As public pressure mounts on San Francisco and other cities to force people who are mentally ill and homeless into treatment programs, many of those already confined under what’s known as “conservatorship” have no place to go.
There are at least 56 people in regular short-term treatment hospitals such as Zuckerberg San Francisco General Hospital, as well as six people in the city’s jails, who are under a San Francisco court-ordered mental health conservatorship but are waiting for a long-term treatment bed to open up.
One individual in a local jail has been waiting for a treatment bed for nearly 1,200 days, according to Kara Chien, managing attorney of the SF Public Defender’s Mental Health Unit.
The problem extends far beyond SF: In a statement, the California Department of State Hospitals said that it is currently 99 people over its contracted bed allotment for individuals under conservatorship.
“Even though conservatorship is the last level of care, there’s no care available,” Chien said.
Conservatorships grant the courts or other guardians legal authority over a person who has been deemed unable to care for themselves. They have gained new attention as the homelessness crisis explodes, with many calling for more aggressive use of conservatorship for people struggling with drug addiction and mental illness.
A new state program called CARE Court—created by the Community Assistance, Recovery and Empowerment (CARE) Act—could end up bringing even more people into conservatorship and worsening the backlog.
Health care providers, advocates and local leaders are blaming a shortage of intensive mental health facilities at the state level, as well as a lack of services to help people avoid conservatorship altogether.
“Nobody at the state level is taking responsibility for these problems,” said SF Supervisor Rafael Mandelman, who has advocated for increased conservatorship. “We need another state mental hospital […] and that wouldn’t even begin to scratch the surface of the need.”
San Francisco primarily sends people to Napa State Hospital, one of the state’s six mental hospitals, which has approximately 1,255 beds. In SF, there are 94 city-contracted treatment beds for people under mental health conservatorship. Yet currently, the city conserves nearly 600 people in various types of mental health conservatorship, which are assigned based on a patient’s diagnosis and propensity for violence.
At a recent hearing, nurses from SF General Hospital described dangerous conditions in the city’s emergency units thanks to a revolving door of patients in severe mental health crises. The Department of Public Health acknowledged in a statement to The Standard that the city’s long-term mental health facilities are usually at capacity, leaving mentally ill patients waiting in regular hospitals while competing for a limited number of beds at the state level.
The California Department of State Hospitals pointed to investments by Gov. Gavin Newsom intended to help localities build more mental health infrastructure, including $2.2 billion in grants for new behavioral health facilities and $1.5 billion for “bridge housing” for homeless individuals with behavioral health conditions.
Alex Barnard, a sociology professor at New York University who has written extensively about conservatorships in California, said that the state needs to improve coordination among counties that are fighting for treatment spots.
In a general hospital setting, conserved patients run the risk of infection, and nurses that are trained in providing stabilizing care are unequipped to provide long-term mental health rehabilitation.
“An acute care hospital is not a place for people to live,” Barnard said. “It’s demoralizing for the staff. Your training is to deal with acute crises and instead you have somebody who’s just lingering.”
Several nurses at SF General Hospital declined to be interviewed for this story due to the sensitivity of the issue. Dignity Health, a nonprofit that operates two hospitals in San Francisco, said in a statement that they have seven conserved patients this month.
“These patients typically stay with us for long periods of time as finding a safe destination is difficult due to the shortage of long-term custodial and psychiatric care facilities,” the statement read. “When conserved patients are boarded at acute care hospitals but do not need acute care services, we lose the opportunity to help another patient in crisis.”