San Francisco’s homeless population is a diverse group. Some were evicted from their homes, sleeping on the streets or in shelters until they can find a job, save some money, and get back on their feet. Others suffer from mental illness, drug addiction, or both. And while Navigation Centers have taken in hundreds of people from all backgrounds and helped them back on their feet, for years a small population has cycled in and out of San Francisco General Hospital’s emergency room and San Francisco’s jail, and 5150’ed into a 72-hour psychiatric hold. A person with severe mental illness or a debilitating drug addiction is difficult for current homeless infrastructure to treat, as long-term care and support is simply beyond the scope of what outpatient drug treatments and short-term psychiatric programs can offer.
A bold new bill, however, could grant authorities permission to take away a person’s rights temporarily, in order to get them off the streets and into serious care. If done well, it would be a firm but necessary step to help the city’s most vulnerable populations get the help they need. If executed badly, we’d be taking a huge step backward toward a police state that criminalizes and locks up mentally ill people, taking away their civil rights and freedoms.
Senator Scott Wiener introduced Senate Bill 1045 in Sacramento, in conjunction with Senator Henry Stern of Los Angeles. It’s currently a spot bill — which means it’s not fully drafted— so details on exactly who will qualify and how it will be enforced are slim. It’s described as an extension of the state’s current conservatorship laws, which currently apply to those who are determined to be “gravely disabled as a result of a mental health disorder or an impairment by chronic alcoholism.”
Under SB 1045, that conservatorship would include those who “suffer from chronic homelessness accompanied by severe mental illness, drug addiction, repeated commitments, or exceptionally frequent use of emergency medical services.”
Wiener explained his motivations at a press conference Monday.
“Only a tiny percentage of people on our streets — perhaps 1 percent of the population — fall into the category that we’re talking about here,” he told the media. “For the vast majority of homeless people in San Francisco, this bill has nothing to do with them. This is a tiny population that is dying on our streets, that is in the ER all the time, that is being taken to the psych emergency room repeatedly. This is a life-or-death situation, and it is beyond humane to sit back and watch as these people die.”
The 1 percent statistic is notable. While it may seem like a tiny number of people, the Department of Homelessness counted 7,499 people living unhoused citywide in 2017. That means this bill could theoretically apply to 75 of them.
Wiener’s bill would push this forward on a statewide level, but Supervisor London Breed has hopped on the bandwagon, announcing legislation at the Board of Supervisors meeting Tuesday that would change the city’s laws around the criminalization of homeless people. It would also transfer the responsibility for all non-criminal mental health conservatorship cases from the District Attorney’s office to the City Attorney’s office.
“As a progressive city, we must do more to care for those who cannot care for themselves,” Breed said on Monday. “It’s not compassionate to let those who are grappling with severe mental-health and substance-abuse issues simply wither away on our streets.”
Breed is one of several supervisors who’ve attempted to help this population in their districts.
“There is an elderly man who lives in the Haight Ashbury that I often visit and check on,” she said. “He is mostly harmless, but he is schizophrenic and deals with extreme trauma. When his mental-health issues flare up, he sometimes becomes a harm to himself and a harm to others. His rage festers and becomes uncontrollable, and he becomes unable to take care of himself and his own basic needs.
“What he really needs is someone to take care of him,” she adds. “He can’t do it alone. I personally have tried to get him into shelter services, but he’s refused to stay. Despite my attempts over the last 3 years, he’s still on our streets.”
The story is similar to a case that Supervisor Hillary Ronen encountered when she tried to find help for a woman named Alice who spent years living outside at 16th Street BART, refusing shelter services. Under current law, mentally ill people can refuse help, even if it’s detrimental to their health and wellbeing.
So the system requires change to help vulnerable people who are unable to care for themselves. But who qualifies for this extra layer of conservatorship, and how it should be enforced, is up for debate. Will they be detained on the streets? In emergency rooms? And what if family steps in?
Wiener acknowledged this is a tricky piece of the bill, which has yet to be crafted.
“We’re engaged in a process now to flush that out,” he said. “We didn’t want to prejudge that, because it’s a complicated issue, so we’re going to be working very closely with the counties and the health departments, as well as with the advocates — who are probably skeptical of this, because of the civil liberty implications.
“To be clear, conservatorships are a very serious thing,” he added. “They take someone’s liberty away temporarily, and the county steps in and makes basic decisions for them until they become healthy, are able to be independent, and can make those decisions for themselves.”
Advocates are indeed skeptical. Daniel Meyer, a public defender who works specifically with mental-health conservatorship cases, challenged the order of the system.
“We haven’t tried the housing-first alternative,” he told SF Weekly. “There’s a right to housing in New York. You can conserve as many people as you want, but if you don’t have housing for them where are they going to go? Are they going to stay on the street in tent encampments? Use models that work, like housing first, not just taking peoples’ rights away.”
Jennifer Friedenbach, executive director of the Coalition on Homelessness, echoed that sentiment, telling SF Weekly that neither Wiener nor Breed had reached out to her organization about either the state bill or the local legislation.
“Always a bad sign,” she noted.
As the state legislation is still a spot bill with few details, the Coalition doesn’t have a position on it yet. But the idea that conservatorship will fix this problem is not one Friedenbach buys.
“What you see on the streets is the result of over $40 million in direct service cuts in San Francisco’s behavioral health programs between 2007 and 2012,” she said. “We need to dig a lot deeper to truly address the mental-health crisis. We know that a short stay in a locked facility is not going to dramatically change our outcomes and has the danger of turning people away from seeking mental health services, and potentially further traumatizing them.”
And at the end of the day, it all comes back to affordable housing.
“There probably are areas that could be improved in the conservatorship system but it is no silver bullet and will not magically result in the housing that is so desperately needed to stabilize one’s mental health,” Friedenbach says. “We would suggest a complete rebuild of our entire system, including housing for every severely mentally ill person.”
SB 1045 will be reviewed by the California Senate in May, with the goal of reaching Governor Jerry Brown’s hands by Sept. 1. If passed, it would be instituted in January of next year.
Nuala Sawyer is SF Weekly’s news editor.
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