Licensing body confirms SFGH housing facilities for the mentally ill — with 45 beds left empty and no new patients for months— are not on ‘probation’ and ‘can add or accept residents.’
Last month, a hue and cry was raised in response to a plan from the mayor and Department of Public Health to repurpose scores of beds on the San Francisco General Hospital campus reserved to permanently house the severely mentally ill into temporary beds for the homeless.
Temporary respites are good. But permanent housing is better. And the Department of Public Health’s rationale for transforming permanent housing into temporary shelter unearthed an even more disturbing fact. In the midst of a homeless crisis that often relegates San Francisco’s vulnerable mentally ill to the streets, dozens of the beds created to permanently house them at the city’s Behavioral Health Center weren’t being used.
This is bewildering, and all the more so when one considers the state of San Francisco’s streets, the staggering monetary cost of providing housing for the homeless — and both the monetary and human costs of not providing housing for the homeless.
And there’s a goodly amount of room here to house mentally ill people prone to homelessness. If the city chooses to use it.
The Behavioral Health Center is tucked away in a remote corner of the SFGH campus. It’s peaceful here, with sunlit patios and lush vegetation. On the structure’s third floor is a locked facility called the Mental Health Rehabilitation Center with 47 beds. One floor down is the Residential Care for the Elderly facility, with 59 beds. And, on the ground floor, is the Adult Residential Facility, with 55 beds — for now.
Twenty-three beds were vacant on that first floor. Twenty-two were empty on the second floor. All were filled on the top floor. No new patients have been admitted to the first floor Adult Residential Facility since September 2018. The last patient admitted to the second floor Residential Care for the Elderly arrived in April.
You don’t have to be a trained mental health professional to notice 45 empty beds, or the dearth of new patients — a situation that simply shouldn’t happen in a city with San Francisco’s visible needs and woes. But, of course, the trained mental health professionals working here did notice, and they asked about it.
Mission Local has spoken to some dozen current or former workers here. They confirm they were told by management figures up to and including Behavioral Health Center director Linda Sims that the Adult Residential Facility and Residential Care for the Elderly were “on probation” following a series of violations observed by state inspectors. That probation, workers say they were told, precluded the hospital from admitting new patients.
This is a bewildering response, too. And why it was offered is not clear — because it’s simply not true.
Yes, both facilities have been cited quite a bit in the last four years. Management personnel of both facilities were called into come-to-Jesus “noncompliance meetings” in late 2018 with the Community Care Licensing Division of the California Department of Social Services. And, following those meetings, both facilities are now operating under “corrective action plans.”
You can read those plans here and here. There are lots of bullet points about training procedures and policies and “coaching and progressive discipline.” As a result of the 2018 death of Residential Care for the Elderly patient Ruby Lee Andersen, that facility is now barred from accepting new dementia patients or keeping any existing dementia patients on-site (But, at a “board and care” facility like this, dementia patients should never have been accepted in the first place).
Yet there is simply no state-mandated prohibition on either facility taking in new residents writ large — as staff here says they were, repeatedly, told by management.
“Other than the aforementioned restrictions on dementia patients, the facilities can add or accept residents,” confirmed Rodger Butler, a spokesman for the California Department of Social Services.
What’s more, when asked if it was accurate to state that the city facilities were “on probation,” as numerous workers say management repeatedly told them, Butler replied “It would not be accurate. It would be accurate to say they are subject to increased compliance monitoring.”
For many workers who matter-of-factly told me that their workplace was “on probation,” this came as a shock. And a betrayal.
“But I heard this, universally, from several supervisors — that they were unable to take patients,” said W.D. Flient, a 33-year nurse who works on the third floor. “Wow! This is amazing.”
Adds 14-year patient care assistant Suzette Meyer, “we were told the reason for the empty beds and us not having new residents is because of the numerous citations we received and we’re on two-year probation, from licensing.”
When informed this wasn’t accurate, she replied “I’m in shock.”
Sharifa Rahman, a mental health rehabilitation worker who’s worked in the building for nearly two decades, said “we were told by all of our managers. They all told us we are on probation with Community Licensing Care.”
When informed that this is not so — with written confirmation from Community Licensing Care — she was deeply saddened.
