S.F. Moves to Enact Wiener’s Conservatorship Bill

A homeless man is picked up by paramedics on the Embarcadero, April 2018. (Courtesy Image)

A controversial mental-health bill that entered the State Senate earlier this year may have found its home in San Francisco. SB 1045, authored by Senator Scott Wiener, would grant authorities the right to take away someone’s rights if they are frequent users of the city’s hospital, jail, and psychiatric wards. 

Supervisor Rafael Mandelman introduced a local bill nearly identical to Wiener’s at a Board of Supervisors meeting on Tuesday. Under the legislation, a person would meet the new conservatorship criteria if they are homeless and are a high utilizer of emergency departments, have a history of frequent incarceration due to behavior resulting from severe mental illness or a substance-abuse disorder, or a history of 5150 holds. 

“I see this as a start of a conversation for our city, and I look forward to collaborating in the weeks ahead with stakeholders, advocates, and key city departments to make this program as effective as possible,” Mandelman said. “We can’t allow our neighborhoods to serve as open-air mental institutions, our jails as shelters, and our hospitals as a temporary way-station between the two. It’s not humane and it’s not the response of a civilized government in one of the wealthiest cities in the world.” 

Wiener, Assemblymember David Chiu, and Mayor London Breed also support the bill. 

“Conservatorships we know are a challenge, and we are going to continue to engage all stakeholders on finding solutions for the purposes of helping this population,” Breed said Tuesday.

But despite the support of many politicians, the bill has failed to win the support of many of the aforementioned “stakeholders,” including independent health centers and homelessness organizations in S.F. Some adamantly oppose it. 

“There has not been any showing of current barriers in existing law or practice that prevent counties from providing the care and services they propose with this bill,” Mary Howe, executive director of the Homeless Youth Alliance, says. “SB 1045 does not propose a solution that meets the sponsors’ goals of addressing homelessness and the need for behavioral health care. San Francisco is already failing and unable to meet the housing and medical needs of the very people this bill seeks to help.”

Dr. Vitka Eisen, president and CEO of HealthRIGHT 360, is concerned that the main change in conservatorship law expressed in SB 1045 was the specific inclusion people who use drugs. The current law is limited to those who abuse alcohol. 

“We’re coercing treatment for substance use in a way that has not actually been done,” Eisen tells SF Weekly, noting that the only way to do that currently is through a court order. 

“This is in fact a level of coercion that has not previously existed,” she says. “I have pretty deep concerns about that. That being said, I truly do understand the tremendous challenges faced by people who have a substance-abuse disorder related to methamphetamine. Those people who suffer from that condition exhibit behaviors that appear to be pretty self-destructive. I want to believe that the people that are putting this legislation forward want to approach this same condition with compassion. But what else can we do before we step over and coerce people into substance-use treatment?”

Other health organizations have also expressed skepticism over the legislation. According to the Examiner, groups such as the San Francisco Mental Health Board, the Mental Health Association of San Francisco, and Senior and Disability Action — which were only invited to speak with politicians three business days before the bill was scheduled to be introduced — expressed everything from concern over the speed with which this was moving to fears it was taking a big step backward and criminalizing the mentally ill.  

The number of people affected by the conservatorship bill vary depending on who you talk to. Simon Pang, captain of the San Francisco Fire Department EMS-6 team, which responds to the regular high users of 911 services, says he estimates “less than 10 individuals have such severe substance-abuse disorder and mental disorganization that they cannot perform routine acts of daily living.” In contrast, the city’s Department of Public Health says somewhere between 50 and 100 people would qualify. Earlier this year, Wiener said it would apply to “only a tiny percentage of people on our streets — perhaps 1 percent of the population,” which, if the annual homeless point-in-time count is accurate — hint: it isn’t — would be 75 people. 

Currently, the above numbers also only apply to unhoused people living on our streets. In the new legislation, that’s changed.

“When we initially introduced the bill, it was limited to chronic homeless,” Wiener tells SF Weekly. “We did that to try to make it a little more targeted, but that requirement was removed. There are groups who are marginally housed who are also in crisis, although most people who have the ability to pay rent are probably less likely [to qualify].”   

This puts a slight damper on the concern that conservatorship would only apply to people without homes, adding to the litany of ways in which San Francisco criminalizes homelessness. 

After all, as Howe points out, “If someone is required to be confined for their own safety, then one’s housing status is irrelevant.”

With the introduction of SB 1045 this week, the city faces a conundrum. The mental and physical health crises on our streets are absolutely unacceptable, but is this the right path? As the Department of Public Health states, 12 percent of the unhoused people who accessed health services last year accounted for 74 percent of the department’s costs. And if that’s true, then housing appears to be the obvious answer. With Nov. 6 right around the corner, it’s odd that these politicians aren’t standing up for Proposition C, which would double their homelessness budget. 

“I know everyone up here is supportive of the need to build up our funding for responses to homelessness,” Mandelman said at a conservatorship press conference Tuesday, as he stood next to Chiu, Breed, and Wiener. 

If only that were true.

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S.F. Moves to Enact Wiener’s Conservatorship Bill