Penal (Pen.) Code, § 1367, subd. (a).)
   
2. Sets forth procedures for inquiring into and determining mental competence, including suspending criminal proceedings, as specified. (Pen. Code, § 1368, subd. (b) & (c).)
   
3. Establishes the procedures for the treatment of individuals found IST and charged with a misdemeanor. (Pen. Code, §§ 1370.01, 1370.2; Welfare & Institutions Code, § 5623.6, subd. (b).)
   
4. Specifies that, on a non-emergency basis, a county department of mental health, or other designated county department, may administer involuntary psychiatric medication to a defendant confined in the county jail if specified conditions have been met, including a noticed hearing before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer, as specified. Provides for an expedited hearing if emergency or interim medication is being administered. (Pen. Code, § 2603, subd. (c).)
   
5. Provides that at the hearing, the standard is whether there is clear and convincing evidence that the inmate has a mental illness or disorder, that as a result of that illness, the inmate is gravely disabled and lacks the capacity to consent to or refuse treatment with psychiatric medications or is a danger to self or others if not medicated, that there is no less intrusive alternative to involuntary medication, and that the medication is in the inmate’s best medical interest. Entitles an inmate to file a motion for reconsideration. (Pen. Code, § 2603, subd. (c).)
   
6. Provides that a physician may take appropriate action in an emergency. An emergency exists when there is a sudden and marked change in an inmate’s mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others, and it is impractical, due to the seriousness of the emergency, to first obtain informed consent. (Pen. Code, § 2603, subd. (d).)
   
7. Specifies that if psychiatric medication is administered to a person incarcerated in the county jail on an emergency basis, the medication shall only be that which is required to treat the emergency condition and for only so long as the emergency continues to exist. Provides a process for obtaining an ex parte order if it is necessary to continue emergency medication beyond the initial 72 hours pending the full mental health hearing. (Pen. Code, § 2603, subd. (d)(1)(B) & (d)(2)(A).)
8. Requires court review of an involuntary medication order at 60-day intervals in the case of an incarcerated person awaiting arraignment, trial or sentencing. (Pen Code, § 2603, subd. (e)(1).)

This bill:

1. Provides that notwithstanding the statutory authority to administer psychotropic medication on an involuntary basis to a defendant confined in the county jail, if a defendant charged with a misdemeanor has been found IST, a psychiatrist may administer psychiatric medication without the defendant’s informed consent in either of the following circumstances:
2. An emergency, defined as:
   1. A situation in which action to impose treatment over the person’s objection is immediately necessary for the preservation of life or the prevention of serious bodily harm to the patient or others, and it is impracticable to first gain consent. It is not necessary for harm to take place or become unavoidable prior to treatment; or,
   2. When there is a sudden and marked change in an inmate’s mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others, and it is impractical, due to the seriousness of the emergency, to first obtain informed consent; or,
3. Upon a court’s determination that the defendant is gravely disabled, as defined, and that the defendant does not have the capacity to refuse treatment with psychiatric medication.
   
4. Requires that before administering medication in an emergency, the facility must file with the Office of Administrative Hearings, and serve on the defendant and their counsel, written notice of hearing within 72 hours after commencing medication and 21 days prior to the hearing. |
   
5. Requires the written notice to include:
6. The diagnosis, the factual basis for the diagnosis, the basis upon which psychiatric medication is recommended, the expected benefits of the medication, any potential side effects and risks to the inmate from the medication, and any alternatives to treatment with the medication;
7. Advise the inmate of the right to be present at the hearing, the right to be represented by counsel at all stages of the proceedings, the right to present evidence, and the right to cross-examine witnesses. Counsel for the inmate shall have access to all medical records and files of the inmate, but shall not have access to the confidential section of the inmate’s central file which contains materials unrelated to medical treatment; and,
8. Inform the inmate of their right to contest the finding of an administrative law judge authorizing treatment with involuntary medication by filing a petition for writ of administrative mandamus, and their right to file a petition for writ of habeas corpus with respect to any decision of the Department of Corrections and Rehabilitation to continue treatment with involuntary medication after the administrative law judge has authorized treatment with involuntary medication.
   
9. States that an order for emergency psychiatric medication is subject to the following limitations:
10. A hearing must be held within 21 days of the notice, unless counsel for an inmate agrees to a different period of time; and,
11. The inmate shall be entitled to and be given the following due process protections:
12. A psychiatrist has determined that the inmate has a serious mental disorder;
13. A psychiatrist has determined that, as a result of that mental disorder, the inmate is gravely disabled and does not have the capacity to refuse treatment with psychiatric medications or is a danger to self or others;
    1. A psychiatrist has prescribed one or more psychiatric medications for the treatment of the inmate’s disorder, has considered the risks, benefits, and treatment alternatives to involuntary medication, and has determined that the treatment alternatives to involuntary medication are unlikely to meet the needs of the patient;
    2. The inmate has been advised of the risks and benefits of, and treatment alternatives to, the psychiatric medication and refuses or is unable to consent to the administration of the medication;
    3. The inmate is provided a hearing before an administrative law judge;
    4. The inmate receives expedited access to counsel;
    5. An administrative law judge determines by clear and convincing evidence that the inmate has a mental illness or disorder, that as a result of that illness the inmate is gravely disabled and lacks the capacity to consent to or refuse treatment with psychiatric medications or is a danger to self or others if not medicated, that there is no less intrusive alternative to involuntary medication, and that the medication is in the inmate’s best medical interest. Failure of the “department” to provide timely or adequate notice pursuant to this section shall be excused only upon a showing of good cause and the absence of prejudice to the inmate. In making this determination, the administrative law judge may consider factors, including, as specified;
    6. The historical course of the inmate’s mental disorder, as determined by available relevant information about the course of the inmate’s mental disorder, shall be considered when it has direct bearing on the determination of whether the inmate is a danger to self or others, or is gravely disabled and incompetent to refuse medication as the result of a mental disorder; and,
    7. An inmate is entitled to file one motion for reconsideration following a determination that they may receive involuntary medication, and may seek a hearing to present new evidence, upon good cause shown.
14. Provides that a determination that the defendant may receive involuntary medication remains valid for one of the following periods, whichever occurs first: one year after the date of the initial determination of the emergency; or, ninety days after referral to a mental health diversion program.
    
