Like the boulders of Clinton Park being rolled off the sidewalk, put back on, taken off again — and now perhaps replaced with bigger boulders — the political tug-of-war between a faction of the Board of Supervisors and Mayor London Breed over reforming San Francisco’s mental health system draws on, as people continue to suffer on the street. 

Supervisors Hillary Ronen and Matt Haney on Tuesday announced a revised version of a proposed March 2020 ballot measure that would overhaul San Francisco’s mental health system, a proposal they withdrew in July pending more outreach to the Department of Public Health and the unions. 

But Breed has given no indication she will support the revised proposal after officially walking away from negotiations on Sunday. 

The plan, called Mental Health SF, would no longer provide round-the-clock mental health services to every San Franciscan, as Ronen and Haney initially proposed. Rather, it would now provide these services to adult San Franciscans on public health plans, with no insurance at all, or in immediate crisis, even if privately insured. 

The plan would nonetheless cost the city $100 million annually, underwritten by a proposed tax on companies whose CEOs earn 100 times more than its ordinary employees. Here’s some of what that would pay for:  

  • A “Mental Health Service Center” would be set up and run 24/7 as a low-barrier access point for mental health services, substance abuse treatment, psychiatric medications, and referrals to longer-term care. It would also include a “drug sobering center” that would provide treatment beds, clinical support, and other services. 
  • Mental Health SF would also establish an “Office of Coordinated Care,” which would provide an inventory for available programs and services across the system. It would connect patients with appropriate case managers and health professionals, and coordinate with Jail Health Services and Psychiatric Emergency Services, as well as collect data for system improvement. 
  • A “Mental Health Street Crisis Team” would be formed. The team would be an expansion of the existing Mobile Crisis Team — composed of professionals trained to address mental health crises and substance abuse on the street. 
  • The initiative would establish an “Office of Insurance Accountability” that would hold private health insurance companies accountable to federal and state law if their clients are subject to excessive wait times. 
  • The plan would “expand services” so as to cut down on wait times and offer services to its covered clients “on demand.” 
  • Private-insured San Franciscans who are in crisis and unable to access timely services would be provided services, “as determined by a licensed clinician.”

Supervisor Hillary Ronen (left), Matt Haney (center), and Jennifer Esteen held a press conference on Mental Health SF on Oct. 1, 2019, at City Hall. Photo by Julian Mark.

Ronen and Haney said their $100 million annual cost estimate would add to the $400 million the city already spends on mental health services. Ronen said she believes that the city is currently wasting a “large portion” of existing expenditures due to “logjams” in the system.

Ronen added that spending more on the front end could curb the number of people forced onto the streets due to their mental illness. Right now, she said, the system is “hamster-wheeling” people in and out of services, which is a waste of money. 

“Every time you get someone stabilized and they decompensate again,” she said, “it’s that much harder to get them stabilized that second and third and fourth and fifth time around.”

She said she and Haney are currently working with the Controller’s Office for official cost estimates. Ronen said she expects the controller’s analysis to match her and Haney’s estimates, but “if they are more than $100 million, we are committed to tweaking the legislation” so that it costs less. 

The two supervisors say the revenue will be raised through so-called “Excessive CEO Salary Tax,” a separate ballot measure that would appear on a November 2020 and, if passed with a simple majority, tax companies whose high-paid employees earn 100 times the salaries of their rank-and-file workers. 

“We believe we addressed the concerns [the Mayor’s Office] brought up during our many meetings,” Haney said. “… we haven’t heard from them yet. We were prepared to present these amendments to them but they left the talks unexpectedly.” 

Breed, indeed, sent Ronen and Haney a letter dated Sept. 29, explaining that she believed the two sides had “fundamental policy differences in approach and who we are trying to serve.” 

Namely, the mayor believed the initiative should not serve the privately insured — at all. She also had reservations about the proposed low-barrier services center, explaining that a similar building already exists at 1380 Howard Street. “I am committed to supporting and expanding the services provided there,” she said. 

Breed also opposed the supervisors’ “insistence” on taking the initiative to the ballot, instead of being “shaped legislatively” within City Hall. “My door remains open to having discussions around the future of behavioral health services in our city,” Breed wrote, “but until the proposed Mental Health SF program addresses these fundamental differences in policy approach, we will no longer be engaging in these meetings.” 

In response to questions regarding whether the mayor is willing to resume talks in light of the amendments, Breed spokesman Jeff Cretan said that the mayor and the Department of Public Health are implementing a plan “to help 4,000 people who are homeless and living with mental illness and addiction on the streets.” 

“These are our most vulnerable residents who are in crisis that need help today,” he said, giving no indication either way on the mayor’s opinion of Mental Health SF’s current version. 

But Jennifer Esteen — a Department of Public Health psychiatric nurse and member of SEIU 1021, which supports the initiative — said at Tuesday’s press conference that the Health Department  and Mayor’s Office have been too focused on “short-term solutions,” mentioning Navigation Centers and the halted plan to replace permanent mental health beds with temporary shelter beds. 

“So if we take someone off the street for a day or two, or even two weeks, and we offer them access to treatment — that’s wonderful,” Esteen said. “But after that — then what?” 

The legislation will be voted on at the Board of Supervisors Rules Committee on Oct. 30 at 1 p.m.