Even though San Francisco has added several hundred residential treatment beds for people with mental-health or substance-use disorders in recent years, the city is far from meeting the needs of those on the streets, according to officials speaking today on the state of the city’s treatment programs.
“We’re not where I hoped we would be when we started,” Supervisor Rafael Mandelman said today at a hearing on the status of San Francisco’s Residential Treatment Bed Expansion Plan. The plan, which was announced in July 2021, set a goal of 400 new overnight treatment spaces for those with mental-health or substance-abuse disorders.
That expansion has been a relative success: To date, the Department of Public Health has added 356 residential beds under the plan since 2020, bringing the total number of residential beds to some 2,551.
About 1,861 of those are used for mental-health programs, and 690 for substance-abuse treatment. The total number fluctuates, too, as some beds are “as-needed” and shared with other counties.
But there are many thousands more San Franciscans struggling with some combination of homelessness, mental health and drug addiction, according to city data.
As of August 2022, among the nearly 19,000 San Francisco adults who experienced homelessness in the previous year, 46 percent had a serious mental-health or substance-use disorder, including 3,070 people with both, according to data from Mental Health SF.
And, according to SEIU 1021, the city’s largest public-sector union, whose workers help residents qualify for substance-abuse treatment, there are currently only 46 spaces available in city-run treatment centers.
City officials named a lack of funding for the inadequate response.
“I understand that capacity has been a major issue,” said Supervisor Hilary Ronen. But, if the city increased funding for treatment beds, “maybe we could find the capacity to go along with it,” she said.
“[The bed shortage] comes from decades of disinvestment, inadequate policy choices and levels of government at the federal and state level that result in a significant number of challenges at the municipal level,” added Dr. Hillary Kunins, the health department’s director of behavioral health.
Proposition F
The bed shortages could cloud the fate of Proposition F, a March 5 ballot measure that would require some welfare recipients to undergo screening for illegal substance use and participate in a treatment program if they are found to be using — “if that program is available at no cost.”
“Proposition F will not be successful if we don’t have significantly greater ability to get treatment to folks who need it,” said Mandelman after today’s hearing.
Kunins acknowledged the lack of capacity. She also emphasized the difficulty of recruiting and retaining facility staff: In the second half of 2023, staff shortages reduced mental-health residential bed capacity by 15 to 20 percent, according to the public health department’s presentation. “Ultimately, the absolute objective is that we don’t lose people to care, [and] people are not turned away with no other alternative,” said Kunins
As for Prop. F, “nothing happens unless we actually have a treatment offer,” added Mandelman. “So, if we don’t have a treatment offer, it’ll be status quo.”
San Francisco is “a city of great programs and miserable systems,” Mandelman added. “I don’t think we are organized, as a city … to grapple with this need.”
THANK YOU for reporting on this.
Our dumb mayor wants to deny aid to anyone not agreeing to drug treatment, but there is NO PLACE FOR THEM TO GET TREATMENT even if they agree. So what will happen is drug users will simply not apply for aid, and steal more and likely die quicker. Maybe that is the Mayor’s goal?
SF Department of Health counts sobering center beds and navigation center beds, short term voluntary residential treatment programs as mental health treatment beds but there is a difference between “mental health” and psychotic disorders. The latter require stabilization in an acute or sub acute inpatient facility and this is the population that winds up in jail or on the streets.
There is a big difference between sobering center beds and RESIDENTIAL care beds with 24 hour medical care and extensive psychiatric care.
Campers,
Blame Reagan.
Pardon my language but w/no animous these places were called ‘Insane Asylums’ by the public and every city had them.
Reagan’s reformers went with ‘Community based’ models that had patients living alone or in groups or in groups with resident care and social workers.
Great idea.
Never built enough capacity.
Could be because he also lowered the taxes of the rich from levels of up to 90% down to less than an average worker pays, sometimes to nothing.
Didn’t 2018’s Prop C create a dedicated funding stream for substance treatment? Is there a plan to build capacity with that, or is it business as usual where political requirements determine what groups are going to be funded and where they’ll operate?
We need to move towards safe supply for opiates/oids because expensive, often non-existent treatment is rarely successful over the long term.
I’d rather pay addicts to use behind closed doors like they did before Reagan and then Clinton I restricted SSI than to have to deal with conservative Puritan scolds clutching their pearls at having public substance use come into their field of vision.