The Board of Supervisors on Tuesday approved conservatorship legislation backed by Mayor London Breed and introduced by Supervisor Rafael Mandelman.

Plan backed by Breed to force treatment of mentally-ill substance users wins approval

Board of Supervisors passes conservatorship legislation 10-1 with amendments

After some last minute tweaks, the Board of Supervisors approved legislation Tuesday to expand the power of The City to compel mentally-ill people with substance abuse issues into court-ordered treatment.

The vote came after months of debate over whether The City should expand compelled treatment when there are not adequate services available for voluntary treatment.

But in the face of a threat from proponents to take the proposal to the ballot and political pressure to address visible mental illness on the streets, the board approved the measure introduced by Mayor London Breed and Supervisor Rafael Mandelman in a 10-1 vote, with only Supervisor Shamann Walton in opposition.

“What you see on our streets, what you see playing itself out on our streets is a crisis,” Breed told reporters before the board’s vote Tuesday. “We have to do something a lot different than we have in the past.”

“San Franciscans have made it clear that they are unwilling to continue to allow severely mentally ill and addicted people to languish on our streets,” Mandelman said in a statement, after spending seven months working to pass the legislation at the board. He called the effort “a small but important step to bring the sickest, most vulnerable, and hardest-to-reach individuals into care.”

Nearly 30 groups, including the Coalition on Homelessness and Senior and Disability Action, who call themselves the Voluntary Services First Coalition, sent out a strongly worded statement denouncing the approval despite amendments introduced by Board President Norman Yee and Supervisor Matt Haney meant to address some of their concerns.

Those amendments require repeat offerings of adequate voluntary services before the conservatorship is sought and increased reporting.

“Our coalition appreciates efforts by several supervisors to reduce harm caused by [the legislation] by introducing amendments,” the statement said. “We’re still firmly in opposition to the law, knowing that this is the wrong direction to go to address a housing crisis and health system crisis that will take major changes and investment to fix.”

The group said they plan to continue to work toward improving “people’s access to effective and dignified services and housing.”

Haney said that the amendments make it “a stronger policy now.” He added that those impacted are “a population that often ends up on the streets in South of Market, the Tenderloin when they are failed repeatedly by our system. What this whole process has revealed is that we have a broken system.”

Walton said that he was still not “comfortable” with supporting the proposal because his concerns about the disproportionate impacts on people of color were not adequately addressed. He said he also worried it would increase negative interactions with police officers.

The legislation implements Senate Bill 1045, which was introduced last year in Sacramento by state. Sen. Scott Wiener, permitting San Francisco, Los Angeles and San Diego to launch the five-year pilot program.

Under the proposal, those suffering from mental illness and substance use can come under court-ordered treatment, including in locked psychiatric facilities, if they are held on eight 5150s, or 72-hour emergency psychiatric holds, in a 12-month period. They would have representation by attorneys in the Public Defender’s Office.

Wiener praised the board’s vote in a statement.

“It’s neither progressive nor compassionate to stand by while people die,” Wiener said. “We need to offer voluntary services to those in need, but for people incapable of accepting services, we need to consider helping them via conservatorship.”

It was discovered earlier this year that because of the way Senate Bill 1045 was drafted, it would only impact five people. But a pending bill in Sacramento, Senate Bill 40, would change the parameters to allow up to about 50 people to be conserved in San Francisco.

SB 40 recently passed the Senate in a 36-0 vote and is now before the Assembly.

In pushing for the approval of the legislation, Breed has emphasized plans for increased spending of $50 million on mental health and substance use services over the next two fiscal years, including opening up 100 beds. That’s in addition to 100 already approved.

The first 100 already-approved beds include 14 opened at Hummingbird Place on the San Francisco General Hospital campus and 14 beds at the St. Mary’s Medical Center at the SF Healing Center. The remaining beds are 72 substance use residential units on Treasure Island operated by Health Right 360, all of which are expected to become operational by July.

Pending approval of the budget proposal, the additional 100 beds include 52 residential mental health treatment beds for those with dual diagnosis that have yet to be sited and 50 behavioral health respite and assisted living beds, which would include more Hummingbird beds and other beds in yet to be determined locations.

The legislation expands The City’s existing conservatorship power under the Lanterman-Petris-Short (LPS) Act, which allows someone to be held involuntarily and treated in a mental health facility if the person is deemed “gravely disabled,” which means they are unable to provide their own basic needs like food, clothing or shelter.

jsabatini@sfexaminer.com

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