Letters: This change to state’s conservatorship law would get drug users off streets and save lives

Opinion // Letters to the editor

Chronicle readers

June 29, 2023

Used Narcan nasal spray kits are scattered near where they were administered to someone showing signs of a drug overdose in San Francisco. SB43 would define drug use disorder as a grave disability under the state’s conservatorship law.

Benjamin Fanjoy/Special to The Chronicle

As public mental health professionals and advocates for people with behavioral health disorders in the Bay Area, we support SB43, which will redefine what constitutes a grave disability under California’s conservatorship law, Lanterman Petris Short Act of 1972, which currently fails to recognize substance use disorders other than alcoholism.

We fully agree with The Chronicle's editorial; a comprehensive approach is needed to address the problems we face in caring for the most severely ill individuals, but a current lack of resources should not prevent reforms with the potential to save lives. 

SB43 eliminates arbitrary distinctions between mental health conditions and debilitating substance abuse disorders, which do not serve our patients.  

Current law defines “gravely disabled” as the inability to provide for one’s basic needs due to a mental health condition or chronic alcoholism. SB43 would include serious substance abuse disorders, including methamphetamine or fentanyl addiction; an incremental step to help those most affected — and often homeless — from revolving through emergency rooms and jails and dying prematurely. 

While concerns for civil liberties are justified, SB43 would have individuals who qualify brought into a civil — not criminal — process under existing law with multiple protections for individual rights.  

We agree that there is an urgent need to invest in our behavioral health infrastructure and workforce, but we must also bring our laws up to date so that when those investments are made, California’s health care providers can treat individuals suffering from the full range of behavioral health conditions.

Dr. Fumi Mitsuishi, associate clinical professor, UCSF Department of Psychiatry and Behavioral Sciences; director, San Francisco General Hospital Division of Citywide Case Management
Dr. Lisa Fortuna, professor and executive vice chair, UCSF Department of Psychiatry and Behavioral Sciences; chief of service, psychiatry, San Francisco General Hospital
Dr. Matt State, professor and chair, UCSF Department of Psychiatry and Behavioral Sciences

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Letters: This change to state’s conservatorship law would get drug users off streets and save lives

Officials look to expand conservatorship law to get homeless into care

The growing homeless population is getting out of hand for providers and city leaders. Now some want to create a new way to help those who can't help themselves. KPBS reporter Tania Thorne says it would mean changing conservatorship laws.

 

By Tania Thorne

When you hear “conservatorship,” you likely think of Britney Spears and the Free Britney movement.

Last November, a judge put an end to her 14-year probate conservatorship, which meant her father was assigned to care for her and manage her assets.

But there’s another type of conservatorship that some lawmakers see as a tool to combat the homelessness crisis.

The Lanterman-Petris-Short Act, or LPS Act, allows a judge to appoint a conservator over a person with a mental health disorder.

“We're not talking about an extremely wealthy, very famous celebrity, ” said San Diego Mayor Todd Gloria. “We're talking about the sickest and most vulnerable people that live on the streets of San Diego and on the streets of cities across the nation.“

Gloria wants to expand the LPS Act to force more mentally ill homeless people to go into treatment.

Currently, the law says people who courts rule as “gravely disabled” can be placed under conservatorships and put in a healthcare facility, even if it’s against their will. Gloria wants to expand that definition.

“A portion of these folks end up in the criminal justice system, which I hear very clearly from the public, they are not comfortable with," he said. "There has to be some choice other than leaving them on the streets or incarcerating them in prison. We have to have a better option."

But some providers say that even changing the law and putting more homeless people under conservatorships doesn't change that there are not enough places for them to go.

“How does anything change the day after that law is signed if we don't have more treatment beds, more housing, more funding for services?” said Michelle Cabrera with the County Behavioral Health Directors Association of California.

Cabrera said people stand a better chance at long-term recovery when they enter into services voluntarily.

“The vast majority of people, including people with serious mental illness and or substance use disorder needs, voluntarily and willingly accept both services as well as housing when it is offered to them," she said. "Our problem in California is that we have a major deficit of housing that meets the needs of very low-income Californians."

Services are scarce right now, said Greg Anglea, the CEO of Interfaith Community Services, which provides supportive services in San Diego.

“Far too often we have to ask somebody where did you sleep last night and is it safe to sleep there again because help is not available today,” he said.

He said addressing conservatorship reform before expanding resources is a backward way of thinking.

“Until we have access to these resources, taking away people's rights who want to access those resources, but who can't, is going too far and it is not something we would advocate for,” he said.

Keri Souza has been homeless since 2016 and knows she has a mental illness.

“I let them know that I have a mental illness and that I need help with my medication and that I need to have an eval, but I don't think a lot of people know to say that,” she said.

She questions what will happen if someone rejects a conservatorship.

“What if you don't want to do what they're asking you to do?“ she said. “Is that going to affect me negatively? Am I now not going to get the services that I need? That would be pretty pertinent.”

Every Wednesday, Souza goes to a Humanity Showers event for a shower, food and clothes.

Jordan Verdin, who runs the program, is worried that conservatorships could violate people’s trust.

