Thursday, March 1, 2018

Can New Laws Address Severe Mental Illness and Chronic Homelessness?

A small minority of San Francisco’s homeless population suffers from severe mental illness. Can California step in to help?

We’re all familiar with the common myths about San Francisco’s homeless residents: that many people on the street are not simply impoverished, but suffer from serious mental illness and self-medicate with substance abuse; and that the City will not, or cannot, compel these people into medical treatment and housing. A brisk walk through Civic Center or the Tenderloin can easily give reinforce those theories, but now, Supervisor London Breed and State Senator Scott Wiener have introduced legislation to address the most visible aspects of this crisis. 

Wiener’s new bill, SB 1045, would expand the criteria that local governments could use to provide conservatorship for individuals who suffer from chronic homelessness, accompanied by debilitating mental illness, severe drug addiction, repeated psychiatric commitments, or excessively frequent use of emergency medical services. It is an idea that was first championed by the late Mayor Ed Lee, and is now carried on by his staff in the Department of Public Health.

The causes of homelessness are far more complicated than popular assumptions suggest. But the Department of Public Health has identified a small, core group of individuals - 50 to 100 people - who are deeply mentally ill and chronically homeless. So much so, that they cannot seek treatment themselves. This small group—estimated to be just 1% of the entire homeless population—has undergone multiple psychiatric commitments and repeatedly required emergency medical services. They absorb major resources from the social services system. 

“This is not about the broad homeless population,” said State Senator Scott Wiener, who has worked extensively on this issue, on KQED’s Forum. “People walk down the street and they see someone, everyday, who is clearly in distress and incapable of making decisions for themselves. They wonder—why aren’t we doing something [to help these people]?”

Currently, conservatorships can only be utilized if an individual is unable to care for themselves due to “grave disability” (like not being able to feed themselves) or due to physical health issues, cognitive impairment, and elder abuse. Unfortunately, this mechanism currently excludes those who may have severe mental illness or drug addiction.

These individuals are often legally held by the City for 72 hours after exhibiting signs of mental illness, but then sober up during that time. By the time they appear in front of a judge, they seem able to care for themselves and are released back onto the streets, the very environment which triggered their mental illness in the first place.

Mayor Ed Lee and his staff wanted to expand the conservatorship program to include individuals they knew had repeated psychiatric commitments and frequently used emergency medical services.

Gail Gilman, Executive Director of Community Housing Partnerships, said “We too often see in supported housing individuals who need a higher level of care and who in the midst of their addiction or mental health crisis are unable to make decisions for themselves and need an intervention.”

The issue is not unique to San Francisco. In Southern California, Supervisors Mark Ridley-Thomas and Kathryn Barger are re-evaluating the effectiveness of the Los Angeles County’s conservatorship program. In the State Capitol, Senators Henry Stern, Ben Allen, and Steven Bradford (all from Los Angeles) also co-authored the bill with Senator Scott Wiener.

Board of Supervisors President London Breed followed up SB 1045 with a local legislative package of her own. Her bills aim to decriminalize mental health and homelessness conservatorship cases by changing their jurisdiction from the District Attorney’s office to the City Attorney. Breed hopes this would allow conservatorship cases to be treated similar to family custody cases, instead of as a crime.

Breed’s legislative package also calls on city agencies to collaborate on a list of highest-risk individuals suffering from mental illness, substance abuse, and chronic homelessness. In a press release, Supervisor Breed stated: “As a progressive city, we must do more to care for those who cannot care for themselves. It's not compassionate to let those who are grappling with severe mental health and substance abuse issues simply wither away on our streets.”

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