HOPING FOR A CHANCE TO HEAL
People living on the street with mental illness, addiction may find help even harder to get during pandemic
For DeRon Cary, a treatment counselor in San Francisco, the thought of people trying to kick drug addictions in the outside world — where they would be isolated and on the streets — is unimaginable during this pandemic. But inside a rehab facility where he works, he feels his clients at least have a chance. They have routines, three meals a day and a community looking out for them.
“It’s not pretty out there,” Cary said on a recent afternoon, sitting inside the facility run by nonprofit HealthRight 360. “A lot of clients who were living on the streets say that if it wasn’t for this place, they don’t know what they would do.”
In a city where thousands struggle with debilitating drug addictions — and often, homelessness and mental illness as well — treatment beds, shelter beds and case managers can be hard to come by. Cary says many of his clients consider themselves the lucky ones, able to get help when so many others are stuck outside.
But legislators, advocates and medical professionals are deeply worried about those still out on the city’s streets, especially now that a projected $1.7 billion deficit over the next two fiscal years will likely make it harder for City Hall to fund the extra resources needed to help them.
San Francisco’s behavioral health care system offers a spectrum of services, from Health
Right 360’s drug treatment programs to locked psychiatric wards at San Francisco General Hospital. Prepandemic, City Hall was intensely focused on reforming and increasing capacity within nearly every aspect of the system.
There were new ideas like a meth sobering center, a safe injection site and plans for many new behavioral health beds around the city. Mayor London Breed and the Board of Supervisors were also focused on a sweeping initiative called Mental Health SF that would overhaul the entire system and pump $100 million more into spending on behavioral health, which already amounts to $400 million annually.
But now, many of those reforms have been delayed or put on hold altogether, as the Department of Public Health shifts resources to respond to the pandemic. And looming over public health officials, along with every other city department, are the dramatic budget cuts they will face over the next few years.
That leaves officials caught balancing problems brought on by the pandemic — record joblessness and shuttered offices and stores — and those that have long persisted: homelessness, drug use, mental illness and a housing shortage.
Last fall, the Department of Public Health launched a project to focus on 237 of the city’s sickest homeless people, who also suffer from mental illness and drug addiction. The point of the initiative, the “shared priority project,” was to have several city departments work together to get the 237 housed.
Ten months later, 111 of those people are in permanent supportive housing. But, according to data shared with The Chronicle, as of June 5 many remain in perilous positions: 68 are on the streets; 10 are missing; 37 are in temporary shelter. Eleven have died.
As a team works roundtheclock to help this small group, the project reveals just how hard it is to help those suffering from extreme mental health and medical problems within the city’s fractured system — and how important it is to plug the holes.
Dr. Anton Nigusse Bland, appointed the city’s director of behavioral health reform in 2018, said improving behavioral health services is still a major focus.
He pointed to a bond measure Breed introduced for the November ballot that would give the city $107 million to spend on mental health and substance use disorder treatment facilities. He also said the department has been able to reach more people than it normally would because mental health and drug treatment service providers are regularly going to the shelterinplace hotels.
But he stopped short of promising that existing programs and initiatives wouldn’t see eventual cuts.
To help close the anticipated $1.7 billion deficit over the next
two years, each city department has to slash its budget by 10% in the upcoming fiscal year — with an extra 5% identified that can also be cut if need be. For this first round of cuts, Greg Wagner, the health department’s chief financial officer, said the department may be able to weather at least part of the year without service cuts.
“But if we do need to meet that additional 5%, we will not have the ability to move forward without making some of those harder choices,” he said.
Already, the pandemic has hobbled some plans to reform and boost capacity in the city’s system. Supervisors Hillary Ronen and Matt Haney, who wrote the initial Mental Health SF plan, are working on a way to make it more feasible — like implementing it in phases instead of all at once.
Meanwhile, other plans like the new meth sobering center have been put on hold; a planned psychiatric respite facility on Valencia Street had to cut its bed count from 50 to 20 so there would be enough room for clients to social distance; implementation of a new law to mandate treatment for those considered extremely mentally ill and addicted to drugs has been delayed; Breed’s hopes of adding more than 100 behavioral health care beds around the city have been slowed.
Steve Fields, CEO of Progress Foundation, which runs programs around the city for those struggling with mental illness, said he was looking forward to the commitments City Hall had made to improving the system before the pandemic.
“We were on the right track,” he said.
His foundation had to put on hold plans for two new residential treatment programs, realizing the health department likely couldn’t commit to acquiring a new site and funding it. Fields said his existing residential programs have cut capacity by 10% to 20% for social distancing.
“It will be an interesting discussion about what we can’t afford to lose, and what we can grow back up when things get better,” he said. “But if we are looking at a ($1.7 billion) deficit, we know there are going to have to be some draconian cuts.”
At the beginning of the pandemic, HealthRight 360 scrambled for weeks to figure out how to continue its services.
When Chris Summers, 35, joined the program from jail at the end of March, he was immediately placed into a twoweek quarantine where he was mostly confined to his room. The rules in treatment are rigid as it is, so to have even more imposed on him — mandatory masks, social distancing, no visitors — has been difficult.
But, he said, it’s better than being in jail or out on the streets.
“It’s a hard time to be in rehab,” he said. “But in a weird way, it’s also the best time. I mean, if someone is going to get their life changed, now is the time.”
Vitka Eisen, CEO of HealthRight 360, said there have even been some beneficial changes due to the pandemic: like the ability to do more telehealth visits with those who can access them, and new state guidelines that allow people to stay longer in each program if they have nowhere else to go. It’s a welcome change for the existing residents, but also means there’s less room for new people to come in.
She said she’s concerned about impacts the budget cuts could have in the future.
“There’s a possibility that we have to rethink the direction that we were going in,” she said.
Since the pandemic hit, conditions on San Francisco’s streets have dramatically worsened. The number of tents citywide grew 71% until early June when the city started bringing more people inside. The surge in tents came as shelters limited how many people they could let in. Case managers say more clients are relapsing as they struggle with the pressures of job loss, isolation and uncertainty. The number of homeless deaths increased more than threefold — from 14 to 48 — in an eightweek period between March and May, as overdoses increased and services were trimmed.
But inside the rehab center, Cary said he’s glad the men can largely ignore the realities outside — at least for now.
“As long as this place is open and as long as I’m working here, I’m going to do everything I can to try to help them,” he said.