Dueling behavioral health plans headed for March 2020 ballot as city leaders spar over reform plans

Update 5:10 p.m.: Mayor London Breed filed paperwork Tuesday that would place her proposal to reform San Francisco’s behavioral health...

Update 5:10 p.m.: Mayor London Breed filed paperwork Tuesday that would place her proposal to reform San Francisco’s behavioral health system, called Urgent Care SF, on the ballot in March 2020.

Earlier on Tuesday, Breed introduced the legislative framework for her proposal, but declined to state at that time whether she would seek its implementation through the ballot process. Last month, Breed withdrew her support for a ballot intiative by two city supervisors also seeking to reform the system, called Mental Health SF, saying that she believed that change should be made in City Hall, not at the ballot box.

“To preserve flexibility [and] to protect the program, if legislation does not move forward in City Hall, the Mayor also submitted an initiative ordinance that would go before the voters in the March 2020 election. This initiative ordinance can be withdrawn any time within the next six weeks, and the Mayor introduced it to have as a last resort,” the mayor’s office said in a statement on Tuesday.

Supervisors Hillary Ronen and Matt Haney, who are spearheading Mental Health SF, also pulled papers Tuesday to place their measure on the March 2020 ballot. If neither party withdraws their measures, voters could be asked to choose between two behavioral health plans next year.


Original story: A disagreement over how to reform San Francisco’s behavioral health care system may result in dueling initiatives by two city supervisors and Mayor London Breed.

Over the past six months, supervisors Hillary Ronen and Matt Haney have worked to finetune Mental Health SF, a ballot initiative that would aim to provide universal mental health treatment to San Franciscans in crisis. The supervisors hope to qualify the measure for the March 2020 ballot by a Tuesday filing deadline.

However, Breed is also expected to announce her own initiative Tuesday to address gaps in the system, called Urgent Care SF, according to sources close to the issue who say the initiative builds on Heal Our City, a reform plan announced by Breed in September.

That plan aims to help some 4,000 homeless San Franciscans who have mental illness and substance use disorders, starting with 230 people identified to be most at-risk, by expanding and streamlining housing and healthcare services.

Rather than going to the ballot, Breed’s Urgent Care SF would make incremental changes — like increasing the number of caseworkers to lower the caseworker-to-client ratio, which currently is at 1 to 17, down to 1 to 10 — legislatively.

Jeff Cretan, Breed’s spokesperson, told the San Francisco Examiner on Monday that Breed “wants to have this conversation around mental health in City Hall.”

“She believes that everything being proposed by the board can be done legislatively and at City Hall and that is her preference,” said Cretan.

He added that Breed “does not support any programs that will divert focus and resources from helping those most in crisis on the streets and that is her concern with Mental Health SF.”

Cretan declined to share details of Breed’s proposal with the San Francisco Examiner Monday night, but said that Breed and the department of Public Health “have been talking about… an initiative focusing on the 4,000 people who exist at the intersection of homelessness, mental health issues and addiction.”

Breed’s plan includes initiatives that she has already announced in recent months, like aquiring board and care facilities that are at-risk of shuttering and creating additional sobering centers for indiviuals struggling with substance abuse. The San Francisco Chronicle reported that the effort is estimated to cost some $200 million.

The dueling proposals reveal the ongoing conflict that has prevented city officials from uniting around a reform plan.

“This is the same set of incremental policies that the mayor announced three weeks ago, now she’s just changed the name to Urgent Care SF,” said Haney, who added that as of Monday he had not been approached by Breed about her proposal but called it “cynical.”

“They are still refusing to restructure our system to effectively coordinate care so that people don’t fall through the cracks, back out onto the street.”

Breed withdrew her support for Mental Health SF earlier this month, when she walked away from negotiations with Ronen and Haney. Breed has said she would prefer to go through The City’s legislative process, rather than placing systemic reforms before voters, and among other things criticized the supervisors’ measure for initially aiming to provide free mental health care to all in need, including privately insured patients.

Mental Health SF is expected to cost The City, which already spends some $400 million annually on behavioral health services, an additional $100 million per year.

The funds for Mental Health SF would be generated by through a separate ballot initiative called the Excessive CEO Salary Tax, planned for the November 2020 ballot, that will charge companies that compensate their highest paid workers “100 times more than their average workers a little more,” Ronen said earlier this month.

In an attempt to secure Breed’s buy-in for their measure, Ronen and Haney earlier this month made a number of revisions to Mental Health SF, including narrowing the eligibility pool and creating a 24-hour-a-day, 7-day-a-week, clinically trained street crisis team focused on providing services to those experiencing a mental health crisis.

As of Monday, Ronen’s office reported additional revisions, including limiting the eligibility to homeless individuals with mental illness or substance use disorders, people at imminent risk of becoming homeless, uninsured individuals, as well as people with severe mental illness insured through Medical and Healthy SF.

“My district is directly across from The City’s overflowing emregency psych ward. On any given day you can see people in hospital gowns wandering the streetsof the Mission in complete metnal breakdown,” said Ronen. “My constituents and I just can’t accept small measures any longer. Mental Health SF is the big systems change we need to get mentally ill people off the streets and into care.”

But the amendments appear to have failed to sway Breed.

“There’s nothing about Mental Health SF that can’t be done in City Hall,” said Cretan.


This is a developing story, please check back for updates.

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