Supervisors spar over solutions to SF General’s mental health bed fiasco

Members of the San Francisco Board of Supervisors on Tuesday condemned the Department of Public Health’s decision to repurpose 41 permanent mental health beds at San Francisco General Hospital into temporary beds for the city’s mentally ill homeless population. 

“Make no mistake, this decision will lead to more people with mental illness being diverted back onto our streets,” said Supervisor Hillary Ronen in a pointed speech. “There is no way around that.” 

Ronen and Supervisor Matt Haney jointly called for a hearing on how that decision came to pass. Moreover, they raised questions about how it was that the Adult Residential Facility, which offers permanent housing and care to people suffering from severe mental illness, kept beds empty in the midst of San Francisco’s deepening mental health crisis. 

Meanwhile, Supervisor Rafael Mandelman toed the line and asked the City Attorney to draft legislation that would require the Department of Public Health to fill all 55 long-term residential treatment beds at the mental health facility “as soon as possible.” 

While that appeared to support filling them with long-term patients, the potential legislation gives the Health Department a 2021 deadline, when its permission to use the beds for temporary patients expires.

“I would certainly prefer to have all those beds used for permanent beds than for short-term homeless beds,” Mandelman said. “However, I would rather have them used as short-term homeless beds than sit there empty as they have for years.” 

Yet, given the crisis on the streets, it’s unclear why Health Department could not fill the beds with long-term patients immediately — and indeed, health care workers told Mission Local that both the patients and the staff were in ample supply. 

Ronen was not happy with Mandelman’s plans for an ordinance to give the Health Department two years to get the permanent beds online, which she believed gave the Health Department too much leeway to use the facility as a temporary shelter. 

“Supervisor Mandelman just announced that he is working on legislation that will result in dozens of mentally ill people being kept in locked wards for two years,” Ronen said in a statement immediately following Mandelman’s announcement. “His misguided idea for legislation has been developed without the consultation of the emergency psych nurses that care of severely mentally ill people every day.” 

In mentioning the locked wards, Ronen was referring to the impacted third floor and its 47 beds at the higher-security Mental Health Rehabilitation Center. That floor holds some patients who are ready now to move to the underutilized Adult Residential Facility. 

In a phone interview, Mandelman said Ronen’s criticism “is a mischaracterization of my statement and is otherwise untrue.” He added he’s had some “conversations with the union” and has “talked to advocates.” 

The crisis began to unfold two weeks ago when 19 patients at the 55-bed “Adult Residential Facility” received letters informing them they had two months to relocate to another part of the hospital. The reasoning? The facility was being underutilized, with only 32 of the 55 beds full. 

As such, administrators argued, it would be better used as a temporary psychiatric shelter for homeless individuals suffering from mental illness. Under that arrangement, only a portion of the long-term patients would be allowed to stay while the other patients would be moved. The remaining 41 beds would be filled with temporary patients.   

Department of Public Health officials blamed staffing shortages for the 41 beds that are currently unfilled, but staffers told Mission Local they could still be filled with the staff at hand. 

Moreover, as Mission Local’s Joe Eskenazi revealed on Monday, facility higher-ups willfully lied to staff, telling them that 45 beds — 23 on the ground floor 55-bed Adult Residential Facility and 22 on the second floor Residential Care for the Elderly facility — had been kept empty because a state licensing agency had restricted them from accepting more patients. That was false. 

“How was this decision made to close these critical beds for seriously mentally ill people? Why were families of residents at the facility, workers at the facility and the residents themselves not told about this in advance? And why was the truth held from the workers who are responsible for providing care for these vulnerable residents?” Ronen asked on Tuesday, referencing Mission Local’s reporting on the issue.

Ronen said both Department of Public Health Officials and Department of Human Resources officials will be called to the carpet to answer these questions, as well as others: why the beds were kept empty, why no new patients have been added for a year, and how changes to the facility’s function was communicated to staff. 

Haney said it was imperative the board “get to the bottom” of the situation. “To me, this is irresponsible and illogical.” 

Separate and apart from the debate over the 41 empty beds, Mandelman introduced a resolution that would, for 18 months, require conditional use authorization for any proposed change of use from a residential care facility — a move that would seek to curb the decline of the city’s board and care facilities. 

Since 2012, the city has lost 21 residential care facilities, a 26 percent decline resulting in a loss of 112 beds, according to a 2019 report by the city’s Long-Term Care Coordinating Council Assisted Living Working Group. The Department of Public Health has learned of the planned closure of three additional facilities, Mandelman said in a statement. 

Jennifer Esteen, a DPH psychiatric nurse who played a major role in exposing the mental health bed fiasco, told Mission Local that, in 2013, the city contracted with 999 board and care beds, and that number is now 601. 

“There is a mental health crisis in San Francisco, and we need to do everything we can to make sure sick and mentally ill people have a place to get care,” Mandelman said. 

The Department of Public Health did not have a chance to weigh in at Tuesday’s meeting. But, rest assured, they’ll have their chance during Ronen and Haney’s hearing this month.