Housing best weapon against mental illness
What we reported: San Francisco can make a substantial dent in homelessness only by tackling one of society’s most intractable problems: mental illness.
People with mental health disorders are the most visible but hardest to reach of San Francisco’s homeless. They make up a third of the homeless population and, by some assessments, nearly two-thirds of the chronically homeless — the 2,100 or so people who have been homeless for at least a year.
But treating them requires aggressive, seamless care that isn’t consistent with life on the streets. Advocates for people who are homeless and mentally ill understand how best to treat their patients — with individualized care in stable, supportive housing — but the system isn’t nearly large enough.
The city needs beds. It needs inpatient psychiatric beds to help stabilize people who are having mental health emergencies, and transitional beds for when they’re released from the hospital but still in need of support. It requires beds for people who need addiction treatment and beds in facilities that teach life skills and provide mental health care.
And San Francisco needs beds in affordable housing so those who have completed treatment can move on to make room for new patients.
What has happened: A year ago, Mayor Ed Lee told The Chronicle that San Francisco needed several hundred additional beds for people with mental health problems. So far, the city has added — or has plans to add — about 100 beds.
The behavioral health center at San Francisco General Hospital, where patients can get long-term mental health care, added 10 inpatient beds, boosting the total to 47.
The city’s Public Health Department also added beds and services at its Medical Respite and Sobering Center at Mission and Eighth streets, where homeless people can live for several months after being released from the hospital or while getting sober. An additional 34 beds are expected to become available there in July.
The mayor’s proposed 201718 budget includes funding for about 70 more beds at varying levels of care for homeless people with mental health problems or substance addictions.
The city is still in dire need of more safe places to treat people with mental health and substance abuse issues. But there are also investments beyond beds.
In May, Tipping Point Community, a San Francisco charity that partners with povertyfocused nonprofits, pledged $100 million toward cutting the chronically homeless population in half over the next five years. One of its first donations was $612,000 to the Public Health Department for its Medical Respite and Sobering Center expansion.
The charity is also funding a study of existing mental health programs to determine which are best suited for expansion, said Rachel Metz, the policy director at Tipping Point. The group plans to release its report this fall.
“We need to be careful about investing in programs that are sustainable,” Metz said.
What’s missing: San Francisco is still far short of having enough beds to house homeless people with the most critical mental health needs at every level of care.
A fundamental step that still needs to happen is an inventory of services and beds available to homeless people suffering from mental illness. For too long, San Francisco’s services have been scattered and disorganized, with not nearly enough communication among providers.
“The city’s put the resources out there, Tipping Point has put some money in. I’m just looking for a plan to emerge,” said Steve Fields, executive director of the Progress Foundation, San Francisco’s oldest nonprofit provider of mental health care to the homeless.
Tipping Point also will start looking for ways to boost federal and state funding for mental health services by tapping into existing sources of revenue.
The city’s public health director, Barbara Garcia, said much of her agency’s focus will be on identifying and treating the most vulnerable homeless people — in particular, those with chronic mental health and substance abuse issues.
The mayor’s budget includes some movement in that direction. For example, Lee is calling for expanded funding for paramedic teams that work with police to intervene with homeless people who are the most frequent users of 911.
Moving the most vulnerable homeless people into housing with supportive services isn’t just humane — it’s cost-effective. Chronically homeless people with the greatest needs are costing the city about $150,000 a year apiece for emergency medical care, while a bed in supportive housing can cost half that.