Before Michelle landed in a locked ward at San Francisco General Hospital in November, she was spiraling downward. She had been homeless off and on for three years as she struggled with schizophrenia and bipolar disorder. She was using drugs and wasn’t taking the psychiatric medication she needed.

Michelle was forced into mental health treatment after a judge determined her “gravely disabled” — unable to care for her basic needs like food and shelter. After entering intensive psychiatric care at the hospital, her delusions, paranoia and outbursts subsided. Within a month, her psychiatrist said she was ready to move to a less-restrictive facility.

But then several months passed inside her cramped room at the hospital while she waited for a bed to open somewhere else.

“I’ve been trying to do my best,” Michelle, whose name is being withheld to protect her privacy, said inside the hospital in April as tears streamed down her face. “Five months I’ve been here, and I’m getting crazier. I have no freedom. All I’m doing is looking at these walls.”

Michelle’s plight offers a window into the debate raging in City Hall over whether San Francisco should expand its laws around compelling people into treatment. While Michelle’s story shows how court-ordered treatment can be a lifeline for the severely mentally ill, it also illustrates one reason opponents are wary of the expansion: the current behavioral health system is already clogged with so many patients that it may not have the capacity to adequately help more.

The question will head to the Board of Supervisors for a vote Tuesday. While the 11-member board is still unclear on what it will do, both sides agree on one point: San Francisco’s behavioral health system isn’t working. Scores of mentally distressed people wander the streets every day, visibly in need of help, despite the city spending nearly $400 million on hundreds of treatment programs.

“The area where there is no disagreement between the opposition and me is that we need more voluntary services,” said Supervisor Rafael Mandelman, who is spearheading the legislation through the board. “The area where there is some disagreement is that we also need more involuntary services. ... We have to do both.”

Supervisors Mandelman, Vallie Brown, Catherine Stefani and Aaron Peskin said they support the law, while Supervisors Hillary Ronen, Shamann Walton and Gordon Mar initially said they were against it. But last week, some supervisors said they were considering amendments that could persuade them to support the law. The amendments were not immediately available.

Under existing state laws, San Francisco can conserve people who are considered “gravely disabled” by a mental illness, which means they are unable to care for their basic needs. Authorities can also involuntarily hospitalize people deemed to be a danger to themselves or others. There are currently about 600 people under court-ordered treatment in the city, which includes both inpatient and outpatient treatment, according to the Human Services Agency.

By the numbers $400 million: Amount that San Francisco spends on hundreds of treatment programs for mental illness and substance abuse 2,000: The number of treatment beds currently 100: The number of treatment beds that Mayor London Breed plans to add to next year’s budget 600: Number of people under court-ordered services in the city, which includes both inpatient and outpatient treatment Source: S.F. Department of Public Health How existing state law and expanded plan compare A Lanterman Petris Short Conservatorship, passed in 1967: Permits a judge to order inpatient or outpatient psychiatric treatment for those who are “gravely disabled,” meaning they are unable to care for their basic needs, such as food, shelter and clothing due to a mental disorder or chronic alcoholism. The order lasts for up to a year and can be renewed. SB1045, if approved by the Board of Supervisors: Permits a judge to order inpatient or outpatient treatment for those who are incapable of caring for their health and well-being and who are severely mentally ill, addicted to drugs, have been involuntarily taken into an emergency crisis unit — called a 5150 — at least eight times in a year, and have denied voluntary outpatient treatment.

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The supervisors must decide whether to implement Senate Bill 1045, a state law written by Sen. Scott Wiener, D-San Francisco, that allows San Francisco, Los Angeles and San Diego counties to impose inpatient treatment on those who are severely mentally ill, addicted to drugs and have been taken into an emergency crisis unit — known as a 5150 hold — at least eight times in a year. The law, which passed last year, allows the changes during a five-year pilot program.

The probate court would have to offer patients voluntary assisted outpatient treatment, or determine it’s not appropriate, before forcing someone into conservatorship.

The outpatient treatment requirement narrows the number of people who would qualify under SB1045 to about five people in the city. But a proposed state law, SB40, which recently passed the Assembly, would remove the requirement that the court determine whether patients need to be first offered assisted outpatient treatment and leave that decision in the hands of clinicians. That would expand the number of eligible people up to approximately 55, according to the Department of Public Health.

Despite the low numbers, the potential changes set off months of impassioned arguments in City Hall over how San Francisco should deal with its most vulnerable who refuse mental health treatment and are often found strewn across the sidewalk, addled and gaunt, with needles in their arms or violently yelling into the air.

