S.F. Moves Toward Mental Health Reform — But How Far Will It Go?

Should negotiations fail, dueling measures are headed to the ballot.

A contingent of supervisors and Mayor London Breed are in a standoff over competing proposals headed to the voters — this time over how much to overhaul mental health system.

The version put forward by Supervisors Hillary Ronen and Matt Haney, Mental Health SF, is heavily informed by psychiatric care experts and would establish provide mental health services and substance abuse treatment to all San Francisco adults who may be homeless, uninsured, or using public programs like MediCal. It would also set up an office to advocate for privately-insured people who still face delays in receiving care through their providers.

Breed’s version, Urgent Care SF, focuses on bringing services to the roughly 4,000 people in San Francisco with severe cases of mental or behavioral health.

“I understand where they’re coming from but we want to go bigger,” Ronen said at a Rules Committee hearing on Wednesday. “We brought everyone together in a room and said the system is broken. What do we do to fix it?”

Wednesday’s hearing made it clear that the supervisors’ version had the voice of the people behind them. Groups like SEIU 1021, National Union of Healthcare Workers, Coalition on Homelessness, and Housing Rights Committee of San Francisco who rallied before the hearing on the steps of City Hall. (Prior to entering, a protestor was arrested and cited for trespassing and resisting arrest, which public commenters and supervisors denounced.)

It also presented a rare opportunity for people to share their personal struggles with mental health and suicidal thoughts that extended to concern for friends or loved ones. Wynd Kaufmyn, the vice president of CCSF’s American Federation of Teachers 2121, talked about her daughter’s episodes that included schizophrenia and being placed in multiple psychiatric holds. She thinks of her daughter when passing other people on the street in need of mental health care.

“Today she’s living a healthy, full life with friends…the reason is because she had the resources she needed,” Kaufmyn said. “Thank you for the legislation and don’t compromise.”

Supervisors Hillary Ronen and Matt Haney introduced Mental Health SF in June as a counter-solution to a controversial conservatorship law. The proposal drew from Healthy SF to make mental health services universal but was scaled back during negotiations with Breed, who pulled out out of talks with the supervisors in late September.

“The same policies that are being proposed can go through the process at the Board of Supervisors,” Breed said shortly after negotiations first ended. “And that was one thing where there was a major disagreement, and the supervisors are determined to go to the ballot no matter what.”

Breed and the supervisors resumed negotiations earlier this month but both still filed competing ballot measures by the Oct. 15 deadline. However, if they come to an agreement by the Nov. 26 deadline to withdraw measures for the March 2020 ballot, mental health overhaul could arrive months earlier without a vote. A similar back-and-forth happened with three dueling measures that gave way to November’s Proposition E to allow educator housing on public land.

Voters will end up deciding between two measures if an agreement is not reached. Should Breed’s Urgent Care SF receive more votes, Mental Health SF would not pass despite receiving simple majority.

Ronen and Haney have stood firm that bold changes are necessary to address the city’s pressing mental health challenges. Supervisors Gordon Mar and Shamann Walton also support Mental Health SF.

“Frankly, we’re done with the incrementalism,” Haney said at the hearing. “We don’t want to be here in five years about how everything is fine and we’re taking these little steps. We’re long past that.”

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