Supervisors Send List of Demands to New Director of Mental Health Reform

"To say we are frustrated is an understatement," stated the letter, which was sent to Dr. Anton Nigusse Bland by four supervisors — including the Board president.

Dr. Anton Nigusse Bland shakes hands with Mayor London Breed, who appointed him to the new role of Director of Mental Health Reform. March 27, 2019

Dr. Anton Nigusse Bland, the brand-new Director of Mental Health Reform, has occupied the seat for less than two months — but already, supervisors are holding his feet to the fire. On Monday, Board President Norman Yee and Supervisors Matt Haney, Hillary Ronen, and Shamann Walton penned a strongly-worded letter to Bland, citing their dissatisfaction with the city’s current system for treating those who use drugs or experience mental illness, and frustration over a lack of information and transparency during recent hearings on Senate Bill 1045, psychiatric resources, and methamphetamine treatment. 

“Attempts by the Board of Supervisors to find clarity in the form of hearings, audits, and countless meetings have been met with conflicting facts, shifting data, and obfuscation,” they wrote. “No one in your department can tell us exactly why the system is dysfunctional, what we need to do to fix it, or even where the Board of Supervisors can place additional funding to build capacity and get people on a path to stability. To say we are frustrated is an understatement.”

Included in the letter are five areas in which Yee, Haney, Ronen and Walton demand solutions. First and foremost is the number of people on waitlists for mental health and substance abuse treatment centers — which the city has failed to produce during any of the related hearings in the past few months. The only answer thus far has been a vague “one to seven months.” 

The Department of Public Health has also failed to provide any examples of a process by which someone is tracked as they make their way in and out of the city’s health systems — making understanding the effectiveness of, say, locked wards almost impossible. 

Similarly, supervisors blasted the fact that based on the Department of Public Health’s own data, 38 percent of patients discharged from Psychiatric Emergency Services have no referrals to continuing treatment, be it the name and address of a therapist, or a case worker who can track their progress. As a result, many cycle in and out of PES, which is an expensive high level of care that treats many people who could benefit from a less intensive support system.

Issues of staffing and beds were also raised. Oddly, despite the claims from doctors and nurses that there is a serious shortage of acute care and residential treatment beds in San Francisco, no one has been able to provide even the roughest estimate of what number we would need to increase those to in order to adequately meet the needs of everyone suffering from mental health issues in San Francisco. 

In addition, the supervisors cited the unsatisfactory rate of one intensive case manager for every 17 patients, saying it’s clear that “San Francisco needs outreach teams working 24 hours a day, seven days a week.” 

The letter comes in advance of what’s sure to be a contentious vote June 4, as all 11 supervisors take on SB 1045 to expand S.F. ability to forcibly lock up people experiencing severe mental illness. It could be a tight vote, and if it doesn’t pass, Supervisor Rafael Mandelman says he’ll take it to the ballot.

In the meantime, the new director of mental health reform has a long to-do list, but he’s not coming in cold; before being appointed to his role by Mayor London Breed, Bland ran Psychiatric Emergency Services. And that’s a good thing, because Yee, Haney, Ronen, and Walton have only given him until June 15 to meet with them and propose some solutions.

“Abandoning mentally ill people to wander the streets of San Francisco without care or medication is both morally wrong and dangerous,” they said. 

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