“There is a very clear argument that San Francisco needs more continuity of services. It shouldn’t be the hospital or the streets,” said John Snook, executive director of the Treatment Advocacy Center, which lobbies for more services for the seriously mentally ill. “It’s such a broken system, and the question is, where do you want to start?”

One place to start is with expanding the number of treatment options, mental health experts say. A requirement of SB1045 is that cities must have enough resources, such as psychiatric facilities and outpatient treatment, to care for people brought into the system through a conservatorship.

The city currently has about 2,000 treatment beds across more than 300 different programs. Mayor London Breed — a co-sponsor of the law — added about 100 since coming into office and plans to add another 100 beds to the system in next year’s budget.

Still, a snapshot of wait times for those held at San Francisco General Hospital shows that patients sometimes get stuck in locked wards longer than they should as they wait for a bed to open up in a less restricted facility.

Wait times vary. According to a snapshot of data provided to The Chronicle by the health department, 17 out of 20 conserved patients on May 24 were waiting for a bed to open up somewhere else. Four were waiting for placement in facilities outside of the department’s purview.

One group was waiting for an average of two weeks, while another group was waiting for an average of two months for a different facility. One other patient had been waiting for about six months. On May 21, the department said, one patient was finally moved out of the locked ward at San Francisco General Hospital after waiting 389 days for another bed to open up elsewhere.

The person waiting for six months was Michelle, who is particularly difficult to treat because she is developmentally delayed. After the Department of Public Health said it did not have any facilities that would be appropriate for her last year, they gave her case to Golden Gate Regional Center, which manages facilities for people with developmental disabilities.

But several people familiar with the system — including social workers, mental health advocates and Michelle’s attorney — said Michelle’s long wait time is not unusual among conserved people in San Francisco.

Michelle’s “circumstances are unfortunately all too common,” Deputy Public Defender Daniel Meyer, who represents clients on conservatorship — including Michelle — said in a statement. “Michelle’s case reflects the overburdened state of our mental health system and its inability to timely and adequately address the needs of those who need it most.”

In April, shortly after a reporter interviewed Michelle, Golden Gate Regional Center said it found her an unlocked placement at an apartment in Redwood City with 24-hour, one-on-one care. She was expected to move in Monday.

Supervisor Ronen, who originally opposed the law, argues wait times for people like Michelle show how the city is failing to efficiently move people from one level of care to another. While she isn’t against the idea of conserving people, she said SB1045 is a “Band-Aid on a broken system that ultimately is not going to make a difference on the streets.”

“I would rather spend our time, energy and resources in building a system, so when we conserve people today, we have the treatment slots in place to make conservatorship successful,” she said.

Supervisors Ronen and Matt Haney recently proposed a ballot measure that would guarantee the right to quick, effective mental health care in the city, including coverage for mental illness and addiction.

Breed said the SB1045 legislation is a critical tool for the city to help a subset of the homeless population that is languishing without care.

“We are adding more treatment beds for people with mental health issues and substance use disorder, but we also need policies in place to help those who cannot help themselves,” Breed said in a statement. “It is not humane to leave people to suffer on our streets when we know we have a solution that can help.”

Meanwhile, some mental health providers argue that there’s value to conserving people, even if the current system isn’t perfect. Rachel Rodriguez, a former social worker in the psychiatric unit at Saint Francis Memorial Hospital, said she had to “face the fact” that conserved patients would sometimes be in the wrong setting for months.

Even if a patient is left waiting in a locked ward until a bed opens somewhere else, she argued, they are better off there than back on the streets or in a shelter where they could further deteriorate — making it that much harder to treat them if they ever manage to get a bed.

“Those folks who have had eight 5150s are sometimes the ones eating out of trash cans, running in traffic and probably engaging in small theft,” she said. “But these are people who are never going to walk into the door” for treatment.

Snook, of the Treatment Advocacy Center, said the debate over SB1045 is “embarrassing” as the law is a “bare minimum attempt to serve a population that is obviously being failed.” San Francisco, he said, “is struggling to even take this small step.”

Supervisor Mandelman said that if his colleagues knock down the legislation Tuesday, he has another plan: putting the issue before voters in November.

“There are not enough services,” Mandelman said. But, he said, “It’s not cheap to keep jailing and 5150-ing the same person over and over ... while they’re not getting any better.”

Trisha Thadani is a San Francisco Chronicle staff writer. Email: tthadani@sfchronicle.com Twitter: @TrishaThadani