City Hall Passes Mental Health Reform That Will Cost Over $100 Million

The long path to a unified front brings expanded treatment, crisis outreach teams, and other initiatives — once funded.

With Mayor London Breed on board, San Francisco supervisors unanimously passed on Tuesday what’s billed as an overhaul of the mental health system.

Under Mental Health SF, the city would provide mental health services and substance abuse treatment for all San Francisco adults who may be homeless, uninsured, or on public programs like MediCal or Healthy SF. An office would also be established to help privately-insured people experiencing delays to receive care.

At least $100 million to $178 million annually and $8 million in start-up costs is needed for the overhaul, according to a Budget and Legislative Analyst report, though it could be capped at $150 million. That money could come from new revenue streams like Ronen’s initially-proposed “Excessive CEO Salary Tax,” or even something that goes before voters.

“San Francisco will soon have access to a comprehensive mental health program,” said Supervisor Hillary Ronen, who lead efforts for the legislation. “This is a concrete plan that will help vulnerable people who are suffering from mental illness and substance abuse. It’s long past due for City Hall to take action on our mental health crisis and I’m so pleased that we were able to come together to make it happen.”

The legislation was once wrapped in tough negotiations to consolidate dueling ballot measures and now has the unanimous co-sponsorship of the full Board of Supervisors, and support from Breed and the Department of Public Health. The version put forward by Ronen and other supervisors initially envisioned providing care to all San Franciscans, as informed by psychiatric care experts and community leaders. Breed’s version, Urgent Care SF, set its sights on the roughly 4,000 people with severe cases of mental or behavioral health.

Supervisors and Breed reached a compromise that includes an office to negotiate better, faster care for privately-insured patients. Breed also pledges to hire a Director of Mental Health (not to be confused with the city’s mental health reform director) by next summer and to fast-track appointments for a 13-person working group overseeing the implementation.

“With the passage of Mental Health SF, we can keep moving ahead to address the serious mental health and substance use challenges on our city’s streets,” Breed said in a statement. “As we work to reform our entire mental health system, we’ll continue prioritizing the most vulnerable people, and providing targeted services to those who are experiencing homelessness, mental illness, and substance use disorder.”

The legislation revolves around five key areas: opening a Mental Health Service Center and Office of Coordinated Care, a 24/7 citywide crisis response team that the public can call, expanding mental health and substance use treatment, and launching an Office of Private Health Insurance Accountability.

The service center is instructed to open within two years, stay open 24/7, and serve as a centralized access point with drug sobering, pharmacy services, psychiatric assessment, and case management. Coordinated care is intended to “minimize unnecessary bureaucracy,” the legislation says, with intensive case managers and treatment plans while collecting data.

Data collection is good news to Jennifer Friedenbach, executive director of the Coalition on Homelessness. But she sees Mental Health SF more as a starting point.

“We don’t have the data tracking to know what the system needs,” says Friedenbach.”If they end up attaching funding to it and increase capacity, it’ll go a long way. It’s not going to comprehensively address the problem.”

Proponents of the overhaul like Supervisor Matt Haney said there will be more action coming on mental health.

“Passing Mental Health SF is a huge step forward, but we still have a long way to go,” Haney said. “Supervisor Ronen and I are committed to working with the mayor, our colleagues, and stakeholders to ensure that Mental Health SF is fully implemented and fully funded. We will not rest until every component of this program is up and running.”

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