Dozens of people gathered at Zuckerberg San Francisco General Hospital on Thursday to protest what they described as a “short-sighted” directive by Mayor London Breed to close 41 permanent treatment beds for mental health patients in exchange for a shelter-bed expansion at the hospital.
Standing outside of the hospital’s Behavioral Health Center at 887 Potrero Ave. — where 18 patients in the Adult Residential Facility this week received 60-day relocation notices — the protesters called on the Department of Public Health to walk back a proposal that would further erode The City’s options for treating some of its most vulnerable residents.
Hospital staff, ARF patients and some city leaders said that they were “blindsided” by the plan and vowed to fight cuts to the ARF, which provides a total of 55 permanent residential mental health beds. In exchange, 14 beds will be added to the hospital’s Hummingbird Place, a short-term psychiatric respite program at the hospital that currently operates 29 beds and where client stays average about 19 days.
Public Health officials have said that none of the people facing relocation from the ARF will go homeless.
“We have a crisis of people suffering from mental health and addiction issues on our street, and the innovative model at Hummingbird Place has been successful in providing people with the care they need,” said Andy Lynch, a spokesperson for Breed, in a statement to the San Francisco Examiner.
“By expanding Hummingbird into space that was being underutilized, we’re able to help meet the needs of people who might otherwise continue to deteriorate on the street, while ensuring that all current patients continue to receive the same care they have been receiving,” he added.
But homeless and mental health advocates present at Thursday’s rally said that the beds serve different populations. Hummingbird Place focuses on individuals with mental health or substance use disorders who are often also experiencing homelessness, while the residential treatment beds serve mental health patients who will never live independently.
“They are churning people through the system in order to juke their stats,” said Jennifer Friedenbach, director of the Coalitionon Homelessness. “So they can say at the end of the day they served so many people. But what they do is they put them in [to Hummingbird Place] and they push them out.”
Supervisor Hillary Ronen said that the plan to reduce capacity at the ARF was “developed in secret” and that she only learned about it through the advocacy of the hospital workers. Ronen and Supervisor Matt Haney are the proponents of Mental Health SF, an initiative planned for the March 2020 ballot that would provide free mental health care and substance use disorder treatment.
“We made an agreement with the Mayor’s Office that we would move Mental Health SF from the November to the March ballot in order to have additional time to talk to them in depth about our system and how to reform it. At no time did they mention this was in the works,” said Ronen.
On Thursday, Ronen, who indicated that she would likely call a hearing on the issue, called Breed’s plan a “game of smoke and mirrors to pretend they are doing something without the real deep structural changes that take vision, time, commitment.”
State-licensed residential treatment beds are among the hardest to secure and operate, whereas Navigation Center beds such as those offered at Hummingbird Place can be opened “anywhere in this city without any OK from the state,” said Ronen.
Haney said in a statement on Thursday that while short-term beds are needed, they should not be added “at the expense of shutting down 75 percent of the capacity at ARF.”
“We need a bold and comprehensive mental health solutions that don’t compromise the needs of one group in favor of another,” Haney said.
The ARF overhaul comes amid efforts by Breed to expand local conservatorship laws, giving The City more power to force individuals who need it into treatment.
“Shutting down the very beds they need to get that treatment is stunning. Where are people going to go?” said Ronen.
ARF patients who will be forced to move out of the unit said on Thursday that they feared for their wellbeing.
“Our director gave us 60-day notices out of the blue — it’s kind of unreal. It’s like, ‘Oh, I have two months to think about moving,” said Donna Mateer, who has lived in the ARF for 15 years.
“I don’t think it’s fair. Mental illness is a real thing. Having to live with it is a job in itself,” said Mateer. “I’m so very thankful today to be alive.”
Describing the plan as a redistribution of beds and resources, public health officials hope that expanding Hummingbird Place will provide some relief to the hospital’s overburdened Psychiatric Emergency Services. In the 2017-18 fiscal year, 33 percent of Hummingbird Place referrals came from PES, said Kelly Hiromoto, DPH’s director of transitions.
“We know there are a lot of people presenting at the Psychiatric Emergency Room that can benefit from being at Hummingbird Place — every day we get someone to stay with us there means we can work with them and engage them in care that is more supportive,” said Hiromoto.
Hiromoto cited staffing issues in response to criticism that the department has kept some 40 beds in the Behavioral Health Center empty — including 23 in ARF — for at least a year.
“It’s been hard for staff to get a full census. We had some regulatory issues that are care concerns, and those things coupled together have made it challenging to fill [the ARF] to capacity,” said Hiromoto.
Hiromoto acknowledged that The City is seeing an increasing demand for permanent assisted living placements — such as those offered at ARF and at board and cares — but added that programs like Hummingbird Place are crucial in terms of connecting individuals in crisis with The City’s system of care.
Lynch said Breed added $500,000 annually to the budget to support board and care facilities, stabilizing some 350 patients at those facilities, and is utilizing $1.1 million in new funding to support some 25 people “in long-term care in the community.”
He said The City is currently working to “develop a more financially feasible operating model.”
Jennifer Esteen, a psychiatric nurse at the hospital advocating against cuts to the ARF, said on Thursday that Breed’s directive comes as a host of independent board and care facilities contracting with the City are set to shutter — a trend that is reflected across California.
According to Esteen, The City contracted for 999 assisted living beds such as the ones offered at the ARF in 2013. Today, that number has decreased by nearly 40 percent to 601 beds.
An additional 40 assisted living beds will be lost this year as another four independent board and care facilities are set to close their doors.
“Right now 46 beds are empty in the [Behavioral Health Center] — 23 for seniors, 23 for adults. When you talk about patients languishing in the in-patient unit there is no reason for it,” said Esteen.
Those beds could be used to house patients who have been “stuck” in locked settings or are currently living in the community without proper supervision, said San Francisco psychiatrist Jennifer Cummings.
“I have clients who have been in the in-patient psych unit for months. I heard of patients being in there for over a year because there was no safe discharge plan for them,” said Cummings, who called on The City to provide funding for all of its board and care facilities and not to “destroy a long-term solution in favor of rotating door housing and political expediency.”