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Sober Nation

Putting Recovery On The Map

06-19-19 | By

San Francisco Backs Forced Treatment for Mentally Ill Drug Users

As one of the most expensive cities in the nation, San Francisco is plagued with income inequality and a growing number of homeless people – jumping 17 percent since 2017. Some suffer from drugs, mental health issues such as PTSD, bipolar disorder, and schizophrenia, and there are also those who suffer from both simultaneously.

Most of these people find themselves in and out of shelters, jail, psychiatric centers, and are often times unaware they need steady treatment.

On Tuesday officials in San Francisco decided to back a controversial plan to combat the issue, allowing the city to force people with acute mental illness and addiction into treatment without consent.


The proposal for a new pilot program known as S.B. 1045 passed 10-1. The bill expands the use of a mechanism known as conservatorship, which gives a court-appointed guardian the authority to make decisions for a person considered, “gravely disabled.” Although the pilot program may affect as few as five people a year, the measure has gained growing criticism among critics who says the move represents a grave threat to civil liberties.

While Mayor London Breed and other supporters feel the proposal is necessary to help those who are often homeless, addicted to drugs and are simultaneously suffering from mental illness, making them a danger to themselves, several members of the Board of Supervisors voiced their own concerns about the possibility of taking away a person’s civil liberties.

“Allowing people to continue to suffer on our streets is not acceptable or humane, and I am glad the Board of Supervisors supported our approach to finally make a change,” Breed said in a statement after the vote.

Some critics say the measure is politically driven and in a violation of civil rights that go against the underlying tones of a liberal city. Additionally, a number of homelessness advocates in the city noted that the move is aimed at avoiding a potential ballot fight over the issue, stating that San Francisco lacks the resources to successfully expand and treat the number of people in a program as such.

A Political Move

Critics worry that the bill will lead to prolonged involuntary confinement. While eight psychiatric holds – known in California as a 5150 – will not automatically lead to a conservatorship, a person may be help for up to 72 hours and a medical professional can request additional holds.

“What they’re not taking into account is the huge incentive police will have to 5150 people,” said Jennifer Friedenbach, executive director of the Coalition on Homelessness. She argued that even if only a handful of people ultimately qualify for a conservatorship, the new law will allow for the de facto detention of homeless and mentally ill people.

“Pretty disheartening, when you’re talking about a really serious issue, taking away people’s civil liberties,” said Jennifer. “We want to do something that actually works, that’s not just a fake political move.”

Conservatorships have been used in California since 1972 to involuntarily treat people grappling with mental illness and alcohol abuse. The new law lets courts “conserve” those who use other substances or have entered psychiatric emergency services at least eight times in a year.

“It’s hard, it’s really an issue of freedom and personal agency,” said Lena Miller, program director of the Bayshore Navigation Center, a shelter in the city. “On the other hand, what do you do when a person is having a break with reality and can’t really take care of themselves?”

“We Have A Moral Responsibility”

Sen. Scott Wiener, a San Francisco Democrat, co-authored the state legislation that allows pilot programs in Los Angeles, San Francisco and San Diego counties.

“Too many people are deteriorating and dying on San Francisco’s streets, and we have a moral responsibility to help them,” he said in a statement after the vote. “It’s neither progressive nor compassionate to stand by while people die.”

While there may be disagreements between the specifics, it’s clear that everyone can agree help is needed.

District 8 Supervisor Rafael Mandelman, pushed for the legislation.

“I think whatever population we’re dealing with — whether it’s one or five or 40 — there are clearly people on our streets who need help who are not getting it and are not going to seek it themselves,” Mandelman explained. “And we need the tools to reach out and get them the care they need.”

San Francisco Mayor London Breed has pledged $50 million dollars for more treatment and recovery beds in next year’s budget, and this year the department has budgeted nearly $400 million for mental health and substance abuse services. Last year they provided help to more than 25,000 people.


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