Summary
At least 25% of the Our City, Our Home (OCOH) Fund must be appropriated for mental health services, such as the purchase and operational costs of treatment beds, case management and treatment that follows individuals experiencing homelessness into housing, outreach services and other mental health programs targeted to people experiencing homelessness. Though the OCOH Fund ordinance uses the term “Mental Health” to describe this service area, the City uses the term “behavioral health” to encompass an array of mental health and substance use treatment and support services. During the two-year period of this report, Fiscal Year 2020-2021 (FY20-21) and Fiscal Year 2021-2022 (FY21-22), the City expended $42.2 million and served 7,195 clients through a portion of behavioral health residential treatment beds, assertive outreach services, and permanent supportive housing behavioral health and clinical services funded by OCOH. Expenditures supported the addition of 131 new treatment beds, increasing the behavioral health treatment bed inventory by 6% overall. Spending also added capacity in case management, assertive outreach and drop-in services. During the two-year period, the Department of Public Health (DPH) and the San Francisco Fire Department (FIR) delivered the services funded through the OCOH Mental Health service area.
Spending on Mental Health Programs
During FY20-21 and FY21-22, the City budgeted a total of $202.5 million in the OCOH Mental Health service area and expended $42.2 million during that timeframe. By the close of FY21-22, the City encumbered an additional $8.6 million in contracted services. Encumbered funds are obligated to a specific purpose, such as through a contract or grant, but not yet disbursed. When combined, the City spent or encumbered 35% of budgeted funding during the two-year period.
There are two types of costs within the Mental Health service area: acquisition and operating costs. Acquisition costs are related to the purchase of buildings and/or the rehabilitation of facilities to support OCOH-funded programming. Operating costs include personnel, contracts with service providers (including treatment bed providers), and other service delivery related expenses. A significant portion of the OCOH Mental Health service area budget ($130.3 million, 64%) has been appropriated for facility acquisition, though just $9.4 million had been expended or encumbered by the close of FY21-22. Financing for new facility acquisition can take time to implement. Though not yet encumbered through a contract, a majority of the Mental Health service area acquisition balance has been planned or reserved for specific acquisition projects where negotiation and financing is still underway.
The dashboard below aggregates a two-year budget inclusive of FY20-21 and FY21-22. The cards at the top of the dashboard show the total two-year budget for OCOH Fund Mental Health programs, the total amount expended in these programs during FY20-21 and FY21-22, and the amount of funding encumbered as of June 30, 2022. The bar chart in the dashboard below shows Mental Health expenditures associated with facility acquisition and program operation.
Mental Health: Budget, Expenditures, and Encumbrance
Data notes and sources
Data notes and sources
The two-year budget reflects a cumulative amount budgeted from July 1, 2020 through June 30, 2022, including all budget revisions during the two-year period. The OCOH Fund is a special fund which allows unexpended fund balances to carry forward into the following year automatically. The revised two-year budget includes the FY20-21 carry-forward balances; the revised budget also includes budget reductions made to account for revenue shortfalls during FY21-22.
Two-year expenditures reflect a cumulative amount expended from July 1, 2020 through June 30, 2022. Most OCOH funds were on reserve beginning July 1, 2020, with a portion of budgeted funds released from reserve as of December 16, 2020, and additional funds released from reserve in June 2021. Certain expenditures in FY20-21 occurred after December 16, 2020, though most expenditures occurred after June 2021.
This dashboard does not reflect reclassified General Fund advances of costs budgeted and expended prior to FY20-21. FY20-21 and FY21-22 financial data included in the dashboard was extracted from the City’s financial system after the close of the FY21-22 books and all adjustments related to the year-end close occurred.
During FY20-21 and FY21-22, the City spent $33.5 million of OCOH funding on the operation of mental health services. The City expended the largest portion of OCOH Mental Health funding on Assertive Outreach Services, with $14.2 million in expenditures over FY20-21 and FY21-22. Spending was impacted by program implementation timelines. Some mental health programs, like assertive outreach services, initiated during FY20-21, while others took more time to be planned, contracted, and implemented. The next section provides information about when OCOH-funded capacity was added to the system.
The dashboard below aggregates FY20-21 and FY21-22 budget and expenditures for Mental Health operating costs. Budget and expenditures for acquisition are excluded. The cards at the top of the dashboard show the total two-year budget for Mental Health operating costs, the total amount expended in these programs during FY20-21 and FY21-22, and the amount of funding encumbered as of June 30, 2022. The bar chart in the dashboard below shows the total two-year spending within each category of OCOH-funded Mental Health programs.
