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Politics & Policy

San Francisco Mayor Says State Must Do More for People With Mental Illness People, Addiction

Written by Mike EgePublished Oct. 24, 2023 • 5:17pm
Mayor London Breed speaks at a press conference in Portsmouth Square in San Francisco Chinatown on Sept. 28, 2023. | Source: Juliana Yamada for The Standard

San Francisco Mayor London Breed said that the city may need more state assistance in implementing a new law intended to make it easier to place severely ill individuals under conservatorship. 

At a Board of Supervisors meeting Tuesday, Breed answered a question from Supervisor Rafael Mandelman about Senate Bill 43, which broadened the criteria for determining whether someone is “gravely disabled,” notably taking into consideration a person’s substance use disorder. The bill was signed into law by Gov. Gavin Newsom on Oct. 10. 

Mandelman noted that the Department of Public Health “has struggled to expand its supply of accessible beds … even to come up with a method of analyzing our need for such beds, much less, proposing a plan to get there.” 

Conservatorship beds “on any different level, whether it's a locked bed or a bed where people can move in and out at their leisure are very, very, very expensive,” Breed said, pointing out that the city has added 350 out of a goal of 400 new beds during her term.

“I'd love to see the state take a little bit more responsibility in helping us with state facilities that could operate in ways other than what we're expected to do here locally,” she added. “We don't necessarily have the capacity that we truly need right now.” 

Breed also noted that “on any given night, our beds are not at full capacity and, and that is a problem” that she hoped that implementation of SB 43 would solve. 

“We're going to definitely need more beds than we do have” as the law takes effect, Breed said.  

Before the meeting, Mandelman told The Standard that there have been issues in finding placements for severely ill patients at the local level. He pointed to recent problems at Laguna Honda Hospital and the city’s shrinking number of board and care facilities

“I do think that if we are going to try to create a significant number of placements in locked subacute facilities and board and care, it would have to be a top priority to figure out how to pay for the capital costs and the ongoing operating costs,” Mandelman said in a phone call. “Are we doing this on our own, or are we doing it with our counties? In some ways, it seems like it ought to be the cheaper option.”

Mandelman requested an update from the Department of Public Health on its progress in acquiring more care beds at the meeting.

Supervisor Connie Chan had also suggested a regional approach in getting shelter and services to people experiencing homelessness faster, as part of an “Equitable Recovery Plan” back in March. 

Breed also referenced SB 43 in answering a question from Supervisor Myrna Melgar asking for help with increased numbers of people living on the streets in her district and on the west side of the city generally.

“On West Portal Avenue, we had, you know, two to three folks before the pandemic who were folks we knew, we knew their stories. Now we're seeing anywhere between 15 and 20 folks who are regularly sleeping on the streets, in the throes of addiction, which are very visible.” Melgar said. 

Breed responded with promises of better outreach and said, “I am really grateful for the new tool that we'll have that we'll be able to use in January to really push for conservatorship for behavioral health challenges, which also now includes substance use disorder. 

“Our goal is to try and be a little bit more aggressive in pushing people into treatment into services.”

Mike Ege can be reached at

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