“Coming out here and speaking to people, you’ll see a lot of the underlying issues are really deep-rooted in trauma and displacement," he said. "These policies will actually perpetuate the trauma deeper by displacing them and removing them from their communities.”

But Gloria said the problem can’t continue as it has and something has to be done.

“San Diegans see this every single day, people who are clearly not capable of caring for themselves being left on the streets where they're vulnerable, sick, in some cases dying,“ he said. “It's absolutely unacceptable, we have to do something different and that's why we need to change our state's conservatorship laws.”

He will spend the next year working to change the law.

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Officials look to expand conservatorship law to get homeless into care

Editorial: San Diego County should OK conservatorship law to help with homelessness

A San Francisco city worker tells a homeless man that the area next to him on is about to be power washed and points to an area he might want to move to.

(AP)

Authorities need all the tools they can get to help homeless, their communities

By The San Diego Union-Tribune Editorial Board

California’s problem with homelessness is so much worse than it used to be that there’s a sense of helplessness about how intractable the situation has become in Los Angeles, San Francisco, Oakland and — perhaps to a lesser extent — San Diego. The Golden State has 130,000 homeless people, a stunning quarter of the U.S. total, and that number has increased since 2016 by more than in any other state — even as local and state governments spend more time and money than ever on the vexing issue.

Now a new state law that was opposed by just one member of the Legislature before being signed by Gov. Gavin Newsom gives authorities a valuable, if controversial, tool to lessen problems and provide aid to the most troubled homeless residents who can cause the most costly and disruptive problems.

The measure by Sen. Scott Wiener, D-San Francisco, is the product of Bay Area leaders’ frustrations with laws that put limits on how public health officials can deal with and help homeless people who suffer from severe mental illness, addiction or both. It amends and beefs up a bill he got enacted last year that allows county supervisors in San Francisco, Los Angeles and San Diego to set up five-year pilot programs that expand conservatorships, under which a guardian or a protector is appointed by a judge to oversee the daily life of an individual with physical or mental limitations. Without further action by the Legislature, such programs would expire on Jan. 1, 2024.

The law allows these counties to seek to force individuals into first temporary 28-day housing conservatorships and then six-month housing conservatorships after an eighth 72-hour involuntary detention in a 12-month period. Such conservatorships could be requested by the sheriff and by officials with mental health and social services agencies, who are required to establish the necessity of the action with a report on the targeted person’s history. The law includes provisions meant to preserve due process rights by allowing individuals to challenge authorities’ decisions in court. On balance, the measure reflects Wiener’s conviction that it’s “beyond inhumane to sit back and let these people die when we have the ability to help them.”

But that argument was rejected by the ACLU of California, the California Public Defenders Association, the Western Center on Law and Poverty, and Disability Rights California. These groups depicted the proposal as an unwise retreat from individual rights and questioned whether the three counties could provide the services necessary to making housing conservatorships work.

The latter concern is worth considering, given the struggles of local governments in providing adequate homeless facilities. But Wiener says that the standard requiring that only individuals who have faced multiple “5150” detentions could be subject to conservatorships means only about 1% of the homeless in San Francisco could potentially be affected. That’s likely true in San Diego County as well.

In an interview Thursday with The San Diego Union-Tribune Editorial Board, San Diego City Attorney Mara Elliott said conservatorships “can be a very valuable tool. There are certain individuals who need more help ... [they’re] not going to be helped with a shower or services.” Elliott added that the requirement that a judge agree to the conservatorship provides due process.

The case for conservatorships is persuasive. The Board of Supervisors should begin evaluating a county pilot program as soon as possible. As Elliott said, officials need all the tools they can get to help the homeless and the communities where they live.

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Editorial: San Diego County should OK conservatorship law to help with homelessness

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

New state conservatorship law to take effect next year

District of Trumbull Probate Judge T.R. Rowe announced that Connecticut passed a new conservatorship law that affects a common probate court matter on May 24.

District of Trumbull Probate Judge T.R. Rowe

The law, Public Act No. 17-7, is called An Act Concerning Conservator Accountability. A conservator is someone appointed by the probate court to supervise the affairs of a person who cannot manage his or her personal care or finances without assistance. According to the Trumbull Probate Court, it oversees hundreds of such conservatorships throughout the towns of Trumbull, Easton and Monroe.

The new law will change conservator accountability in two key ways, Rowe said. The new law requires the Probate Court Administrator to develop standard, statewide policies for conservators to follow and to educate conservators about the standards and came into effect on July 1. These standardized policies will both guide conservators through their duties and also assist the court in evaluating whether the conservator has been managing the conservatorship properly. 

The law also creates permits the Probate Court Administrator to audit an account managed by a conservator to ensure he or she manages it according to the court’s policies and standards of conduct. The Probate Court Administrator will have the authority to conduct these audits randomly to deter financial misconduct and it will come into effect on January 1, 2018.

“Our current conservatorship system runs quite well, but this new law will be a nice improvement. Conservators play a vital role in the lives of thousands of needy folks in our state every day,” Rowe said. “We will now have a mechanism in place for greater uniformity in the care given to conserved people.”

Rowe added, “The discretion the legislation gives to the Probate Court Administrator to randomly audit conservatorship accounts will provide additional safeguards as well.”

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New state conservatorship law to take effect next year