San Francisco to consider forced treatment for mentally ill addicts

State Sen. Scott Wiener coauthored the legislation allowing the pilot programs.
State Sen. Scott Wiener coauthored the legislation allowing the pilot programs.
(Rich Pedroncelli / Associated Press)

San Francisco supervisors were expected to consider a proposal Tuesday that could force drug addicts with serious mental illnesses into treatment.

Mayor London Breed and other supporters of the proposal say the move — known as conservatorship — is necessary to help addicts who are often homeless and suffering from a mental illness, making them a danger to themselves.

They say the number of people who could be forced into treatment is small, likely fewer than 50.


Critics call the measure a violation of civil rights that runs against the principles of the liberal city. They also say San Francisco lacks the services and shelter to successfully expand the number of people in such a program.

Incomes are generally high in San Francisco, where the median price of a home is $1.4 million and median monthly rent for a one-bedroom unit is $3,700. But the city struggles with a growing number of homeless people — some with disturbing street behavior fueled by drugs, schizophrenia or bipolar disorder.

They shuffle from the streets to jail and psychiatric care, unaware they need steady treatment, sometimes dashing into traffic or screaming at strangers.

“Anyone who’s been to San Francisco recently, either in our downtown or in the neighborhoods I represent, has seen an alarming number of people who seem to be mentally ill, or in some kind of psychosis, and they seem to be not getting the care that they need,” said Supervisor Rafael Mandelman, a cosponsor of the measure whose district includes the Castro.

State Sen. Scott Wiener, a San Francisco Democrat, coauthored the state legislation allowing the five-year pilot programs for forced treatment in Los Angeles, San Francisco and San Diego counties.

The 11-member San Francisco Board of Supervisors has been divided on the proposal. It has not yet been officially considered by supervisors in San Diego and Los Angeles counties.


The proposal would allow a court to appoint a public conservator for someone who has been involuntarily detained for psychiatric hospitalization at least eight times in a year under section 5150 of California’s welfare and institutions code. The treatment could last for as long as a year.

San Francisco’s public health department has identified 55 people who fit the definition and another 48 people who have been detained six or seven times.

The department has budgeted nearly $400 million this year for mental health and substance abuse services and last year provided help to more than 25,000 people.

Last year, voters approved a tax on some of the city’s wealthiest companies to raise money for homeless and mental health services. And this year, several supervisors are proposing a November ballot measure to guarantee mental health services for everyone.

Jen Flory, a policy advocate with the Western Center on Law and Policy, which lobbies on behalf of poor people, said it’s no accident that the most expensive cities in California are seeing more people with serious problems on the streets.

Her organization opposes the San Francisco measure, saying there are insufficient services available to make it work. She hopes people are offered outpatient services with fewer restrictions.


“These are very difficult people to house, but what works is to continually try to work with somebody until something works,” she said. “We don’t know of forced models that work.”

Mandelman said most of the people targeted by the program are well-known to merchants, residents and staff at psychiatric facilities. Watching them deteriorate is heartbreaking, he says.

“They see them going from ‘kind of not great’ to being in absolute and complete distress,” he said.