EDITORIAL On Mental Health Crisis demands proper remedy
Aplan to put universal mental health care before San Francisco voters this fall reflected the urgency to address the crisis quickly but not the necessity to do so effectively. Last week’s decision to delay the initiative provides a valuable opportunity for Supervisors Matt Haney and Hillary Ronen to work with Mayor London Breed to close the distance between their good intentions and the flawed policy they put forward.
Haney and Ronen deserve credit not just for their willingness to revise the proposal but also for their insistence on grappling with the crisis in a concerted and coordinated fashion. The supervisors’ frustration with the current state of affairs is palpable and appropriate. Mental health care is a national failure that is more visible and visceral in San Francisco, where too many struggles with mental illness take place on the streets among the city’s disproportionate and rapidly growing population of homeless people.
That is in large part due to the persistent housing shortage that is forcing more and more vulnerable San Franciscans out of their homes — and on which the Board of Supervisors has a nearly perfect record of dithering and denial. That could be one reason for Haney and Ronen’s misguided determination to address mental illness generally rather than focus on the most pressing aspects of the problem in the city. The supervisors have proposed a sweeping new entitlement extending to every resident with a mild case of anxiety or depression — almost as if housing and caring for those contending with the most severe diseases and the most dire circumstances weren’t sufficiently difficult.
The delay will also give the supervisors and the administration a chance to answer the related question of how much the program will cost and how the city will pay for it. The supervisors and the administration, obviously at loggerheads over this and other matters, have provided cost estimates that varied by a factor of at least three and as much as 15 — from $70 million to $1.1 billion a year — leaving any voter attempting to gauge the expense at a complete loss.
Breed recently created and filled a new post, director of mental health reform, to evaluate the city’s system and recommend reforms, and she has plans to spend an additional $50 million on mental health care, which already costs the city nearly $400 million a year. Given that any program the supervisors come up with will be run by the mayor’s Department of Public Health, the supervisors and Breed should strive to reach consensus on more than just the likely budget of any major mental health care initiative. “In an ideal world,” Ronen told The Chronicle this week, “we would have been working on this together from the getgo.” Hear, hear.
Then there is the supervisors’ quirky proposed means of paying for the new mental health program: an added corporate tax based on the discrepancy between chief executive and rankandfile salaries. Whatever its appeal as a populist political statement, it doesn’t rise to the level of serious fiscal policy. Wealth inequality is yet another significant national problem that the supervisors should forgo attempting to solve in favor of the abundant challenges more plainly within their purview. Compounding its shortcomings, the new levy was originally scheduled to go before voters four months after they cast ballots on the program it would fund.
Once the supervisors figure out how much their program is likely to cost, they should devise a rational, stable and concurrent means of providing the needed revenue. A mental health program that is fiscally and otherwise sound will be more likely to achieve the supervisors’ lofty goals.