San Francisco Chronicle - (Sunday)
S.F. hub provides mental health lifeline
SoMa center seeks to ensure clients don’t fall through cracks
Shelley Hayden, a long COVID patient who has to rest every day with her legs up, takes a break with her dog, Theo.
For years, people struggling with addiction or mental illness have bounced from the streets to emergency rooms and jail cells in San Francisco, often failing to get connected to the longterm care they need.
But now, officials say these San Franciscans can get a case manager in a new South of Market office who can help them navigate a complicated health care system — 2½ years after reform legislation mandated its creation.
The Department of Public Health’s new Office of Coordinated Care at 1360 Mission St. hosts a director and 20 case managers who are responsible for helping people coming out of jail, psychiatric emergency care or other settings get into treatment or transition from one set of services to another. By the summer, the city plans to have 40 case managers in the office.
“People who need care aren’t always able to access the care and aren’t always able to successfully stay in care. This office is intended to fill that gap,” said Dr. Hillary Kunins, the city’s behavioral health director, who oversees a budget of $607 million for fiscal year 2021-22. “To achieve the health outcomes that we want to see for San Francisco, we need to support some of the people with the most serious illness — mental illness or substance use disorder — to get the care that is going to help them stay healthier and help our city stay healthier.”
Kunins said the office will focus partly on people who were recently subjected to an involuntary psychiatric hold.
“We want to prioritize getting those folks connected into care so we can prevent the next crisis,” she said.
The pandemic delayed the office’s opening while also making the homelessness and drug crisis worse.
The need is dire as the city continues to struggle with the visible challenges of homelessness, mental illness and drug addiction on its streets. In 2019, a city report found that 4,000 people struggled with all three conditions, spurring
the passage of Mental Health SF — legislation to reform the city's broken care system.
The legislation called for adding 400 treatment beds, creating alternative police responses to mental health crises on the streets, setting up a one-stop-shop mental health service center and the Office of Coordinated Care. City officials did launch alternative responses, but they have added only 147 out of the 400 beds planned and have not yet opened the service center.
“By creating strategic investments, by creating more capacity as well as coordinated care, we want to make the best use of resources,” Kunins said. “No doubt we will have to continue to tackle the needed expansions ... but we believe that we can still do so much more through this coordinated care approach.”
When the pandemic hit, the city got sidetracked from implementing many of these reforms even as street conditions worsened. The situation got so bad that Mayor London Breed declared a state of emergency over drug overdose deaths in the hard-hit Tenderloin.
The emergency let the city quickly implement pieces of Mental Health SF — cutting months-long bureaucracy to hire 200 health workers quickly and creating a linkage center to get people help, although very few of the people who've visited have gotten into drug or mental health treatment. Some of the quick hiring helped staff the new Office of Coordinated Care.
The city has already rolled out teams of mental health professionals to respond to 911 calls about mental health crises. A recent report showed most people in those interactions remained on the streets, but case managers have followed up in 79% of cases to try to get them into treatment or services in a pilot of how the new office will function.
But although care may be easier to access, the city still has too few treatment beds, and some in need of help reject it. Some local politicians are pushing to expand conservatorship, arguing that people on the streets who are too sick to understand their condition should be compelled into treatment.
Supervisor Hillary Ronen, one of the architects of Mental Health SF, said the coordinated care office is “at the heart” of the legislation.
“We have a lot of cuttingedge, amazing programs in San
Francisco. The problem is they don't work together,” Ronen said. “They don't speak together, and there's no one overseeing really sick patients who come in and out of these services.”
Ronen acknowledged that the city does not have enough treatment beds. But she said the coordinated care office should be able to help by providing data city officials can use to invest in the programs that will have the most impact.
“This is a long time coming and is essential for us to finally start to see and feel a difference on the streets of San Francisco,” Ronen said. “We can't see systemic change until this office is up and running. I am cautiously optimistic.”