Housing Conservatorship - SAN FRANCISCO - City and County of San Francisco
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SAN FRANCISCO Housing Conservatorship
Overview
Housing Conservatorship is designed to help individuals:
• who cycle in and out of crisis;
• are incapable of caring for health and well being;
• have refused multiple offers of voluntary services;
• are not eligible for other existing programs (e.g., AOT, LPS).
• Criteria includes:
• Be diagnosed with a serious mental illness and substance use disorder;
• As a result the individual has functional impairments or a psychiatric history
demonstrating that without treatment it is more likely than not that the person will
decompensate to functional impairment in the near future;
• Be incapable of caring for their own health and well-being;
• Have eight or more 5150 detentions in a 12-month period;
• Have been provided with opportunities to engage in voluntary treatment. 2Implementation
• Legislation
• September 2018- SB1045 signed by Governor
• June 2019- SB1045 adopted by San Francisco Board of Supervisors
• October 2019- SB 40 signed by Governor
• Continued collaboration across partners
• Active engagement and outreach for individuals
• Notice for individuals with 5+ 5150 WIC Holds
• Forms finalized with court (June 2020)
3Implementation
• 1 person is conserved
• As of 1/31 15 individuals had 8+ 5150’s
• 8 of those are being served in ICM or AOT/3 linked to outpatient services
• 7 are currently experiencing homelessness/4 are housed in SIP hotel
• 7 people have been served (are on the pathway)
• 5 cases are close to being filed
4Evaluation Requirements from Health Code- FY 19/20
Requirement
1. Number and status of persons who have been recommended for a Housing Conservatorship, evaluated for eligibility for a
Housing Conservatorship, and/or conserved
2. The effectiveness of these conservatorships in addressing the short and long term needs of those persons, including a
description of the services they received
3. The impact of conservatorships established on existing conservatorships and on mental health programs provided by the
city
4. The number of detentions for evaluation and treatment under Section 5150 that occurred in SF during the evaluation
period, broken down by the type of authorized person who performed the detention
5. Where a detention under Section 5150 was performed by a peace officer, an explanation as to why the peace officer was
the appropriate person to perform the detention
5Evaluation Requirement #4
The number of detentions for evaluation and treatment under Section 5150 that occurred in SF
during the evaluation period, broken down by the type of authorized person who performed the
detention
Note: Data includes a significant number of duplicate individuals included in both counts.
Data Source Unique Individuals Total 5150 Count
SFDPH: Coordinated Care Management System
1,048 2,224
(CCMS)
Local hospital systems - 6,751
Total unduplicated cases - 8,975
*CCMS data represents only those treated at PES
**11 individuals with eight or more 5150s; 450 individuals with more than one 5150
*** includes data from California Pacific Medical Center, Saint Francis Memorial Hospital, St. Mary's Medical Center, and UCSF
6Evaluation Requirement #4: Limitations
• Likely a large number of duplicates
• No data from some hospitals in San Francisco
• Plans to address duplication:
• New data pull after migration to Epic database is complete
• Outreach to Hospital Council of Northern and Central California
7Evaluation Requirement #5
Where a detention under Section 5150 was performed by a peace officer, an explanation
as to why the peace officer was the appropriate person to perform the detention
Data sources:
• Data from SFPD on all officer-involved 5150s in FY2019-20
• Date, reason for emergency call, resolution
• Data from a random sample of SFPD incidence reports
• 147 unique reports pulled from FY2019-20
• More information on type of incidence including incidence narrative
8Evaluation Requirement #5
50%
34%
10%
5%
Stranger/no relation Friend, acquaintance, relative Caseworker, social worker, facility staff Police officer, security officer
61%
38%
12%
Danger to self Danger to others Gravely disabled
N Harm to Self Harm to Victim Incidents with Weapons Involvement
Detention Reason
Danger to self 89 21% 1% 20%
Danger to others 55 4% 16% 36%
Gravely disabled 17 - 6% -
9Population Data: Fiscal Year 2019/20
• Information for individuals who had 4+ 5150’s and seen at PES (113 individuals):
• Demographics
• 32% between ages 40-50
• 64% Male
• 32% African American/Black, 50% White
• Urgent/Emergent Services
• Average of 10.4 visits to PES
10Demographics
62.50%
49.6%
50.00% 47%
48%
37%
37.50% 33.4% 34%
30.8% 31.9%
26%
25.00% 23%
15% 15%
12.1% 12%
12.50% 10%
8.8%
5% 6.0% 5%
2.7%
0.00%
White Black/African American Asian Latinx
FY 18/19- 4+ 5150 FY 19/20 4+ 5150 FY 19/20 Overall PES
2018 SF US Census Estimate SFPD incident report sample
1
1Information Sharing and Engagement
Email: Housing.Conservatorship-Workgroup@sfdph.org
Website Updates:
www.sfdph.org/dph/comupg/knowlcol/housingconserv/default.aspAssisted Outpatient Treatment (AOT)
Assisted Outpatient Treatment
• Commonly known as “Laura’s Law”
• Must be adopted by a county
• Court ordered outpatient treatment for individuals with severe
mental illness
• Does not allow for forced treatment or forced medications
• Designed to assist individuals with severe and persistent mental
illness who are not engaged in treatment, are deteriorating, and
have a history of poor treatment compliance
• Goal of reducing hospitalization, incarceration, and victimization
14AOT San Francisco
• Community based, mobile, multidisciplinary, mental health team
• Multiple opportunities to engage in voluntary services
• Whatever it takes approach focused in principles of recovery and wellness
• AOT Care Team
• Program Manager (Psychologist)
• Clinicians
• Team Members (Peer Specialist, Family Liaison)
• UCSF Department of Psychiatry-Citywide AOT
• Clinical Supervisor
• Clinical Case Managers
• Psychiatrist
• Peer Specialist
• Nurse
15Referral Source
• Referral sources outlined in the legislation
• Predominantly treatment providers and family members
• Focus on family support
16Demographics- Served in FY19/20
Gender
52%
40%
1% 1%
Female Male Trans Nonbinary
Age
28%
22%
14% 14% 15%
7%
18-25 26-35 36-45 46-55 56-65 65+
Race/Ethnicity
Other 5%
Latinx 11%
Asian 12%
White 34%
Black/African American 37%
0% 5% 10% 15% 20% 25% 30% 35% 40%
17
Race/EthnicityRisk Factors
PES 82%
Psychiastric Hospitalization 82%
Incarceration 55%
Homelessness 67%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Column1
18Outcomes
• 51% successfully connected to intensive case management
• 3 individuals were treated under a court order
• Citywide Case Management FY 19/20
– 9% reduction in PES contacts
– 24% reduction in psychiatric hospitalizations
– 49% reduction in jail contacts
19Information Sharing and Engagement
Phone: 415-255-3936
Email: aot-sf@sfdph.org
Website Updates: www.sfdph.org/aot
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