Tenderloin Welcomes Mental Health Clinic, Demands Broader City Action on Homelessness

Diana Josefsson strolled down Geary Boulevard on a recent Monday morning with a box of donuts for the block’s newest residents.

The neighborly gesture was an olive branch. Josefsson was welcoming staff and future clients at the opening day of a new drop-in mental health stabilization center at 822 Geary. It’s the city’s latest effort to address street-level homelessness and crack down on drug-related challenges — issues locals say have been concentrated in the Tenderloin neighborhood for too long.

“We really hope that this is successful for the city in addressing some of the problems which have been pretty horrific since the pandemic,” said Josefsson, who lives around the corner from the new facility in a Lower Nob Hill apartment, where she’s witnessed the neighborhood’s ups and downs.

She and other residents toured the facility last week and told KQED they’re cautiously optimistic about the site, which is still ramping up staffing and expanding from its current capacity of four clients to eventually serve 16 people, who can stay for 23 hours at a time.

The neighbors are also urging other districts to shoulder their fair share in addressing the crises that have long been concentrated in the Tenderloin, South of Market and Bayview neighborhoods.

“We really would like to see other neighborhoods take on some of these burdens. It can’t all get stuffed into the Tenderloin and Lower Nob Hill,” Josefsson said after dropping off the pastries. “A neighborhood has to be a mix of services as well as storefronts, housing and other elements that go into creating a healthy neighborhood.”

The stabilization site is part of Mayor Daniel Lurie’s “Breaking the Cycle” program to reduce street homelessness and connect more people to drug treatment and mental health care. The site will be open 24 hours and primarily serve people experiencing mental health crises who don’t require an involuntary psychiatric hold, connecting them to next steps such as higher levels of care.

Staff will also direct clients to a scarce number of shelter beds. The city recently announced it is opening 279 interim housing beds, a far cry from Lurie’s campaign promise to create 1,500 new shelter beds in his first six months in office.

The site will provide a convenient drop-off point for police, paramedics and street crisis response teams, while alleviating overcrowded emergency rooms. It is staffed by nurses, doctors and behavioral health specialists who help clients stabilize during or after acute mental health emergencies, including those stemming from drug use, panic attacks, depression or suicidal ideation.

“We don’t have time to move slowly. If we want to help people who are struggling, we must act right now to get them off the streets and into treatment,” Lurie said at the ribbon-cutting ceremony. “That’s exactly what this 24–7 police-friendly stabilization center will be.”

The site is not yet fully operational. Construction was still underway during Monday’s soft-opening, as first-responders popped in to ask where to direct clients.

Still, it’s a stark contrast to a pop-up services center the city rapidly erected on Sixth Street earlier this year. Unlike that site — a cluster of tents and picnic tables in a former Nordstrom parking lot, where staff hand out free coffee and referrals — 822 Geary resembles a modern health clinic. Soft lighting and exposed wood ceilings surround recliner chairs where clients can rest. They can also take showers, do laundry, get a hot meal and refill psychiatric medications.

Clinical director Danny Hicks said the site opened up far faster than other locations typically do. That became possible after Lurie’s fentanyl state of emergency ordinance passed the Board of Supervisors in January, shortly after he took office. The measure allows Lurie to cut through red tape when hiring and contracting services aimed at overdoses and homelessness.

The Department of Public Health oversees the stabilization center, while Crestwood Behavioral Health Inc., which also operates the San Francisco Healing Center at St. Mary’s Hospital, will manage health care programs on site.

“There’s been a huge push from the mayor and from DPH to open this program very early, so Crestwood is trying to do as best as we can to oblige,” Hicks told KQED on the facility’s first official day.

“We’re opening our doors at noon and primarily getting referrals from the street crisis team and figuring out that workflow in real time,” Hicks continued. “We want to eventually allow walk-ins. We will get there. However, we are in the nuts and bolts phase of opening and have to start serving this community in some capacity.”

The site at 822 Geary, a former Goodwill the city purchased in 2021, has reignited long-standing frustrations over how the Tenderloin has historically borne the brunt of homelessness, outdoor drug use and dealing and other systemic challenges.

Opinion in the neighborhood is divided, with some residents advocating for more shelter beds and low-barrier services to meet existing needs, while others resist further concentration of more facilities.

Recently, as the stabilization center prepared to open, some neighbors fought back against plans to extend two Tenderloin hotels, the Adante and the Monarch, as interim housing for homeless people for up to five more years. The city compromised, extending the leases for one year instead.

Several supervisors are now taking the fight to City Hall.

Supervisor Bilal Mahmood, who represents the Tenderloin, is proposing an ordinance that would require the city to approve at least one new facility — such as a shelter, transitional housing, residential care or drug treatment program — in every supervisorial district.

“We’ve overly concentrated (health and homelessness) services here for so long that there’s very little for the residents who live here to do,” Mahmood told KQED, adding that he supports the stabilization center. “This isn’t about taking people who live in the Tenderloin and moving them. This is about supporting your neighbors and giving them a place to stay when they fall on hard times.”

He noted the Tenderloin is home to nearly 3,500 children and he wants to see toy stores, ice cream shops and other family-friendly businesses open alongside service providers.

The proposal will be presented at the Board of Supervisors this week. Mahmood has support from supervisors representing SoMa, the Mission, North Beach, the Inner Sunset and parts of the West Side.

“We have seen the city leadership put resources and services for our unhoused community in low income communities and communities of color for a long time. And that’s been problematic,” said Supervisor Shamann Walton, whose district includes Bayview.

A safe parking site there recently closed, leaving families living in RVs to scatter across the city. Walton hopes the city can reopen the safe parking site or find an alternative, while expanding options across neighborhoods.

“The unhoused problem is a San Francisco problem, and so we all need to step up and play a role in addressing and providing services for this population,” Walton said.

Supervisor Myrna Melgar, who represents West Portal, Park Merced and other West Side communities, is also backing the proposal. Homelessness has increased in her district in recent years, particularly among people living in cars and RVs. But unlike in the Tenderloin or Bayview, many West Side neighborhoods lack homeless outreach crews, shelters or other low-barrier mental health services.

Melgar recalled a man from the Ingleside Terraces neighborhood who struggled with mental illness and substance use, becoming homeless after his family sold their home. He later died on the street in the neighborhood.

“The reality is folks are on our streets suffering,” Melgar said. “We have no services in District 7 — like none. For me, this is not so much about sharing the load, it’s about serving the people we have here who are obviously in distress and getting worse.”

But some supervisors representing wealthier, more resistant districts have yet to sign on. District 2 Supervisor Stephen Sherrill, who represents the Marina, praised the opening of 822 Geary, but has not expressed support for Mahmood’s plan. He did not respond to requests for comment on expanding mental health and homeless services citywide.

Lurie is weighing in delicately.

“Our team has been implementing a data-driven strategy to identify the right sites to meet the needs of those in crisis on our streets,” said Charles Lutvak, a spokesperson for the mayor. “We will continue working with Supervisor Mahmood and the entire board to build on that strategy and give people struggling on our streets a better option.”