In San Francisco, a 2022 audit was blunt: The city had no system to measure whether conservatorships work, no coordinated plan to oversee care, and no data showing that people conserved under the LPS Act saw improvement.
Nonetheless, the city doubled down on expanding conservatorship. San Francisco and San Luis Obispo County were the only California counties to implement SB 43 as soon as possible, in January 2024; others chose to wait until closer to the deadline in 2026. Newsom celebrated San Francisco’s early adoption as an example for the rest of the state.
Ahead of implementation, city departments trained around 1,700 staffers and clinicians, and materials were distributed to hospitals.
But the implementation of new rules and processes did not come with the resources necessary to provide care — just as the original LPS Act intended for municipalities to take over mental healthcare but didn’t provide the funding needed to do so.
“It does no one any good if we conserve somebody and have no care lined up,” said Dr. Daniel Tsai, director of the SF Department of Public Health. “They’re still on the street, not getting care. It’ll look nice on a chart for an upward line, but it won’t actually solve the outcome we’re looking for.”
Keris Jän Myrick, vice chair of Disability Rights California, said “it’s like fixing a bullet wound with a Band-Aid.”
“If there are no services and supports there — which they weren’t there before — they certainly aren’t going to be there now,” she added.
Aaron Meyer, chair of the governmental affairs committee for the California State Association of Psychiatrists, said San Francisco’s struggle to implement the law reflects a statewide lack of planning. The legal change did not come with consistent guidance. There is no model referral form, standard, list of best practices, or oversight at the state level. But most of all, there is not enough state funding for the complex residential treatment centers many conservatees require.