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SF Close to Reaching Goal of 400 New Residential Treatment Beds, but Major Obstacles to Care Remain

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A stopped-over man walks past San Francisco City Hall, with a law enforcement vehicle parked nearby in the plaza.
San Francisco City Hall on Aug. 19, 2023. (Liu Guanguan via Getty Images)

San Francisco is closing in on its goal to add 400 new residential treatment beds for people suffering from mental illness and substance-use disorders.

Despite ongoing staffing issues at many care facilities, the city is just 44 beds shy of reaching the expansion goal that its Department of Public Health set in 2021, and now has a total of nearly 2,600 beds, health officials told members of the Board of Supervisors Budget and Finance Committee on Wednesday.

“While there are gaps depending on staffing, overall, there is an increase in residential care,” said Hillary Kunins, San Francisco’s director of behavioral health services.

But some supervisors said they were fed up with what they called uneven progress in meeting the city’s dire need for more affordable live-in treatment programs, and argued the city still lacked a comprehensive data collection system for tracking how many people actually use the beds.

“Are we making progress? Are we falling behind? Are we running in place?” Supervisor Rafael Mandelman said at the hearing. “Based on the way we are tracking these numbers, I don’t know whether we have more San Franciscans getting that level of care today than we did five years ago.”

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The city has new tools, like Care Court, to place people under mandated treatment, he added, but “we have that basic problem of not having places for people to get care.”

The majority of the city’s treatment beds (1,861) are used in programs focused on mental health, with roughly 700 other beds reserved for substance-use disorder treatment, according to the city’s Department of Public Health. Those entering and exiting residential care programs can now also receive support from the department’s Office of Coordinated Care, which opened its doors in 2022.

That current total number of beds marks a 20% increase from the city’s baseline bed count in 2020. And more treatment programs are slated to come online this year, including an 18-bed facility for people with co-occurring mental health and substance-use disorders and a 10-bed center for younger adults, health officials said.

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But a significant number of those beds often remain unfilled, despite high demand, due in large part to ongoing citywide staffing shortages. In the first half of the current fiscal year, staffing challenges reduced the behavioral health system’s capacity by up to 20%, said Kunins, the behavioral health services director.

“Behavioral health workforce retention and recruitment are significant challenges,” she told supervisors at Wednesday’s hearing.

The hearing comes as San Francisco continues to face a converging crisis around overdose deaths, mental illness and homelessness. At the same time, many of the city’s private home board-and-care facilities have closed down in recent years, putting more pressure on the public system to provide residential care, particularly for seniors and adults with disabilities.

Laguna Honda Hospital, one of the city’s largest skilled nursing facilities, has also not admitted a new patient for nearly two years after federal regulators decertified the facility in 2022. The hospital typically serves lower-income, older residents but also provides various mental and behavioral health services.

Supervisor Myrna Melgar, whose district includes Laguna Honda, said there needs to be greater statewide investment into residential treatment.

“There is a need for beds in California, not just San Francisco. Why don’t we treat this like infrastructure?” she said. “The way we are counting the need is wack.”

Barriers to treatment also go beyond just the number of beds available, said Tanya Mara, who works with the city’s jail health services. She told supervisors it took three weeks to get one client into treatment because of a legal backlog.

“She had failed to appear in court in Alameda, but because of our close relationships with county behavioral health, we got them on the phone and got that warrant lifted so we could place her,” Mara said. “It’s frustrating and requires skilled, fiery social workers who will keep pushing all of these systems.”

Adam Francis, senior director for policy and advocacy at San Francisco Marin Medical Society, noted that while the bed data is imperfect, it helps get the city closer to addressing its mental health and addiction crisis.

“These are real human lives we are talking about. Not just beds,” he said during public comment. “These are mothers and sons and brothers. When they fall through the cracks, it’s devastating.”

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