15. States that a person who is subject to an involuntary psychiatric medication order under these provisions has legal and civil rights of persons involuntarily detained under the Lanterman-Petris-Short Act.

Comments

Involuntary Medication of County Jail Inmates, county jails house inmates that have already been through the criminal process and have been sentenced, and they also house individuals who are detained in jail while they face criminal charges. In 2012, the Legislature enacted law providing procedures for involuntary medication which specifically applied to the portion of the county jail population that have been sentenced to imprisonment in the county jail. AB 1907 (Lowenthal, Chapter 814, Statutes of 2012) In 2017, The Legislature extended the involuntary medication procedure to inmates confined in county jail but not yet sentenced, including, but not limited to, a person housed in a county jail during or awaiting trial proceedings, a person who has been booked into a county jail and is awaiting arraignment, transfer, or release. AB 720 (Eggman, Chapter 347, Statutes of 2017) When the provisions authorizing involuntary medication of pretrial inmates was first enacted, the Legislature put in a sunset date of January 1, 2022. Subsequently, the Legislature extended the sunset date until January 1, 2025, and then until January 1, 2030.

Generally, an inmate confined in a county jail shall not be administered any psychiatric medication without their prior informed consent. (Pen. Code, § 2603, subd. (a).) However, if a psychiatrist determines that an inmate should be treated with psychiatric medication, but the inmate does not consent, the inmate may be involuntarily treated with the medication, either on an emergency basis or non-emergency basis as specified in the law. (Pen. Code, § 2603, subd. (b).)

FISCAL EFFECT: Appropriation: No Fiscal Com.: No Local: No

SUPPORT: (Verified 4/30/25)

Alameda County Families Advocating for the Seriously Mentally Ill

California State Sheriffs’ Association

Family Advocates for Individuals with Serious Mental Illness of Sacramento

National Alliance on Mental Illness

Steinberg Institute Treatment Advocacy Center

Treatment Advocacy Center

OPPOSITION: (Verified 4/30/25)

ACLU

Initiate Justice

Cal Voices

California Coalition for Women Prisoners

California Public Defenders Association

Courage California

Disability Rights California

Justice2jobs Coalition Sacramento

La Defensa

Survived & Punished

ARGUMENTS IN SUPPORT:

According to the California State Association of Psychiatrists, the sponsor of this bill:

SB 820 . . . ensures that a defendant found incompetent to stand trial (IST) for a misdemeanor offense is provided the appropriate medical treatment and supportive services needed for them to achieve wellness.

In the event of a defendant lacking mental competency to understand court proceedings, a judge may find them incompetent to stand trial (IST). In such cases, they are then offered alternatives, such as mental health diversion and assisted outpatient treatment (AOT). However, many defendants do not access these alternatives due to the severity of their symptoms and the fact that these programs remain voluntary. Should they be found ineligible or refuse to participate, their cases are typically dismissed with no further requirements of behavioral health services. This gap in care has severe consequences on recidivism rates and homelessness for this population despite them having been identified by the court as exceedingly vulnerable.

SB 317 (Stern, Chapter 599, Statutes of 2021) made significant updates to the IST system for misdemeanor offenses. However, it inadvertently limited the ability of psychiatrists to utilize all available tools at their disposal, including involuntary medication. Regardless of medical necessity, there is currently no mechanism to compel these individuals to take prescribed medication – a crucial tool in stabilizing patients.

California faces a significant and ongoing shortage of bed space. Because of this, these individuals often spend extended periods in jail while their mental health declines, ultimately making successful reintegration even more difficult. Until infrastructure catches up to demand, it is vital that the ability to provide involuntary medication during the crucial period between the IST hearing and the proffer of services be reinstated – exactly what SB 820 aims to do while retaining existing protections. Doing so will improve their chances of accepting and benefiting from treatment while reducing recidivism and homelessness.

ARGUMENTS IN OPPOSITION:

According to the California Public Defenders Association,

As currently drafted, SB 820 expands the authority to involuntarily medicate individuals in jail settings without guaranteeing fundamental due process protections or requiring consideration of less restrictive, more clinically appropriate alternatives for treatment. This approach raises serious constitutional concerns and risks compounding the harm experienced by some of the most vulnerable people in our county jails.

Antipsychotic medications are powerful agents that can profoundly and often permanently affect an individual's mind, body, and behavior. While these drugs may offer therapeutic benefits, they also carry serious and sometimes irreversible side effects, including:

• Body rigidity, tremors, and drooling
• Blurred vision and akathisia (motor restlessness)
• Acute dystonia (severe involuntary spasms of the upper body, tongue, throat, or eyes)
• Tardive dyskinesia (a potentially permanent neurological disorder marked by involuntary facial movements)
• Neuroleptic malignant syndrome (a rare but life-threatening condition)^[1]

The decision to forcibly medicate a person, particularly to alter their mental state and behavior, is one of the most intrusive exercises of government power. It implicates fundamental rights to liberty and bodily autonomy and must be governed by the highest procedural safeguards.

SB 820 authorizes involuntary medication in jails without clearly requiring essential protections guaranteed under existing law. These include the right to an evidentiary hearing, to be present at that hearing, to have counsel at all stages of the proceedings, to have access to medical records, to present evidence, and to cross-examine witnesses. Additionally, SB 820 authorizes up to one year of forced medication without ongoing judicial review.

By contrast, Penal Code § 2603 requires the court to review any order for involuntary medication at intervals of no more than 60 days. Before any such order is issued, the individual is entitled to a full and fair hearing with all the accompanying due process protections.

