People hold signs as a group of supervisors announce “Mental Health SF,” a ballot initiative for the November 2019 election to reform mental health care at City Hall on Tuesday, May 28, 2019. (Kevin N. Hume/S.F. Examiner)

Voters could be asked to approve massive expansion of mental health, substance abuse services

Proposed ballot measure seeks to address lack of options for those seeking treatment

San Francisco voters could be asked to vote this November on whether to expand and improve the coordination of mental health and substance services to ensure people receive the care they need without delay.

The effort to launch Mental Health SF through a ballot measure was announced Tuesday at a rally by Supervisors Hillary Ronen and Matt Haney. It has picked up the support of at least three other colleagues, including board president Norman Yee and Supervisors Gordon Mar and Shamann Walton.

One of the main cornerstones of the measure is the creation of a Mental Health Service Center, possibly at San Francisco General Hospital, that would be open around the clock.

“Mental Health SF will create a 24 hour, 7-day a week center that will offer immediate care to any San Franciscan that needs it,” Ronen said at the rally. “It doesn’t matter how severe your mental illness or substance use illness is. It doesn’t matter what your insurance status is. If you need help, we will provide it.”

Ronen said the center would provide access to a psychologist or a psychiatric nurse, medication and case management services along with a “mobile outreach team to bring people in that are suffering on our streets.”

The measure would create an Office of Coordinated Care “to oversee the seamless delivery” of the program’s services and that it is “accountable and proactive in how it delivers care.”

The program would also expand services.

“We have a big problem in our city that our everybody knows about. We have thousands of people who are suffering — many of them on our streets but not all on our streets — from mental illness, from substance abuse and they are not getting the care that they need and deserve,” Haney said. “Right now we have a system that is disconnected and disjointed.”

The measure does not include specifics of how services will be expanded. Those details will be spelled out by an 11-member Mental Health Working Group that would start meeting by April 1, 2020 and submit final recommendations to the board.

“Mental Health SF shall provide mental health services, substance use treatment and psychiatric medications to every San Franciscan who does not have appropriate and timely access to care,” a draft of the measure says.

The measure also does not include any new funding mechanism to pay for the expansion of services. Backers say they plan to place on the March 2020 ballot a surcharge, or “Excessive CEO Salary Tax,” on the gross receipts of companies whose CEOs earn at least 100 times more than their median workers. This tax measure could potentially generate up to $80 million annually.

Mayor London Breed’s spokesperson Jeff Cretan said the mayor hasn’t yet reviewed the proposal and declined to comment on it.

A Bay Area business group questioned the funding proposal.

“If you want stable, reliable funding for mental health services it seems odd to pursue a source of revenue that is inherently volatile,” said Rufus Jeffris, a spokesman for the Bay Area Council, in an email. “And before asking voters to approve yet another tax that discourages jobs and investment, it might make more sense to examine the complex reasons for why so many experts seem to think our mental health system is completely broken. Is money the real problem?”

The shortfalls in the existing mental health system have come under increased scrutiny in a series of Board of Supervisors committee hearings at a time when there is increased political pressure for elected officials to address those living on the streets with apparent signs of substance use and mental illness.

The draft measure identifies some of the system’s inadequacies. “While the city has 24,500 people who inject drugs, it only has 267 treatment beds available with an additional 68 beds for those who struggle with mental illness,” the measure says.

It also notes that patients released from 5150 emergency psychiatric holds “often face wait times when seeking housing options,” in some cases up to seven months.

The proposal comes as Breed is advocating for an expansion of conservatorship, or judge-ordered treatment, to include those who are held on eight 5150 psychiatric holds in a year and have both substance abuse issues and mental illness.

Breed’s proposal is opposed by homeless and disability advocates who oppose coercive treatment and instead call for adequate voluntary services. These same advocates showed up to support Mental Health SF.

The full board will vote on Breed’s conservatorship proposal June 4.

Breed also in April hired Dr. Anton Nigusse Bland to serve as The City’s first Director of Mental Health Reform. However the ballot measure would ensure the board and nonprofits who provide health services have a greater say over the changes to improve the overall system.

Backers say the expansion of services will cost an estimated additional $40 million a year, an estimate based on the cost of existing services provided by nonprofits backing the effort. The Department of Public Health’s Behavioral Health Services currently spends $370 million annually on mental health and substance use services, treating more than 30,000 patients.

The measure is expected to be officially introduced next week. It could end up on the ballot if it gets at least six votes by the 11-member board or through four signatures of board members.

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