San Francisco Leaders OK Plan to Prioritize Mental Health Care for Homeless

SAN FRANCISCO (CN) – Taking the first step in tackling one of San Francisco’s most intractable problems, city leaders on Tuesday advanced a bold plan to reform the city’s mental health care system and give homeless residents 24-7 access to care, but more funding is still needed for the program.

Someone sleeps on the sidewalk in the Tenderloin neighborhood of San Francisco. (Photo by NICHOLAS IOVINO/Courthouse News Service)

“With the passage of Mental Health SF, we have the blueprint, overarching vision and structure on how we are finally going to implement our mental health system,” San Francisco District 9 Supervisor Hillary Ronen said at a board meeting Tuesday.

It’s a problem that has reached crisis levels in San Francisco, with scenes of people suffering from mental health problems or drug addiction shooting up on sidewalks, darting into traffic, shouting at strangers and in some cases resorting to violence, as occurred in August when a man attacked a woman outside a residential building, saying he was trying to save her from “robots.”

The plan, which was unanimously approved by the Board of Supervisors on Tuesday, resulted from a compromise between two progressive board members and San Francisco Mayor London Breed. Both sides were marching toward a costly and bitter fight next year over competing ballot measures for their respective plans.

Ronen and District 6 Supervisor Matt Haney were pushing for a “Mental Health SF” plan that would provide services to all San Francisco residents, paid for by a proposed tax on businesses with CEOs that make 100 times more than their median wage-earning employees.

Breed rejected that proposal as too costly and impractical. She introduced a competing plan, dubbed “UrgentCareSF,” which would provide comprehensive services to homeless residents suffering from mental health problems and drug or alcohol addiction.

The Department of Health estimates that 4,000 homeless people suffer from mental health or substance use disorders. A January 2019 survey identified about 8,000 homeless people living in San Francisco, but the city’s Department of Homelessness and Supportive Housing reported serving about 18,000 people who lacked shelter last fiscal year.

The mayor and supervisors announced a compromise deal on Nov. 12 that would prioritize care for homeless residents while also creating a new city agency to help all residents. It calls for the creation of a 24-7 mental health center for homeless residents and an Office of Private Insurance Accountability that will advocate for insured residents who are denied mental health coverage by private insurers.

“Mental Health SF will make San Francisco the first city in the country to provide universal access to coordinated mental health care and substance use treatment,” Haney said in a statement last month. “If you are homeless, uninsured, and diagnosed with a serious mental illness or substance use disorder, Mental Health SF will ensure that you get the medical treatment you need, and if you are insured but not getting the care you are entitled to, the city will help advocate on your behalf.”

The legislation, which does not require voter approval, mandates the creation of an 11-member working group to make recommendations on how best to design and implement the reforms. The group will tackle questions such as how many outreach workers and clinicians should be hired and how personalized treatment plans for thousands of patients should be developed and executed.

The plan also establishes an Office of Coordinated Care, which will oversee the delivery of care across multiple agencies and city-funded behavioral health systems. The office will aim to “minimize unnecessary bureaucracy,” according to the legislation.

Despite those ambitious goals, city leaders have yet to identify exactly how to pay for the plan which they estimate will cost at least $100 million per year. The city already spends $400 million per year on mental health care. Last month, the mayor announced plans to ask voters to approve a bond in November 2020 to help fund mental health care, but the city has not specified how much money it will seek to borrow.

According to Ronen, the mayor has vowed to hire a new director of the Mental Health SF program by next summer and to work with supervisors to help identify new funding sources for the project.

However, Ronen said she would not take a new tax on high-paid CEOs off the table if the city is unable to find the necessary funding.

“I will not rest until we have the funding we need to fully realize Mental Health SF, and we will continue to explore every single option for funding including the need for an excessive CEO salary tax if we need that,” Ronen said.

Mayor Breed also appeared before the board at the start of Tuesday’s meeting, warning that the city faces the possibility of a “significant budget deficit” next year. She urged board members not to push for additional projects and reforms without adequate funding to support them. The city currently has a budget of $12.3 billion per year.

“We have to be responsible to the public when we talk about finances,” Breed said. “We still don’t know where all the money for Mental Health SF is coming from so to add layers and layers of responsibility is just not the responsible thing to do.”

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