A plan to expand San Francisco’s ability to involuntarily hold the homeless for mental health and substance use treatment will impact far fewer people than initially thought.
While The City has identified dozens of people potentially eligible for the holds, a requirement of the state law authorizing the local program has inadvertently limited the pool of those who could qualify to fewer than 10, city officials told the San Francisco Examiner Friday.
To be considered under the proposal for a judge-ordered involuntary hold, or conservatorship, a person would need to have had eight or more 5150 psychiatric emergency holds in a year, according to the terms of Senate Bill 1045. The bill, co-authored by state Sen. Scott Wiener and passed by the state legislature last year, is intended to address the chronically homeless who are suffering from substance use and mental illness.
The City has identified 55 persons “who potentially meet the criteria for SB 1045,” having had eight or more more 5150 holds in 12-month periods over the past two years, according to Rachael Kagan, a spokesperson for the Department of Public Health.
But further limiting the possible number of eligible people is a requirement that The City also has to first seek through court petition to help the person through Laura’s Law, otherwise known as assisted outpatient treatment, or AOT.
It’s estimated that that prerequisite brings the number eligible down to below 10, Mayor London Breed’s spokesperson Jeff Cretan confirmed to the Examiner.
That’s because most of the 55 put on frequent 5150 holds are known to be unsuitable candidates for assisted outpatient treatment.
Wiener is now seeking an amendment to SB 1045 to change the provision, which was added to the bill last year during the approval process. He called it “clean-up legislation to ensure that SB1045 can be effectively implemented.”
“It would be unethical to force The City to seek frivolous AOT petitions for people they know aren’t appropriate candidates,” Wiener said in a text message. “The bill retains the AOT requirement, but with flexibility in cases where the department medically determines that a person isn’t an AOT candidate.”
Cretan said that they are “aware Sen. Wiener is working on legislation to address this issue” and that they still plan to move forward with the program. He said that it’s “worth doing” if it can help just one person.
He added, “This is not a one year program. It is a multi-year program.”
The debate over the conservatorship proposal could come to a head as early as March before the Board of Supervisors Rules Committee. Supervisor Rafael Mandelman, who co-introduced the local legislation with Breed to implement the program, said he is committed to seeing it through, despite the limited reach of the proposal and opposition from groups like the Coalition on Homelessness and the Mental Health Association of San Francisco.
“I’m not willing to back down,” Mandelman said. “If it’s four, it’s still worth doing. If it’s one, it’s still worth doing.”
Supervisor Hillary Ronen, chair of the Rules Committee, hasn’t taken a position on the legislation, but questioned whether the limited impact it would have is worth it, given the concerns being raised by advocates over civil liberties.
Ronen said that she’s been told by staff in the Mayor’s Office it would only impact two to five people given the limitations of SB1045, which were apparently only recently recognized.
“I haven’t decided yet,” Ronen told the San Francisco Examiner Friday. “I’m still trying to figure it out. It’s just not going to be very impactful.”
The plan has strong support in some sectors, however, including among downtown business interests.
A Jan. 23 letter signed by leaders of 10 influential groups, including the San Francisco Chamber of Commerce, the San Francisco Travel Association, the Hotel Council and the Hospital Council of Northern and Central California, calls upon the Board of Supervisors to pass the legislation.
“The public health and humanitarian crisis playing out on our streets impacts all of us,” the Jan. 23 letter reads. “Without adequate tools to intervene, people battling untreated mental illness and drug addiction will continue to deteriorate on sidewalks, in parks, and across our public spaces. The status quo is unacceptable to those who are left outside to suffer.”
The letter concludes: “We live here, work here, and represent businesses that collectively employ tens of thousands of people who also live in this city. We believe that Housing Conservatorships will make a lasting, positive long-term impact in the lives of our neighbors most in need.”
Jessica Lehman, executive director of Senior and Disability Action, which opposes the legislation, said in response to the letter that “decisions about how to respond to the homelessness and mental health crisis must be made with people directly affected, people who have had trouble accessing services and getting their needs met.”
She said that “forcing people into treatment is not only wrong; it is ineffective at creating lasting change and it is the wrong use of the city’s funds.”
“If we are serious about helping people, we need to provide quality, intensive mental health and substance use services, along with permanent supportive housing. To think that anything else will work is to ignore the facts,” she continued.
Breed, who made the conservatorship plan part of her platform in her run for mayor last June, most recently referred to the legislation during her Jan. 30 state of the city address.
“To help those who are truly suffering get real treatment, I’ve partnered with Supervisor Mandelman on conservatorship legislation,” Breed said. “Because when people can’t care for themselves, we need to care for them.”
She also announced that she would create a new position, the Director of Mental Health Reform, “who will better coordinate mental health care for those suffering in our City, strengthen the programs we have that are working, and, yes, cut the ineffective programs — because clearly some things just aren’t working.”