On Monday, the San Francisco Board of Supervisors’ Rules Committee will at long last take up whether San Francisco should implement Senate Bill 1045, a state law on conservatorships. A conservatorship is a legal action where a judge appoints a protector to manage the financial affairs and/or daily life of a person who does not currently have the capacity to take care of themselves. The new law allows conservatorships for a tiny number of people suffering from a combination of mental health and substance-use disorders who would not otherwise quality for a traditional conservatorship.

The state legislation, authored by state Sen. Scott Wiener, D-San Francisco, and signed into law last year, requires each county to vote on whether to adopt it.

To hear its loudest opponents tell it, SB1045 is an abomination: at worst, a deprivation of civil liberties on par with the death penalty; at best, the abandonment of California’s decades-long commitment to de-institutionalize care for mentally ill individuals.

In truth, the law is a modest step.

Conservatorships are not new — for more than 50 years the Lanterman-Petris-Short Act has set the legal standard under which counties may conserve residents “gravely disabled” by a severe mental illness.

Yet, in the eyes of many, Lanterman-Petris-Short has fallen short. Generations of family members and clinicians have chafed against a standard that, as interpreted by some judges, has seemed to exclude too many very sick people from potential conservatorship.

Furthermore, Lanterman-Petris-Short makes no provision for individuals suffering from serious substance-use disorder, an increasing challenge for our public health system. For example, methamphetamine use is on the rise in San Francisco, especially among unhoused people suffering from untreated mental illness. Between 2016 and 2017, 54% of homeless patients at San Francisco General Hospital’s Psychiatric Emergency Services were suffering from a meth-use disorder. Many of these individuals are using emergency services multiple times each year.

The trouble is that no matter how many times meth-induced psychosis may land the same individual in the hospital or jail, that individual can continue to refuse help. Lanterman-Petris-Short does not allow the city to do anything about it. Too many sick people simply continue on this relentless, expensive and tragic merry-go-round until it ends in death or permanent mental disability severe enough to finally merit a traditional conservatorship.

SB1045 opponents argue that we need to expand access to voluntary mental health services, that it would be cheaper and more humane to address behavioral health and substance use issues before they become a crisis. I could not agree more. Implementation of SB1045 should free up more resources for preventive and voluntary services, as fewer resources will be spent managing the merry-go-round.

But expansion of voluntary services alone will do nothing to bring the hardest-to-reach, sickest people into care. The response from the critics? A rhetorical shrug of the shoulders.

Critics also argue that SB1045 is not worth implementing because it will only impact a few people. The irony here is that Sen. Wiener limited the reach of SB1045 specifically to respond to their criticisms. As a result, any SB1045 conservatorship must meet a number of objective and subjective tests:

• The individuals considered for conservatorship must suffer from both a serious mental illness and a substance use disorder;

• The individuals must have been placed on an involuntary psychiatric hold at least eight times in the prior year;

• The county must have tried other less restrictive alternatives; and

• A judge must determine that establishing a conservatorship is the “least restrictive” and “most clinically appropriate” means to provide for the proposed conservatee’s care.

These requirements, appropriately, set a high bar. The law may apply to fewer than 10 people a year. Nonetheless, San Francisco should seize every tool it is offered to save lives and minds.

Some might reasonably wonder why SB1045 has stirred such passionate opposition. I believe that the answer lies in a deeper disagreement about the appropriateness of involuntarily treating sick people whose illness prevents them from seeking or accepting appropriate care and treatment. To be sure, depriving adults of their liberty, even for limited periods of time and under judicial supervision, should never be done lightly. But sometimes it must be done.

SB1045 strikes an appropriate balance, and its modest scope will allow us to test whether more assertive public health responses to severe substance-use disorder can be effective. We should all hope the answer is yes.

Rafael Mandelman represents District Eight on the San Francisco Board of Supervisors.