After Months of Contentious Arguments, S.F. Passes Mental Health Conservatorship Bill

The issue was hotly contested in recent weeks, but in the end, the progressive-majority Board acquiesced to avoid passing it on to voters.

A highly controversial bill to expand the city’s discretion on treating its most severe homeless mentally ill population has ricocheted around City Hall for months. Senate Bill 1045, drafted by state Senator Scott Wiener, would expand San Francisco’s ability to conserve — simply put, take guardianship over — people suffering from severe mental illness. Currently, the Landerman Petris Short Act enables counties in California to take that step if someone is experiencing a serious mental health crisis and is a chronic user of alcohol. SB 1045 would expand those qualifications to also include people who use drugs, and anyone who’s been 5150d — dropped off at Psychiatric Emergency Services — eight times in one year. 

Estimates on how many people would be affected by this expansion are low; some say only 10 in the entire city. But it’s a serious move. Once you’re fully conserved, you lose the right to live alone, choose your doctor, access your bank accounts, own a pet, or communicate with the outside world. The ACLU calls conservatorship ” the greatest deprivation of civil liberties aside from the death penalty.”

It’s something disability rights advocates and mental health professionals have largely opposed. “This plan was designed without input from people with mental health conditions, substance use, or homelessness, or from disability rights or mental health groups,” read a statement from the Voluntary Services First Coalition, made up of more than a dozen local health and social justice organizations. “It relies on a false and paternalistic narrative that people do not know what is best for themselves, without acknowledging that people often use drugs to self-medicate when homeless or when struggling to get mental health care, and without recognizing the trauma caused by 5150s and forced treatment. This approach does not address the underlying problem of the lack of voluntary services in the community.”

On Tuesday, despite significant prior opposition to the bill from several members of the Board of Supervisors, it passed nearly unanimously. The meek statements from supervisors who weeks earlier had slammed the proposal were a 180, to say the least. 

So, what happened? To put it mildly: politics. Supervisor Rafael Mandelman and Mayor London Breed, who are both ardent supporters of SB 1045, threatened to take the issue to the November ballot if it wasn’t approved by the Board of Supervisors. For those who oppose the bill, this was a scary proposition. San Francisco voters tend to be conservative when it comes to the rights of homeless people, as was evidenced by 2016’s Prop. Q that banned tents on sidewalks, and 2010’s Prop. L that prohibits sitting or lying on sidewalks. SB 1045 could easily pass in voters’ hands, and it would then be nearly impossible to amend. 

In addition, another ballot measure on mental health is heading to voters this fall, which raised concern that the two would be pitted against one another. Mental Health S.F., drafted by Supervisors Hillary Ronen and Matt Haney, would create universal mental health care for everyone in the city, regardless of housing status or insurance. A new Mental Health Service Center would be built — most likely near Zuckerberg San Francisco General Hospital — that would offer drop-in services 24 hours a day, seven days a week. And, an Office of Coordinated Care would be created to loop all of the city’s disjointed mental health systems under one network, theoretically preventing people from falling through the cracks.

It was a better choice, supervisors seemed to decide, to water SB 1045 down and pass it internally than send it to voters. In order to get their support, Mandelman accepted his colleagues’ proposed amendments that repeated offerings of services must be made before the county is allowed to take guardianship over someone’s care. This, combined with the mayor’s recent commitment to adding 100 more behavioral health treatment beds to reduce wait times seemed to make it an easier pill to swallow.

“It’s a very small number of people,” Haney said. “I think the amendments address some of the issues and provide greater guaranteed services, housing, and accountability.”

Supervisor Sandra Lee Fewer kept it short. “This is a pilot program. We will learn from it,” she said.

It was Supervisor Shamann Walton was the single holdout, preventing the measure from getting unanimous support from the Board. “Whenever you take freedoms away from people it’s typically Black people and people of color,” he said. “I haven’t gotten any response from the department (of public health) on what they would even try to do to combat that.” 

He also slammed the idea that police-centered responses to mental health are an appropriate plan of action. “5150s involve law enforcement,” he said, citing the fact that people are often picked up by police before being transported to Psychiatric Emergency Services. “A big focus we’ve been moving toward is to alleviate negative interactions with law enforcement in the community. I’m still not comfortable with the fact that medical providers will not be determining the 5150s.”

But in the end, SB 1045 passed 10-1. The case is closed, and Mandelman summed it up well. “I’m sure all of us would love to move on,” he said.

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