Mental Health: Operations Budget, Expenditures, and Encumbrance
Data notes and sources
Data notes and sources
The two-year budget reflects a cumulative amount budgeted from July 1, 2020 through June 30, 2022, including all budget revisions during the two-year period. The OCOH Fund is a special fund which allows unexpended fund balances to carry forward into the following year automatically. The revised two-year budget includes the FY20-21 carry-forward balances; the revised budget also includes budget reductions made to account for revenue shortfalls during FY21-22.
Two-year expenditures reflect a cumulative amount expended from July 1, 2020 through June 30, 2022. Most OCOH funds were on reserve beginning July 1, 2020, with a portion of budgeted funds released from reserve as of December 16, 2020, and additional funds released from reserve in June 2021. Certain expenditures in FY20-21 occurred after December 16, 2020, though most expenditures occurred after June 2021.
This dashboard does not reflect reclassified General Fund advances of costs budgeted and expended prior to FY20-21. FY20-21 and FY21-22 financial data included in the dashboard was extracted from the City’s financial system after the close of the FY21-22 books and all adjustments related to the year-end close occurred.
Implementation of Services and Capacity Added
During FY20-21 and FY21-22, the OCOH Fund supported the implementation of new services as well as the expansion of existing services, including the addition of 131 new treatment beds made available through OCOH funding. Service areas include Treatment Beds, Assertive Outreach, Drop-In Services, and Case Management and Clinical Services. See the Glossary at the end of the page for definitions of various programs and terms used here.
Acquisition and Rehabilitation of Treatment Facilities
In December 2021, the City purchased a building that will serve as a 16-unit crisis diversion center. The facility is undergoing renovations and necessary improvements in order to serve clients with short-term, urgent care interventions as an alternative to hospital care. Additionally, during FY21-22, the City used the OCOH Fund to make improvements to facilities necessary for operating OCOH-funded services, including the Office of Coordinated Care and the Drug Sobering Center.
Treatment Bed Expansion and Operation
The City used the OCOH Fund to add 131 treatment beds to its broader portfolio by June 2022, and during FY21-22, the City completed procurement for an additional 124 treatment beds scheduled to begin operations in FY22-23. The 131 treatment beds newly operating in FY21-22 span six program types (see the glossary at the end of this page for definitions of each program):
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Managed Alcohol Program: 10 beds added using OCOH funding
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12-month Rehabilitative Board and Care: 30 beds added using OCOH funding
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Locked Sub Acute Treatment (also known as Mental Health Rehabilitation Beds): 31 beds added using OCOH funding
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Psychiatric Skilled Nursing Facility: 13 beds added using OCOH funding
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Dual Diagnosis Transitional Care for people with justice involvement: 24 beds added using OCOH funding
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Residential Care Facility (also known as Board and Care): 23 beds added using OCOH funding
DPH produces a Behavioral Health Residential Treatment Bed Expansion dashboard to document a complete listing of treatment beds added to the system or under development, as well as planned opening dates. The dashboard reflects the current number of beds that have been added to the system including beds that have opened since the close of FY21-22. Note, the OCOH fund supports the majority of the new beds on the dashboard, but not all new beds being added to the system.
Assertive Outreach Services
The City began implementing new outreach teams designed to support individuals experiencing homelessness with acute behavioral health needs, including mental health and substance use crises, as early as January 2021. The City implemented the first Street Crisis Response Team in January 2021 and expanded to seven teams by the end of FY21-22. The City implemented two Street Overdose Response Teams during the two-year period. Other overdose prevention activities included supporting expanded access to medication for addiction treatment, contingency management, harm reduction, and related clinical support. The City also completed the expansion of behavioral health capacity among Street Medicine and Shelter Health teams by the end of FY21-22.
Drop-In Services
Using OCOH funds, the City expanded hours for the Behavioral Health Access Center’s pharmacy beginning in December 2021, and expanded the hours for the Behavioral Health Access Center itself as of June 2022. OCOH funding added clinical staffing for drop-in programs support youth and transgender clients experiencing homelessness.
Case Management and Clinical Services
The City implemented several OCOH-funded services in a pilot stage during the two-year period and increased services and staffing capacity over time. In January 2022, the City launched Permanent Housing Advanced Clinical Services (PHACS) at ten permanent supportive housing sites, and in May 2022 added ten additional sites. The 20 PHACS locations provide health care linkages to 2,400 households. The City implemented the Bridge and Engagement Services Team (BEST) to serve homeless clients leaving hospitals in January 2022, and launched care coordination services for priority populations in June 2022.
