Focus on a fix for mental health

There’s widespread political agreement in San Francisco that the city’s streetlevel mental health crisis needs urgent solutions. Although the city currently spends more than $360 million on behavioral health services, it’s struggling to provide permanent assistance to thousands of its most ill and vulnerable residents. Dr. Anton Nigusse Bland, the city’s director of mental health reform, has identified 4,000 San Franciscans who are suffering from a combination of severe mental illness, substance abuse, and homelessness and are “high users” of urgent and emergency psychiatric services.

There’s no way to solve this crisis without a dramatic overhaul of San Francisco’s fractured mental health care system.

Unfortunately, the political response to this crisis up until this point has been fractured as well.

San Francisco supervisors Matt Haney and Hillary Ronen have been working on Mental Health SF, a potential $100 million measure for the March 2020 ballot that would mandate huge changes to city services, including the creation of a street crisis team for mental health, a new drug sobering center, and the creation of a new office to help insured people access mental health care.

Haney, Ronen and Mayor London Breed have been at odds over this proposal.

Breed is particularly concerned that their plan would include immediate treatment for San Franciscans who already have private insurance.

So Breed has announced her own $200 million initiative, dubbed UrgentCareSF.

Breed’s plan includes new sobering centers, adding 800 new mental health treatment beds, acquiring some of the private boardandcare facilities that provide longterm mental health treatment but are struggling to stay open in a very expensive city, and hiring potentially hundreds of case workers and mental health care professionals to create individualized treatment plans and support for the 4,000 people identified by Nigusse Bland.

Breed does not want to put her plan on the ballot.

“My strong preference is to do this at the Board of Supervisors,” she said in a Tuesday Chronicle editorial board meeting.

But she said she would put her own plan on the ballot if she remains at impasse with Mental Health SF’s supporters.

Given the voter confusion that would result from dueling ballot measures — and the fact that there are great policy hazards that result from locking in a systemic overhaul via ballot measure — the best result would be for Breed, Haney and Ronen to come to an agreement.

Considering the scale of the problem, and the necessity for a rapid and coordinated response, this would also be the best result for the thousands of San Franciscans who are suffering from illness on the streets, and the hundreds of thousands of residents who no longer want to watch them suffer.

Even insured people find it difficult and expensive to access mental health care.

But the price tags for both of these plans are eyepopping, and furthermore, a massive revamp of mental health care provision will require additional costs in the form of new workers, new forms of outreach, and far more supportive housing to keep ill people stable and secure for the long term.

San Francisco’s focus needs to be on those who have the fewest resources to advocate for themselves.

A program that focuses on helping the city’s worstoff 4,000 would be the most humane, effective and financially prudent choice.