Supervisors press on with mental health care ballot measure despite mayor’s opposition

City leaders seeking to overhaul San Francisco’s behavioral health system are forging ahead with a ballot initiative that would provide...

City leaders seeking to overhaul San Francisco’s behavioral health system are forging ahead with a ballot initiative that would provide universal treatment to San Franciscans in crisis, despite having lost the mayor’s support for the measure last week.

After initially agreeing two months ago to work with supervisors Hillary Ronen and Matt Haney, who authored Mental Health SF, on rounding out the measure, Mayor London Breed last week pulled out of the negotiations. She said that her office and the supervisors had reached an impasse on issues such as whether The City should provide free mental health care to all in need, including privately insured patients.

On Tuesday, Ronen and Haney announced a list of revisions that have been made to the measure, 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, which they said they had planned to present to Breed.

“That was unfortunate — we felt like we were getting somewhere,” said Ronen about Breed ending talks on the measure. “But we don’t feel that has to be the end of the story. Our door is wide open.”

According to Ronen, Mental Health SF was always meant to target those who are most in need, but the supervisors’ honored feedback from Breed and health department officials to whittle down the number of patients who would be eligible for free or low cost mental health care and focus on the “sickest on our streets.”

Instead of serving all San Franciscans — insured or not — the measure is now written to serve a smaller number of people, including those who may have private insurance but are unable to get immediate care through their providers.

The supervisors plan to create an Office of Private Insurance Accountability. The office will collect data on the private insurance market, recoup city funds spent on crisis prevention and ensure that companies are meeting their obligations to patients in accordance with state and federal law.

The supervisors have also revised their proposal to create and staff up a Street Crisis Prevention Team that will respond to reports of San Franciscans in mental distress. The effort aims to limit responses from police or fire officials to calls about mental health crises.

During an editorial board interview with the San Francisco Examiner on Thursday, Breed said that while she disagreed with the supervisors about the scope of eligibility for Mental Health SF as well as the construction of a brand new mental health drop-in facility, the major point of contention was their determination to seek reform through the ballot process.

“I’m not supportive of working towards a goal of putting something on the ballot that doesn’t have to go on the ballot,” Breed told the Examiner on Thursday, adding that the negotiations had become more “political” than “productive.”

“The same policies that are being proposed can go through the process at the Board of Supervisors. And that was one thing where there was a major disagreement, and the supervisors are determined to go to the ballot no matter what,” said Breed.

On Tuesday, mayor’s office spokesperson Jeff Cretan said that Breed and health department officials are “implementing a plan now to help the 4,000 people who are homeless and living with mental illness and addiction on our streets,” called Heal Our City.

The plan proposes increasing the number of mental health beds and outreach services, “coordinating departments to get more people into housing and strengthening accountability and transparency to make our system easier to navigate,” said Cretan.

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 measure’s proponents have said that they are working with the City Controller to assess the actual costs and are willing to make further changes should it cost more than $100 million.

They hope to generate the funds 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” to fund the initiative, said Ronen.

Legislation to place Mental Health SF on the March 2020 ballot is expected to be introduced in the coming weeks, prior to a public hearing on the measure scheduled for Oct. 30.

Frontline employees on Tuesday said that drastic and structural changes are needed to fix The City’s broken system of care, given that there are vacant beds in the Behavioral Health Center at Zuckerberg San Francisco General Hospital while people are waiting for care.

Jennifer Esteen, a ZSFGH psychiatric nurse, has been at the forefront of a DPH worker-led movement to “Save the Adult Residential Facility” after revelations in August that the health department planned to suspend dozens of long term, residential treatment beds in exchange for short term shelter beds at the hospital.

“There’s been some attention by DPH administrators and mayors office to focus on short term solutions [like] navigation centers and Hummingbird Place, which is a shelter with respite care. But all of that is temporary,” said Esteen. “If we take someone off the street for a day or two or even two weeks and we offer them treatment, wonderful. But what about after that?

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