Supervisors Propose Universal Mental Health Care in San Francisco

Save ArticleSave Article

Failed to save article

Please try again

A homeless encampment in San Francisco's Mission District. "Mental health and substance use programs in San Francisco right now are completely uncoordinated and a mess. We all see it ... when we walk on the street and see people in misery," said Supervisor Hillary Ronen. (Brittany Hosea-Small/KQED)

San Francisco Supervisors Hillary Ronen and Matt Haney want the city to offer free mental health care and substance abuse treatment to any city resident in need.

The supervisors, along with state Assemblyman Phil Ting (D-San Francisco), on Tuesday are announcing a push for a November ballot measure to create what they say would be the first universal mental health care system in the nation.

"We have a crisis of people who are severely addicted to drugs and that have severe mental health illnesses that are wandering the street and that desperately need help," Ronen said in an interview Tuesday morning.

"San Franciscans are ready for a bold and big change. They're sick of little measures around the edges. They want a fix to this crisis. The status quo is dangerous," she said. "We can't keep failing."

The plan, which would be called Mental Health SF, would be similar to the city's Healthy San Francisco program that offers health care services to uninsured city residents. It would provide treatment to anyone who has a mental health illness or substance addiction and asks for help — even if they have health insurance.

The proposal, first reported on by the San Francisco Chronicle, would be paid for by state funding and a proposed tax increase on companies that pay their chief executive officers 100 times more than the median compensation paid to their employees.

"We have become one of the most unequal cities in the country, with CEOs making hundreds and hundreds times more than their average worker," Haney said.

Homelessness and Mental Health

The plan calls for a 24-hour, seven-days-a-week service center that accepts anyone no matter how severe their needs and an office that would coordinate care.

"Mental health and substance use programs in San Francisco right now are completely uncoordinated and a mess. We all see it ... when we walk on the street and see people in misery," Ronen said. "Every single day we see people being released onto the street with their hospital bands on who are still clearly in crisis and don't know what to do and where to go," she said.

The program would also expand residential treatment and housing services already operating in San Francisco for people with severe mental illness and substance abuse.

Ronen and Haney plan to put a separate measure on the fall ballot, dubbed the Excessive CEO Salary Tax, that would place an extra surcharge on businesses that have chief executives who make at least 100 times more than the firms' typical workers. They believe the tax would generate about $80 million a year, adding to the city's $370 million annual budget for mental health and substance abuse treatment.

Mental Health SF would rely on some state money as well. The state Medi-Cal program covers half the cost of services to low-income Californians enrolled in the program. Ronen said San Francisco should draw down more funding from Proposition 63, a tax approved by voters in 2004 to fund services for Californians with serious mental illnesses.


The program would also use some funding from an IPO tax recently proposed by Supervisor Gordon Mar to raise the employer payroll tax on stock-based compensation.

A representative for a leading business lobbying group raised concerns about the idea.

"There's little question that we need to do a far better job of providing mental health care services. It's not just a San Francisco issue, it's an issue across the entire Bay Area and California," said Rufus Jeffris, a spokesman for the Bay Area Council.

"A big danger in this proposal is relying on highly volatile jobs and wealth taxes to fund an ongoing expansion of services. And given criticism about a lack of coordination and coherence in a system that some have described as 'devastatingly broken,' voters will need to decide whether spending more money is the right approach," Jeffris said in an email.

Notably absent from the press conference announcing the plan were San Francisco’s mayor, London Breed, and anyone from the city’s department of public health.

Both offices said they couldn’t comment on the proposal yet because they both hadn’t seen it until Tuesday, when it was announced to the public.

Those offices have been trying to address shortfalls in mental health care. The mayor recently hired the city’s first ever director of mental health reform, Dr. Anton Nigusse Bland, who previously directed psychiatric emergency services at San Francisco General Hospital.

He is now tasked with evaluating the city’s mental health and substance abuse treatment services, particularly for homeless people, and making recommendations for changes.

The city is also participating in a pilot project overhauling the delivery of drug treatment services through Medi-Cal – a project that includes some features proposed in the Mental Health SF program.

But Ronen says it’s not nearly enough.

"We haven't seen a single plan that comes out of the mayor's office to deal with this crisis at the scale that we're dealing with," Ronen said. "We need a massive overhaul."

To staff the program, Ronen believes the city can accomplish what the private health care industry can't. Kaiser Permanente has been the target of numerous complaints about long wait times for mental health appointments, which clinicians there say is due to under staffing. Their union recently authorized a strike over the issue, following a five-day strike in December. Patients with Blue Shield coverage say when they call therapists listed on the insurer's network, most are not taking new patients.

Both companies routinely explain this by saying there is a shortage of clinicians. But Ronen says this is an excuse.

"Part of Mental Health SF is we're going to pay people what we need to pay them to attract them, and we're going to have the revenue to do so," she said.

The program will also rely heavily on peer counselors, who don't carry the same high-level degree that demands such high salaries.

"Sometimes the best care, and the best coaching, it comes from people who've experienced the illness themselves," she said.

The two supervisors plan to officially introduce the measure at next Tuesday's board meeting. They need six supervisors to support the proposal, and currently five are backing it. Along with Ronen and Haney, Supervisors Mar, Shamann Walton and Norman Yee are on board. Ronen expects Supervisor Aaron Peskin to back it as well.