These protections are particularly vital when treatment is provided in a jail. Many county jails are currently under receivership, consent decrees, or active litigation due to chronic and systemic neglect of individuals with serious mental illness. ^[2] In multiple jurisdictions, for-profit contractors tasked with providing mental health care in jails have failed to meet even minimum standards. ^[3]

SB 820 represents a significant departure from California’s ongoing efforts to reduce reliance on jails as our de facto mental health systems and threatens to further entrench jail-based solutions in lieu of more appropriate inpatient or outpatient treatment options. Notably, unlike § 2603, SB 820 does not require counties to first seek placement in suitable treatment facilities before resorting to jail-based intervention.

While emergency intervention may, in rare cases, be necessary, it must remain an exception—allowed only when no less restrictive alternatives exist and only after meaningful judicial review. SB 820, as currently drafted, fails to provide these essential safeguards.

Prepared by: Cheryl Anderson / PUB. S. / (916) 651-4118

5/1/25 16:38:46

**** END ****

1. Scott T. Stroup & Neil Gray, Management of Common Adverse Effects of Antipsychotic Medications, NAT’L LIBR. MED. (Sept. 2018), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145248/ ↑

2. Consent Decrees | Office of the Sheriff | County of Santa Clara

   Settlement Reached in Contra Costa County Jail Class Action Lawsuit - Prison Law Office

   Settlement Approved in Sacramento County Jail Class Action to Ensure Better Treatment of People with Disabilities and Reform Solitary Confinement Practices | Disability Rights California

   LA County Reaches Settlement with ACLU to Improve Conditions in Jails – COUNTY OF LOS ANGELES ↑

3. Wellpath Held in Contempt in Suit at California Jail | Prison Legal News;

   Lawsuit Alleges Wellpath Community Care Withheld a California Jail Detainee’s HIV Medication for Months, Leading to His Death from AIDS - Davis Vanguard;

   California health care giant Wellpath fails patients, critics say ↑

SENATE COMMITTEE ON PUBLIC SAFETY

Senator Jesse Arreguín, Chair

2025 - 2026 Regular

Bill No: SB 820 Hearing Date: April 29, 2025

Subject: Inmates: psychiatric medication: administration

HISTORY

Source: California State Association of Psychiatrists

Prior Legislation: AB 2547 (Ta), failed in Assembly Public Safety Committee, 2024

SB 1400 (Stern), Ch. 647, Stats. 2024
SB 1317 (Wahab), Ch. 326, Stats. 2024

SB 35 (Umberg), Ch. 283, Stats. 2023

SB 317 (Stern), Ch. 599, Stats. 2021

SB 1187 (Beall), Ch. 1008, Stats. 2018

AB 2186 (Lowenthal), Ch. 733, Stats. 2014

AB 2625 (Achadjian), Ch. 742, Stats. 2014

SB 1412 (Nielsen), Ch. 759, Stats. 2014

Support: Alameda County Families Advocating for the Seriously Mentally Ill; California State Sheriffs’ Association; Family Advocates for Individuals with Serious Mental Illness (FAISMI) of Sacramento; National Alliance on Mental Illness (NAMI-CA); Steinberg Institute Treatment Advocacy Center

Opposition: ACLU; Initiate Justice; Cal Voices; California Coalition for Women Prisoners; California Public Defenders Association; Courage California; Disability Rights California; Justice2jobs Coalition Sacramento; La Defensa: Survived & Punished

PURPOSE

The purpose of this bill is to create an alternative process for involuntarily medicating defendants confined in the county jail who are found incompetent to stand trial (IST) and charged with a misdemeanor.

Existing law guarantees that, in all criminal prosecutions, the accused shall enjoy the right to be informed of the nature and cause of the accusation. (U.S. Const. 6th Amend.)

Existing law states that a defendant is incompetent to stand trial (IST) if, as a result of a mental health disorder or developmental disability, they cannot understand the nature of the criminal proceedings or assist counsel in their defense in a rational manner. (Pen. Code, § 1367, subd. (a).)

Existing law provides that a person shall not be tried or adjudged to punishment while mentally incompetent. (Pen. Code, § 1367, subd. (a).)

Existing law specifies procedures for inquiring into and determining mental competence, including suspending criminal proceedings, as specified. (Pen. Code, § 1368, subd. (b) & (c).)

Existing law requires, if the defendant is found mentally competent, the criminal process to resume, and the trial on the offense charges to proceed. (Pen. Code, §§ 1370; 1370.01.)

Existing law establishes the procedures for the treatment of individuals found IST and charged with a misdemeanor, as follows:

• The trial, judgment, or hearing on the alleged misdemeanor is suspended and the court must conduct a hearing on whether the defendant is eligible for mental health diversion;
• If the court finds that the defendant is not eligible for diversion, the court must hold a hearing to determine which of the following actions to take:
  • Order modification of an existing mental health diversion treatment plan in accordance with a recommendation from a treatment provider;
  • Refer the defendant to outpatient treatment;
  • Refer defendant for possible conservatorship proceedings;
  • Refer the defendant to the Community Assistance, Recovery and Empowerment (CARE) program; or
  • Dismiss the charges if the defendant does not qualify for these services; and,
    
• If the misdemeanor charges are dismissed, and the individual is not receiving the above-described services, the court must notify the defendant of their need for mental health services. The court shall additionally provide the individual with contact information of specified mental health services. (Pen. Code, §§ 1370.01, 1370.2; Welf. & Inst. Code, § 5623.6, subd. (b); Cal. Rules of Court, rule 4.130, subds. (f)(1) & (3).)

Existing law states the Legislature’s intent that the court consider all treatment options, as provided, prior to dismissing criminal charges but allows the court to dismiss any misdemeanor charges pending against a defendant found IST in the interests of justice. (Pen. Code, §§ 1370.01, subd. (e), 1385.)

Existing law states the Legislature’s intent that a defendant subject to the misdemeanor IST procedures receive mental health treatment in a treatment facility and not a jail. (Pen. Code, § 1370.01, subd. (c).)

Existing law allows the court to dismiss any misdemeanor charges pending against a defendant found IST. (Pen. Code, § 1370.2.)

