If San Francisco continues at this pace, 2019 may go down as the year where the city (finally) got serious about its residents’ mental health. The conversations spurred by the controversial Senate Bill 1045 — to expand conservatorship laws for unhoused people experiencing mental illness or drug addiction — are finally shining a light on the ethics around coercive care, the psychological impacts of living on the street, and how few resources our city has to manage any of it.
Since the new year we’ve had a City Hall hearing on 5150s and San Francisco’s behavioral health resources, Supervisor Rafael Mandelman has requested a report from the city’s Budget and Legislative Analyst on the city’s current conservatorship numbers and called for a hearing on behavioral health services for people in jail.
As politicians get more involved, requesting hearings and reports and presentations done in layperson’s terms, an obvious need has arisen for someone to manage it all. During her state of the city address in January Mayor London Breed stated that she planned to create a new city position: a director of mental health. On Wednesday, at a press conference at Dore House, a short-term residential care facility for people with mental illnesses, she announced her pick: the former medical director of Psychiatric Emergency Services, Dr. Anton Nigusse Bland.
“It is no secret we face serious challenges around mental health in our city, and while I am committed to expanding our mental health and substance use stabilization beds, we must also make sure that we are utilizing our resources effectively and not letting people fall through the cracks,” Breed says.
Key aspects of Nigusse Bland’s role include reviewing the city’s current systems and making recommendations for reform. “We’re going to take a look at [patients’] experiences, we’re going to examine the data, and we’re going to assess the programs that are currently in place,” he says. “We’re going to build upon what’s working, and develop new approaches as well.”
Bland brings with him an immense amount of experience — which has helped him see firsthand where the city’s failures are.
“In my time at Psychiatric Emergency Services, I have seen people in crisis who are disconnected from care and resources in their community,” Nigusse Bland says. “I often challenge our staff to ask ‘what are their barriers? What can we do as a system to bend in their direction?’ ”
One of the first challenges Nigusse Bland will be faced could be an expansion of the city’s conservatorship laws. A vote over SB 1045 — which would allow people who’d been 5150d eight times or who used drugs to receive treatment in a locked facility for up to a year — is expected to take place at the Board of Supervisors in the coming weeks. And, a task force on meth use is being created and will launch in April — an area which Nigusse Bland has extensive knowledge.
A replacement for Nigusse Bland’s position at Psychiatric Emergency Services has yet to be announced.