Recent films such as the documentary “Framing Britney Spears” and Netflix movie “I Care a Lot” have reawakened dialogue about conservatorship—a legal arrangement where a judge appoints a person or organization to manage the affairs or finances of an adult unable to care for themselves.
In San Francisco, the debate over conservatorship has been raging for at least two years since the California state legislature proposed and passed SB 1045. The law makes it possible for the county to assume responsibility for someone suffering from a combination of mental health and substance abuse disorders after that person has been placed on at least eight 5150s, or emergency psychiatric holds, within a year’s time.
Critics say the law—authored by State Senator Scott Wiener (D-San Francisco)—threatens people’s civil liberties, while proponents believe it helps bring stability to those with severe mental health and drug abuse problems.
Yet as hotly as it was contested, since SB 1045 passed in 2018, only one person has been conserved in San Francisco. As of Jan. 31, 63 people have been identified as at risk for conservatorship, seven are on the pathway to conservatorship and 10 are being treated through less restrictive options. Those numbers were revealed during a presentation on SF’s Housing Conservatorship pilot program to the Public Safety and Neighborhood Services Committee on March 11.
District 8 Supervisor Rafael Mandelman is a major supporter of SB 1045’s adoption at the county level. But he’s disappointed with its slow implementation and impact so far.
“It's been nearly two years since the board vigorously debated and ultimately opted into SB 1045,” Mandelman said. “I said at that time that even if SB 1045 only helped one person, I believed it was worth doing. And I still believe that, but I didn't think it would actually literally be just one person.”
For Mandelman, the issue of conservatorship is not only a policy issue or a trendy pop culture topic but a matter close to his heart. His mother battled mental illness and homelessness throughout her life, and eventually, Mandelman had to conserve her. He remembers vividly the moment when he realized that he would have to play a significant role in overseeing her affairs.
“I'm a freshman at Yale, and I'm on a payphone in the library talking to her in a homeless shelter, which was this sort of crazy dichotomy,” he told Here/Say.
Ahead of the March 11 hearing, we Zoomed with the Supervisor to discuss his take on San Francisco’s progress on conserving people, conservatorship’s reawakening in the public eye and what the county needs to do to move forward.
Here/Say: Why is supporting conservatorship programs important to you?
Rafael Mandelman: It's personal for me. My mother suffered from mental illness for most of her adult life... [and] was homeless for a period of time. She was in a shelter in Southern California.
There was a period where I had a kind of conservatorship over her to help manage her affairs and get her into a better place.
The awareness that I've had from seeing my mother and having to try to help is that there are people who just can't run various aspects of their own lives, whether it is their finances or their medical decisions or their housing decisions. And we need to have mechanisms for family members or for the counties to step in and help those people.
So it's a personal matter, but it's also a policy matter.
Here/Say: Why is conservatorship needed in San Francisco?
Mandelman: As an elected official in San Francisco in 2021, when I walk out my door, and I see... people who clearly can't take care of themselves being left to make decisions about whether they will or not be housed... whether or not they will take medication, whether or not they will use extremely serious, mind-altering drugs... Those folks need more support and help than they're getting.
There are so many people who are out on the streets who are just too much for their families to handle, who have needs that are so acute. And, paradoxically, when you're too much for your family to handle the support that we have for you and your family, it's not there. That safety net is not there. I don't know if that's a paradox or just a tragedy.
Here/Say: To date, the county has conserved a single individual under SB 1045. Is that enough?
Mandelman: As we were trying to pass the local SB 1045 legislation, [I said] that if we only conserved one person, we should move forward with it. Now, that line is being put to the test. I do think it is a hard law to implement.
Here/Say: Why is conservatorship particularly hard to implement in San Francisco?
Mandelman: I do think eight 5150s is too much.
There are the legal barriers, but there's also a practical barrier of just not having enough placements.
We have a real shortage of beds in facilities that are locked. That is often going to be the first step for someone who you're trying to keep out of the hospital, and you're trying to keep out of jail, but [they] still can't be allowed to go out on their own without some supervision. You need those facilities that have a lock on the door, and we just don't have nearly enough.
Here/Say: What does San Francisco need to do to scale its level of conservatorship?
Mandelman: At the county level, we need to do a better job of creating more placement options, either in San Francisco or in the Bay Area, and working in collaboration with other county governments to have appropriate facilities, placements and board and cares for folks who need something more than just a home. Because there are unhoused people who simply need a home, and then there are people who really need more than that. We need to do a better job as a county of trying to make all of those levels of care available. But we also need to be pushing on the state to help fund that.
Mandelman: I'm not going to weigh in on Britney. I will say that Britney is not under a Lanterman–Petris–Short conservatorship. She's under a probate conservatorship, I believe. It underscores the need to be attentive to the potential for abuse when you are depriving people of their liberty.
There is potential for abuse in any system caring for vulnerable people, whether it's the foster care system [or a] conservatorship system. But the answer to the potential for abuse in the foster care system has never been to do away with foster care. It is to reform these systems, put in safeguards, have oversight, root out the problems. But you don't give up. You don't simply say, ‘We've done a bad job of taking care of vulnerable people. The solution is not to take care of vulnerable people.’
And yet, in the conservatorship context, people sometimes make that argument. It boggles my mind. It is frustrating. I think it's wrong, but it's a fight we have to fight.
Here/Say: Conservatorship is a controversial subject. What do you think needs to change about the conversation around conservatorship?
Mandelman: I think people understand that it is wrong that we don't take care of these seriously sick people around us. I think people need to channel that feeling of frustration and sadness and anger into a demand that local government and state government do better.
And that doesn't mean going back to mass institutionalization. It definitely doesn't mean throwing all the people who you see on the street who are really sick in jail. [The solution] should be to get people the care that they need even when they don't know they need care.
This conversation has been edited for length and clarity. The views expressed in this Q&A are the interviewee’s own and do not represent an editorial position by Here/Say Media. We’ll be exploring opposing viewpoints in future coverage.
Video by Sophie Bearman.
Christina Campodonico can be reached at firstname.lastname@example.org