Why SF’s new laws to force more mentally ill, addicted people into treatment haven’t been used yet

San Francisco Chronicle, June 5, 2020

By Trisha Thadani


When San Francisco expanded its ability to force people into treatment last year, the idea was to help the sickest of the sick: those who are severely mentally ill, addicted to drugs, and continuously cycling in and out of the city’s hospitals.


An additional 50 to 100 people, a small sliver of the city’s most vulnerable, were expected to qualify for court-ordered mental health treatment. But, one year later, not a single person has been considered under the new program, and different public agencies are blaming each other — and the coronavirus pandemic — for the delay.


The finger-pointing and sluggish adoption comes as San Francisco struggles to provide enough services for its 8,000-plus homeless population, the majority of whom also suffer from mental illness and drug addiction. The delays highlight the bureaucratic hoops involved in providing care to those on San Francisco’s streets, even through a pilot program that was only expected to last five years.


Supervisor Rafael Mandelman, who spearheaded the local effort with Mayor London Breed to expand court-ordered mental health treatment — also called conservatorship — said the delays are “incredibly troubling.”


“This was not going to solve the entirety of the problem, but this was supposed to be one of an abundance of pilots and attempts,” he said. “But the fact that this one thing takes so long raises a ton of questions.”


The pilot program was made possible by two state laws written by Sen. Scott Wiener, D-San Francisco. San Francisco’s Board of Supervisors voted to adopt the first law, Senate Bill 1045, in June. SB40, which fixed issues with the first, was adopted in October.


Even though public health officials said they have a list of about 10 people who might qualify for conservatorship, they say they cannot move forward because the Superior Court and City Attorney’s Office must first agree on the legal process to file a petition under the new laws. In the meantime, the Department of Public Health said it will support those people with “other types of services.”


However, Ken Garcia, a spokesman for the court, said it is ready to accept petitions — but no one has filed any yet.


“We are ready to handle petitions when and if they are brought to the court,” he said. “However, the court does not and cannot initiate petitions, and cannot take action on any case until it is presented to the court by an appropriate party.”


Meanwhile, the City Attorney’s Office, which oversees the program, said it’s waiting for the court to give its final approval on the process, but efforts have been delayed due to the pandemic.


“We were working with the court to implement that process when a global pandemic hit,” said John Coté, spokesman for the city attorney. “We are in contact with the court about finalizing the process and hope to have it in place soon to begin filing petitions.”


Garcia did not respond to multiple follow-up questions about whether the court has signed off on a process for accepting petitions.


The decision to adopt the pilot program caused a tense, months-long fight in City Hall over whether it was humane to treat people against their will, and if San Francisco had enough resources to do so. While those in favor of the expansion said it was a necessary tool for helping those who need extra structure and support, those against it said the city should instead focus on expanding its voluntary services and housing options.


The mayor and board eventually adopted the first law in June, amid mounting pressure to help the thousands of people suffering from homelessness, mental illness and drug addiction. Breed hailed the pilot program as a small but “important step” toward getting people off the streets and into treatment, “rather than continuing to cycle in and out of the emergency room, and often the criminal justice system.”


It takes a massive effort to start a new program, especially when many of the city’s resources are suddenly redeployed to respond to a pandemic. Still, Jeff Cretan, a spokesman for the mayor, said she’s “frustrated” at all the bureaucracy involved in getting the program up and running.


“COVID has absolutely impacted a number of initiatives that we’ve been trying to put forward, including conservatorship, but we’ve been working on this for a long time,” he said.


Under state law, San Francisco can now conserve people who are considered “gravely disabled” by a mental illness, meaning they are unable to care for their basic needs.


The new laws expand conservatorship to include those who are addicted to drugs, as well as deemed severely mentally ill and have been taken to an emergency crisis unit, known as a 5150 hold, at least eight times. About 630 people are currently conserved in San Francisco, for both inpatient and outpatient care.


Critics say the bar for court-ordered treatment is still too high, and there are likely hundreds more on the city’s streets who are too sick to get treatment on their own. They also say the guarantee of “clinically appropriate housing” after someone completes treatment is an unrealistic promise in San Francisco, where housing is in short supply.


John Snook, executive director of the Treatment Advocacy Center, said the new laws were so “watered down” that it is unsurprising they haven’t been used yet.


“To say that you can’t help someone until they have been allowed to fall apart (several) times in a year is almost laughable,” he said. “When people need help the most, the system seems at its weakest. And this is more evidence of that.”


Until the pandemic hit, reforming the behavioral health care system was a top priority in City Hall. Now, many initiatives to increase access and resources for those in need have been hobbled by the pandemic.


One example is a sweeping initiative, originally written by Supervisors Hillary Ronen and Matt Haney, that planned to invest an additional $100 million a year to increase staff, treatment beds and access points for those in need. Given the looming $1.7 billion budget deficit, Ronen said she is revising the legislation to make it more realistic under the city’s new economic realities.


Breed also had a plan to add 112 behavioral health beds around the city. But the status of that plan is currently unclear.


Despite the hurdles caused by COVID-19, Wiener said he expected the pilot program to be implemented by the end of 2019 — months before the pandemic hit the city. While he realizes that it takes a lot of work to start a new program, he said he is “very frustrated” at the delay.


“We want to help people. That was the whole point of this legislation,” he said. “Fifty to 100 people is a significant amount of people who are at risk of dying.”

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