Officials in San Mateo County are adding an unusual tactic to their multi-pronged approach to tackling the homelessness crisis: making it a crime to refuse to accept available, temporary housing.

In a unanimous vote, county supervisors have moved forward with the measure — despite significant opposition from civil rights groups and some homeless advocates — which would allow authorities to issue a misdemeanor violation to anyone living in a homeless encampment who refuses to move into available, temporary housing after a health evaluation and at least two warnings.

“One of the toughest challenges we face is addressing and assisting those in encampments who tend to decline services or refuse services,” Supervisor Dave Pine said at last week’s board meeting. “The hope is it will be a tool to help move individuals into shelter.”

Opponents worry it will criminalize homelessness.

But Pine, along with board President Warren Slocum, co-sponsor of the ordinance, said it is the latest in a host of comprehensive solutions — including a street medicine team and the conversion of hotels to temporary housing — aimed at reducing homelessness in San Mateo County.

“Forty homeless people die in San Mateo County every year. ... That’s just not acceptable,” Slocum said. This proposal “isn’t about criminalizing people, it’s about helping those who really may not be able to help themselves. ... We really do have the capacity to house people and get people the help they need.”

Officials said the county has up to 30 unused shelter beds available every night, though that falls short of the estimated 44 people living in homeless encampments across unincorporated San Mateo County. Many more encampments are in the county’s 20 cities, including Daly City and Redwood City, but this ordinance would apply only in unincorporated areas.

After San Mateo made investments to respond to the homelessness crisis in the last two years, the number of people on the streets significantly dipped, with more accessing shelter facilities, according to County Executive Officer Mike Callagy.

“We’re down now to the hard-to-reach population, the population that doesn’t want to come in,” he said.

Under the measure, someone in an encampment who refuses an offer for an available bed will have 72 hours to change their mind, receiving two written warnings. After that, authorities could issue a misdemeanor citation, which Callagy said would be handled through diversion programs, such as mental health court.

But no one would be cited if county officials don’t have a bed available, Callagy said. He emphasized that the goal is not to issue tickets or route people into the criminal justice system but to get services and housing to those in need.

“We believe that once offered those options, most people will avail themselves to the services,” Callagy said. He hopes the citations are rarely issued but are used as a deterrent.

“At the end of the day, it’s about saving lives,” said David Canepa, another county supervisor. “I don’t buy into the narrative that we should do nothing.”

County officials touting the proposal said it was based on a Houston ordinance, adopted in 2017, that made homeless encampments on public property illegal and tried to funnel people into temporary housing. While that program has been highlighted for its success at removing encampments and helping people get off the streets, the Houston Chronicle found that tickets and arrests for violating the provision — given only after a warning and an offer of housing — continue to increase.

While many West Coast municipalities face legal roadblocks to clearing encampments, San Mateo County attorneys said the ordinance adheres to legal precedent that protects the right to sleep outside when no alternative housing is available.

In Los Angeles, city officials have been making efforts to address growing encampments by encouraging people to accept temporary shelter and enforcing laws that forbid blocking sidewalks or other specific places.

In San Mateo County, the ordinance has drawn critics, including the American Civil Liberties Union, religious leaders and the San Mateo County Private Defender Program, which represents indigent defendants. Critics say they worry about the unintended consequences of such a law.

“Policing is no way to get people into treatment,” said William Freeman, senior council of ACLU of Northern California, decrying the “seriously flawed ordinance.”

While he praised the county for its recent work on homelessness, he said that “anti-camping ordinances invite over-policing and abuse.”

Lauren P. McCombs, an Episcopal deacon and a leader for Faith in Action Bay Area, called the criminalization of homelessness “inhumane treatment of our unhoused neighbors.”

“Our county needs to solve this crisis by ensuring safe and affordable housing options that are available to all residents, with strong incentives and not threats of incarceration,” she said.

County officials took into account some concerns from the public, amending the ordinance to include a health evaluation before warnings are issued and a review process scheduled to launch after a few months.

Supervisor Noelia Corzo said her half-brother is homeless in San Mateo County, so she knows first-hand how complex the issue is. She said she was proud of the county for “doing something different” while supporting the measure in a preliminary vote last week.

But in last week’s final vote, Corzo was the lone opponent to the measure, citing concerns about the negative effects a misdemeanor charge could have, according to the Mercury News.