San Francisco Mayor Daniel Lurie and Assemblymember Catherine Stefani announced a new state bill Monday, authored by Stefani, that would allow judges to order involuntary mental-health medication in some circumstances.
At a press event at SF City Hall Monday morning, Lurie and Stefani, along with SF Board of Supervisors President Rafael Mandelman, announced the proposed bill, for which Lurie will serve as sponsor. The potential new law would fill a gap in how severely mentally ill patients are handled in legal settings, with a judge being given the ability to authorize the involuntary administration of mental health medications.
Under current law, judges are able to order a mentally ill person into assisted outpatient treatment, however they are not able to authorize the involuntary medication of that person without their consent.
"Too many people in San Francisco are falling into crisis when intervention could — and should — come sooner," Lurie said in a statement. "At the center of this effort is a simple reality: Stability is the gateway to recovery. For many people with severe mental illness, medication is what allows treatment to work at all. Without it, housing placements fail, care plans break down, and crises repeat themselves—often with greater harm each time."
Stefani spoke about the bill, saying it "gives courts and doctors a responsible tool to intervene before situations escalate."
The SF City Attorney's Office and the Department of Public Health both endorse the measure as a necessity for dealing with severe cases on city streets. Public Health Director Daniel Tsai says in a statement, "In San Francisco, we want to utilize every effective tool available to help individuals with serious mental illness stabilize and eventually thrive in the community." And City Attorney David Chiu calls the proposed legislation "an important step towards closing gaps in our behavioral health system."
Lurie is framing the state bill as another piece in his larger Breaking the Cycle plan, announced two months into his tenure as mayor last year.
"I believe our city must be judged by how we care for our most vulnerable residents," Lurie said.
Board President Rafael Mandelman, who has talked publicly about his own family's struggles with mental illness treatment, has been a consistent advocate for conservatorships and involuntary treatment measures. Mandelman said Monday that he will introduce a resolution at the Board of Supervisors meeting on Tuesday in support of the state bill.
He said that while the city "build[s] out... capacity for additional conservatorships, there are and will remain many very sick individuals on our streets, in our emergency rooms, and in our jails who would benefit from interventions short of a full conservatorship." He added, "Allowing a court to order involuntary treatment through assisted outpatient treatment is one such potentially lifesaving and less-intrusive intervention."
Under Governor Gavin Newsom's direction three years ago, cities across the state are mandated to create CARE courts and to compel more "gravely disabled" mentally ill people into conservatorships. San Francisco already complies with that directive, though the city lacks adequate bed space for the number of people in need of in-patient treatment.
The bill announced Monday would address the need for more involuntary treatment of those who don't, necessarily, require immediate inpatient treatment — though it does call to question how long they'd remain stabilized if left on their own, following the initial dose or doses of medication.
Critics of the CARE court policy raised the same issue in recent years, suggesting that only extended inpatient treatment is appropriate in many cases, and everything else is simply a band-aid.
"Some of the people who meet the criteria for CARE Court have been on the streets for so long, it’s hard to imagine them needing less than the complex treatment that is only available in inpatient facilities — and then, once they are discharged, supportive housing. Both are in short supply," said veteran mental health advocate Randall Hagar of the Psychiatric Physicians Alliance of California, per Capitol Weekly. Most severe cases, Hagar added, "need a lot of inpatient time to get better, and medications throughout the process."
Photo by Christina Victoria Craft
