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A homeless person is sitting on a sidewalk in San Francisco. (Justin Sullivan / Getty Images)
Faced with a complex hybrid problem of homelessness, addiction and mental illness, San Francisco officials on Tuesday passed a controversial bill that extends the city's ability to force addicts with mental illness to undergo treatment. .
Although the pilot program only covers five people a year, it has opposed elected officials to critics who say this is a serious threat to civil liberties.
Both parties agree that the city must do more to stem a complex crisis fueled by a shortage of affordable housing, a drug epidemic and limited mental health resources. All this in one of the the most expensive cities in the country, where the homeless population has jumped 17% since 2017.
"It's difficult, it's really about freedom and personal agency," said Lena Miller, program director at Bayshore Navigation Center, a city shelter. "On the other hand, what do you do when a person breaks with reality and can not really take care of herself?"
The council of the city's supervisory authorities voted 10 to 1 for the implementation of SB 1045, a bill passed last year by state legislators, which expands the use of A mechanism called conservatism, which gives a court-appointed guardian the power to make decisions for a person found to be "severely disabled".
Conservatives have been used in California since 1972 to involuntarily treat people with mental illness and alcohol abuse. The new law allows courts to "keep" people who use other substances or who have entered psychiatric emergency services at least eight times a year.
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According to Rachael Kagan, director of communications for the San Francisco Department of Public Health, about half of all psychiatric emergencies are related to methamphetamine use.
"We feel that it is necessary to update our conservation program in San Francisco because the current program does not take into account the needs of people with substance abuse disorders," Kagan said. "The clinicians who serve these people really need this tool."
But opponents fear that this will lead to prolonged and involuntary internment. Although eight of these events (known as 5150 hold -ings) do not automatically result in a custody warrant, a person can be held in detention for up to 72 hours and a health professional can ask for additional plugs.
"What they do not take into account is the huge incentive the police will need for 5,150 people," said Jennifer Friedenbach, Executive Director of the Coalition on Homelessness. She argued that even if only a handful of people were eligible to become conservative, the new law would allow the de facto detention of the homeless and the mentally ill.
In a 2018 statement, Susan Mizner, director of the ACLU program for the defense of the rights of persons with disabilities, said that guardianship was "the greatest attack on civil rights outside the death penalty".
Members of the Progressive faction of the council, all Democrats, expressed their concerns, but in the end all but one of the supervisors supported the bill after proposing amendments to reduce its scope.
Although last minute changes mean that even fewer people will probably be kept – an essential amendment requires that they be first treated as an outpatient – the state legislator who wrote SB 1045 has already introduced a new bill in Sacramento that could bring every year 50 other residents of the city to be preserved, according to estimates from the Department of Public Health.
State Senator Scott Wiener (D), a former San Francisco supervisor, championed the issue at the state level, with local support from San Francisco mayor, London Breed, and board supervisor Rafael Mandelman. In a statement after the passage of the bill, the Mayor welcomed this initiative, which she saw as an important part of her plan to address mental health and addiction issues.
[He is a stylist to Hollywood stars. But his most personal work is giving cuts to the homeless.]
"This is an important step that will help people [on] our streets get the treatment they need, rather than continuing to come and go to the ER, and often to the criminal justice system, "she wrote. "Trusteeship will finally allow us to break this cycle by providing long-term care."
Angelica Almeida, who heads the outpatient treatment program assisted by the Department of Public Health and will lead the new program under S.B. 1045, highlighted the legal protections afforded to the conserved people. Although they may be held in a locked room and lose control of their property, those retained may not be required to take medication and are represented by a public defender. Almeida's office is responsible for ensuring that they are detained "in the least restrictive setting possible".
She recalled that the increased use of conservation can be an important tool to end the cycle of preventive detention of people involuntarily detained during drug-related episodes, released after starting to take drugs again.
"What we know as providers is that, along with this cycle, a person is getting worse," she said. The new law, said Almeida, allows her and her colleagues to provide long-term support to patients "in recovery and well-being. "
However, those who have an overall view of San Francisco's interlocking mental health, addictions and homelessness crises do not have illusions about the easy solution. Kenneth Kim, director of Behavioral Health Services at GLIDE, a non-profit organization in the Tenderloin district of the city, said comprehensive and well-funded efforts would be needed to significantly reduce the problem.
"This use is really hopeless, which is unfortunate," said Kim. "It could mean institutionalizing people where it's not appropriate."
Miller, who is also director of Urban Alchemy, a non-profit organization that employs previously incarcerated people, said the mix of addiction, mental illness and extreme poverty or homelessness is a problem that society has not yet fully understood. She compared S.B. 1045 to the recycling of some plastic bottles to avoid climate change.
"We have never seen this before, we have never had to deal with it before and we have not done it now."
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