San Francisco, CA — Mayor London N. Breed, along with Senator Scott Wiener and Supervisor Rafael Mandelman, today announced the next steps for implementing a strengthened conservatorship program in San Francisco. With Senate Bills (SB) 40 and 1045 now in law, San Francisco will be able to better treat people suffering from severe mental illness and substance use issues, and provide them with permanent supportive housing. The Office of the Public Conservator in the Department of Aging and Adult Services, the Department of Public Health, and City Attorney Dennis Herrera are key partners in implementing conservatorship.

“We are moving forward to implement SB 1045 and SB 40 to help our most vulnerable residents. Conservatorship allows us to provide the wraparound services needed to stabilize people suffering from severe mental health and substance use issues, and help them begin their recovery to get their lives back on track,” said Mayor Breed. “We cannot allow people on our streets who are suffering to continue cycling in and out of our hospitals and the criminal justice system without getting the help they need. Allowing them to deteriorate on our streets when they are incapable of caring for themselves is not humane.”

San Francisco’s Office of the Public Conservator manages the city’s conserved population. However the type of conservatorship offered under SB 1045 and SB 40 serves a new and distinct population of individuals who, as a result of both a serious mental illness and a substance use disorder, fall through the cracks of San Francisco’s existing programs. These individuals often have multiple visits to psychiatric emergency services in psychosis and under the influence of drugs, yet 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.

SB 1045, authored by Senator Wiener, addresses the gaps in the current system and creates a five-year pilot program allowing for strengthened conservatorship laws that focus on providing housing and wraparound services for people suffering from serious mental health and substance use.

“It’s neither compassionate nor progressive to allow seriously addicted and mentally ill people to continue to die on our streets,” said Senator Scott Wiener (D-San Francisco), who authored SB 40. “Last year, I authored Senate Bill 1045 to create a new conservatorship program focused on providing supportive housing and wraparound services for those who can’t care for themselves. SB 40 builds on these changes so that more people can get the help they need. I thank the Governor for signing this legislation, which will save lives.”

“SB 40’s passage will allow San Francisco to effectively and successfully implement the expanded conservatorship program authorized under SB 1045,” said Supervisor Rafael Mandelman. “As the methamphetamine epidemic continues to threaten the lives of far too many people living on our streets, this critical program will allow us to intervene with life-saving care and services. With SB 40 now in place, we can better provide the sickest and most vulnerable San Franciscans with the help they need.”

“The hardship on our streets is an all-hands-on-deck situation,” said City Attorney Dennis Herrera. “Our office is glad to do our part. We have brought more than 100 new conservatorship cases since this responsibility was transferred to our office in January. We are currently working with stakeholders to implement the new type of conservatorships authorized in Senate Bill 40. We welcome this new tool to help people suffering from mental illness and substance abuse to turn their lives around. We will ensure that our implementation follows the law, including due process.”

On Wednesday, October 2, Governor Gavin Newsom signed SB 40 (Wiener) into law. SB 40 makes technical amendments to SB 1045, and strengthens San Francisco’s conservatorship program. Under SB 1045, which was signed by Governor Brown in September 2018, County officials must go before a judge to prove that an individual is in need of conservatorship. Provided there are no other viable alternatives, the individual can be placed under conservatorship for six months, with the ability to petition monthly for a hearing for release. The law requires the court to constantly monitor cases to ensure that an individual needs to remain conserved.

As a result of SB 1045 and SB 40, there is 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, clinically-appropriate housing.  

The City will now begin working to petition the courts to conserve people who are eligible. The City estimates that there between 50 and 100 individuals in San Francisco who currently meet the criteria for conservatorship. This population will expand over time as more individuals are put under a 5150 hold for the eighth time.

Housing Conservatorship Working Group

Mayor Breed and Supervisor Mandelman introduced legislation at the Board of Supervisors to implement SB 1045 and strengthen the City’s conservatorship program. On June 11, 2019, the Board of Supervisors voted to implement Senate Bill 1045. The law requires that San Francisco establish a working group to evaluate the effectiveness of the implementation of conservatorship.

In compliance with the law, the City has a “Housing Conservatorship Working Group,” which is a 12-person body charged with assessing the effectiveness of the new conservatorship to meet the needs of the people that qualify for the program, and to advise the State Legislature and the Board of Supervisors on our implementation efforts. The Mayor is responsible for three of the seats on the Working Group, and she has appointed Simon Pang, Captain of the San Francisco Fire Department’s EMS-6 Team and representative of a labor union; Rachel Rodriguez; co-founder and director of the Community Payee Partnership; and Kelly Dearman, Executive Director of the San Francisco In Home Supportive Services Public Authority.

The Working Group is comprised of representatives from City agencies and departments, disability rights advocacy groups, labor unions, organizations providing direct services to homeless individuals, and employees of Behavioral Health Services and a San Francisco hospital. The Working Group will have its first meeting on October 21, and will submit a report on the conservatorship program to the State Legislature by January 1, 2021.

Ongoing Behavioral Health Initiatives and Investments

Conservatorship is one of the tools at the City’s disposal to address the behavioral health crises on our streets. To help those in need of mental health and substance use treatment, Mayor Breed has designated $50 million over two years to fund 100 new treatment beds, for a total of 212 new behavioral health beds since becoming Mayor.

In addition to conservatorship, Mayor Breed has launched a new initiative to help the approximately 4,000 people who are experiencing homelessness, mental health care, and substance use disorder in San Francisco. Mayor Breed has announced several elements of the initiative, and will be releasing additional details over the coming weeks. The initiative will begin with connecting the 230 most vulnerable people with care coordinators to provide them with care that meets their health needs and the appropriate level of housing to help them get off the street. City agencies will work together to streamline housing and healthcare to make it more straightforward for those 230 people to be connected to shelter and permanent supportive housing.

The City is also expanding the hours of the Behavioral Health Access Center, which is as centralized location for drop-in behavioral health care services and is partnering with Tipping Point Community to open 15 new Hummingbird psychiatric respite beds. Last month, Mayor Breed announced the Department of Public Health is creating a real-time inventory of treatment beds, which will allow potential clients and service providers to search for availability of beds.

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