San Francisco prepares to expand conservatorships for homeless people

A state bill would allow courts to appoint a conservator for a person who is chronically homeless and unable to care for themselves due to mental illness or substance use, based on frequent trips to emergency rooms, stays in jail and 5150s. (GABRIELLE LURIE/SPECIAL TO THE S.F. EXAMINER)

San Francisco is preparing for an expanded use of conservatorships in anticipation of state legislation that would allow The City to increase their use for homeless persons suffering from mental illness or substance use.

The City’s Public Conservator currently has 577 people under mental health conservatorships and receives about 16 referrals monthly of people admitted for psychiatric care through an initial 5150 72-hour emergency hold.

However that number is expected to increase if state Sen. Scott Wiener, D-San Francisco, succeeds in passing Senate Bill 1045, which expands the criteria for placing a person under conservatorship. The bill would allow courts to appoint a conservator for a person who is chronically homeless and unable to care for themselves due to mental illness or substance use, based on their frequent trips to emergency rooms, stays in jail and 5150s.

The Senate Public Safety Committee will hold a hearing on the bill Tuesday.

Meanwhile, the Board of Supervisors Budget and Finance Committee approved legislation Thursday that would have the City Attorney’s Office take a leading role in arguing for conservatorships. The District Attorney’s Office currently handles the cases but would only handle them for those also facing criminal charges if the legislation is approved.

The City Attorney has proposed three new positions to handle the workload beginning January 2019, which would cost $717,874 annually, according to a report from the budget analyst.

Board of Supervisors President London Breed, who introduced the legislation, said that it was important for the City to “expand the capacity for addressing these particular issues” and “make this process efficient.”

Jill Nielsen, who oversees the Public Conservator program under the Human Services Agency, said she had visited Sacramento this week with Mayor Mark Farrell’s staff to support Wiener’s bill.

Nielsen said that the bill would address a trend they are seeing in San Francisco of homeless persons undergoing psychosis as a result of drug use, such as methamphetamine.

“There are other drugs that our homeless individuals out on the streets are actively using and it creates this agitation psychosis that many of us are very familiar with just from walking to BART or wherever we might be going,” Nielsen said.

Conservatorships are currently allowed under the Lanterman-Petris-Short (LPS) Act passed in the 1960s, 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.

Nielsen said that conservatees have remained under conservatorship for an average of five years. “Although LPS conservatorships are intended to be short term, the individuals that we are serving do have serious mental illness and it takes time for them to achieve recovery,” Nielsen said.

Nielsen said when someone is referred, they are evaluated and some are placed in locked facilities while others are located in community settings like a residential care facility for elderly or single room occupancy hotels with supportive services. She noted that in some cases medications are provided involuntarily.

Should Wiener’s bill pass, San Francisco would need to approve legislation to adopt the new conservatorship criteria, according to the budget analyst.

The board postponed a vote Tuesday for one week on a resolution introduced by Breed supporting Wiener’s bill.

David Elliott Lewis, who serves on the Mental Health Board and provides Crisis Intervention Training for police officers, spoke against the resolution. “To enact another law that can deprive people of civil rights to address a political need of seeing homeless people on the street is really troubling,” Lewis told the board Tuesday.

He added, “We need housing and treatment and community supports.”

Barbara Garcia, Public Health Department director, said Thursday that the combination of mental illness, addiction and homelessness “really does cause their inability to take care of themselves,” which is why she supports Wiener’s proposal.

Garcia said it would “provide a little bit of respite for these individuals, a little bit of respite for the neighborhood.”

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San Francisco prepares to expand conservatorships for homeless people