A new city ordinance being proposed by SF Supervisor Ahsha Safaí would expand the number of personnel on the city's streets who could order mental health holds for individuals experiencing mental health crises.
Under current law, only the police and doctors can order mental health holds — known as a 5150 hold under the California Welfare and Institutions Code — when a person appears to be potential danger to themselves and others. A 5150 hold confines the individual involuntarily in psychiatric care for up to 72 hours. Safaí proposed Tuesday that San Francisco paramedics should be given the power to impose these holds to0, which would have the added benefit of taking responsibility for mental health crises out of the hands of police.
As the Chronicle reports, the proposed law is aimed at empowering SF's Street Crisis Response Teams — which are made up of paramedics, social workers, and non-law-enforcement personnel — with handling people in crisis who need immediate treatment.
SF Fire Department Captain Simon Pang, who oversees the Street Crisis Response network, tells the Chronicle, "This is an alternative to law enforcement. This is a replacement."
He adds that the appearance of the police forcing a homeless and mentally ill person into confinement increases stigma around mental illness, and he says, "people with a history of mental illness... can be triggered by the presence of law enforcement."
It's possible that more teams on the street able to impose these holds will mean that the city's psych wards could get very busy. There were about 9,000 mental health holds ordered in the city during a 12-month period between July 2019 and June 2020, or about 25 per day, according to the Department of Public Health, up from 5,754 in the previous 12 months. This number likely represents far fewer than 9,000 individuals, with some individuals getting held more than once per year.
In 2018, state Senator Scott Wiener sponsored a bill that Governor Jerry Brown signed into law that created a five-year pilot program in San Francisco, San Diego, and Los Angeles counties expanding the criteria for 5150 holds, and allowing for more conservatorships that house people in mental health treatment for extended stays.
San Francisco then created the Housing Conservatorship Program in 2019, but the program seems to have been little used so far. A spokesperson for London Breed explained to the Examiner in early 2020 that the city was still working with the courts, eight months on, to establish the proper forms and documentation necessary for the program, and no one had been put in a conservatorship at that point.
The ACLU and other mental healthcare advocates continue to voice objection to expanded conservatorship laws.
According to a January 2020 report by a 12-member working group overseeing the program, the hope is that more individuals in conservatorship will reduce the number of 5150 holds burdening the hospital system.
Photo: Yihong Chen