San Francisco Mayor Seeks More Homeless Housing Through Conservatorship Law

SAN FRANCISCO (CBS SF) — San Francisco Mayor London Breed has introduced citywide legislation to implement a new conservatorship law that helps house and treat homeless people suffering from mental health and substance abuse issues.

Senate Bill 1045, authored by state Sen. Scott Wiener, D-San Francisco, allows the counties of San Francisco, Los Angeles and San Diego to set up a conservator in cases for people who can’t care for themselves.

In conjunction with the city legislation, Breed announced that she intends to add between 70 and 90 new beds for mental health patients to the city’s navigation centers and hospitals over the next year.

“This is about getting people who are severely ill the help they desperately need,” Breed said in a statement. “There is a small subset of our homeless population that are clearly, visibly suffering on our streets.”

She said, “They are frequently in and out of the hospital or criminal justice system, but they never receive the comprehensive care they need to stabilize and get back on their feet. It is simply inhumane for us to allow them to continue to deteriorate without intervening.”

Breed has directed the city’s Department of Public Health to figure out ways to increase the number of beds at the city’s navigations centers and Zuckerberg San Francisco General Hospital.

At Tuesday’s Board of Supervisors meeting, Supervisor Rafael Mandelman, along with Breed, introduced the legislation to support SB 1045.

“I believe it is imperative that we move the ball forward,” Mandelman said. “Everyday that San Franciscans suffer in our streets and jails for untreated mental illness is one day too many. We cannot continue to allow our neighborhoods to serve as open mental institutions and shelters as jails.”

He said, “SB 1045 is not a cure all. It does offer a new tool to help people suffering from severe mental illness and addiction … We must seize every opportunity to improve conditions of those suffering mental illness.”

“I am thrilled that San Francisco is moving to implement my bill, SB 1045, which will help some of our most vulnerable residents get the help they need,” Wiener said in a statement. “I am grateful to Mayor Breed and Supervisor Mandelman for understanding that the faster we implement this tool, the faster we can help those suffering on our streets.”

SB 1045, signed into law last month by Gov. Jerry Brown, is set to take effect on Jan. 1.

According to Breed’s office, the city’s health department has estimated that the new conservatorship law will impact between 50 and 100 people in the city; individuals who are the most likely to need city services. Last year, only about 12 percent of homeless people who used city services accounted for 73 percent of the costs.

A coalition of several groups, including the Coalition on Homelessness, have voiced opposition to SB 1045, arguing that conservatorship takes away individuals’ civil liberties, affecting decisions about their body, housing and medical care.

The Coalition on Homelessness is pushing for Proposition C on this November’s city elections, which would use a business tax to provide funds for housing and treating homeless people suffering from mental health and substance abuse issues.

Breed and Wiener have both opposed Proposition C, arguing that the conservatorship law is the way to ease the city’s homelessness crisis.

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San Francisco Mayor Seeks More Homeless Housing Through Conservatorship Law

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

Can New Laws Address Severe Mental Illness and Chronic Homelessness?

A small minority of San Francisco’s homeless population suffers from severe mental illness. Can California step in to help?

We’re all familiar with the common myths about San Francisco’s homeless residents: that many people on the street are not simply impoverished, but suffer from serious mental illness and self-medicate with substance abuse; and that the City will not, or cannot, compel these people into medical treatment and housing. A brisk walk through Civic Center or the Tenderloin can easily give reinforce those theories, but now, Supervisor London Breed and State Senator Scott Wiener have introduced legislation to address the most visible aspects of this crisis. 

Wiener’s new bill, SB 1045, would expand the criteria that local governments could use to provide conservatorship for individuals who suffer from chronic homelessness, accompanied by debilitating mental illness, severe drug addiction, repeated psychiatric commitments, or excessively frequent use of emergency medical services. It is an idea that was first championed by the late Mayor Ed Lee, and is now carried on by his staff in the Department of Public Health.

The causes of homelessness are far more complicated than popular assumptions suggest. But the Department of Public Health has identified a small, core group of individuals - 50 to 100 people - who are deeply mentally ill and chronically homeless. So much so, that they cannot seek treatment themselves. This small group—estimated to be just 1% of the entire homeless population—has undergone multiple psychiatric commitments and repeatedly required emergency medical services. They absorb major resources from the social services system. 

“This is not about the broad homeless population,” said State Senator Scott Wiener, who has worked extensively on this issue, on KQED’s Forum. “People walk down the street and they see someone, everyday, who is clearly in distress and incapable of making decisions for themselves. They wonder—why aren’t we doing something [to help these people]?”

Currently, conservatorships can only be utilized if an individual is unable to care for themselves due to “grave disability” (like not being able to feed themselves) or due to physical health issues, cognitive impairment, and elder abuse. Unfortunately, this mechanism currently excludes those who may have severe mental illness or drug addiction.

These individuals are often legally held by the City for 72 hours after exhibiting signs of mental illness, but then sober up during that time. By the time they appear in front of a judge, they seem able to care for themselves and are released back onto the streets, the very environment which triggered their mental illness in the first place.

Mayor Ed Lee and his staff wanted to expand the conservatorship program to include individuals they knew had repeated psychiatric commitments and frequently used emergency medical services.

Gail Gilman, Executive Director of Community Housing Partnerships, said “We too often see in supported housing individuals who need a higher level of care and who in the midst of their addiction or mental health crisis are unable to make decisions for themselves and need an intervention.”

The issue is not unique to San Francisco. In Southern California, Supervisors Mark Ridley-Thomas and Kathryn Barger are re-evaluating the effectiveness of the Los Angeles County’s conservatorship program. In the State Capitol, Senators Henry Stern, Ben Allen, and Steven Bradford (all from Los Angeles) also co-authored the bill with Senator Scott Wiener.

Board of Supervisors President London Breed followed up SB 1045 with a local legislative package of her own. Her bills aim to decriminalize mental health and homelessness conservatorship cases by changing their jurisdiction from the District Attorney’s office to the City Attorney. Breed hopes this would allow conservatorship cases to be treated similar to family custody cases, instead of as a crime.

Breed’s legislative package also calls on city agencies to collaborate on a list of highest-risk individuals suffering from mental illness, substance abuse, and chronic homelessness. In a press release, Supervisor Breed stated: “As a progressive city, we must do more to care for those who cannot care for themselves. It's not compassionate to let those who are grappling with severe mental health and substance abuse issues simply wither away on our streets.”

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Can New Laws Address Severe Mental Illness and Chronic Homelessness?