Clients Served
In FY20-21 and FY21-22, 7,195 cumulative clients received services in OCOH-funded mental health programs where data is available. Among three types of treatment beds (locked residential treatment, residential care facilities, and managed alcohol program), 139 unique clients received services. Two assertive outreach programs, the Street Crisis Response Team and the Street Overdose Response Team, served 6,791 cumulative clients. This includes clients who engaged with the program more than once during the reporting period. A program to deliver behavioral health and clinical services within permanent supportive housing sites served 265 unique clients. The City used OCOH funds for case management and drop-in programs as part of the OCOH Mental Health service area, but data on clients served in these programs was not available for this report.
The City used OCOH funds drawing from both the Mental Health and Homelessness Prevention OCOH service areas to fund the “Permanent Supportive Housing Behavioral and Clinical Health Services” program. However, information about clients served in this program is only included in the Mental Health section of this report. The Department of Public Health provides these services.
The cards at the top of the dashboard below show the number of clients served in each of the three mental health programs where data is available. The bar chart shows the number of clients served by mental health treatment bed type.
Unlike the other OCOH service areas where data is reported at the household level, Mental Health service area data is reported at the client level because the City provides mental health services at the client level.
Mental Health: Clients Served
Data notes and sources
Data notes and sources
This report includes treatment beds in facilities that received at least 20% of their funding from OCOH in FY20-21 and FY21-22. All clients served in those facilities during the reporting period are counted in this report. Clients may receive services in more than one mental health treatment facility type, and the sum of clients served by treatment facility type may be greater than the total number of unique clients served. The Department of Public Health used OCOH funds during the reporting year to support additional bed types beyond those reported here; these bed types and the clients served through those facilities have been excluded due to OCOH funds representing less than 20% of the overall DPH funding for the facility.
Client Outcomes
Many of the programs funded through the Mental Health service area are components of the Mental Health SF initiative administered by the Department of Public Health. Outcome data for new programs is limited as programs are still being established. Additionally, DPH is in the process of designing and gathering data to report on “Key Performance Indicators” (listed below) for Mental Health SF which will speak to outcomes for a large proportion of OCOH-funded programs and services. Key Performance Indicator data will be published by DPH as it becomes available.
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Housing: Increase the percentage of the Mental Health SF target population assessed for housing.
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Housing: Increase the percentage of the Mental Health SF target population who are placed in supportive housing.
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Routine Care: Increase the percentage of the Mental Health SF target population receiving routine health care.
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Routine Care: Increase the percentage of people receiving routine health care post 5150 discharge.
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Wait Times: Decrease wait times for intensive case management services.
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Wait Times: Decrease wait times for residential treatment beds.
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Overdose Response: Increase the amount of naloxone distributed in the community.
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Overdose Response: Increase the percentage of persons with opioid use disorders started on buprenorphine or methadone treatment.
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Overdose Response: Reduce the number of deaths due to overdose.
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Overdose Response: Reduce the disparity rates in deaths due to overdose.
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Quality of Life: Improve quality of life and functioning for persons in the Mental Health SF target population.
As noted above, two OCOH-funded assertive outreach programs for which data was available served 6,791 clients during the reporting period. These two programs produce monthly reports showing cumulative operational statistics and limited outcome information among the clients engaged through assertive outreach engagements.
The Street Overdose Response Team cumulative data shows that among the 1,670 emergency calls related to an overdose handled by the team since August 2021, 56 of them (3%) resulted in delivery of medication that is used in treatment of an opioid disorder. Data also shows that 683 clients accepted harm reduction supplies (41%).
The Street Crisis Response Team cumulative data shows that among the 5,508 client engagements conducted by the team during the reporting period, 52% resulted in follow-up with the client or a care provider by the Office of Coordinated Care.
Client Demographics
The City collects demographic data about the clients served in OCOH-funded mental health programs where data are available. Demographic categories include race and ethnicity, age, gender identity, and sexual orientation. Demographic data is unduplicated.
Race and ethnicity was unknown for about half of clients served. Among clients where race and ethnicity was recorded, 1,340 identified as white, 825 identified as Black of African American, and 363 identified as Hispanic or Latino/a.
Two thirds of clients served in OCOH-funded mental health programs are between ages 25 and 54.
Most clients identified as male.
Data about clients’ sexual orientation was only available for clients served in mental health treatment beds. About half of clients identified as straight or heterosexual. Sexual orientation was unknown for about half of clients served.
Client Demographics: Race and Ethnicity
The following dashboard shows the race and ethnicity of clients served through OCOH-funded Mental Health programs during FY20-21 and FY21-22, where data was available.
