A hiring spree of mental health and drug treatment clinicians. A 24-hour facility where people can sober up and get connected to services and shelter. A centralized system that tracks available treatment beds in real time.
Many San Franciscans may not realize these policies are part of Mayor London Breed’s emergency plan for the Tenderloin, given her emphasis on law enforcement solutions in public statements. Perhaps even fewer people realize these public health interventions are pulled in large part from Mental Health SF, a city ordinance passed in 2019.
The mayor’s Tenderloin emergency declaration, approved by the Board of Supervisors in the wee hours of Christmas Eve following a contentious 10-hour hearing, will rapidly implement existing city policies from Mental Health SF that previously languished due to a mix of bureaucratic regulations, the pandemic and the priorities of The City’s “strong” mayor, who enjoys broad power over the levers of government.
But these public health efforts have been overshadowed by other, more controversial elements of Breed’s broader Tenderloin public safety plan, such as increasing police spending and giving outdoor drug users a choice between treatment and jail. Breed’s unusually sharp rhetoric dominated headlines — and the public’s understanding of what was being proposed — before substantive details of her plan had been hashed out.
As the plan begins to take shape with a mix of public health interventions (which are popular among progressives) and law enforcement interventions (which are not), progressive-leaning politicians and organizations are in an awkward position.
“I’ve gotten hundreds and hundreds of emails from people who are very upset with me for supporting (the mayor’s Tenderloin plan), which I understand because they don’t know all the details about how this is really going to advance Mental Health SF and the underlying health system response that we need,” said Supervisor Hillary Ronen, a co-author of Mental Health SF. “The rhetoric has all been about making life miserable for drug addicts through police presence in the Tenderloin.”
While many details remain to be sorted out, a general picture of the public health side of The City’s Tenderloin emergency plan came into view this week.
On Monday, San Francisco leased a seven-story office building at 1170 Market St., facing UN Plaza, that will serve as a 24-hour “linkage center” for people experiencing homelessness, mental health challenges or addiction. The facility will have a capacity of 100 clients at any given time and will provide a wide range of services, including mental health and substance abuse treatment, temporary shelter and vocational counseling, as well as connect clients to services at other locations. (Consuming drugs will not be allowed at the linkage center, as The City continues to work on a separate process to open a safe consumption site by September.)
The linkage center is “directly adapted from the mental health service center that you and Supervisor (Matt) Haney had been asking us to do for many years,” Grant Colfax, head of the Department of Public Health, told Ronen at the Dec. 23 hearing.
The emergency declaration will also enable San Francisco to hire 200 already budgeted health care workers in the next 90 days, bringing staffing to the levels set out in Mental Health SF. These positions include behavioral health clinicians, case managers, nurses and psychiatrists who will staff up the linkage center and help build the architecture for a more coordinated system of care, which is another provision of Mental Health SF. (The ordinance was designed to help people with substance abuse disorders as well as mental and behavioral health challenges.)
“For about half of the positions, it saves a year of the hiring process,” Ronen said. “That will radically change the type and availability of assistance and services by mental health professionals to individuals who are dying of overdoses in the Tenderloin.” Ronen added that the hiring process itself needs reform. Most city workers must take a civil service exam and enter a candidate pool — two lengthy and paperwork-heavy steps — before being eligible for a job. The emergency declaration waives those rules for the relevant positions.
“We have the blueprint, the framework and the resources already in place,” said Supervisor Haney, the other co-author of Mental Health SF. “Now, this emergency should give them the tools they need to deliver with urgency.”
Whether voters understand where that blueprint came from and why it went into effect when it did is another matter. If the Tenderloin plan is viewed as a success, Breed is “going to lead the news and now it’s all going to be about the mayor,” said political consultant Jim Ross. For Haney, who represents the Tenderloin, and is currently running in the special election for state Assembly on Feb. 15, that could mean that “even if there’s marked improvements, he won’t get any real credit for it.”
On the other hand, if the plan is perceived as too draconian or overly reliant on the police, it could become a talking point for Haney’s opponents.
“I appreciate the mayor’s initiative to step into a neighborhood where leadership has been lacking,” former Supervisor David Campos, who is running against Haney in the Assembly race, wrote in an email to The Examiner. “But the solution to these emergencies is NOT to restart the failed ‘War on Drugs.’ Police officers are not clinicians.”
Public health or police?
As the Tenderloin emergency plan gets underway, the balance between public health strategies and law enforcement represents the biggest ongoing variable.
When she first announced her Tenderloin plan on Dec. 17, Breed vowed to be “more aggressive with law enforcement,” and give people using drugs in public “a choice between going to the location we have identified for them or going to jail.” She also called for increasing police spending and hiring more officers, and rolling back The City’s anti-surveillance law.
At the Dec. 23 hearing — which Breed did not attend, to the disappointment of several supervisors — city officials appeared to walk back some of the mayor’s statements, emphasizing the public health aspects of the emergency plan.
In an email, Breed’s spokesperson Andy Lynch said the Tenderloin requires a multipronged intervention. “The challenges facing the Tenderloin community… go beyond just people experiencing homelessness or addiction. The mayor has heard repeatedly from families in the Tenderloin that the crime and open-air drug dealing has made them feel unsafe in their own homes,” he wrote, citing assaults on the elderly and criminal activity at playgrounds. “These types of incidents require a police response.”
But when and how the Tenderloin plan will use law enforcement remains unclear. The only publicly released document outlining the strategy and objectives of the emergency declaration calls for “strategic disruption and intervention” of drug dealing, violent crime and illegal vending. It also calls for reducing open-air drug use and tents on the street, without specifying how those objectives will be achieved.
Vague language around these sensitive issues isn’t exactly new: The Mental Health SF ordinance largely avoids the question of coerced treatment and instead calls for special teams to “provide daily, highly intensive, life-saving support” to individuals who repeatedly refuse help with their substance abuse or mental health issues.
As The City moves full steam ahead to tackle some of its most intractable problems, communication seems to be as big a challenge as implementation.
“Part of what’s sad about this is the idea that we have to choose between our compassion and our safety,” Haney said of the discourse surrounding the Tenderloin emergency declaration. “We don’t want that choice. We want compassion and safety.”