Supervisors Hillary Ronen and Matt Haney are demanding a public hearing on a mayoral directive to close 41 residential treatment beds serving mental health patients unable to care for themselves at Zuckerberg San Francisco General Hospital.
The San Francisco Examiner first reported that at least 18 patients received 60-day relocation notices earlier this month informing them that they will soon have to vacate the hospital’s Adult Residential Facility — where some have been living for more than a decade — and move to another part of the facility. The Department of Public Health has justified the bed reductions as a “redistribution” to enable the addition of 27 new Navigation Center beds at the hospital’s Hummingbird Place — a psychiatric respite facility where clients stay for 19 days on average.
“I’m shocked by this decision to eliminate long-term mental health beds at a time when we are in such a crisis,” said Haney. “We need immediate answers on why this decision to eliminate beds was made, how we are going to address urgent staffing shortages, and ensure that we are adding beds, not taking them away.”
Ronen and Haney share concerns voiced by ARF residents and ZSFGH nurses who criticized the plan as a “short-sighted” solution to reducing street homelessness at the expense of long-term services for The City’s most vulnerable residents. They are expected to call for a hearing on the issue when the Board of Supervisors reconvenes from summer break on Tuesday.
Since ARF residents are expected to be relocated in October, Ronen said that she expects to schedule the “hearing within two to three weeks” from Tuesday. She said that she hopes the hearing will shed light on gaps in service and reveal the number of long-term residential treatment beds currently needed in The City’s system of care.
“These are the beds that are most in need in our system — the beds for the sickest who are not able to care for themselves for the long term,” Ronen said. “The people you and I see on the street and our hearts break because they are obviously so ill and so dirty and half dressed and abandoned. These are the beds that those people need.’
Ronen and Haney are spearheading Mental Health SF, legislation planned for the March 2020 ballot that would provide free mental health care and substance use disorder treatment in San Francisco. However, she said that she was unaware of the planned ARF bed cuts despite being actively involved in conversations with DPH officials about gaps in the The City’s mental health system in the context of her initiative.
“They never once mentioned it to us. We had to find out from the hospital workers — that was not a good sign,” said Ronen.
DPH officials have cited staffing woes as a reason for the bed reductions. The Examiner reported earlier this year on more than a dozen psychiatrist vacancies and capacity issues in regard to treatment beds.
“I want to know everything from the decision making process that occurred to close those beds. I want to know the efforts made to hire staff on an urgent priority basis — if any,” said Ronen.
The ARF beds and some 59 long-term residential treatment beds reserved for seniors in ZSFGH’s Behavioral Health Center are licensed by the state and are the only assisted living beds currently operated by the City, a DPH spokesperson confirmed previously.
Assisted living beds are offered by private board and care providers in the community that have contracts with The City, but those too are dwindling at alarming rates.
Jennifer Esteen, a ZSFGH psychiatric nurse who works to place mental health patients in the appropriate care settings and is advocating against the ARF cuts, estimates that the board and care beds decreased from 999 in 2013 to 601 beds in 2019.
The hospital is currently licensed to operate a total of 55 ARF beds, but some 23 have remained unfilled for over a year, despite ZSFGH nurses reporting that they have limited options when it comes to discharging patients from other units.
They have alleged that by not filling the ARF to capacity, The City is leaving some patients who are eligible for the unit languishing in locked care settings or other units longer than prescribed, or living unsupervised in the community.
A DPH spokesperson said that the beds were persistently empty and that the redistribution would help serve a wider variety of needs, adding that the ARF license is held in suspension and could be used again at a later time.
The spokesperson confirmed Thursday that an ARF bed costs The City $290 per day to operate. In contrast, a Navigation Center bed, which is meant to be temporary and serve as an opportunity to connect patients to appropriate services, costs $150 per day.
Ronen said that she is also searching for answers on the hospital’s hiring plan and long-term plans for addressing The City’s homelessness and mental health crises.
“I see DPH nibbling around the edges and not addressing the actual solutions to the mental health crisis on our streets,” said Ronen. “It seems to me that they take this short term, easy way out of things — which is why San Franciscans don’t see improvement.”
In recent years, Ronen spearheaded efforts to open Navigation Centers — or temporary, low-barrier homeless shelters — in her district.
She said that she believes in the success of the Navigation Center model, and that more such beds are needed, including at Hummingbird Place — but not at the expense of long-term treatment.
“Of course we need more Navigation Center beds. I fought for them tooth and nail since I started as a supervisor. To take away state licensed beds that we can put people in that cannot take care of themselves for the long term — it just makes absolutely no sense,” said Ronen, describing the decision as either an act of “expediency” by DPH or a “lack of a long-term vision.”
A DPH spokesperson confirmed previously that The City is searching for sites to open two additional Hummingbird Place centers outside of the hospital, including one in the Tenderloin.
This story has been updated to reflect additional comment from the Department of Public Health.