Working Together on Mental Health SF

Taking action now in City Hall to help those in crisis

London Breed
4 min readNov 12, 2019

It is no secret that we have real challenges around mental health in San Francisco, especially for so many people on our streets. We see too many people who are struggling with substance use disorder, with mental health challenges. This is unacceptable and inhumane for those who are in crisis on our streets and for everyone who lives in our City.

The data is clear. Our Department of Public Health, under our Director of Mental Health Reform, has identified 4,000 residents who are experiencing homelessness and behavioral health crises.

We know who these individuals are, and we know that we need to act now. The seriousness and urgency of this issue demands that we all work together. Simply put, it is too important an issue to let politics get in the way.

That’s why I’m proud that today, Supervisors Hillary Ronen, Matt Haney, and I announced that we have reached an agreement to implement Mental Health SF, so we can continue helping people in crisis today while also reforming our City’s behavioral health system.

We all agree we can do this in City Hall, without going to the ballot. By working together through the legislative process, we can move more quickly and with more flexibility to help those in need.

Mental Health SF will allow us to build on the work we are doing now to help people struggling on our streets, and create longer-term, system-wide reforms that help everyone who interacts with our behavioral health system.

What We Are Doing Now

We are creating more places for people to go so they don’t have to suffer on the streets. In addition to opening 1,000 new shelter beds by the end of 2020, we have already funded 212 new behavioral health beds in the last year, and we have set goal of opening hundreds more. We are also protecting the City’s Board and Care facilities that provide housing and treatment in the community, many of which are in danger of closing.

We are taking steps to help those cannot help themselves, like implementing a new conservatorship program for those who struggle with mental health and substance use disorder.

We are pursuing innovative solutions, like opening a Meth Sobering Center, so when people are in crisis, they have somewhere to go that isn’t jail or the emergency room.

We are improving access to services, like creating a real-time behavioral health bed inventory, so that people and service providers can more easily find open treatment beds when they or their clients need them.

We are expanding care and services for those most acutely suffering by connecting the most vulnerable of the 4,000 people in crisis with shelter and permanent supportive housing so they can get off the street, and we are committed to expanding long-term housing options in the city.

Mental Health SF

Our new compromise version of Mental Health SF will prioritize services for those who are homeless, which will ensure we can continue doing this work we have already begun to help those most in crisis on our streets today. Mental Health SF will also focus on implementing longer term reforms to our behavioral health system, which is critical to changing how we provide care in our City.

Here are some of the long-term, structural changes we’ll be making once we have identified funding:

· Renovate the Behavioral Health Access Center so that it can serve as a centralized Mental Health Center.

· Create a new Office of Coordinated Care to ensure that care for all people participating in Mental Health SF are being coordinated and tracked.

· Establish an Office of Private Insurance Accountability to help people with insurance get the coverage that they are legally entitled to receive from their provider.

How To Pay For It

While Mental Health SF can be created in City Hall, we know that we will need to go to the ballot to pay for these services. Along with Supervisor Rafael Mandelman, I’ve already begun the process to place a Public Health bond on the November 2020 ballot so we can build more mental health beds, expand existing facilities, and acquire Board and Care facilities at risk of closure. President Norman Yee and I have also initiated a process to develop a comprehensive business tax reform measure for the November 2020 ballot, which can be used to create an ongoing funding source to pay for Mental Health SF.

With both these measures, we will have a plan to build, expand, and operate this dramatic expansion of services and care under Mental Health SF.

This crisis is urgent and I’m glad that we’ve reached an agreement to move forward on providing care to people with behavioral health needs — especially our most vulnerable residents. We all want solutions, and by working together, we can make a difference or those suffering in our City and on our streets.