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Advocates say SF unprepared to implement conservatorship program for homeless, mentally ill

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The Mayor’s Office is working to introduce legislation at the Board of Supervisors as soon as next month to allow for San Francisco to launch a conservatorship program for people who are chronically homeless and experience severe mental illness or substance abuse.(Kevin N. Hume/S.F. Examiner)

City officials are hurrying to launch a conservatorship program to force the homeless and mentally ill into treatment by early next year, but homeless advocates argue there are not enough resources or safeguards for the civil rights of those in the program in place.

A law signed by Gov. Jerry Brown in September allows San Francisco, Los Angeles and San Diego to expand efforts to involuntarily treat the chronically homeless and others who are suffering from such severe mental health and substance abuse issues that they are unable to care for themselves. The program is expected to capture some 50 to 100 people annually, city officials said on Friday.

Counties must pass legislation to implement the law, and City leaders have said they want to introduce the necessary legislation at the Board of Supervisors quickly— potentially as early as next month. The Board of Supervisors also voted earlier this year to approve an ordinance sponsored by Mayor London Breed to give the city attorney authority over civil conservatorship proceedings.

“There is an interest in doing this as soon as possible,” said Supervisor Rafael Mandelman, a supporter of the law who is working with Breed on the issue. “I’d like to see us in a position to start implementing [the expansion] early in the New Year.”

On Friday, Breed — a proponent of SB 1045 — convened stakeholders from various city agencies, as well as homeless, mental health, senior, disabled and civil rights advocacy groups and service providers, for a private meeting at City hall.

Jeff Cretan, the mayor’s communication’s director, told the San Francisco Examiner that before “legislation was issued by Brown,” the mayor’s staff started “to work together to do outreach to advocacy groups…with the goal of introducing legislation soon.”

But many of those at the meeting called on the city to take a step back.

“Let’s slow it down. I’m not against it in principle, but let’s improve our whole public health system,” David Elliot Lewis, of the Mental Health Association of San Francisco. “We don’t have a health director currently — I think that’s a problem that we don’t have leadership in our health department.”

Lewis added that he would like to see Proposition C, the November ballot measure that would raise $300 million annually to house 4,000 homeless San Franciscans, pass before conservatorships are expanded in San Francisco.

Other stakeholders said that Friday’s meeting was their first meaningful opportunity to weigh in — and many were not convinced that The City is ready to implement the expansion just yet.

Terezie Bohrer, a member of the San Francisco Mental Health Board, which she said has not taken an official position on the legislation, said there are not enough resources or housing, to ensure the success of the conservatorship expansion.

“If this bill puts resources in place that’s certainly one thing,” she said. “But I would hate to see that people will have to lose their rights in order for that to happen. That’s beyond belief — that you have to lose your rights in order to get services.”

Homeless and mental health advocates have long argued that involuntary conservatorships are the wrong approach to addressing the population of chronically homeless and mentally ill individuals living on San Francisco’s streets.

“We think it violates the right of people with disabilities, with mental health conditions, by jumping to involuntary treatment when we know that voluntary services and housing are not available,” said Jessica Lehman, executive director of Senior and Disability Action.

The advocacy group is part of a larger coalition of community groups formed to oppose implementation on the city level — they are concerned that the expansion will not address the “underlying drivers of psychiatric disabilities, substance abuse and homelessness and lacks the necessary resources to be successful,” according to a statement issued by the coalition on Friday.

City leaders have referred to SB1045 as ‘housing’ conservatorships, because the new law requires conserved people who have received treatment and have been stabilized to be placed in permanent, supportive housing. In order to become eligible, a patient must have been placed on eight 5150 emergency holds.

“The legislation requires that the housing that somebody gets under conservatorship will not displace services that someone could get voluntarily — but how can that not happen when we know there are thousands of people who are not getting the services they need?” said Lehman.

“We can’t bump up a set of folks to get that involuntarily without displacing others,” she added. “Will we have a system where people have to go through conservatorships just to get services — or have to go through a traumatic 5150 experience just to get bumped up the list?”

Deputy Public Defender Simin Shamji called Friday’s meeting “a good start,” but added that “services and housing” needed to be the focus to ensure San Francisco’s capacity to “implement a program like this.”

Shamji added that another prerequisite for conservatorship under the new law is that anyone who is referred must have gone through a voluntary Assisted Outpatient Treatment program first, and questioned whether those resources were available.

“I think that the real issue here is, do we have a real alternative so that we can actually implement this hopefully well-meaning law,” she said. “This is a new area for lots of people and for it to be properly implemented, we need to take a step back and look at it from a systems perspective.”

Jeff Kositsky, director of the City’s Department on Homelessness and Supportive Housing, agreed that more housing availability and services are needed, but added that “we shouldn’t let those needs keep us from fixing things that we can.”

Earlier this month, Breed announced that she is planning to add 1,000 more shelter beds over the next two years.

Every year, 300-400 vacant units of housing became available to serve severely mentally ill individuals, said Kositsky, adding that the individuals that would be served by the conservatorship expansion are “probably already our priority clients anyway,” and that the conservatorship expansion’s implementaiton would not change the department’s prioritization requirements for housing and shelter.

“Large scale systems failures need to be addressed,” said Kositsky. “But if we can help 50 to 100 people a year that we couldn’t help last year, I am all for that…I don’t think we should stop this just because we are trying to fix other things.”

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