Existing law requires the court to dismiss the criminal charges at the end of the diversion period if the individual performs satisfactorily on diversion. (Pen. Code, § 1370.01, subd. (e).)

Existing law establishes mental health diversion for misdemeanor and felony offenses and sets forth eligibility requirements. (Pen. Code, §§ 1001.35 & 1001.36.)

Existing law authorizes the administration of psychotropic medication on an involuntary basis to a defendant confined in the county jail if a psychiatrist determines that they should be treated with psychiatric medication, specified procedures are followed, and the treatment is consistent with the standard of care. (Pen. Code, § 2603, subd. (b).)

Existing law specifies that, on a non-emergency basis, a county department of mental health, or other designated county department, may administer involuntary psychiatric medication to a defendant confined in the county jail only if all of the following conditions have been met:

• A psychiatrist or psychologist has determined that the inmate has a serious mental disorder;
• A psychiatrist or psychologist has determined that, as a result of that mental disorder, the inmate is gravely disabled and does not have the capacity to refuse treatment with psychiatric medications, or is a danger to self or others;
• A psychiatrist has prescribed one or more psychiatric medications for the treatment of the inmate’s disorder, has considered the risks, benefits, and treatment alternatives to involuntary medication, and has determined that the treatment alternatives to involuntary medication are unlikely to meet the needs of the patient;
• The inmate has been advised of the risks and benefits of, and treatment alternatives to, the psychiatric medication and refuses, or is unable to consent to, the administration of the medication;
• The jail has made a documented attempt to locate an available bed for the inmate in a community-based treatment facility in lieu of seeking to administer involuntary medication. The jail shall transfer that inmate to such a facility only if the facility can provide care for the mental health needs, and the physical health needs, if any, of the inmate and upon the agreement of the facility;
• The inmate is provided a hearing before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer:
  • If the inmate is in custody awaiting trial, including an inmate whose criminal proceedings are suspended for competency proceedings, the hearing and any ex parte orders shall be submitted to a judge in the superior court where the criminal case is pending; and,
  • A superior court judge may consider whether involuntary medication would prejudice the incarcerated person’s defense;
• The inmate is provided counsel at least 21 days prior to the hearing, unless emergency medication is being administered, in which case the inmate would receive expedited access to counsel, as specified;
• The inmate and counsel are provided with written notice of the hearing at least 21 days prior to the hearing, unless emergency or interim medication is being administered, in which case the inmate would receive an expedited hearing;
• In the hearing, the superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer determines by clear and convincing evidence that the inmate has a mental illness or disorder, that as a result of that illness, the inmate is gravely disabled and lacks the capacity to consent to or refuse treatment with psychiatric medications or is a danger to self or others if not medicated, that there is no less intrusive alternative to involuntary medication, and that the medication is in the inmate’s best medical interest;
• The historical course of the inmate’s mental disorder, as determined by available relevant information about the course of the inmate’s mental disorder, shall be considered when it has direct bearing on the determination of whether the inmate is a danger to self or others, or is gravely disabled and incompetent to refuse medication as the result of a mental disorder; and,
• An inmate is entitled to file one motion for reconsideration following a determination that they may receive involuntary medication, and may seek a hearing to present new evidence, upon good cause shown. This does not prevent a court from reviewing, modifying, or terminating an involuntary medication order for an inmate awaiting trial if there is a showing that the involuntary medication is interfering with the inmate’s due process rights in the criminal proceeding. (Pen. Code, § 2603, subd. (c).)

Existing law provides that a physician may take appropriate action in an emergency. (Pen. Code, § 2603, subd. (d).)

Existing law states that an emergency exists when there is a sudden and marked change in an inmate’s mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others, and it is impractical, due to the seriousness of the emergency, to first obtain informed consent. (Pen. Code, § 2603, subd. (d)(1)(A).)

Existing law specifies that if psychiatric medication is administered to a person incarcerated in the county jail on an emergency basis, the medication shall only be that which is required to treat the emergency condition and shall be administered for only so long as the emergency continues to exist. (Pen. Code, § 2603, subd. (d)(1)(B).)

Existing law states that if the clinicians of the county department of mental health, or other designated county department, identify a situation that jeopardizes the inmate’s health or well-being as the result of a serious mental illness, and necessitates the continuation of medication beyond the initial 72 hours pending the full mental health hearing, the county department may seek to continue the medication by giving notice to the inmate and their counsel of its intention to seek an ex parte order to allow the continuance of medication pending the full hearing. If an order is issued, the psychiatrist may continue the administration of the medication until the hearing is held. (Pen. Code, § 2603, subd. (d)(2)(A).)

Existing law specifies that in any case in which it appears to the person in charge of a jail, or juvenile detention facility, or to a judge, that a person in custody in that jail or juvenile detention facility may be mentally disordered, they may cause the prisoner to be taken to a facility for 72-hour treatment and evaluation and they shall inform the facility in writing, which shall be confidential, of the reasons that the person is being taken to the facility. (Pen. Code, § 4011.6; Welf. & Inst. Code, § 5150.)

Existing law provides that an order by the court authorizing involuntary medication of an inmate shall be valid for no more than one year. In the case of an incarcerated person awaiting arraignment, trial or sentencing, the order shall be valid for no more than 180 days and the court shall review the order at intervals of not more than 60 days to determine whether the ground for the order remains. At each review, the psychiatrist shall file an affidavit with the court that ordered the involuntary medication affirming that the person who is the subject of the order continues to meet the criteria for involuntary medication. A copy of the affidavit shall be provided to the defendant and the defendant’s attorney. (Pen Code, § 2603, subd. (e)(1).)

Existing law states that in determining whether the criteria for involuntary medication still exist, the court shall consider the affidavit of the psychiatrist or psychiatrists and any supplemental information provided by the defendant’s attorney. The court may also require the testimony from the psychiatrist, if necessary. The court, at each review, may continue the order authorizing involuntary medication, vacate the order, or make any other appropriate order. (Pen Code, § 2603, subd. (e)(1).)

