San Francisco may force treatment on mentally ill drug users

If passed by the San Francisco Board of Supervisors, the measure only would apply to a handful of people, the city's department of public health estimated.

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 income inequality and a growing number of homeless people — some with disturbing street behavior tied to 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 measure co-sponsor whose district includes the Castro neighborhood.

Sen. Scott Wiener, a San Francisco Democrat, co-authored state legislation that allows five-year pilot programs for forced treatment in Los Angeles, San Francisco and San Diego counties. He is working on a bill to amend that legislation to expand the number of people affected.

The 11-member San Francisco Board of Supervisors has been divided on the proposal, although there was talk Tuesday of compromise amendments. Supervisors in San Diego and Los Angeles counties have not officially considered it.

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. The treatment could last for as long as a year.

Only about five people could be forced into treatment in San Francisco, said Rachael Kagan, spokeswoman for the city's Department of Public Health. Wiener's new bill could bump that up to 55, which is the number of people who now fit the definition for at least eight holds.

The health department has identified an additional 48 people who have been detained six or seven times.

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

Voters last year approved a tax on some of the city's wealthiest companies to raise money for homelessness 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 not enough services are 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, the supervisor, 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.