Mayor, Mandelman introduce legislation to place mentally ill into conservatorships

Mayor London Breed announced legislation Tuesday that would put San Francisco on track to expand conservatorships to cover residents with “severe mental health and substance abuse issues,” with a focus on the homeless.

Touted by city leaders as a creative solution to the problems posed by a small, highly troubled group of individuals, homeless and mental health advocates have expressed doubts over the City’s readiness to implement the controversial law, citing a lack of resources and uncertainties over whether the civil rights of those in the program would be protected.

Perhaps in response to those concerns, Breed on Tuesday also revealed plans to double the mental health beds at Zuckerberg General Hospital’s Hummingbird Place, a city facility specifically serving homeless patients with psychiatric and addiction disorders, to a total of 14 and add 70-90 new mental stabilization health beds by next year. That follows Breed’s announcement earlier this month that she plans to add 1,000 more shelter beds over the next two years.

“By providing these beds, we can leave no doubt that people have an option to get off the streets every night,” she said in a press conference at Hummingbird Place. “I decided that we needed to move faster and we need more beds.”

A portion of these beds will be reserved for the 50 to 100 individuals that the conservatorship program is expected to serve each year. The local legislation will be introduced by Supervisor Rafael Mandelman at the Board of Supervisors hearing on Tuesday.

It is unclear when the legislation will return to the board for a full vote. A hearing must first be held to establish whether The City has sufficient resources to launch the program, according to Mandelman’s office.

City service providers on Tuesday joined the mayor in arguing for forcing a small slice of San Francisco’s residents into involuntary drug and mental health rehabilitation services.

Over 7,000 emergency psychiatric assessments are conducted at ZSFGH each year, according to Dr. Anton Nigusse Bland, medical director for Psychiatric Emergency Services (PES), who added that six out of ten individuals served there are also experiencing homelessness.

But opponents to the conservatorship expansion granted under Senate Bill 1045 — as well as stakeholders guiding the local implementation — told the San Francisco Examiner as recently as Friday that many questions remain unanswered.

Specific concerns include the City’s capacity to fully fund the program and provide the supportive housing required for those conserved under the new law, as well as safeguards around the civil rights protections.

The new law requires a person to have been placed on eight 5150 emergency holds prior to being placed in a conservatorship, among other things. The legislation guiding the local implementation allows for health officials as well as police to make referrals.

Breed did not take questions about the legislation Tuesday, but Mandelman called it a “necessary first step” in starting the conversation around what expanded temporary conservatorships would look like in San Francisco.

Much of that conversation in the coming months will be focused on “resourcing this program and others affecting this population,” he said, adding that the city “must ensure that we are not taking resources away from other programs.”

In response to concerns over potential civil rights violations, Mandelman said that he believes that “opportunities for abuse in San Francisco are minimal.”

“The person will have a public defender, a judge will be determining it, and conservatorships can be terminated sooner than a year if the clinician decides it’s appropriate,” he said. “It is hard to get a conservatorship over someone and there are lots of opportunities for people to step out of conservatorships.”