Existing law states that if a determination has been made to involuntarily medicate a county jail inmate, the medication shall be discontinued one year after the date of that determination, unless the inmate gives their informed consent to the administration of the medication, or unless a new determination is made pursuant to the procedures set forth above. (Pen. Code, § 2603, subd. (f).)

This bill provides that notwithstanding this authority to administer psychotropic medication on an involuntary basis to a defendant confined in the county jail, if a defendant charged with a misdemeanor has been found IST, a psychiatrist may administer psychiatric medication without the defendant’s informed consent in either of the following circumstances:

• An emergency, defined as:
  • A situation in which action to impose treatment over the person’s objection is immediately necessary for the preservation of life or the prevention of serious bodily harm to the patient or others, and it is impracticable to first gain consent. It is not necessary for harm to take place or become unavoidable prior to treatment; or,
  • When there is a sudden and marked change in an inmate’s mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others, and it is impractical, due to the seriousness of the emergency, to first obtain informed consent; or,
• Upon a court’s determination that the defendant is gravely disabled and that the defendant does not have the capacity to refuse treatment with psychiatric medication. The fact that a defendant has temporary access to food, clothing, shelter, personal safety, and necessary medical care while incarcerated does not constitute evidence that the defendant is able to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care, which shall be evaluated based upon the defendant’s ability to provide for those needs while not incarcerated.
  

This bill defines gravely disabled as a condition in which a person, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.

This bill requires that before administering medication in an emergency, the facility must file with the Office of Administrative Hearings, and serve on the defendant and their counsel, written notice of hearing within 72 hours after commencing medication and 21 days prior to the hearing.

This bill requires the written notice to include:

• The diagnosis, the factual basis for the diagnosis, the basis upon which psychiatric medication is recommended, the expected benefits of the medication, any potential side effects and risks to the inmate from the medication, and any alternatives to treatment with the medication;
• Advise the inmate of the right to be present at the hearing, the right to be represented by counsel at all stages of the proceedings, the right to present evidence, and the right to cross-examine witnesses. Counsel for the inmate shall have access to all medical records and files of the inmate, but shall not have access to the confidential section of the inmate’s central file which contains materials unrelated to medical treatment; and,
• Inform the inmate of their right to contest the finding of an administrative law judge authorizing treatment with involuntary medication by filing a petition for writ of administrative mandamus, and their right to file a petition for writ of habeas corpus with respect to any decision of the Department of Corrections and Rehabilitation to continue treatment with involuntary medication after the administrative law judge has authorized treatment with involuntary medication.

This bill states that written notice is not required if:

• The defendant gives informed consent to continue medication; or,
• A psychiatrist determines that the psychiatric medication is not necessary and administration of the medication is discontinued.

This bill states that an order for emergency psychiatric medication is subject to the following limitations:

• A hearing must be held within 21 days of the notice, unless counsel for an inmate agrees to a different period of time; and,
• The inmate shall be entitled to and be given the following due process protections:
  • A psychiatrist has determined that the inmate has a serious mental disorder;
  • A psychiatrist has determined that, as a result of that mental disorder, the inmate is gravely disabled and does not have the capacity to refuse treatment with psychiatric medications or is a danger to self or others;
  • A psychiatrist has prescribed one or more psychiatric medications for the treatment of the inmate’s disorder, has considered the risks, benefits, and treatment alternatives to involuntary medication, and has determined that the treatment alternatives to involuntary medication are unlikely to meet the needs of the patient;
  • The inmate has been advised of the risks and benefits of, and treatment alternatives to, the psychiatric medication and refuses or is unable to consent to the administration of the medication;
  • The inmate is provided a hearing before an administrative law judge;
  • The inmate receives expedited access to counsel;
  • An administrative law judge determines by clear and convincing evidence that the inmate has a mental illness or disorder, that as a result of that illness the inmate is gravely disabled and lacks the capacity to consent to or refuse treatment with psychiatric medications or is a danger to self or others if not medicated, that there is no less intrusive alternative to involuntary medication, and that the medication is in the inmate’s best medical interest. Failure of the “department” to provide timely or adequate notice pursuant to this section shall be excused only upon a showing of good cause and the absence of prejudice to the inmate. In making this determination, the administrative law judge may consider factors, including, but not limited to, the ability of the inmate’s counsel to adequately prepare the case and to confer with the inmate, the continuity of care, and, if applicable, the need for protection of the inmate or institutional staff that would be compromised by a procedural default;
    
  • The historical course of the inmate’s mental disorder, as determined by available relevant information about the course of the inmate’s mental disorder, shall be considered when it has direct bearing on the determination of whether the inmate is a danger to self or others, or is gravely disabled and incompetent to refuse medication as the result of a mental disorder; and,
  • An inmate is entitled to file one motion for reconsideration following a determination that they may receive involuntary medication, and may seek a hearing to present new evidence, upon good cause shown.

This bill provides that a determination that the defendant may receive involuntary medication remains valid for one of the following periods, whichever occurs first:

• One year after the date of the initial determination of the emergency; or,
• Ninety days after the date when the defendant is referred to a mental health diversion program.

This bill states that a person who is subject to an involuntary psychiatric medication order under these provisions has legal and civil rights of persons involuntarily detained under the Lanterman-Petris-Short Act.

COMMENTS

1. Need for This Bill

According to the author:

California is facing mental health and homelessness crises, where vulnerable individuals are cycling in and out of our jails without getting adequate treatment. While the state has made massive investments in behavioral health infrastructure, it’s going to take time for new beds to come online. In the meantime, demand is urgent and growing. Jails have become de facto treatment facilities, leaving vulnerable Californians who need treatment with minimal support and resources. The problem is acute for those declared incompetent to stand trial (IST) for a misdemeanor, who are experiencing severe mental health crises and have particularly high rates of recidivism. SB 820 builds on efforts to keep these individuals safe, out of the criminal justice system, and getting the help they need by granting doctors the discretion to use the medical treatment they deem most appropriate, including involuntary medication. By allowing involuntary medication orders during the crucial period between the IST hearing and the proffer of services, including mental health diversion and assisted outpatient treatment, this bill will prevent further deterioration while these individuals are in custody, bringing targeting resources to an already identified, impacted population to improve the likelihood that they are accepted into and consent to diversion options. SB 820 keeps existing protections while enabling these vulnerable individuals to access the treatment they need to stabilize, reintegrate into society, and achieve recovery.

