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Board hears mayor on SB 43 implementation; officials say conservatorship changes will increase demand for treatment beds
Summary
The San Francisco Board of Supervisors pressed Mayor London Breed on Tuesday about whether the city has the beds and services to implement SB 43, the state law expanding conservatorship criteria to include substance use disorder and inability to care for medical needs, and the mayor said an executive directive is in place but that more and different placements will be required.
The San Francisco Board of Supervisors used part of Tuesdays question period with Mayor London Breed to discuss the implementation of Senate Bill 43, the state law that expands conservatorship eligibility to include substance use disorder and incapacity to care for medical needs.
Supervisor Rafael Mandelmann led the discussion, thanking the mayor for supporting SB 43 and asking whether the Department of Public Health (DPH) can supply the placements that will be necessary if more people are routed into conservatorship and treatment. Mandelmann said the city has long struggled to expand the supply of locked subacute facilities and board-and-care beds appropriate for people with severe mental illness.
The mayor said SB 43 goes into effect Jan. 1 and that she has issued an executive directive instructing city departments to prepare policies and procedures for implementation, to remove barriers to referrals and to require data collection to monitor effectiveness. Breed said the city already treats roughly 16,500 people for mental health disorders and does services for over 4,500 people for substance use disorder, and that the city recently added about 350 beds toward a 400-bed objective.
Breed and Mandelmann both warned the audience that the kinds of beds needed for people subject to conservatorshipparticularly locked facilitiesare expensive and in short supply. The mayor said capacity is complicated by staffing and that some beds are not at full occupancy for operational reasons. She also suggested the state may need to play a larger role in providing specialized facilities.
Mandelmann asked what changes DPH must make to rise to the challenge. The mayor said the departments must be on the same pageabout bed availability and referral pathways and must collect data to track referrals and placements. She said the citythrough the directiveis attempting to reduce delays in referring people to care once the law is in effect.
No formal action or vote was taken during the discussion.
Why it matters: SB 43 changes who can be considered for conservatorship and could increase demand for locked or long-term board-and-care placements. Supervisors, public commentators and the mayor agreed that the city will need more capacity, better referral coordination and funding to implement the law effectively.
What remains unclear: The mayor declined to make a project-specific commitment about placements or beds; supervisors pressed DPH to produce an updated beds-optimization study and to provide a clear plan for where patients subject to conservatorship will be placed. Mandelmann said he and others are still waiting for DPHs updated analysis of bed needs and capacity.
Next steps: The mayor and DPH will be expected to provide data and a plan to the board ahead of SB 43s Jan. 1 effective date. Supervisors indicated they will hold follow-up hearings on bed capacity, placements and the DPH plan.
