San Francisco state and city leaders announced a proposed legislative change Monday aimed at expanding the use of court-ordered assisted outpatient treatment as part of an effort to confront the city’s ongoing mental health crisis. The announcement was made during a morning press conference outside San Francisco City Hall, where officials described the proposal as a significant shift in how treatment for severe mental illness is handled in California.
Mayor Daniel Lurie joined members of the San Francisco Board of Supervisors and state representatives to outline the legislation, which would allow courts to authorize involuntary medication as part of assisted outpatient treatment, commonly referred to as AOT. Under current California law, courts may order individuals to participate in outpatient mental health treatment, but they cannot require medication even when clinicians believe it is necessary to prevent serious harm or deterioration.
City and state leaders said that limitation has hindered treatment teams from responding effectively in high-risk situations involving individuals with severe mental health conditions who are unable or unwilling to comply with prescribed care. The proposed bill would allow counties, with court approval, to include involuntary medication in AOT plans when medical professionals determine it is essential for stabilization and safety.
Officials emphasized that the legislation is intended to address gaps in the existing system, particularly in cases where individuals cycle repeatedly through emergency rooms, jails, and the streets without sustained treatment. Supporters argue that the change would provide clinicians with an additional tool to intervene earlier and more consistently, potentially reducing hospitalizations, incarceration, and public safety concerns.
The bill will be authored by Assemblymember Catherine Stefani and sponsored by Mayor Lurie, signaling close coordination between state and city leadership. President of the Board of Supervisors Rafael Mandelman is expected to introduce a resolution supporting the legislation, which would formally express the board’s backing as the proposal moves through the state legislative process.
Leaders acknowledged that involuntary treatment raises complex legal and ethical questions, but said safeguards would remain in place, including court oversight and medical review. They stressed that the goal is not punitive action, but continuity of care for people who are unable to recognize their need for treatment due to the severity of their illness.
San Francisco officials have increasingly called for changes to mental health policy as the city grapples with visible street-level crises, including homelessness, substance use, and untreated psychiatric conditions. The proposed expansion of assisted outpatient treatment reflects a broader push to recalibrate the balance between individual autonomy and community safety, while prioritizing access to sustained medical care.
If approved by the Legislature and signed into law, the bill would give counties the option to adopt the expanded AOT framework, rather than mandating participation statewide. Supporters say this flexibility would allow local governments to tailor implementation based on available resources and community needs, while still addressing what they describe as an urgent public health challenge.
