Eight months after San Francisco authorized a new program meant to compel persons suffering from mental illness and substance abuse into treatment, The City has yet to conserve anyone, according to a new report.
The “Housing Conservatorship Program” was intended to address the crisis visible on the streets by expanding The City’s legal authority to seek court supervision of those it deems unable to help themselves.
The program was made possible under state Sen. Scott Wiener’s Senate Bill 1045, which passed in September 2018.
The Board of Supervisors in June 2019 approved legislation authorizing the program, which was advocated for by Mayor London Breed despite opposition from homeless and disability advocates who argued it would take away persons’ civil liberties.
But eight months later The City has not compelled anyone into treatment, according to a new report from a 12-member working group mandated under the legislation to evaluate the program. The program is a five-year pilot that ends in December 2023. The San Francisco Housing Conservatorship Preliminary Evaluation Report, which said the program remains in its “pre-implementation stage,” was written by city-contracted consultant Harder+Company Community Research.
Mayor London Breed’s spokesperson Jeff Cretan attributed the delay in implementation to the need for San Francisco Superior Court approval.
“We have been working diligently and collaboratively with the Courts as they must approve of the process and the necessary forms and documentation associated with this new type of conservatorship before any case can proceed,” Cretan said in a statement to the San Francisco Examiner. “We are optimistic that the process will be set up shortly and that we will be able to proceed with advancing cases soon.”
He added that “we are the first county in the state to implement this new program, so we are working hard to ensure that we balance helping those suffering in our city and ensuring their civil rights as we do so.”
Breed had announced in October 2019 that The City would begin implementation of the program, after a subsequent state law passed, Senate Bill 40, that fixed some issues with the initial bill.
For The City to conserve someone under the new law, the person must have a dual-diagnosis of a serious mental illness and substance use disorder and have been placed on a psychiatric emergency hold, known as 5150s, at least eight times in a 12-month period. Those placed on 5150 present an imminent danger to themselves or others or they are considered gravely disabled due to a mental disorder.
The Department of Public Health, which oversees the program, has estimated that 50 to 100 people would meet the criteria for conservatorship.
“DPH and partner agencies have worked with several people who might meet the criteria and who so far have been engaged in voluntary services, assisted outpatient treatment, or other types of conservatorship,” the Department of Public Health said in a statement.
The working group issued its first report to the board and Breed Tuesday afternoon, as required by the local legislation.
The report includes a “partial estimate” of the number of times people were placed on emergency psychiatric holds for fiscal year 2018-19, “as well as insights into the conditions necessary for successful data collection, tracking, and analysis.”
One possible way to measure the program’s effectiveness over time is by whether there the number of 5150s declines, the report said.
There were at least 5,754 emergency 5150 holds in San Francisco during the fiscal year 2018-19 that were attributed to 3,810 different people, the report said.
There were limitations to the data, however, and the report said that the “true count” of 5150s during this time period “is likely higher, though it is not possible to approximate at this time.”
The working group is also charged with obtaining details around 5150 cases and why police officers were “appropriate” to respond to them.
Case-specific data was not available to answer these questions, but general data showed the reason police officers responded to 35 percent of the emergency calls that led to 5150s was a call reporting a “person attempting suicide,” according to police dispatch logs.
“Although this does not provide additional insight into what the caller is saying to dispatch about a person’s presentation or behavior at the time of the call,” the report said.
The second most common reason, at 12 percent, was a call reporting a “mentally disturbed person.”
The report also said that 96 percent of police emergency calls that involved a 5150 evaluation were “resolved with the individual detained without criminal charge, while the remaining individuals were either cited for minor infractions or booked into the county jail once their psychiatric crisis was resolved.”
Additional reports are due annually to the mayor and board, as well as the state legislature, from January 2021 to January 2023.
Conservatorships under SB1045 are different from those allowed since 1972 under the Lanterman-Petris-Short Act. The LPS Act allows counties like San Francisco to conserve individuals deemed gravely disabled due to serious mental illness or chronic alcoholism.
Under LPS, “as of December 2019, San Francisco’s Office of the Public Conservator currently oversees the care of 625 individuals,” the report said.