San Francisco Chronicle - (Sunday)
Effort to aid mentally ill starts slowly
S.F. has compelled only one person for treatment
For years, Supervisor Rafael Mandelman has been pushing to get more San Franciscans with mental illness and drug addiction into treatment — and in the most severe cases compel them into getting help.
But nearly two years after San Francisco opted in to a controversial state law forcing severely mentally ill and drug addicted people into treatment, the city has placed only one person in care. The bill’s sponsor, state Sen. Scott Wiener, estimated when it passed that it would help 50 to 100 people.
“I am concerned, here we are almost two years later, about what our slow progress ... may say about the city’s broader ability to help a population who we don’t seem able to help in other
ways,” Mandelman said at a Board of Supervisors hearing Thursday. “We are so clearly failing the people who are the sickest and have the most acute illness.”
The slow pace worries officials about the city’s capacity to deal with severely mentally ill people suffering on the streets and cycling in and out of emergency rooms.
Still, there was some progress on getting people into treatment. As of the end of January, 62 other people were on the path to a courtapproved mandated treatment plan, called conservatorship, with 16 people on the last step, health officials told supervisors during the Thursday hearing. Another 140 individuals received lower level outpatient services, including 60 who are no longer on the path to mandated treatment.
In June 2019, the Board of Supervisors opted into a state law — called SB1045 — that allowed the city to force a sliver of the population with the most acute needs into mandated treatment.
It took until June 2020 to get the legal paperwork to fully start the program in San Francisco, officials said Thursday. But actually helping people through the new law has proved challenging due to cumbersome requirements and pandemic constraints. “Although we knew the housing conservatorship program would only serve a small number of individuals, it does remain disappointing that we have not been able to help more vulnerable people at this point,” Jill Nielsen, San Francisco’s public conservator, told supervisors Thursday. “I do want to assure you that we are absolutely committed to growing the program.”
In response to the slow pace, health officials pivoted this year to ramping up use of a 1960s state law called the LantermanPetrisShort Act that allows a psychiatrist to directly refer people who are unable to care for themselves into courtapproved treatment without as much documentation.
The law applies if a psychiatrist determines that someone is unable to provide for their own food, clothing and shelter as the result of serious mental illness or chronic alcoholism, but isn’t in imminent danger and doesn’t need to be in inpatient treatment. It doesn’t apply to drugaddicted people.
Since Jan. 1, the city has put 10 people into care under this provision, compared to six people from 2018 to 2020. San Francisco is following the steps of Los Angeles County, which increased its use of the law last summer with its severely mentally ill homeless population.
So far, San Francisco has only focused on stabilizing people who are housed, but at some point started to unravel in a mental health crisis, with outpatient treatment. But the city wants to expand the law’s use to help the sickest of the thousands of homeless people who also struggle with addiction and mental illness, Nielsen said.
Meanwhile, the debate over whether the city should care for people who can’t take care of themselves — while taking away their autonomy — still rages.
“Our priority both ethically and legally is to serve individuals at the least restrictive option for them and as best as we can to engage individuals in voluntary services,” Angelica Almeida, director of the city’s justice-involved behavioral health services, said during the hearing. “But we know conservatorship is an important tool in our tool belt.”
Some service providers and advocates push back against what they call a draconian measure.
“It’s a significant deprivation of civil liberties,” Jessica Lehman, executive director of the nonprofit advocacy group Senior and Disability Action, said during public comment. “We talk about people being unable to care for themselves, and we need to remember it’s subjective. We need to offer people housing and voluntary services earlier rather than leaving them in crisis for years and then saying they’re unable to make rational decisions.”
Supervisor and health officials stressed Thursday that they want more intervention before people get to the point of conservatorship as well as making sure that housing is offered with voluntary treatment.
Conservatorship under SB1045 is a complicated process, Nielsen said. Before someone is conserved, that person must be subject to eight documented psychiatric holds because they were a danger to themselves or others within 12 months. They also must receive nine documented offers of voluntary treatment.
“These requirements, while wellintentioned, are excessive and they make it challenging for us to prepare a case,” Nielsen said.