A new report by the city's Budget and Legislative Analyst’s Office finds that the city has been involuntarily committing about half the number of mentally ill individuals as it did half a decade ago, partly due to a lack of inpatient beds.
On Friday, a report commissioned by SF Supervisor Rafael Mandelman arrived from the Budget and Legislative Analyst’s Office looking into the use and effectiveness of so-called Lanterman-Petris-Short (LPS) Conservatorships in San Francisco. The report comes two months after the Board of Supervisors voted to approve new legislation around conservatorships that was proposed by Mandelman and endorsed by Mayor London Breed. That law simply affirmed that the city would adopt state law SB 1045, expanding conservatorships for individuals who have required emergency care more than eight times in a year, and exhibit severe mental illness.
The new report aims to provide guidance to the Board as they move forward with future legislation and address the ways in which the city has failed its mentally ill homeless population in recent years. It finds that one primary reason why conservatorships — which involve extending the stays of those individuals on 72-hour "5150" holds to 14 and then 30 days at a time — have been employed less frequently in San Francisco since 2012 is the law of acute and sub-acute inpatient beds. SF referred 141 people for conservatorships in the 2017-2018 fiscal year, versus 284 people in 2012-13. Meanwhile, acute inpatient psychiatric beds at SF General dropped from 88 in 2008 to 44 in 2011, and sub-acute fell by a third in the last six years, to 241.
As the Chronicle reports, Mayor Breed has announced funding for 212 additional beds throughout the city, which will come available in the next year.
But Mandelman insists that the ways in which progressives have discussed the civil rights implications of conservatorship, and have resisted legislation to strengthen the city's ability to use it, have been anything but progressive. "It’s completely inhumane," he says to the Chronicle. "If you have known a friend or a loved one and seen that person in psychosis and seen how far that psychotic individual is from their true self, you cannot believe keeping that person in that state is somehow honoring their autonomy." Mandelman himself was raised by a mentally ill mother in Southern California before coming to live with relatives in San Francisco at the age of 11.
The new report finds that San Francisco currently has fewer people per capita under conservatorship than other Bay Area counties, and in addition to a dwindling number of places to put committed individuals, this dearth also may have to do how the city defines "gravely disabled." The 50-year-old conservatorship law creates a complicated framework for keeping a person committed for a year or more, and given that people's mental states and stabilities fluctuate, it allows some chronically ill individuals to bounce in and out of care.
A third and equally important factor in the slipping number of conservatorships in the city: The city's Office of the Public Conservator has been under-staffed and unable to handle its caseload. A fourth reason: That office falls under the city's Department of Human Services, and it hasn't coordinated well about its cases with the Department of Public Health.
Under yet another state law proposed by state Senator Scott Wiener — SB40, still making its way through the Assembly — the number of new, chronically mentally ill individuals estimated to be eligible for conservatorship in San Francisco would be 55.
According to the latest homeless census — which did not count individuals currently in inpatient care — 39 percent of those on the streets of San Francisco suffer from psychiatric or emotional conditions.