New data shows that a program in San Francisco to mandate more homeless people struggling with addiction and mental illness into treatment has largely failed, pointing to the city’s ongoing struggle to help thousands of people suffering on its streets.
Three and a half years ago, San Francisco started a pilot program to compel more people into treatment who met certain strict criteria. Officials estimated the program could help 50 to 100 people get housing and treatment for six months, but only three individuals entered the program and none remain in it today.
The problem is daunting. In 2019, San Francisco identified about 4,000 unhoused people who also struggled with addiction and mental illness. While many of those people could be helped with more voluntary treatment, some may be too sick to accept care. Despite progress in improving some aspects of the city’s mental health system, an unknown number of the 4,000 remain on the streets.
While the program was meant to help more of these people, in particular those impaired by drug addiction who aren’t covered under other forms of conservatorship, the reality is that the requirements were so onerous, few people met the criteria, according to the health department.
Since June 2019, the city has filed only four petitions for what’s called “housing conservatorship,” one of which was not approved. While other kinds of conservatorship exist, they too have strict requirements that limit who is eligible.
Of the three people who entered the new program, two were moved to another kind of conservatorship for people with mental illness, the city’s health department said Friday when it released its annual report on the subject. It wasn’t immediately clear what happened to the third person.
The program — which sunsets at the end of the year —requires that someone has a dual diagnosis of mental illness and substance use disorder and has been placed on at least eight temporary involuntary mental health holds, called 5150s, which send them to a hospital, within a year. The target population was also homeless. People must repeatedly refuse voluntary treatment first.
A law authored by state Sen. Scott Wiener, a Democrat from San Francisco, allowed the city to launch the pilot program.
But Wiener said Friday his original law was hamstrung by a slew of factors. It got watered down by another piece of state legislation the next year, making it more restrictive. Next, the Board of Supervisors added more requirements during a contentious political debate. Logistics and paperwork delayed the implementation, and as soon as it got off the ground, the pandemic slowed progress.
“So not shockingly, not a lot of people have been conserved,” he said.
“It is so frustrating to me and so many San Franciscans when you walk down the street and see someone who’s clearly falling apart and dying, and you see that person every day falling apart a little more, and you wonder why is no one doing anything about this, why is no one saving their life?” he continued.
The report said 27 total notices have been delivered to 14 people informing them they’re on a potential path to housing conservatorship. There are no petitions waiting court approval.
The city’s health department said in a statement Friday that multiple barriers have hindered the program. They said those include limited referrals from partners, extensive documentation requirements and challenges receiving confidential patient records from private hospitals.
The health department said “stronger laws and more resources would make the San Francisco Housing Conservatorship programs a more effective tool” in the city’s system.
Wiener said he had planned to come back to the legislature this year to fix problems with his law, but instead is setting his sights on supporting a package of laws to reform a broader form of conservatorship, called LPS, that state Sen. Susan Eggman is planning to put forward. Wiener said he believes that with new leadership in the legislature, reforms will pass this year and help more people into treatment.
Mayor London Breed, who has lobbied for stronger conservatorship laws for years, supported a similar package of reforms last year.
Breed’s health department runs San Francisco General, which sees many of the patients who might be a fit for the program in its psychiatric emergency room and its inpatient psychiatric unit. People frequently cycle through the units because of a lack of long-term care.
The city also runs numerous street outreach teams – some to respond to people with mental illness and others who have just overdosed – where experts have the power to write mental health holds that would set someone on this path to conservatorship.
Recent data shows that in a majority of interactions with the team responding to mental crises, people in 57% of engagements remained in the community. In only 5% of cases were people placed on holds – a rate that two social workers told the Chronicle they felt didn’t reflect the higher need for hospitalization among their clients.
Critics say mental health holds and conservatorship should be extremely limited because it takes away people’s civil rights.
