A sure-fire way to get the severely mentally ill off the street and into safe treatment

Yet San Francisco has only used it for one person in over two years

Supervisor Rafael Mandelman is supporting the most unpopular good idea in San Francisco.

Mandelman wants the city to make greater use of the conservatorship law, SB 1045, passed over two years ago through the efforts of State Sen. Scott Wiener. It would let counties “conserve” a seriously mentally disturbed individual and put them in a safe facility where they would be required to take their medication.

The alarm bells you hear are from advocates of social justice. As they say whenever conservatorships come up, this will confine people against their will. It will violate their civil rights. They will have to live in a supervised facility and will not be able to leave if they wish.

To his credit, Mandelman answers those criticisms directly. Yep, he says, that’s what we would be doing.

“We are taking away people’s liberty,” he said. “There are risks to that. There are risks to the foster care system. And to nursing homes. But the answer is not to abandon these people.”

Frankly, Wiener’s bill was a long slog with strong pushback from advocates. And by the time it was passed there were enough mandatory restrictions added to make it difficult to put anyone in a conservatorship. For instance, to be eligible, an individual must have been booked on at least eight 5150 emergency psychiatric holds in 12 months.

And, when the measure got to San Francisco, there was contentious debate in the Board of Supervisors. It passed in June, 2019, but even more restraints were added to to the state measure. Those make it even harder to get a severely mentally ill person off the street and into treatment. It is, as one person characterized it, the belief that “Everybody has a right to be crazy.”

But as we often say here, the theorists need to speak to the realists. That means the family members who are deeply concerned about their loved one and often are desperately trying to get them into full-time treatment.

One who knows the heartbreaking toll is Mandelman, whose mother suffered mental breakdowns for most of her life.

In one of her worst episodes, Mandelman says, she removed all her clothes and took off running down a city street.

But, he says, that was years ago. It was a different time. Her breakdowns were handled with long term treatment.

“She’d be taken to a hospital,” Mandelman says. “But she’d spend a week there. Or two. Sometimes it was six months. Sometimes she was in a shelter, but she was never on the street.

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Nothing like that is happening now. Mandelman has found an academic supporter in New York University professor Alex Barnard. Barnard’s paper, “Authority and Accountability: Evaluating California’s Conservatorship Continuum,” runs to 80 pages and is full of nuggets of interest.

To Mandelman’s point about shorter stays in psychiatric hospitals, Barnard cites a study that shows in 1990 people stayed in psychiatric care an average of 25 days. In 2010 it was six and a half days.

And just to be clear, it isn’t because the guidelines are so strict that no one is qualifying for confined treatment. There are plenty of people who meet the criteria.

Barnard says a 2019 study from San Francisco found that in four months, nine people visited the public psychiatric hospital 168 times.

You may have heard the story of the disabled woman in Corona Heights, whose house was invaded last week by a 39-year-old mentally ill man. He walked into her house, sat down and refused to leave.

Mandelman got in touch with the woman, who said in a strange way the guy’s weird behavior was re-assuring.

She told him that while the guy was sitting in her house and talking to himself, “He didn’t seem all that aware of me at all.”

Police were called. They knew the man well. He’d been released from jail five days earlier, on a carjacking and kidnapping charge. He’s been jailed four times in the last year, including (according to SFist) once for assault with a deadly weapon.

“There’s a danger to the public,” Mandelman said. “So do we just wait until he does something terrible?”

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That does seem to be the emphasis. Keep them cycling through the system and hope nobody gets killed or seriously injured.

Barnard describes speaking to a member of a Mobile Crisis team who told him, “Our goal is always can we have an alternative plan to keep this person in the community?”

That’s a manifestation of the San Francisco plan of treating people on the street, rather than getting them off it.

“But with some number of these people, it is not successful,” Mandelman said. “To get a person to calm down and then leave — that should not be considered a win.”

There are other factors. Private hospitals, which are doing much of psychiatric emergencies, are motivated to get patients out quickly because insurance payments run out. A 2019 story in Psychology Today found that the current average stay for inpatient psychiatric admission is “between three and 10 days, with many admissions lasting three to four days.”

“These people are dealing with paramedics and police many times a year,” Mandelman said. “But they never get off the hamster wheel.”

There’s nothing theoretical about this. If you live in San Francisco, you encounter seriously mentally ill individuals all the time.

On Monday we were downtown, a block from Union Square. There was a guy on the corner, barefoot, red hair sticking straight up. He was picking up bits of trash and muttering to himself. At intervals he’d run into traffic, dodging cars and shouting.

As Mandelman says, “just another day in San Francisco.”

It’s true. I hardly gave the incident a second thought. Scenes like that are so commonplace we take it for granted.

Currently, the conservatorship program is all but useless. It’s been two years since the Board of Supervisors debated and finally passed SB 1045 with the wholehearted support of Mayor London Breed.

Yet according to the most recent data Mandelman has, just one person has been conserved.

As he said in an interview with Heresay Media, “I said at that time that even if SB 1045 only helped one person . . . it was worth doing. But I didn’t think it would actually, literally be one person.”

At this point supporters of conservatorship realize that the current legislation isn’t working. Which leads to one conclusion:

“We need to get those people we see year after year off the street,” he says. “If laws won’t let us do that, we need to change the laws.”

Contact C.W. Nevius at cwnevius@gmail.com. Suggestions and compliments gladly accepted. Criticism not so much. Twitter: @cwnevius

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