County program could ease conservatorship process for some people with severe mental illness, addiction

San Diego County Board of Supervisors agreed to pursue an expanded conservatorship program that could be in place some time next year.

(Rob Nikolewski / The San Diego Union-Tribune)

San Diego, San Francisco and Los Angeles are cities that can adopt pilot programs that can place more people into conservatorship

By Gary Warth

San Diego County is pursuing a pilot program that would make it easier for judges to order some homeless people with mental health issues into conservatorship, a step that could lead to them to treatment they otherwise would not voluntarily accept.

Because of its strict requirements, they program isn’t expect to apply to many people. However, some concerns already have been raised about how it would affect the civil rights of people with mental health issues, although none of those concerns were voiced when the Board of Supervisors approved the program at a Oct. 29 meeting.

San Diego, Los Angeles and San Francisco counties have an option to create the program under Senate Bill 40, written by State Senator Scott Wiener (D-San Francisco) and signed by Gov. Gavin Newsom in October. It was brought to the San Diego County Board of Supervisors on the recommendations of Supervisors Dianne Jacob and Nathan Fletcher.

The supervisors’ vote directed the county to develop a pilot program as outlined by SB 40 and report back with recommendations for implementing it within one year.

In San Diego County, 43 percent of homeless people surveyed during the 2018 annual Point-in-Time Count stated they had mental health issues. Another 14 percent acknowledged having substance abuse issues, and 9 percent said they abused alcohol.

The bill is focused on helping a small percentage of homeless people so deeply affected by addiction or mental issues that they cannot make their own decisions responsibly. In certain cases, a judge can appoint a guardian or protector as a conservator for six months to make choices for the person that could lead to housing and treatment.

The new program identifies specific reasons why a person may be placed under a conservator, while existing law requires people to be gravely disabled, defined in part as being in danger of seriously harming themselves.

“We will utilize every available tool to address the issues of behavioral health and homelessness,” Fletcher said in advance of the board’s vote in support of the program, which was passed without discussion on the consent calendar.

Fletcher said the county hopes to build a regional, coordinated, integrated behavioral health system that prevents people from needing a conservator, but the new program could be helpful until then.

“Our ultimate success as a region should be judged on keeping people out of that situation, but in the interim we will utilize every option that can provide help to those most in need,” he said.

There is a high bar for eligibility in the program under the bill, which requires people to have been diagnosed with serious mental illness and substance-use disorder. They also must have had at least eight involuntary psychiatric hospitalizations under state Welfare and Institutions code 5150 over 12 months.

Deacon Jim Vargas, president and CEO of Father Joe’s Villages, said there is a need for such a program, but it must be be respectful of people’s civil rights.

“I just want to make sure that any measure that’s adopted is one that’s compassionate and not a matter of criminalizing the issue,” he said. “The core challenge is, these individuals out on the street can’t help themselves. We need to make sure there is a balance where we don’t take away civil rights, but we compassionately and effectively address those issue.”

The bill amends similar bill signed by Gov. Jerry Brown last year. Senate Bill 1045 allowed the three counties to have expanded conservatorship programs, but with the additional requirement that people had to have been ordered into assisted outpatient treatment.

Under Laura’s Law in California, the treatment can be ordered for people who have severe untreated mental illness and a history of violence or repeated hospitalizations.

Because of those restrictions, an analysis of SB 1045 in San Diego County found only eight people would be eligible for the conservatorship program, said Tim McClain, group communication manager for the county’s Health and Human Services Agency. More are expected to be eligible for the program under SB 40 guidelines, but just how many is not known, he said.

Only San Francisco County voted to create a program under SB 1045. Although it was expected to affect only five people in that area, it was considered a controversial move and was met with protests.

About two dozen people, including representatives of the Coalition on Homelessness, disability rights groups and medical professionals, disrupted an April town hall meeting where Wiener and other legislators had appeared to discuss the bill.

The American Civil Liberties Union, Western Center on Law and Poverty and Disability Rights California sent a letter opposing the bill to Newsom in September. No members of any of those groups spoke against it in San Diego.

Homeless advocate Martha Sullivan and former state Assemblywoman Lori Saldaña co-wrote a commentary against the program that appeared this month in The San Diego Union-Tribune. The two cited an analysis of SB 40 that estimated it would assist only up to 100 people in all three counties and doesn’t provide any housing or services for people beyond six months.

Bob McElroy, president and CEO of the nonprofit homeless service provider Alpha Project, saw merit in the program, if done right.

“You have to have either institutionalized care or assisted living care. somebody who knows these populations and has training with these folks,” he said about the need facing some people on the street.

Homeless advocate Michael McConnell also said he said he saw a need for getting mental health treatment to people on the street, but was cautious to endorse the plan.

“I think the execution is what’s going to be super important,” he said. “I’m on the fence about whether we should implement laws like this or not. We haven’t tried hard enough to house these folks, and now we’re going to say we failed. But if we do this, I certainly support the very conservative, narrow definition of who it applies to.”

Linda Mimms, a San Diego advocate for reforms to mental health policies, said she was encouraged by many things the county is doing, but saw problems with the proposed conservatorship program.
“The actual idea of it is great,” she said before quickly adding that more resources for mental health patients are needed statewide for the program to be effective.

She also has criticized for the program for taking a punitive rather than medical approach to mental health by requiring 5150 holds for people.

“We’re criminalizing neurological illness in order to get treatment,” she said.

Vargas said the move is a step in the right direction in helping a specific population get off the street.

“This is a serious issue we have as a society,” he said. “As a society, I think we’re not doing enough to care for those individuals.”

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County program could ease conservatorship process for some people with severe mental illness, addiction