California's new conservatorship law, which expands the pool of potential candidates who can be involuntarily compelled into mental-health or substance-abuse treatment, takes effect January 1, and San Francisco is one of the counties opting to implement it right away.
"In San Francisco we are not delaying," said Mayor London Breed in a statement on X today. "We are prepared to implement our new conservatorship law on day one. We are ready to get people struggling with addiction on our streets into treatment and save lives."
What this will mean in practice remains to be seen, but new law, SB43, expands the definition of "gravely disabled," which had previously been the rubric for applying conservatorship in the cases of mentally ill people. The original definition was "either a condition in which a person, as a result of a mental health disorder, is unable to provide for their basic personal needs for food, clothing, or shelter or has been found mentally incompetent."
SB43 expands that to also include "a condition in which a person, as a result of a severe substance use disorder, or a co-occurring mental health disorder... [is] unable to provide for their personal safety or necessary medical care... [or] the inability for a person to provide for their personal safety or necessary medical care as a result of chronic alcoholism."
Last week, Breed called the new law "a huge victory for San Francisco," and she added it "could be a huge victory for the state of California if other jurisdictions would choose to use this as a tool and implement it."
That comment is a not-so-subtle dig against the many counties that appear to be dragging their feet and/or that don't think they have the resources at hand to begin compelling more people into in-patient treatment.
Governor Gavin Newsom complained about this last week, and then again on Friday expressed his frustrations, as the Chronicle reports.
"We can’t afford to wait," Newsom said. "The state has done its job; it’s time for the counties to do their job. … They have to understand people are dying on their watch."
Among the counties delaying implementation of SB43 are most of the counties in the Bay Area besides San Francisco. San Mateo County's board of supervisors still hasn't even discussed a timeframe for implementation, while Santa Clara County's supervisors voted this week on a "speedy but well-planned implementation" of the law, with no specific date mentioned.
Meanwhile, Napa, Contra Costa, and Solano counties are taking the longest delay allowable under the law, waiting until 2026 to implement it. Sonoma, Marin, and Alameda counties don't appear to have made any decision yet. And in San Joaquin County, which is home to the state senator who introduced SB43, Sen. Susan Talamantes Eggman, the board of supervisors there voted to delay until 2026 as well, saying they did not have the medical facilities that would be necessary to implement it right away.
Elsewhere in the state, another big county, San Diego County, is delaying implementation one year, to 2025.
Advocates say that all too often, individuals suffering from mental-health and often concurrent substance-abuse issues don't get treatment until they end up in the criminal justice system. And the state has for decades been under-funding the mental healthcare system, leading to the crisis we see on city streets today.
Elizabeth Kaino Hopper, an advocate for the new conservatorship law, watched her daughter fall into homelessness and drug addiction because of her mental illness. As she said to the Chronicle last week of the foot-dragging by many counties, "I have a problem with them saying they now need another two years. All that does is continue to criminalize illness."
But the state isn't throwing any money behind SB43, so it's up to counties to look in their already tight budgets to address any additional funding needs, not necessarily knowing how many people will end up needing to be cared for.
There are also disability rights and civil liberties groups who could end up taking legal action, creating more potential financial headaches for counties. These groups argue that SB43 will illegally deprive the mentally ill of their civil rights.
Dr. Mark Ghaly, Newsom's Secretary of the Health and Human Services, tells the Chronicle that counties need to begin implementing the law before the state can begin helping them find resources and capacity to house and treat more individuals.
"These conversations can’t happen until we really move forward with the implementation," Ghaly tells the Chronicle. "We can always find reasons to slow walk just about everything."
Top image: California Gov. Gavin Newsom talks to reporters in the spin room following the FOX Business Republican Primary Debate at the Ronald Reagan Presidential Library on September 27, 2023 in Simi Valley, California. Seven presidential hopefuls squared off in the second Republican primary debate as former U.S. President Donald Trump, currently facing indictments in four locations, declined again to participate. (Photo by Mario Tama/Getty Images)