SF Mayor Breed, Supervisors Agree on Plan to Overhaul City's Mental Health Program

A homeless man sleeps on the grass at Civic Center Plaza on May 17, 2019 in San Francisco. A new compromise proposal to overhaul the city's mental health care system will channel resources to the most the vulnerable residents.  (Justin Sullivan/Getty Images)

San Francisco Mayor London Breed and Supervisors Matt Haney and Hillary Ronen announced a deal Tuesday reconciling their dueling plans to reform the city's fragmented mental health care system.

The trio introduced the agreement outside of City Hall, following months of often tense negotiations on ways to overhaul the treatment of residents grappling with homelessness, mental health and substance abuse issues.

In October, Breed announced she was backing her own comprehensive health care plan — called Urgent Care SF — geared towards some 4,000 homeless San Franciscans suffering from mental illness and substance abuse, an initiative she placed on the March 2020 ballot.

Similarly, Ronen and Haney also announced last month they had filed paperwork to put their own proposal — dubbed Mental Health SF — on the same ballot. That more sweeping plan pushed for systemic change to the city's mental health system, a proposal Breed criticized as too broad and costly.

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Under the new deal, both sides are pulling their respective measures from the ballot, avoiding what promised to be a long, costly fight in the coming months. Instead, the new plan — still called Mental Health SF — is now being introduced as legislation to the Board of Supervisors.

"People didn’t want to see competing ballot measures — a bunch of politics that actually would’ve delayed the solution," Haney said on Tuesday. "What we've put forward here with Mental Health SF is the vision and the framework and the accountability structure to have a system that actually works, because the one we have right now is disjointed, disconnected and is failing our city."

The agreement incorporates Breed's original demand to prioritize treatment for the city's most vulnerable population. But it also retains Ronen and Haney's push to create an Office of Private Insurance Accountability to make sure residents with mental health needs, including those with insurance, receive adequate care.

The new program would also include a 24-hour drop-in center with access to psychiatrists and medication for anyone who needs it, regardless of insurance status.

"I am so excited for the future of mental health in San Francisco because I know this is the right way to do it," Breed said. "We have to start looking at mental health in a whole other way than we did in the past. What happens when someone is a schizophrenic? What happens when someone develops dementia or all these other things? What are we doing to make sure we are helping these people and meeting them where they are?"

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However, without a funding source, the effort to approve and implement the program may be far from over.

City officials still need to identify a funding source, Haney noted. The program is estimated to cost at least $100 million annually, on top of the $400 million the city already spends on behavioral health services.

Funding sources could include a public housing bond, a gross receipts business tax or funding from Proposition C, the a measure passed by voters in 2018 that increases taxes on the city’s biggest corporations to fund housing and homelessness services.

Despite the funding vagaries, Ronen said she was optimistic the program would be fully operational within the next two years.

"We just created the first universal mental health and substance use system in the country," she said. "We're no longer going to waste money, time and the goodwill of patients, and the rest of us quite frankly, by watching people cycle from the street to emergency services, to residential treatment and then right back out on the street, where it is almost impossible to get better."

Additional reporting included from Bay City News' Daniel Montes.