Mental Health: Client Race and Ethnicity
Data notes and sources
Data notes and sources
Race and ethnicity are reported together in the same visuals because DPH collects data on client race and ethnicity together in one question.
Demographic groups with fewer than ten clients are reported as “<10” in the table and with a grey bar in the graph reflecting the number 10. Fewer than 10 households served in mental health programs identified as trans female, genderqueer or gender non-binary, other, or trans male.
Client Demographics: Age
The following dashboard shows the age range of clients served through OCOH-funded Mental Health programs during FY20-21 and FY21-22, where data was available.
Mental Health: Client Age
Client Demographics: Gender Identity
The following dashboard shows the gender identity of clients served through OCOH-funded Mental Health programs during FY20-21 and FY21-22, where data was available.
Mental Health: Client Gender Identity
Data notes and sources
Data notes and sources
Male, Female, or Unknown were the only gender identity options for the Street Crisis Response Team, an assertive outreach program.
Demographic groups with fewer than ten clients are reported as “<10” in the table and with a grey bar in the graph reflecting the number 10. Fewer than 10 households served in mental health programs identified as trans female, genderqueer or gender non-binary, other, or trans male.
Client Demographics: Sexual Orientation
The following dashboard shows the sexual orientation of clients served through OCOH-funded Mental Health programs during FY20-21 and FY21-22, where data was available.
Mental Health: Client Sexual Orientation
Data notes and sources
Data notes and sources
Data about clients’ sexual orientation was only available for clients served in mental health treatment beds.
Demographic groups with fewer than ten clients are reported as “<10” in the table and with a grey bar in the graph reflecting the number 10. Fewer than 10 households served in mental health programs identified as bisexual, gay, lesbian, or same gender loving, other, or questioning or unsure.
Glossary
The glossary provides definitions for certain terms and program names used on this page.
Acquisition
Funds set aside for a capital purchase, e.g., buying and/or renovating a building to serve as housing, a treatment facility, or services site.
Encumbrance
Funds obligated to a specific purpose (e.g., under contract or grant), but not yet disbursed.
Treatment Beds
Beds accommodating in-patients receiving behavioral health care. There are six type of treatment beds that expended or encumbered OCOH funding in FY20-21 and FY21-22, which are defined as follows:
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Managed Alcohol Program treatment beds provide medical care to decrease withdrawal symptoms and allow the patient to rest in a safe environment.
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Residential Care Facility (also known as Board and Care) is a supervised residential program for individuals with mental health issues who require assistance with daily living activities, including meal preparation, medication monitoring, or personal care, but do not need daily acute medical care.
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12-month Rehabilitative Board and Care is similar to a Residential Care Facility as a supervised residential program, but with a transitional care model providing more intensive mental health and treatment support, such as for people who are conserved.
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Locked Sub Acute treatment beds serve individuals who need around-the-clock, close supervision and support by behavioral health staff to ensure the individual takes prescribed medication and receives support services.
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Psychiatric Skilled Nursing Facility beds provide 24-hour inpatient care in a licensed health facility or hospital and include physician, skilled nursing, dietary, and pharmaceutical services, and an activity program.
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Dual Diagnosis Transitional Care are treatment beds that provide transitional care for people in contact with the criminal justice system with a dual diagnosis of mental health and/or substance use issues.
Assertive Outreach Services
Programs designed to support individuals experiencing homelessness with acute behavioral health needs, including mental health and substance use crises.
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Street Crisis Response Teams (SCRT) provide rapid, trauma-informed response to calls for service to people experiencing crisis in order to reduce law enforcement encounters and unnecessary emergency room use.
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Street Overdose Response Team (SORT) responds to people immediately after an overdose, and again within 72-hours, to connect people to care and treatment. Support may include lifesaving naloxone, medication assisted therapy, supportive counseling, and guidance getting substance use treatment, housing, or shelter.
Case Management
Among mental health programs, case management includes supportive services provided by a professional social worker who assesses the client’s needs and arranges, coordinates, and advocates for various services to meet those needs. Additionally, OCOH funds support care management and transition support services to provide equitable and low-barrier access to behavioral healthcare and seamless transitions between systems and levels of care.
Drop-In Services
Mental services available without an appointment on a walk-in basis.
Crisis Diversion
Provides short-term, 24/7 urgent care interventions as an alternative to hospital care targeted to people experiencing homelessness, including crisis care for mental health, substance use disorder treatment, and healthcare in one location with linkage to case management and residential treatment and care.
Return to the OCOH Fund Annual Report Table of Contents to view other sections of the report.