In 2019, San Francisco identified about 4,000 unhoused people who also struggled with addiction and mental illness, many of them deteriorating visibly on the streets.
The tally came not long after the city broadened its rules on who can be forced into court-ordered mental health and drug treatment, a move that could have applied to 50 to 100 people, according to one estimate.
But only two people have been treated by the expanded rules so far.
The anemic numbers reflect the daunting task San Francisco faces as it tries to help thousands of people suffering from the intertwined crises of substance abuse and mental illness.
At stake is the city’s ability to use new legal tools to help some of its most vulnerable residents and confront a public health crisis that has persisted for years.
“We’re failing every single day,” said Supervisor Rafael Mandelman, who has advocated for court-ordered treatment for the most severely ill patients. Mandelman argues mental illness often prevents people from having insight into their disease and therefore from seeking help voluntarily.
Mandelman was hopeful when city officials in June 2019 opted in to a controversial state law
that let San Francisco create a pilot program to expand eligibility for
those who can be placed into conservatorship, which allows a court to
order people into mental health treatment.
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