Mental Health Reform Plan Heads to the Ballot

In November, San Franciscans will decide whether to support universal mental health care. What does this mean for SB 1045?

2019 is the year San Francisco got serious about its residents’ mental health. It’s a long overdue commitment, too. The city has cut tens of millions of dollars from its behavioral-health budget over the past 15 years, while the amount of homeless people on our streets has only risen. The resulting crises are strikingly evident: People have mental-health breaks in the middle of Market Street, turn to illegal substances to manage their issues, and find themselves arrested for both, needlessly filling up our jails.  

It’s a travesty that it’s been allowed to get this bad, but now — finally — politicians are stepping in and demanding we up our resources. On Tuesday, Supervisors Hillary Ronen and Matt Haney announced a November ballot measure called Mental Health S.F., which would create universal access for anyone to see a psychiatrist or receive treatment.

“It doesn’t matter how severe your mental-health or substance-use issue is. It doesn’t matter what insurance you have. If you need help we will provide it,” Ronen says.

Under the ballot measure, San Francisco would build a new Mental Health Service Center — most likely near Zuckerberg San Francisco General Hospital — that would offer drop-in services 24 hours a day, seven days a week. A new Office of Coordinated Care would loop all of the city’s disjointed mental health systems under one network, theoretically preventing people falling through the cracks. And existing mental-health programs would receive an influx of new funding, to ensure they’re better able to meet demand.

Assemblymember Phil Ting has pledged to dredge up money for the effort in Sacramento, but Ronen and Haney also plan to introduce a creative tax: a 0.1 percent surcharge on local companies whose CEOs make more than 100 times more than the median income of their workers, 0.2 percent surcharge on those who make 200 times more, and so on. Two-thirds of voters would need to approve this funding source in either November or March’s elections.

The sweeping nature of the Mental Health S.F. measure seeks to provide help at all levels, ideally before one’s psychological issues become so severe that they require less-voluntary forms of treatment, like locked institutions. Are you a stressed-out tech worker unfortunate enough to be relying on Kaiser’s pathetic mental-health resources? Do you have schizophrenia and need some help refilling your prescriptions because you’re unhoused? If managed well, Mental Health S.F. could successfully treat individuals in either scenario, and everyone in between.

It’s smart and long overdue, but also political. While no one mentioned Senate Bill 1045 during Tuesday’s press conference, its presence hung over the proceedings. Drafted by state Senator Scott Wiener and led locally by Supervisor Rafael Mandelman, it loosens restrictions for institutionalizing severely mentally ill people. In many ways, it’s everything Mental Health S.F. is not. Critics — of whom Ronen has been a vocal one — argue that SB 1045 doesn’t provide support for voluntary services or assist our existing underfunded and under-resourced programs. It scoops up those whom our current mental-health system has failed, and takes away their right to make decisions about their mental health care — for a year or longer.

In contrast, Mental Health S.F. would offer a streamlined entry point into a system of mental healthcare as soon as someone identifies that they need help. Jennifer Friedenbach, executive director of the Coalition on Homelessness, tells SF Weekly she thinks this ballot measure will be a more effective tool down the line.

“This is an approach to truly address the needs of folks on the streets, as opposed to 1045 being a very surface-level measure that doesn’t dig down deep and address the root causes,” she says. “This is really about trying to fix it in the long run.”

The Board of Supervisors will vote on SB 1045 during their June 4 meeting, and that’s where the political side will reveal itself. If the Supes vote it down, Mandelman and Mayor London Breed have pledged to take it to the November ballot, where it would sit alongside Mental Health S.F. The two aren’t mutually exclusive, either. As written, there’s no poison pill provision, so both could pass, but rumors are circulating that supervisors are on edge about putting decisions regarding the care for our city’s most severely mentally ill in the hands of voters. If that’s the case, SB 1045’s critics on the Board could swallow their pride and vote to pass it, with the hope that Mental Health S.F. would make the list of people who would be institutionalized under the new conservatorship law shorter over time, by offering better care before their mental-health issues become so serious.

The Mental Health S.F. ballot measure also puts Breed in a difficult situation once again, forcing her to choose whether or not to endorse a ballot measure that depends in part on the taxing of major corporations, whose interests she moved to protect during last year’s battle of Proposition C. The measure also leapfrogs over the efforts she’s made to remedy the city’s current system, such as the creation of a Director of Mental Health Reform.  

City Hall’s handling of San Francisco’s mental health issues is messy right now, and will no doubt continue to be in the coming months as alliances are forged and politics play out. But five months into 2019, we are finally getting somewhere. If Mental Health S.F. passes and secures the funding it needs to be successful, it could be the boldest plan nationwide to address mental-health crises.

“There’s been a lot of talk about how San Francisco has lost its progressive edge,” Ronen said Tuesday. “We’re here to tell you, ‘We’re still here.’ Mental Health S.F. is going to be the best and most progressive program in the country. We have not lost our heart and soul, and we believe that everyone can live with dignity and wellness.”

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