San Francisco’s big plan to address the mental health crisis evident upon the streets is on the verge of approval, with one of its authors vowing “this is how we are going to fix it.”
The price tag for the expansion of the services is estimated in excess of $100 million — the proposal places a cap of $150 million on the program annually, adjusted with the consumer price index — and The City plans to generate the funding from a November tax measure next year.
While officials are united behind Mental Health SF as the solution to the crisis — all 11 members of the Board of Supervisors and Mayor London Breed are backing it — Supervisor Rafael Mandelman questioned how effective some of the promised services will end up being when the proposal was heard Friday by the board’s Budget and Finance Committee.
But Supervisor Hillary Ronen, who worked with Supervisor Matt Haney to come up with the plan, was adamant.
“This is how we are going to fix it,” Ronen said.
One of the main elements of the plan is to increase the number of case managers and coordinate their caseloads for those living on the streets and leaving Psychiatric Emergency Services or the jails by launching an Office of Coordinated Care, which is estimated to cost up to $35 million annually.
Mandelman questioned if $35 million was enough to actually deliver the promise that “everybody who needs somebody looking after them has someone looking after them.”
The plan is to provide needed care for 4,000 persons identified as homeless who are uninsured or enrolled in Medi-Cal and not receiving adequate treatment for mental health and substance use issues.
Jenny Louie, budget director for the Department of Public Health, said that the cost estimate is based on specific ratios of care. The assumption is that there are 250 “top priority” persons that would require one case manager for every 10 clients.
A “lower tier” of care for a portion of the estimated 4,000 would receive case managers in a ratio of one for every 17 clients.
The remainder would receive less intensive care.
“Recognizing the reality of not being able to engage everyone at that level and still maintain a continuum of care for them, we are assuming that we will still have a touch on everyone at a rate of 1 to 50,” Louie said.
“The biggest workforce expansion that will happen under Mental Health SF is case managers,” Ronen said.
Dr. Grant Colfax, head of the Department of Public Health, said he was “delighted” by “this potentially transformative piece of legislation.”
“We can use this opportunity to have this be the next big thing that our community and our government comes together to solve,” Colfax said.
The legislation requires creation of a working group to develop recommendations on the service expansion and to keep costs below $150 million. The department currently spends annually about $370 million on mental health and substance use disorder services to more than 30,000 residents.
When asked by Mandelman if certain costs estimates would generate the intended results, Colfax said that “we need to test some of these hypotheses and adjust accordingly.”
“I would just ask for your forbearance and patience in terms of being able to answer absolutely yes or absolutely no,” he said. “What I think we have here is a vision.”
Mandelman also questioned whether the planned new crisis intervention team, at an estimated cost of $4 million to $6 million a year, would actually meet the demand. The proposed four-person team with a behavioral health clinician is meant to operate 24/7 to respond to residents calls if they see someone in public undergoing a mental health crisis.
Mandelman said that for Mental Health SF not “to fall flat at some point we need to be honest what the scale and costs are going to look like.”
“If we can do this for $6 million, fantastic. I will be not surprised at all if delivering that response, which San Franciscans deserve, is a lot more than $6 million,” he said.
Halle Hammer, the department’s director of ambulatory Care, said that “we don’t have this service right now. We need to build it. If we are successful then it could become a much more robust service. We just don’t know.”
The Department of Public Health would not provide additional staffing estimates after the hearing.
“Mental Health SF is an exciting framework to transform the mental health and substance use system for the people in our city most in need of services,” Department of Public Health spokesperson Rachael Kagan told the San Francisco Examiner. “Implementation planning is part of the legislation and we don’t have all the details yet, such as the full staffing levels. We are still reviewing models for the crisis response team, and will be working closely with the Fire and Police departments and the Department on Homelessness and Supportive Housing to develop the team.”
The proposal also calls for launching a Mental Health Services Center with 24/7 staffing to assess patients, fill and prescribe medications and provide urgent mental health care. The facility would be located at the department’s existing Behavioral Health Access Center at 1380 Howard St. after significant renovations and relocation of existing second floor offices.
The service expansion envisioned is expected to launch in two years, but that is contingent upon generating at least $100 million a year in new revenue. The primary hope for that is through the business tax reform measure Breed is already working on with Board President Norman Yee.
Every year the planned services mandated by the legislation would require annual approval by the Board of Supervisors once launched.
Ronen and Haney had planned to take the proposal to the ballot, but then negotiated a compromise with Mayor London Breed. The full board will vote on the legislation Tuesday, when it is expected to pass.
Ronen said that she believes the proposal will meet the demand.
“We wanted to set some limits so that we have to use our dollars sensibly,” Ronen said, “We could probably implement this for $100 million extra a year, understanding that the $400 million we already use we are going to use better.”