Nearly two years after a conservatorship program was approved targeting mentally ill residents suffering from substance addiction and living on The City’s streets, San Francisco has only now placed the first person in court-ordered treatment.
In June 2019, the Board of Supervisors approved the controversial “Housing Conservatorship” pilot program allowed under Senate Bill 1045, which had been approved earlier that same year. But challenges in implementing the program, which was promoted by Mayor London Breed and Supervisor Rafael Mandelman, have prevented anyone from being conserved until now. The pilot expires Jan. 1, 2024.
“It’s been nearly two years since the board vigorously debated and ultimately opted into SB 1045,” Mandelman said at a Thursday hearing of the board’s Public Safety and Neighborhood Services Committee. “I said at that time that even if SB 1045 only helped one person, I believed it was worth doing. And I still believe that, but I didn’t think it would actually literally be just one person.”
He said that the “purpose was to address the needs of a relatively small population of unhoused folks who repeatedly cycle through psych emergency, our other emergency rooms, jail, back to the streets and again without ever getting the longer term support and care that they need.”
Under the program, people are eligible for The City to seek a court approved-conservatorship if they have a mental illness and a substance use disorder, and in the past 12 months were held at least eight times at an area hospital on a 5150 for up to 72 hours for a psychiatric emergency evaluation.
Early last year, city officials blamed the challenging process of setting up the legal forms with the courts for the new program as a cause for the delay in implementation.
“In June 2020, the forms were finalized by courts locally, which then allowed us to be able to move forward with cases,” Angelica Almeida, who oversees the Department of Public Health’s assisted outpatient treatment program and the SB 1045 pilot, told the committee. “It really wasn’t until June 2020 that we were able to move forward with cases.”
Almeida said that as of the end of January, they have identified 63 individuals with dual conditions who had at least five 5150s in the past 12 months, of which 16 had at least eight, and one is the one who was conserved.
She said she anticipated The City would ultimately end up conserving “at least a handful of more individuals” under the pilot.
Jill Nielsen, deputy director of programs for the Department of Disability and Aging Services, which oversees conservatorships, said that the “eligibility criteria is far too narrow” for conserving someone under the pilot. She noted that SB 1045 was initially introduced to permit a conservatorship if a person had three 5150s within 12 months, not eight.
However, critics of the bill called for tougher protections against conservatorship under the pilot, including The City doing more to offer voluntary services and housing “before we take away civil liberties.”
“We know there are huge problems with conservatorship,” said Jessica Lehman, executive director of Senior and Disability Action. “It is a significant deprivation of civil liberties.We need to offer people housing and voluntary services earlier rather than having people in crisis for years and then saying that they haven’t made rational choices.”
She refuted the characterization from 1045 backers that opponents of the bill succeeded in getting in amendments that made the pilot overly complex.
“It is great that we have as many protections as we do,” Lehman said. “The people who have had multiple 5150s are disproportionately African-American men and the city must come up with a plan to address that racial disparity before continuing.”