A fix for The City’s “broken” mental health system for the homeless could require hundreds of more housing or shelter beds where people can go after short stays at San Francisco General Hospital for a psychiatric crisis instead of back onto the streets.
That was one of the takeaways from Thursday’s Board of Supervisors Public Safety and Neighborhood Services Committee hearing called by Supervisor Catherine Stefani to figure out the gaps in services and coordination when it comes to treating the homeless with substance abuse and mental health issues in San Francisco.
Various shortcomings were identified during the hearing, but Stefani highlighted the need for shelter beds for those who have a crisis on the street, are held at the hospital until the crisis passes and then are released.
Stefani asked Mark Leary, director of SFGH’s Psychiatric Emergency Services, if homeless persons leaving the hospital after a 5150 hold would voluntarily accept an offer of shelter if it was available.
“There is a range of people that are seen in PES,” Leary said. “I think that most people, once their psychiatric crisis has resolved in PES and they no longer meet the criteria to be held against their will and they are homeless, most of them would want to be able to accept a shelter. I mean that in the most generic of terms, a place where they could stay, a bed.”
When pressed by Stefani, Leary declined to state the number of beds needed. However, Stefani noted that in their private conservations when she visited the hospital he had estimated the need was around 200 to 400 beds.
Leary said a detailed analysis would be needed to confirm those numbers, but acknowledged, “There is a great need there. It’s a large number.”
He noted that sheltering them voluntarily after holds could ensure they would “sustain ongoing treatment” since its more likely their case managers could find them.
“I want that space for those individuals,” Stefani said. “I feel like that’s what we are lacking right now.”
Other gaps in the services noted at the hearing included the long wait times for programs.
Health officials at the hearing were unable to tell supervisors the average wait time to obtain a residential mental health bed, although they estimated it could be months.
Supervisor Hillary Ronen expressed frustration with the lack of a clear answer, and said that board members asking about the mental health system have not received consistent answers during her time in office.
“I don’t feel we have a system that makes sense,” Ronen said
“What we are all trying to understand and we’ve all been trying to understand for a really long time is, where does the system break down?” she continued. “Because we have a broken system.”
After the hours-long hearing, Stefani, who recently took a seat on The City’s Mental Health Board, vowed she would continue investigating the shortcomings of voluntary services.
“If we don’t look at those investments, we are just going to keep doing this over and over again,” Stefani said. ‘“We are going to keep at this. This is not the end of the discussion for me. I am going to keep at it . I am going to keep asking questions. I am going to keep demanding answers.”
The hearing comes as the board is also poised to debate whether to implement Senate Bill 1045, which increases the power of The City to involuntary hold the chronically homeless suffering from substance use and mental illness and force them into treatment.
The San Francisco Examiner previously reported that the bill was initially expected to impact around 50 people but is now expected to only impact as few as two to five people due to the narrow way it is written. State Sen. Scott Wiener is now working in Sacramento on legislation to expand the reach of Senate Bill 1045, which he authored.
Opponents of conservatorships argue involuntary treatment make no sense when voluntary treatment services are inadequate and The City doesn’t yet have a long term vision for reforming the mental health system.
Mayor London Breed plans to appoint someone soon to serve in a new position to reform The City’s mental health services.
Sam Lew, the policy director for the Coalition on Homelessness, said “The City needs more intensive case management that meets people once a day, wherever they are living, and builds relationships based on trust in order to get people into housing and services.”
“There are so many gaps in the system and it is inadequately serving the homeless population,” Lew said. “Thousands of people are waiting for voluntary treatment and housing that don’t exist and homeless people really haven’t had the chance to receive services voluntarily.”
Lew also said that the city needs to complete a study on where the gaps are in the system.
When asked by Supervisor Shamann Walton to specify the gaps, Jeff Kositsky, director of Homelessness and Supportive Housing, said, “There’s gaps throughout the system.”
“There has been a fairly robust development of permanent supportive housing over the past 15 years in this city, but there has not been the same level of growth and in fact I believe there has actually been a shrinking of community-based residential type programs,” Kositsky said.
Roland Pickens, director of the Department of Public Health’s San Francisco Health Network, said that “the gaps really are in low-barrier access programs like the psych respite at Hummingbird” and in “the whole spectrum of what we call the lower level of care.”
Jennifer Friedenbach, executive director of the Coalition on Homelessness, said SB 1045 is a political response but fails to incorporate the views of those who are in need of the services. Nor does it address the need for capacity.
“We have so many people out there on the streets that are suffering from untreated mental illness,” Friedenbach said. “I think what we do, when see that, and often as a city and policymakers, is often times we look at the person and not ask ‘What happened to them?’ maybe think what’s wrong with them, but most often blame them for being out there. Very rarely do we say our system is failing, and the reason that they are out there is that our system failed them.”