1. Relevant Case Law

In Washington v. Harper, (1990) 494 U.S. 210, the U.S. Supreme Court held that a mentally-ill prisoner who is a danger to themselves or others can be involuntarily medicated. Furthermore, the Court held in Riggins v. Nevada, (1992) 504 U.S. 127, that forced medication in order to render a defendant competent to stand trial for murder was constitutionally permissible under certain circumstances. Read together, the Court has stated that these two cases "indicate that the Constitution permits the Government to involuntarily administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges in order to render that defendant competent to stand trial, but only if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the fairness of the trial, and, taking account of less intrusive alternatives, is significantly necessary to the further important governmental trial-related interests." (Sell v. United States (2003) 539 U.S. 166, 179.)

In Sell, the Court further specifies the limited circumstances when the U.S. Constitution permits the government to administer drugs to a pretrial detainee against their will when seeking to render them competent for trial. First, an important governmental interest must exist, like bringing an individual accused of a serious crime to trial. Courts must also consider the facts of the individual case in evaluating the government’s interest in prosecution, including possible civil commitment. Second, involuntary medication must significantly further those government interests. Third, involuntary medication must be necessary to further those interests. Fourth, the administration of the drugs must be medically appropriate and no less intrusive treatment is likely to achieve substantially the same results. (Id. at pp. 180-182.)

The 9th Circuit Court of Appeal, in United States v. Loughner, (2012) (9th Cir.) 672 F.3d 731, considered the following issue: what substantive due process standard must the government satisfy to medicate involuntarily a pretrial detainee on the ground that they are dangerous? The court differentiated between Harper and Sell, stating that the standard that applies depends on the purpose of the involuntary medication:

If the government seeks to medicate involuntarily a pretrial detainee on trial competency grounds, that is a matter of trial administration and the heightened standard announced in Sell applies. See Sell, 539 U.S. at 183. When dangerousness is a basis for the involuntary medication, however . . . , the concerns are the orderly administration of the prison and the inmate’s medical interests. See Harper, 494 U.S. at 222-25; citations omitted.

The Loughner court stated, “. . . , we now hold that when the government seeks to medicate a detainee—whether pretrial or post-conviction—on the grounds that he is a danger to himself or others, the government must satisfy the standard set forth in Harper. ‘[T]he Due Process Clause permits the State to treat a prison inmate who has a serious mental illness with antipsychotic drugs against their will, if the inmate is dangerous to themselves or others and the treatment is in the inmate's medical interest." (Loughner, supra, 672 F.3d at 752 (citing Harper, supra at 227.)

1. Involuntary Medication of County Jail Inmates

County jails house inmates that have already been through the criminal process and have been sentenced, and they also house individuals who are detained in jail while they face criminal charges. In 2012, the Legislature enacted law providing procedures for involuntary medication which specifically applied to the portion of the county jail population that have been sentenced to imprisonment in the county jail. (AB 1907 (Lowenthal), Chapter 814, Statutes of 2012.) In 2017, The Legislature extended the involuntary medication procedure to inmates confined in county jail but not yet sentenced, including, but not limited to, a person housed in a county jail during or awaiting trial proceedings, a person who has been booked into a county jail and is awaiting arraignment, transfer, or release. (AB 720 (Eggman), Chapter 347, Statutes of 2017.) When the provisions authorizing involuntary medication of pretrial inmates was first enacted, the Legislature put in a sunset date of January 1, 2022. Subsequently, the Legislature extended the sunset date until January 1, 2025, and then until January 1, 2030.

Generally, an inmate confined in a county jail shall not be administered any psychiatric medication without their prior informed consent. (Pen. Code, § 2603, subd. (a).) However, if a psychiatrist determines that an inmate should be treated with psychiatric medication, but the inmate does not consent, the inmate may be involuntarily treated with the medication, either on an emergency basis or non-emergency basis as specified in the law. (Pen. Code, § 2603, subd. (b).)

For non-emergency involuntary medication of a county jail inmate, if a psychiatrist determines that an inmate should be treated with psychiatric medication, involuntary psychiatric medication may be administered if the following due process conditions are met:

• A psychiatrist or psychologist has determined that the inmate has a serious mental disorder;
• A psychiatrist or psychologist has determined that, as a result of that mental disorder, the inmate is gravely disabled and does not have the capacity to refuse treatment with psychiatric medications, or is a danger to self or others;
• A psychiatrist has prescribed one or more psychiatric medications for the treatment of the inmate’s disorder, has considered the risks, benefits, and treatment alternatives to involuntary medication, and has determined that the treatment alternatives to involuntary medication are unlikely to meet the needs of the patient;
• The inmate has been advised of the risks and benefits of, and treatment alternatives to, the psychiatric medication and refuses, or is unable to consent to, the administration of the medication;
• The jail has made a documented attempt to locate an available bed for the inmate in a community-based treatment facility in lieu of seeking to administer involuntary medication. The jail shall transfer that inmate to such a facility only if the facility can provide care for the mental health needs, and the physical health needs, if any, of the inmate and upon the agreement of the facility;
• The inmate is provided a hearing before a superior court judge, a court-appointed commissioner or referee, or a court-appointed hearing officer, as specified;
• The inmate is provided counsel at least 21 days prior to the hearing, unless emergency or interim medication is being administered, in which case the inmate is to receive expedited access to counsel. If the inmate is awaiting arraignment, the inmate shall be provided counsel within 48 hours of the filing of the notice of the hearing with the superior court, unless counsel has previously been appointed, and the hearing shall be held no more than 30 days after the filing of the notice with the superior court, unless the date is extended;
• The inmate and counsel are provided with written notice, containing specified information, of the hearing at least 21 days prior to the hearing, unless it is an emergency basis, in which the inmate shall get an expedited hearing;
• At the hearing, the judge, court-appointed commissioner or referee, or a court-appointed hearing officer determines by clear and convincing evidence that the inmate has a mental illness or disorder and due to the illness the inmate is gravely disabled and lacks the capacity to consent to or refuse treatment with psychiatric medications or is a danger to self or others if not medicated, that there is no less intrusive alternative to involuntary medication, and that the medication is in the inmate’s best medical interest, as specified;
• The historical course of the inmate’s mental disorder, as determined by available relevant information about the course of the inmate’s mental disorder, shall be considered when it has direct bearing on the determination of whether the inmate is a danger to self or others, or is gravely disabled and incompetent to refuse medication as the result of a mental disorder; and,
• An inmate is entitled to file one motion for reconsideration following a determination that they may receive involuntary medication, and may seek a hearing to present new evidence, upon good cause shown. A court is not prevented from reviewing, modifying, or terminating an involuntary medication order for an inmate awaiting trial, trial if there is a showing that the involuntary medication is interfering with the inmate’s due process rights in the criminal proceeding. (Pen. Code, § 2603, subd. (c)(1)-(11).)

