The Representative Payee Program serves 1,400 mentally ill and/or frail elderly clients who do not have probate conservatorships of estate. That is, the department provides financial management for these clients but is not the conservator to them. The Public Guardian is the City and County of San Francisco's designated payee for mentally ill clients who are housed in locked psychiatric facilities, as well as Community Mental Health Services clients placed in the community. However, in order to remain in the community, these clients need financial management services, which range from applying and redetermining eligibility for government benefits to working closely with mental health case managers to arrange appropriate spending money and personal items.

The Representative Payee program has grown as a result of aggressive efforts by Community Mental Health and the Veterans Administration to keep clients in the community where they can access the wealth of culturally and linguistically appropriate services available, maintain a level of independence and closeness to family and friends, and at the same time make more efficient use of the City's General Fund and federal VA funds. The Representative Payee program has also decreased the number of homeless veterans by facilitating a reliable rental payment system and ensuring payment for their needs in the community.

The staff works very closely with the Department of Public Health Division of Mental Health, the Veterans' Administration, Social Security Administration and numerous public and private pension sources to ensure that the client's financial stability is maintained.