Mayor Lurie, Assemblymember Stefani, and President Mandelman Announce Legislation Supporting Recovery for People with Serious Mental Illness

SAN FRANCISCO – Mayor Daniel Lurie today announced legislation in partnership with Assemblymember Catherine Stefani and Board of Supervisors President Rafael Mandelman to allow courts to authorize involuntary medication as part of assisted outpatient treatment for people with serious mental illness.  

To address San Francisco’s behavioral health crisis, Mayor Lurie last week announced the launch of the Rapid Enforcement, Support, Evaluation, and Triage (RESET) Center—an alternative to jail or hospitalization for those under the influence of drugs and another way to get drugs and drug users off San Francisco Streets. Under his Breaking the Cycle plan, the mayor opened a 24/7 police-friendly crisis stabilization center at 822 Geary Street, which has shown more success at connecting people in crisis to care. Mayor Lurie has also launched three new recovery-focused interim housing programs and is transforming the city’s response to the crisis—creating integrated neighborhood-based street outreach teams and introducing new policies to end the distribution of smoking supplies without connection to treatment. 

“Too many people in San Francisco are falling into crisis when intervention could—and should—come sooner. At the center of this effort is a simple reality: Stability is the gateway to recovery. For many people with severe mental illness, medication is what allows treatment to work at all. Without it, housing placements fail, care plans break down, and crises repeat themselves—often with greater harm each time,” said Mayor Lurie. “Thank you to Assemblymember Stefani for authoring this legislation and President Mandelman for advancing a resolution of support. We will keep expanding treatment capacity, and we will keep adding the tools that will allow us to save lives.” 

“Recovery starts with stability,” said Assemblymember Stefani. “Ensuring people receive the medication they need reduces the risk of repeated crises and helps keep both individuals and the public safe. This bill gives courts and doctors a responsible tool to intervene before situations escalate. I’m grateful to Mayor Lurie and Supervisor Mandelman for their partnership and leadership in moving this important reform forward.” 

“Since joining the Board of Supervisors, I have worked to expand San Francisco’s legal authority and resources to conserve severely mentally ill individuals who cannot care for themselves,” said President Mandelman. “That work is ongoing, and I am hopeful that the Department of Public Health will soon be opening dozens of new locked subacute mental health treatment beds for conservatees at San Francisco General, a key recommendation of the Residential Care and Treatment Workgroup I co-chaired. However, even as we build out the city’s capacity for additional conservatorships, there are and will remain many very sick individuals on our streets, in our emergency rooms, and in our jails who would benefit from interventions short of a full conservatorship. Allowing a court to order involuntary treatment through assisted outpatient treatment is one such potentially lifesaving and less-intrusive intervention; it has been a privilege to work with Assemblymember Stefani, DPH, the Mayor’s Office, and the City Attorney to develop this proposal.” 

Under current law, courts can order someone to participate in assisted outpatient treatment, but they cannot authorize the medication that is often essential to stabilizing severe mental illness. This gap leaves treatment teams unable to act even when a person is clearly deteriorating and at serious risk of hospitalization, incarceration, or harm. 

The bill will allow counties, with court approval, to include involuntary medication as part of an assisted outpatient treatment plan when it is clinically necessary. Judges would review each case, based on medical evidence and individual circumstances, to ensure treatment is appropriate and justified. 

Individuals will continue to have full due process protections, including notice, legal representation, the right to be heard in court, and ongoing judicial oversight.  

The legislation is designed to keep people and communities safe by ensuring individuals receive the medication they need to remain stable and connected to care. It reinforces that court-ordered treatment is focused on maintaining stability and preventing crises before they escalate. 

“Too many people with serious mental illness keep cycling through crisis because we don’t have the tools to help them stabilize. That’s not fair for people who need treatment, and it’s causing real emergencies on our streets,” said Assemblymember Matt Haney. “Recovery starts with consistent treatment, and sometimes that means giving courts and doctors the ability to step in earlier, with strong safeguards in place.” 

“We’ve worked hard over the years in the legislature, in partnership with the City of San Francisco, to ensure people in crisis receive the treatment and support they need to get healthy,” said Senator Wiener. “Assemblymember Stefani’s legislation will continue our work to help save lives.” 

“We must give our public health experts the legal tools they need to treat those struggling with serious mental illnesses and save lives,” said City Attorney David Chiu. “This effort is an important step towards closing gaps in our behavioral health system.” 

“Requiring the consent of a patient clinically incapable of giving it is a cruelty that should have no place in a compassionate public health response to mental illness,” said District 6 Supervisor Matt Dorsey. “Assisted outpatient treatment cannot work effectively if courts are barred from ordering the medications doctors prescribe as necessary to stabilize their patients. I applaud Mayor Lurie, Assemblymember Stefani, and President Mandelman for a bill that will close the treatment gap, preserve due process, and enable better interventions in behavioral health challenges that too often end in needless tragedy otherwise.” 

“In San Francisco, we want to utilize every effective tool available to help individuals with serious mental illness stabilize and eventually thrive in the community,” said Daniel Tsai, Director of Health for the San Francisco Department of Public Health. “This legislation will ensure patient due process protections, improve outcomes for individuals at high risk, and help more people get the care they need.” 

The bill will be authored by Assemblymember Stefani and sponsored by Mayor Lurie. President Mandelman, who has worked with the Mayor’s Office, Assemblymember Stefani, and DPH to develop this legislation, will introduce a resolution for the Board of Supervisors in support. 

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