SF health department lays out priorities around homelessness and substance abusers

Facing increased political pressure to respond to homelessness and the mental health needs on city streets, The Department of Public Health this week moved to lay out a clear set of strategies.

Elected officials have increased scrutiny of the $2.4 billion department that oversees mental health and homeless services as well as Zuckerberg General Hospital as homelessness and street conditions remain a top concern among voters.

Mayor London Breed, for example, has created a new position to oversee mental health care, and the Board of Supervisors collaborated with her to adopt a broad new vision for the department to address those most in need, known as Mental Health SF.

In response to these pressures, The Health Commission adopted “strategic priorities” this week at the direction of Dr. Grant Colfax, who noticed the lack of such a document when he took over as head of the department about 10 months ago.

“There was no one overarching approachable document that summarized our priorities,” Colfax told the commission at its Jan. 7 meeting, when it discussed the document before approving it this week.

“This is really a document that I expect over time and over the years will evolve, but it is our effort for the first time in many years to summarize our broad brush strategic priorities going forward,” Colfax said.

Among the department’s five identified priority strategies is the work around homelessness and behavioral health.

The document notes that “of the 18,000 adult experiencing homelessness in San Francisco, many with multiple medical and behavioral health needs, nearly 4,000 adults are also suffering with co-occurring mental health and substance use disorder.”

The department aims to “create a unifying vision for the delivery of behavioral health services to adults experiencing homelessness.”

Dr. Lisa Golden, who drafted and presented the document, told the commission that work is underway to prioritize efforts around 237 “highest risk patients” by streamlining housing and access to health care for them and “building that model and then applying it to the larger population.”

The 237 are “shared priority clients identified by Department of Homelessness and Supporting Housing and SFDPH,” the document said.

Golden also said that the department is “looking at innovative opportunities for doing this work.”

The document said that the department will “present solutions for people experiencing homelessness who have not yet engaged in services or who have inconsistently engaged in care.”

The department is also working to “design new harm-reduction alternatives to hospitals for people sobering from methamphetamine use” and to “create a transitional living environment for people with alcohol use disorder.”

The plan provides ways to measure the success of the department’s efforts around homelessness and behavioral health.

Among them is to “increase the percentage of clients who are assessed for housing” and to “reduce the number, length and frequency of behavioral health crisis events.”

Other metrics include improving a patient’s ability to reach their treatment goals and “increase the number of clients who maintain housing.”

James Loyce, Health Commission president, said, “There are some outcomes expected of the strategies you are going to employ and I look forward to having deeper discussions about what the outcomes for each of these strategies actually are as we perform them over the years.”

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