By Tom Li
 |
Supervisor Rafael Mandelman criticized the city’s implementation of a state law intending to increase the number of people placed in conservatorship for treatment of mental illness, saying it has “not been a success.” |
In 2024, San Francisco was one of two California counties that jumped at the opportunity to implement a new law allowing cities to place those struggling with mental illness into involuntary medical treatment.
But 18 months after San Francisco began rolling it out, Board of Supervisors President Rafael Mandelman criticized the city’s implementation, saying it has “not been a success.”
“It’s profoundly disappointing that we are where we are,” Mandelman said during a Thursday hearing, which he had called for, of the Public Safety and Neighborhood Services Committee. Centered on behavioral health issues since he was first elected in 2018, Mandelman has sponsored several actions in support of expanding conservatorship programs. Now, he’s turned critical of the little progress that’s been made.
Passed in 2023, California Senate Bill 43 expanded the population eligible for conservatorship — a legal arrangement where the government can place people deemed unable to care for themselves into involuntary treatment — to include people whose mental illness or drug addiction inhibits their ability to keep themselves safe.
The city saw 136 temporary conservatorships in the first year of the law’s implementation — an increase of 28, or 25%, from the previous year. So far this year, the city has seen 50 additional temporary conservatorships, according to a presentation from the city’s public health and homelessness officials.
But although more than 85% of the new conservatorship cases fell under the expanded criteria of SB43, none relied solely on the new eligibility guidelines, meaning these patients would have qualified for conservatorship without the new legislation.
Mandelman called these improvements “exceedingly modest,” adding that he and other city residents have observed a persistently high number of people in critical need of mental health treatment and placements in conservatorship.
The slow progress arises from a shortage of 100 to 140 locked subacute treatment beds for those struggling with mental illness, according to Daniel Tsai, director of the city’s public health department. He also noted a lack of mixed-treatment facilities that can provide adequate care for patients who require treatment for both mental illness and addiction.
Last month, the state awarded San Francisco $27 million for 73 new treatment beds, including 57 locked subacute treatment beds and 16 dual diagnosis beds for those with both addiction and behavioral health needs. Tsai said that San Francisco currently has about 100 locked subacute beds and has bought 48 out-of-county beds, sending conserved patients as far as Southern California.
Due to the shortage of locked beds, city officials are piloting a program placing conservatorship-eligible people in shelters, while providing them with intensive treatment. The program has enrolled about five patients in the month since its launch, he added.
The program seeks to help those who, with medication or other treatments, may see improvements without locked facilities, Kelly Dearman, executive director of Department of Disability and Aging Services, explained during the hearing.
Though he’s eager to see where the pilot program goes, Mandelman said he’s skeptical about addressing a need for locked treatment facilities by placing people in shelter beds. He fears that people staying in shelters will be more likely to leave their treatment placements and engage in the same activities that led to their initial condition.
Within two years, the city plans to open an additional 57 locked beds at the Behavioral Health Center at San Francisco General Hospital, but the move would displace 82 residents who currently live at the center and receive residential care. The city’s public health department notified residents of the plans in early May, Mission Local reported, stating that no residents will be asked to move until the fall.
On Thursday afternoon, roughly 40 caregivers, family members and residents gathered outside of the center on Potrero Avenue to protest the public health department’s plans to displace those in residential care facilities. Around 90% of the residents have signed a petition calling on the city’s public health commission to reconsider the project.
“I just do not agree with closing beds to open beds,” said Jennifer Esteen, a union representative and a registered nurse who works at the center.
While she emphasized her support for expanding locked facilities, Esteen said the city must not “displace people who are stable in order to find room for other people.” She also noted that a locked treatment facility already located inside the center has more than a dozen vacant spaces and doubts the city will be able to adequately staff and fill the expanded space.
“No current (Behavioral Health Center) resident will move without a secure and appropriate next home,” said Dr. Hillary Kunins, director of behavioral health services, said at the hearing. She added that the city’s acquisition of two assisted living facilities in Hayes Valley will help accommodate any displaced residents.
But Esteen is skeptical of the city’s messaging, sharing that she’s seen cases where residents have not received accommodations under similar promises. She also raised concerns with the plans to move residents to privately contracted facilities, explaining that many residents were previously evicted or mistreated by similar facilities.
 |
Rufus, left, and Ronald, residents of the Behavioral Health Center at San Francisco General Hospital, attend a protest Thursday over the city’s plan to close two floors to convert them into a fully locked psychiatric treatment facility. The plan is expected to displace people with mental health disorders who currently receive around-the-clock treatment, union members said. The protest came as the city is struggling to supply enough beds to place mentally ill people who are a danger to themselves or others into conservatorship. |
Antoinette Conde, the sister of a resident of the center, said she fears that moving her brother to another facility will create unnecessary stress and confusion, worsening his mental state.
A lack of state-level oversight has driven much of this uncertainty over implementation, said Jill Nielsen, deputy director of programs at the Department of Disability and Aging Services, who also serves as the city’s public conservator.
“Counties are operating these programs to some degree in a vacuum,” she said during the hearing.
Last year, several deputy public conservators told the Chronicle that they frequently ran into difficulty finding placements for conservatees, with many ending up on the street. These concerns came amid a push from former Mayor London Breed to aggressively increase conservatorship numbers.
Nielsen noted that the state did not give local governments additional funding to implement the law, a departure from how it provided San Francisco $4 million to implement Gov. Gavin Newsom’s mental health program, CARE Court.
Mandelman similarly advocated for more state guidance and oversight, adding that conservatorship currently “is almost entirely a local activity with very little state regulation.”
Full Article & Source:
‘Profoundly disappointing’: Modest gains in S.F. effort to force mentally ill people into treatment
