San Francisco, CA – The Board of Supervisors today passed legislation introduced by Mayor London Breed and Supervisor Rafael Mandelman to strengthen the City’s conservatorship laws in order to provide care and treatment for San Franciscans most in need, who currently suffer from severe mental health and substance use disorders.

The legislation is part of Mayor Breed’s efforts to improve the City’s response to those in need of mental health and substance use treatment. The Mayor’s efforts include funding 100 new treatment beds last year as well as an additional 100 new beds as part of her recently announced Fiscal Year 2019-2020 and 2020-2021 budget proposal.

“This is an important step that will help people our streets get the treatment they need rather than continuing to cycle in and out of the emergency room, and often the criminal justice system,” said Mayor Breed. “Conservatorship will allow us to finally break this cycle by providing sustained care, which is why we are also expanding our treatment beds and other resources to address the issues that these individuals face. Allowing people to continue to suffer on our streets is not acceptable or humane and I am glad the Board of Supervisors supported our approach to finally make a change. I want to thank Supervisor Mandelman for his partnership on this legislation and Senator Wiener for his leadership at the state level.”

“San Franciscans have made it clear that they are unwilling to continue to allow severely mentally ill and addicted people to languish on our streets. SB 1045 is a small but important step to bring the sickest, most vulnerable, and hardest-to-reach individuals into care,” said Supervisor Mandleman. “Perhaps even more importantly, SB 1045 has spurred a long overdue conversation about radically transforming our response to untreated mental illness and drug addiction. I’m grateful to Senator Wiener and Mayor Breed for their unflagging commitment to advancing that conversation, and I want to thank my colleagues for their support today.”

”Too many people are deteriorating and dying on San Francisco’s streets, and we have a moral responsibility to help them,” said Senator Scott Wiener. “It’s neither progressive nor compassionate to stand by while people die. We need to offer voluntary services to those in need, but for people incapable of accepting services, we need to consider helping them via conservatorship. The purpose of a conservatorship is help people stabilize and get healthy, ultimately transitioning to permanent housing. But until they get there, we need to take steps to help them survive. I want to thank the San Francisco Board of Supervisors for taking this important step, and I commend Supervisor Mandelman and Mayor Breed for their extraordinary leadership.”

Today, individuals who are gravely disabled by both a serious mental illness and a substance use disorder fall through the cracks of San Francisco’s existing systems. They often have multiple visits to psychiatric emergency services when they are intoxicated, but once the drugs clear their system and they improve, they are ineligible for acute psychiatric care, or conservatorship. If they do not accept voluntary services, the cycle often begins again. 

This legislation addresses this population and provides a path for the City to petition a court for a short-term conservatorship in order to provide them the treatment they need and deserve. In order to qualify for conservatorship, an individual must be dual-diagnosed with a serious mental illness and with a substance use disorder, and have been brought to the psychiatric emergency room at least eight times in a 12-month period under an involuntary “5150” emergency hold. A 5150 hold is issued to individuals who present an immediate danger to themselves or others, or are gravely disabled and unable to provide for their basic needs. At the end of the conservatorship process, these individuals are guaranteed permanent housing.    

“With this compassionate step forward, more people in our city will benefit from care for persistent substance use and mental health issues,” said Dr. Grant Colfax, Director of Health. “The SB 1045 conservatorship will help people who are suffering to interrupt the cycle of crisis by remaining in care, filling a crucial gap in our system that has allowed them to continually slip through the cracks. We know that recovery and wellness are possible, and we are gratified to have an additional tool to help some of our most vulnerable residents.”

After two committee hearings for the proposal in May, Supervisor Mandelman and Supervisor Yee worked to identify a series of amendments that clarified the implementation plan for the program but did not change the eligible population. Specifically, the amendments clarify the requirements to repeatedly offer voluntary services, including treatment, prior to an individual being eligible for conservatorship. Offering voluntary services was always part of the implementation plan, but these amendments clarify these requirements.

The legislation is available to the City under Senate Bill 1045, which was introduced by Senator Scott Wiener and signed into law in September 2018. Senator Wiener has introduced SB 40, which has passed the Senate by a 36-0 vote, to clarify the parameters under which someone may be conserved. The San Francisco Department of Public Health estimates that if SB 40 is signed into law, the City legislation would apply to approximately 50 of the most acute individuals in San Francisco per year. 

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