Mayor, supervisors reach consensus on plan to fix SF’s mental health system

Both parties agree to drop ballot measures and pursue reform with legislation.

City leaders have reached an agreement on a plan to reform San Francisco’s broken mental health system after months of negotiations over dueling ballot measures that were headed for the March 2020 ballot.

Supervisors Hillary Ronen and Matt Haney earlier this year introduced Mental Health SF, which initially proposed providing universal mental health care to all San Franciscans in need. Mayor London Breed countered that initiative with Urgent Care SF, which focused care on 4,000 homeless people who have both mental health and substance use disorders.

Rather than sparring over votes, both parties have agreed to withdraw their measures and instead introduce legislation on Tuesday that blends their efforts, the San Francisco Examiner has learned.

Doing so will allow for changes to be made more quickly, said Ronen, adding that Breed has agreed to co-sponsor the supervisors’ measure in exchange for legislative reforms being made within City Hall.

“We’ve agreed to move the legislation to the board and to narrow who will be eligible for Mental Health SF in exchange for faster implementation,” Ronen told the Examiner. “Abandoning people with mental illness on our streets is dangerous and wrong and the people of San Francisco want City Hall to find a solution.”

Days after Breed walked out on negotiations that reportedly reached an impasse in September, the supervisors agreed to a number of revisions to mental Health SF, including serving a smaller number of people who are homeless, uninsured, enrolled in Medi-Cal or Healthy San Francisco. The supervisors also agreed to create an Office of Insurance Accountability to help advocate for services for those with insurance.

Mental Health SF was initially drafted to provide mental health care to all San Franciscans in need, including people with mental illness who have insurance but face barriers like deductibles and lengthy wait lists in accessing care through their providers.

After the supervisors agreed that services would first go to people experiencing homelesness as well as serious mental health and substance use disorders, Breed pledged her support for the measure.

Both parties also agreed to transform an existing Behavioral Health Access Center at 1380 Howard St. into a 24/7 mental health center that will provide access to services for those seeking care. Breed disagreed with a directive in the supervisors’ measure that initially called for a new building to be constructed to house the center.

The ordinance that the city leaders are expected to introduce Tuesday will not become operative unless “either The City’s budget has exceeded the prior year’s budget by 13 percent, or the voters have approved a tax that will sufficiently finance the program, or the Board of Supervisors has approved the appropriation of general funds to finance the program,” according to its language.

It also retains a commitment from both sides to expand and add to The City’s mental health and substance use treatment beds, expand long-term housing options, and create a drug sobering center.

“Every day, people who are mentally ill or severely addicted are abandoned on the streets, cycling in and out of emergency rooms, leaving our residnets and neighborhoods to deal with the consequences,” said Haney. “I will not stop fighting until Mental Health SF is fully implemented, funded and effectively gets peole off the streets and into treatment.”

A Mental Health SF Implementation Working Group will be established to advise various departments and stakeholders, including the Mental Health Board, the Department of Public Health, the Health Commission, the San Francisco Health Authority, and the Board of Supervisors on the ordinance’s design and implementation.

The supervisors initially proposed taxing successful companies whose highest earners make 100 times the median income of their employees to fund Mental Health SF. But now, Breed appears to be pushing for a bond to pay for the new and increased services.

In a letter penned Friday and obtained by the Examiner, Breed asked City Administrator Noami Kelly to revisit The City’s capital plan “to reprioritize and advance a Behavioral Health and Homelessness Bond” for the November 2020 ballot. Some $100 million is needed annually to fully fund Mental Health SF.

“The lack of capacity in our system to serve this population has exacerbated the crisis on our streets and it is incumbent upon us to advance real and meaningful solutions without delay,” Breed wrote in the letter. “We need to move forward. We have no time to waste.”

A Public Health Bond is curently scheduled for the November 2023 ballot. On Nov. 5, San Francisco voters approved a $600 million bond funding measure intended to construct and acquire more affordable housing.

When the legislation passes, Breed has committed to fast tracking its implementation and to hire a new director of Mental Health by the summer.

This is a breaking story, check back for updates.

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