Supervisors push departments for clearer SB 43 outcomes as implementation yields modest conservatorship gains

San Francisco supervisors pressed city health and disability agencies on Thursday about the implementation of California Senate Bill 43, with elected officials and officials from the Department of Public Health and the Department of Disability and Aging Services agreeing that legal change alone has not produced broadly improved outcomes for people with severe mental illness or co-occurring substance use disorders.

President Rafael Mandelmann of the Board of Supervisors convened the hearing at his request and said SB 43 “was not my first ride on the merry-go-round” of conservatorship reform. Mandelmann told the committee, “SB 43 implementation in San Francisco has not been a success in my view,” and said he expected a candid assessment of what has worked and what has not.

Daniel Tsai, director of the Department of Public Health, and Kelly Dearman, executive director of the Department of Disability and Aging Services and public conservator, described a coordinated interagency rollout after San Francisco adopted SB 43 on Jan. 1, 2024. The definition of grave disability was expanded under SB 43 to include severe substance use disorder and inability to provide for personal safety or necessary medical care, in addition to inability to meet basic needs for food, clothing or shelter.

Dearman summarized the conservatorship process under the Lanterman-Petris-Short Act (LPS): only the public conservator may file for conservatorship, which typically begins with a 30-day temporary conservatorship that can proceed to a permanent conservatorship if…