San Francisco supervisors questioned Wednesday whether to approve a multi-million contract with a nonprofit to provide mental health services after a city audit found its performance was “less than satisfactory.”
Citing unanswered questions, the Board of Supervisors Budget and Finance Committee voted to postpone a decision on the Department of Public Health’s proposed $23 million contract with Westside Community Mental Health Center, Inc., a nonprofit that operates a crisis clinic and outpatient treatment services.
The department has asked to amend Westside’s existing $5 million contract by $18 million for several mental health programs and extend the contract through December 31, 2022.
But a budget analyst report shows that the non-profit was not the highest scorer in the department’s recent request for proposals. For one program, general mental health outpatient services, its score landed second to last out of 14 bidders. In another, for specialized mental health outpatient services, dead last.
The department had relied on the group for four programs, but dropped one for youth in the current proposal due to concerns of performance. The report also noted that “Westside’s overall performance monitoring score in FY 2014-15 and FY 2015-16 was less than satisfactory, indicating a need for improvement.”
“Looking at a report like this, to me, it kind of rings some alarm bells,” said Supervisor Rafael Mandelman.
Among the services being proposed is an intensive case management program called Assertive Community Treatment, or ACT, which the department has funded for the past 15 years. The department’s proposal would decrease the program from 139 clients to 80 clients after the nonprofit failed in the past to serve the expected number of clients.
ACT is an intensive case management program for those “who traditionally might be served in acute settings such as psychiatric hospitals or locked facilities,” according to Westside’s website.
“I also don’t understand, why are we giving awards to service providers that are not scoring highly on RFPs, have not always met standards and are not at their budgeted level of deliverables,” said Supervisor Catherine Stefani, who made the motion to postpone the vote. “It makes no sense to me.”
“I am having trouble reconciling how we award this knowing that we have an audit that says they are not performing at a level that we expect them to,” Stefani said.
There’s no requirement the department go with the best score in the bidding process.
Michelle Ruggels, DPH’s business office director, said that “going into the solicitation, it’s clearly stated, it’s not just the top scorers. We have a huge city, and we have a lot of different target populations so we try and have providers that meet all the needs of the different target populations.”
Alexander Jackson, deputy director of DPH’s adult and older adult behavioral health services, said that the nonprofit’s program serves predominately African-American residents who are “medically fragile” and “a lot of them are high users of our medical emergency room and they show up in other parts of our system, whether it’s in jail or being homeless as well.”
When asked about the programs overall effectiveness, Jackson said, “We are comfortable that clients are showing improvement.”
Ruggels said the decision to reduce the clients contracted for in Westside’s ACT program was because the nonprofit just doesn’t have enough staffing.
“They couldn’t retain staff for what they were able to pay, which drives down the number of clients they can serve,” Ruggels said. “Thats been a consistent issue with that program so what we did was drop the number of clients from 139 to 80.”
Ruggels said that for the individual programs the city is contracting for, Westside has met the performance standards in previous years.
Stefani emphasized that increased oversight is needed at a time when mental health “is one of the main things that people are talking about in the City and County of San Francisco” and said she planned to use the delay to discuss the proposal in more detail with the Department of Public Health.
Mayor London Breed said in her Jan. 30 state of the city address that there is a “need to revamp our entire approach to mental health” and announced plans to hire a “Director of Mental Health Reform who will better coordinate mental health care for those suffering in our City, strengthen the programs we have that are working, and, yes, cut the ineffective programs — because clearly some things just aren’t working.”