Momentum is building toward expanding the use of conservatorships to legally compel more people into needed treatment. But the revival of forced treatment has prompted deep concern among mental health and disability advocates, and civil liberties experts.
Homeless people line Ellis Street between Taylor and Jones streets in the Tenderloin in March. As The City grapples with homelessness, drug abuse and a lack of mental health resources, momentum is building toward expanding the use of conservatorships to legally compel people into treatment.
There are different types of conservatorships in California, including mental health conservatorships specifically for people who are considered to be “gravely disabled,” meaning they have a mental health disorder that prevents them from providing their own food, clothing and shelter. Those who are conserved for mental disabilities can be subject to confinement in a locked facility, although some may live in open facilities or group homes.
Although the legal mechanics and heavy-handedness differ between the two approaches, they find common ground in a philosophy that people experiencing homelessness and substance use disorder need a stronger push toward care. Public conservator programs are guided by state law but do not receive any state or federal funding; counties fund the programs entirely. That can create discrepancies on a county-to-county level about how conservatorships operate. And it puts financial strain on caseloads for public conservators who already oversee unsustainable caseloads, Hughes said.
In fact, San Francisco has a higher number of conservatorships compared with 12 other large California counties according to a January report from the Budget and Legislative Office. And that number has been on the rise in San Francisco since 2014, going from 626 in 2014 to 769 in 2020. In 2018, California opened a new housing conservatorship program to compel individuals with mental illness and substance use disorders into treatment. San Francisco officials gave it a shot. The City was facing a disastrous homelessness and substance use disorder crisis, and local leaders were ready to try all possible solutions.
But the bill was watered down in the legislative process, making it more difficult to qualify, its supporters say. An early version of the bill would have required only three 5150 holds within a year, meaning an individual is involuntarily detained for a 72-hour psychiatric hospitalization. The final version required eight annually before steps toward conservatorships could be initiated.
Friedenbach and others argue instead for increasing the availability of affordable and supportive housing and low-barrier health care. People in crisis often must wait weeks and months for placements into residential treatment in San Francisco.Before 1960, most mental health services took place in large state-run hospitals known for having disastrous conditions and rampant abuse and segregation.
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