Emergency medication for a person confined in the county jail requires a showing that there is a sudden and marked change in an inmate’s mental condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the inmate or others and it is impractical, due to the seriousness of the emergency, to first obtain informed consent. (Pen. Code, § 2603, subd. (d).) The initial authorization period for medication in an emergency is 72 hours. If medication is necessitated beyond the initial 72 hours pending a full mental health hearing, the county department can seek to continue medication by giving notice to the confined person and their counsel of the intent to seek an ex parte order for continued treatment. A hearing must commence within 21 days of the notice. The request for an ex parte order must be supported by an affidavit from the psychiatrist or psychologist showing specific facts. The confined person and their counsel have two business days to respond to the ex parte request to continue medication. The court may issue an ex parte order upon a showing that, in the absence of the medication, the emergency conditions are likely to recur. Other than the timelines, the same due process conditions must be met as in a non-emergency situation. (Ibid.)

The law provides that in the case of an inmate awaiting arraignment, trial or sentencing, the involuntary medication order shall be valid for no more than 180 days. The court is required to review the order at intervals of not more than 60 days to determine whether grounds for the order remain. At each review, the psychiatrist is required to file an affidavit with the court affirming that the person who is the subject of the order continues to meet the criteria for involuntary medication. In making its decision, the court is required to consider the affidavit of the psychiatrist or psychiatrists and any supplemental information provided by the defendant’s attorney. The court may also require the testimony from the psychiatrist, if necessary. The court, at each review, may continue the order authorizing involuntary medication, vacate the order, or make any other appropriate order. (Pen. Code, § 2603, subd. (e)(1).) Unless the confined person consents or a new determination is made, as specified, the involuntary medication must be discontinued after one year from the determination that it was necessary. (Pen. Code, § 2603, subd. (g).)

This bill creates an alternative process to allow involuntarily medication of persons who are confined in the county jail and have been found IST after being charged with a misdemeanor. The bill provides for the ability to involuntarily medicate in an emergency situation, as defined, or where a court has found a defendant to be gravely disabled and without the capacity to refuse treatment with psychiatric medication.

According to information provided by the author’s office, this bill is necessary because when SB 317 (Stern), Chapter 99, Statutes of 2021, made significant updates to the IST system for misdemeanor offenses, streamlining access to treatment and reducing jail time, it inadvertently limited the ability of psychiatrists to utilize all available tools at their disposal, including involuntary medication. “Regardless of medical necessity, the severity of an individual’s condition, or how negatively it impacts their wellbeing and treatment access, there is no mechanism to compel individuals to take prescribed medication if they refuse.”

However, as discussed above, there is currently a process in statute to provide for involuntary medication of individuals confined in the county jail facing misdemeanor charges. (Pen. Code, § 2603.) Unlike this bill, it also includes additional guardrails to protect defendants being medicated involuntarily. Importantly, it provides that if psychiatric medication is administered to a person incarcerated in the county jail on an emergency basis, the medication shall only be that which is required to treat the emergency condition and shall be administered for only so long as the emergency continues to exist. (Pen. Code, § 2603, subd. (d)(1)(B).) Additionally, under the county jail statute, in the case of an incarcerated person awaiting arraignment, trial or sentencing, the order for involuntary medication is valid for no more than 180 days and the court is required to review the order at intervals of not more than 60 days to determine whether the ground for the order remains. At each review, the psychiatrist must file an affidavit with the court that ordered the involuntary medication affirming that the person who is the subject of the order continues to meet the criteria for involuntary medication. A copy of the affidavit must be provided to the defendant and the defendant’s attorney. (Pen Code, § 2603, subd. (e)(1).)

The statute authoring involuntary medication in the county jail also provides a process to obtain an ex parte order to continue treatment beyond the first 72 hours and pending the full mental health hearing (Pen. Code, § 2603, subd. (d)(2)(A)). According to information provided by the author’s office, Penal Code section 2603 is difficult to implement for those found IST for a misdemeanor due to its long timelines.

It should be noted that this bill is not reenacting the involuntary medication provision that existed for misdemeanor defendants found IST prior to SB 317. This bill creates a new, and as discussed above and can be seen in excerpts above, hybrid administrative procedure pulling in part from a statute that applies to the California Department of Corrections and Rehabilitation (CDCR). The process in former Penal Code section 1370.01, prior to SB 317, required a court hearing, wherein the court was required to make specified findings to warrant an order for involuntary medication. It was not an administrative process, as this bill creates. The former provision also provided that during the time that the IST defendant was confined in a treatment facility or on outpatient status, they could request the court to review any order. This bill provides that the IST defendant is only entitled to file one motion for reconsideration following the involuntary medication determination. Though they have a right to seek a new hearing, it is limited to presenting new evidence, and only upon a showing of good cause. Moreover, the only emergency involuntary psychiatric medication provision in former law was for persons who had been found by a court to be gravely disabled.

