Jail time often does more harm than good for people facing homelessness, substance abuse and mental illness. Yet that’s where individuals living at the nexus of those crises often end up time and time again.
A new building under construction at 509 Minna St. in the South of Market neighborhood attempts to slow that cycle.
Across San Francisco’s current jail population, 41% of inmates report experiencing homelessness, 55% have challenges with substance use, and about 10 to 12% had a serious mental health diagnosis, according to Dr. David Pating, an addiction specialist at the Department of Public Health.
By default, San Francisco jails have become one of the largest providers of mental health care for some of the most vulnerable populations. Law enforcement, court officials and medical experts all decry the status quo, pointing out that it often leads to worsening health conditions while being an ineffective use of tax dollars.
“All of that keeps people in the cycle of illness and incarceration. And being treated in incarceration is not ideal,” Pating said.
The new 75-bed, five-story building, called the Minna Project, is one solution for those with experiences in the criminal justice system and a history of substance use, homelessness or mental illness. It includes three floors with private rooms for residents and two floors with conference rooms, areas for job interviews and training and recreational space. An industrial-grade kitchen downstairs will serve breakfast, lunch and dinner every day. Residents will have access to on-site therapy and clinical case management and will be encouraged to participate in group meals, neighborhood beautification and bedroom upkeep.
They will also be expected to leave drugs and alcohol behind.
“We have known for quite a while from judges and people providing mental health services that (jail settings) have been a place of high need. Jail isn’t the best place to get those services,” said Pating, who is also overseeing the ongoing effort to add 400 new beds across The City’s mental health infrastructure. The Minna Project puts the latest count at 164, or about 40%, of the planned 400 new beds.
The average daily jail population in San Francisco has decreased significantly over the last decade, going from about 2,144 in February 2008 to 758 in February 2022, according to data from the San Francisco Sheriff’s Department. But affordable housing and higher-level mental health care for people who are exiting the jail system have failed to meet a growing need.
The result is well documented: long wait times in jails for those who qualify for treatment and a vicious cycle in and out of jails and hospitals for those who need supportive housing the most but aren’t getting it, and often wait in jail instead.
Minna residents will be referred from The City’s jails, courts and other behavioral health facilities. Around 35% of individuals detained in San Francisco city and county jails receive care from Jail Behavioral Health Services, the agency that provides medical, psychiatric and substance abuse care within the San Francisco County Jail system, according to a 2016 report. About 15% are treated for a serious mental illness.
Earlier this year, Michael Begert, a San Francisco judge overseeing The City’s drug court, said that zero individuals had been successfully placed into appropriate dual-diagnosis treatment, meaning care that addresses both mental illnesses and substance use disorder. Often, people who have been arrested and qualify for dual-diagnosis treatment are referred to lower levels of care than what they might need, Begert said.
In the meantime, The City’s probation department is increasingly being called upon to fill health care and housing needs.
The Reentry Division of the San Francisco Adult Probation Department, led by several formerly incarcerated individuals with experience with substance abuse and homelessness, is designing the program at 509 Minna. Westside Community Services will oversee day-to-day operations.
“We are infused in the community,” said Steve Adami, Director of the Reentry Division at SFAPD, who struggled with drug addiction and spent time in prison before getting released and earning a master’s degree in public administration from San Francisco State University. “It’s often the same people who are cycled in and out of custody.”
With the addition of three new buildings since last summer, the Reentry Division at SFAPD now oversees 17 transitional housing sites across The City reaching about 420 people daily. Several of the programs are drug and alcohol-free and target formerly incarcerated individuals through a structured environment before securing permanent housing.
The Minna Project is just the latest example. The first 12 or so residents will move in May, and after construction wraps up by fall, the facility aims to have on-site counseling and support groups, medication assistance, case management and recreational activities.
Brian Pearlman, managing attorney at the San Francisco Public Defender’s Office, said he was pleased to see 75 new beds added for a population he often sees waiting months for treatment and housing placements. But he also shared reservations about the transitionary housing approach, rather than immediately setting clients up with permanent housing stability.
“I don’t think 75 beds is enough just for the people we are seeing in the system. And if you don’t put them into (permanent) housing, all the work you have done could mess up,” said Pearlman. “Poverty and substance abuse, that’s what we should be funding solutions for.”
According to SFAPD officials, someone on staff will assist residents with permanent housing placements after completing the 12- to 24-month Minna Project program.
A debated model
The Minna Project will be drug and alcohol-free, although medication-based addiction treatments such as methadone are embraced. The state of California requires licensed drug treatment programs to permit medication-assisted outpatient treatment.
“Some clients have prior substance-related charges, and they have to be able to know when they go in (to the Minna Project) that they will be safe. The counseling services around them will do whatever it takes to have people move forward,” said Pating. “Everyone will be tempted in some way, but they won’t be kicked out for relapse alone.”
A common criticism of abstinence-based programs is that they could set individuals up for failure if they are kicked out during a relapse. Reentry Division officials stated that no one will be evicted for relapsing, which is not uncommon on the road to recovery for people with chronic substance use disorder.
“If people make a mistake, no one will be terminated from the program. We will leverage drug treatment and detox beds, and the goal is to help people stabilize,” said Adami. “If they relapse, the goal is to reacclimate them if they make a mistake.”
Across San Francisco’s public health facilities, harm reduction is used as a research-backed approach to reduce the physical, emotional and social harms that can be associated with drug and alcohol use, and destigmatize challenges around drug use.
Examples of harm reduction may include easy access to clean syringes to reduce the spread of disease as well as distribution of naloxone, a fast-acting opioid overdose reversal medicine.
Many health experts and individuals in recovery view harm reduction and abstinence as part of the same continuum and balk at a false dichotomy sometimes suggested by critics that pits harm reduction and abstinence against one another.
Recently, city supervisors such as Catherine Stefani and Ahsha Safaí have been calling on the public health department to provide more options for individuals who want to live in substance-free environments. The Minna Project is one answer.
Minna Project is one of 17 behavioral health and housing programs that the Probation Department oversees, several of which came online at the same time as Mayor London Breed’s Tenderloin Emergency Initiative. The emergency order ran for 90 days over the winter and aimed to address long-standing challenges in the Tenderloin neighborhood around homelessness, overdoses and crime.
The 30-bed Billie Holiday Center at 93 Sixth St. is another example, along with the Positive Directions TRP Academy, a peer-led, abstinence-based reentry community and transitional housing program based in the Tenderloin for men who previously spent time in prison and struggled with substance use. The five-phase program starts with teaching basic life skills and needs, like signing up for health care and getting familiar with the program’s philosophy, which promotes community service and looking out for one another’s recovery. Positive Directions TRP Academy is not a licensed drug treatment program.
“The people on our streets need help and housing, and the Billie Holiday Center provides both for people who have been involved with our justice system to give them the support they need to prevent recidivism,” said Supervisor Matt Haney, whose district includes the Tenderloin.
Back at the Minna, Adami has big dreams for what just a few months ago was a deteriorating corner on a much troubled Sixth street.
“Saturday mornings we will clean up the alley and pick up trash. Old fashioned. We will also work with urban forestry to do some tree planting. We also will start creating safe passage,” Adami said. “People who are interested in living drug-free and getting clean won’t get bombarded with doom and gloom when they enter that area.”