Treatment beds added, but many go unused
Staff shortages limit care for those with mental health, drug issues
Despite San Francisco expanding its capacity to care for those struggling with mental health issues and drug addiction, dozens of treatment beds are routinely sitting empty.
San Francisco over the past three years has added about 350 mental health and addiction treatment beds, marking a 16% jump in capacity and bringing the city’s total to about 2,550 beds. But from July through December 2023, the city estimates that 15%-20% of its short-term residential mental health beds went unused because of staffing shortages, according to a new report from the Department of Public Health.
At the request of Supervisor Rafael Mandelman, the health department on Wednesday provided an update to the Board of Supervisors’ Budget and Finance Committee on San Francisco’s treatment bed expansion plan. The numbers land amid a nationwide staffing crisis for mental health professionals and as San Francisco continues to try to tackle its long, byzantine hiring process. Mandelman, who said he’s been waiting over a year for the status report, worries the city may be “losing the benefit of any expansion.”
“Is it a real expansion if the beds aren’t staffed and you can’t use them?” he asked a reporter.
In 2019, the Chronicle found the city had a problem with unused addiction and mental health beds throughout the system due to a variety of issues and that officials decided to keep beds empty at a critical mental health facility because of safety issues. After the Chronicle re
porting, Mayor London Breed and her health officials vowed to address the problems.
Recent efforts by state and local leaders to compel more people into treatment stand to exacerbate the problem. Breed, who is campaigning for her reelection, has been a vocal proponent of a new law that expands involuntary commitment of people with severe mental illness. She also introduced a March ballot measure to mandate that San Francisco welfare recipients undergo drug screening and enroll in a free treatment program if they’re a user.
The health department in 2019 identified nearly 4,000 San Franciscans who were homeless and diagnosed with mental health and substance use disorders.
When Breed announced a new plan in 2021 to add 400 new treatment beds for San Franciscans in need, she said she was “responding with the urgency that this crisis deserves.” The city has added about 350 beds since then and lost at least 60 beds due to closures and contract terminations, according to the health department.
Of the total 2,551 beds, DPH contracts for use of about 470 beds that are outside San Francisco, or about 19% of total beds.
Dr. Hillary Kunins, director of San Francisco’s Behavioral Health Services, said the city is taking several steps to address staffing challenges, including using more efficient hiring practices and creating better workforce pipelines with local unions. The San Francisco Controller’s Office is also conducting a staffing analysis of the health department.
Wednesday’s update on the city’s behavioral health beds came nearly four years after the city analyzed and produced recommendations for improving the flow of patients through its behavioral health system. The goal of that study was to match the city’s bed supply with the demand of services across its system.
Some of the greatest areas of need identified in 2020 remain a problem today, including locked facilities that provide treatment services for people diagnosed with serious psychiatric conditions.
The 2020 analysis found that the health department needed to add 31 beds at those facilities to meet demand. As of Wednesday’s update, the city estimates it could require up to 95 more of those beds. It was not immediately clear whether the city had added the previously recommended beds.
“The department needs to look more closely at what they’re doing,” Mandelman said, adding that it seems the agency may be “basically running in place.”
Breed introduced legislation earlier this year in hopes of making it easier to procure such beds. Kunins said the new city policy will improve San Francisco’s chances of claiming more beds in locked facilities. San Francisco is forced to compete with neighboring jurisdictions for many of those beds, which are outside the county.
Mark Salazar, president of the Mental Health Association of San Francisco, understands the limited use of locked beds but is an opponent of the expansion of forced treatment, arguing it’s a “misallocation of resources.”
“The idea that you just build things and people will come is a bit ludicrous,” he said. “We can’t even get treatment and support to folks who are seeking them on a voluntary basis right now.”
During the hearing Wednesday, supervisors grilled Kunins on DPH’s data collection methods, its strategy for coordinating care for people dealing with substance use and mental illness, and the department’s role in improving difficult street conditions. Supervisors also again flagged the shortage in social workers and behavioral health staff as key to ensuring providers have adequate treatment capacity.
Mandelman called San Francisco a city with “great programs and miserable systems” in part because the city takes on innovative approaches — like sobering centers — but doesn’t have enough behavioral health beds.
“The 2020 report said San Francisco has a problem, and four years later, we’re having the same conversation, which is frustrating,” said Mandelman.
Mandelman said he is happy to see that the city has brought some new beds, but DPH needs to do a better job of tracking the numbers of beds it’s losing including for people who require more care than is offered in permanent supportive housing. Meanwhile, Supervisor Hillary Ronen highlighted that the city is “moving in the right direction” by focusing on how people get into treatment, how they’re tracked, how the providers coordinate and how the city can get them back into the system when they leave treatment programs.
But Ronen expressed frustration at the number of people on the streets who are not in treatment.
“We see the work you’re doing, which is all moving in the right direction, but then we have examples of people who are languishing on the street or continue to do the hamster wheel of street to services to jail to street,” Ronen said, adding that the health department’s recently formed Office of Coordinated Care is “supposed to have control over that.”