As a practical considerations, the bill should be clarified to expressly state that it only applies to those defendants confined in a county jail. While that appears to be the intent of the bill, it currently states it applies “if a defendant has been found incompetent to stand trial after having been charged with a misdemeanor…”

Also, the bill, as written, is confusing and challenging to interpret because it incorporates by reference parts of other code sections. The authors should consider rewriting the bill to mirror the language from other statutes that the bill is trying to incorporate rather than referencing parts of other code sections that then reference other subdivisions. As written, it is not always entirely clear the extent to which the author intends to incorporate the substance of a referenced code section. And if code sections are referenced, they should be to provisions that apply to jails not prisons.

1. Argument in Support

According to the California State Association of Psychiatrists, the sponsor of this bill:

SB 820 . . . ensures that a defendant found incompetent to stand trial (IST) for a misdemeanor offense is provided the appropriate medical treatment and supportive services needed for them to achieve wellness.

In the event of a defendant lacking mental competency to understand court proceedings, a judge may find them incompetent to stand trial (IST). In such cases, they are then offered alternatives, such as mental health diversion and assisted outpatient treatment (AOT). However, many defendants do not access these alternatives due to the severity of their symptoms and the fact that these programs remain voluntary. Should they be found ineligible or refuse to participate, their cases are typically dismissed with no further requirements of behavioral health services. This gap in care has severe consequences on recidivism rates and homelessness for this population despite them having been identified by the court as exceedingly vulnerable.

SB 317 (Stern, 2021) made significant updates to the IST system for misdemeanor offenses. However, it inadvertently limited the ability of psychiatrists to utilize all available tools at their disposal, including involuntary medication. Regardless of medical necessity, there is currently no mechanism to compel these individuals to take prescribed medication – a crucial tool in stabilizing patients.

California faces a significant and ongoing shortage of bed space. Because of this, these individuals often spend extended periods in jail while their mental health declines, ultimately making successful reintegration even more difficult. Until infrastructure catches up to demand, it is vital that the ability to provide involuntary medication during the crucial period between the IST hearing and the proffer of services be reinstated – exactly what SB 820 aims to do while retaining existing protections. Doing so will improve their chances of accepting and benefiting from treatment while reducing recidivism and homelessness.

1. Argument in Opposition

According to the California Public Defenders Association,

As currently drafted, SB 820 expands the authority to involuntarily medicate individuals in jail settings without guaranteeing fundamental due process protections or requiring consideration of less restrictive, more clinically appropriate alternatives for treatment. This approach raises serious constitutional concerns and risks compounding the harm experienced by some of the most vulnerable people in our county jails.

Antipsychotic medications are powerful agents that can profoundly and often permanently affect an individual's mind, body, and behavior. While these drugs may offer therapeutic benefits, they also carry serious and sometimes irreversible side effects, including:

• Body rigidity, tremors, and drooling
• Blurred vision and akathisia (motor restlessness)
• Acute dystonia (severe involuntary spasms of the upper body, tongue, throat, or eyes)
• Tardive dyskinesia (a potentially permanent neurological disorder marked by involuntary facial movements)
• Neuroleptic malignant syndrome (a rare but life-threatening condition)^[1]

The decision to forcibly medicate a person, particularly to alter their mental state and behavior, is one of the most intrusive exercises of government power. It implicates fundamental rights to liberty and bodily autonomy and must be governed by the highest procedural safeguards.

SB 820 authorizes involuntary medication in jails without clearly requiring essential protections guaranteed under existing law. These include the right to an evidentiary hearing, to be present at that hearing, to have counsel at all stages of the proceedings, to have access to medical records, to present evidence, and to cross-examine witnesses. Additionally, SB 820 authorizes up to one year of forced medication without ongoing judicial review.

By contrast, Penal Code § 2603 requires the court to review any order for involuntary medication at intervals of no more than 60 days. Before any such order is issued, the individual is entitled to a full and fair hearing with all the accompanying due process protections.

These protections are particularly vital when treatment is provided in a jail. Many county jails are currently under receivership, consent decrees, or active litigation due to chronic and systemic neglect of individuals with serious mental illness. ^[2] In multiple jurisdictions, for-profit contractors tasked with providing mental health care in jails have failed to meet even minimum standards. ^[3]

SB 820 represents a significant departure from California’s ongoing efforts to reduce reliance on jails as our de facto mental health systems and threatens to further entrench jail-based solutions in lieu of more appropriate inpatient or outpatient treatment options. Notably, unlike § 2603, SB 820 does not require counties to first seek placement in suitable treatment facilities before resorting to jail-based intervention.

While emergency intervention may, in rare cases, be necessary, it must remain an exception—allowed only when no less restrictive alternatives exist and only after meaningful judicial review. SB 820, as currently drafted, fails to provide these essential safeguards.

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1. Scott T. Stroup & Neil Gray, Management of Common Adverse Effects of Antipsychotic Medications, NAT’L LIBR. MED. (Sept. 2018), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145248/ ↑

2. Consent Decrees | Office of the Sheriff | County of Santa Clara

   Settlement Reached in Contra Costa County Jail Class Action Lawsuit - Prison Law Office

   Settlement Approved in Sacramento County Jail Class Action to Ensure Better Treatment of People with Disabilities and Reform Solitary Confinement Practices | Disability Rights California

   LA County Reaches Settlement with ACLU to Improve Conditions in Jails – COUNTY OF LOS ANGELES ↑

3. Wellpath Held in Contempt in Suit at California Jail | Prison Legal News;

   Lawsuit Alleges Wellpath Community Care Withheld a California Jail Detainee’s HIV Medication for Months, Leading to His Death from AIDS - Davis Vanguard;

   California health care giant Wellpath fails patients, critics say ↑