“They are using this as a reason to not admit people. This is not just a job for me. I enjoy helping the clients. We could help more people.”
The Department of Public Health did not approve our request to interview Linda Sims.
But it did confirm that workers at the Behavioral Health Center were told it was “on probation” — while, simultaneously, confirming that the Behavioral Health Center is not on probation and never has been.
In May, the DPH wrote to the state licensing board to ask permission to repurpose 41 beds at the underutilized Adult Rehabilitation Facility into a homeless respite. Its reasoning mirrored what journalists and politicians were subsequently told: “The San Francisco Adult Residential Facility continues to be challenged to get consistent, adequate staffing in place to ensure safe operations for all 55 licensed beds.”
This was a claim that struck current and former workers as dubious.
“When we had 48 clients at the Adult Residential Facility, we had the same staffing as we have now with 32,” said Rahman, who has worked here since the program’s inception.
Workers told me that with the city’s healthy wages and generous benefits, “anybody in their right mind” would want to work for the Department of Public Health. They question just how short-handed the Behavioral Health Center is — and how hard management is working to make hires.
Aimée Armata left her position as a behavioral health clinician on the third floor Mental Health Rehabilitation Center in June. She said that a fellow clinician departed in December 2018 — and that position remains open.
This should not be: “There is already a vetted list for clinicians you have to get on to even be a candidate to work for the city,” Armata explains. “All you have to do is put in the requisition and mine from that list.”
There is, she continues, “no shortage. There are a ton of clinicians who are able to work. This was a choice to not quickly rehire.” And, she says, it was a choice to not take new patients in the midst of a homeless crisis.
Every week, she recalls, Armata would attempt to transfer clients from the locked third floor to the board and care facilities within the same building. And, every week, “the refrain was ‘there are no board and care beds. We are closed to admission.’”
This creates a cascading series of problems — monetary and ethical problems. Patients who are psychiatrically stable and should no longer be kept against their will in locked facilities are, in fact, kept against their will, incarcerated in locked facilities because there’s ostensibly no place for them to go. This is a waste of their lives and, also, a waste of resources; someone else certainly needs that bed.
Connie Truong, who works in activity rehabilitation on the third floor, said one patient was approved to move downstairs at least six or seven months ago — but remains locked on the third floor as management claimed the downstairs facilities “are on suspension.”
Armata says she personally discharged patients who had been languishing on the third floor, without medical necessity, for years — even a decade. The privately operated board-and-care beds where they ought to go are, increasingly, non-existent in San Francisco, and the city is now doing its utmost to suspend the beds that are actually under its direct control.
Additionally, because there’s no way out of the third-floor facility, it’s increasingly hard to get anybody in. Considering this is where people who have been conserved are often sent, and considering the city is attempting to expand its ability to conserve the mentally ill, this is a problem.
But there are so many problems.
In the midst of a deluge, it appears management at the Behavioral Health Center has chosen to pull up the ladder to its Ark. While the citations it received are real and the “corrective action plans” created in their wake are real, the move to curtail admissions and leave beds empty supersedes anything in those plans.
The state is not making the Behavioral Health Center do this. The Behavioral Health Center is choosing to do this. And this is a choice that deserves scrutiny.
Supervisors Hillary Ronen and Matt Haney have announced that they will on Tuesday call for a public hearing regarding the plan to transition 41 beds at the Adult Residential Facility into a temporary homeless respite. Ronen has, additionally, sent a series of questions to both DPH director Dr. Grant Colfax and Human Resources director Micki Callahan regarding hiring timelines and decision-making.
That’s a good start. But more, much more, is needed. The choice to hold 45 prime permanent housing beds empty during a time of desperate need — exacerbating a bottleneck that led to psychologically able patients being locked against their will in unsuitable facilities and mentally ill homeless people being left on the streets to fend for themselves — is tantamount to dereliction of duty. It is antithetical to any notion of “public health” or “board and care.”
A full audit of the Behavioral Health Center is not just necessary but overdue. Ronen confirmed that “yes, absolutely” it is within her purview to order one from either the Controller or Budget and Legislative Analyst.
Godspeed. And God help San Francisco. At times, it seems, nobody else will.