Part of OCOH Fund Annual Report FY22-23

OCOH Fund Annual Report FY22-23: Mental Health

Sections

OCOH Service Areas

This page provides information about the Permanent Housing service area. Use the links below to navigate to other OCOH Fund service area pages. 

|     Executive Summary      |      Permanent Housing      |       Mental Health      |

|      Homelessness Prevention    |     Shelter and Hygiene    |     Table of Contents   |  

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 Fiscal Year 2022-2023 (FY22-23), the City expended $61 million and served 8,686 clients through behavioral health residential treatment beds, assertive outreach, case management, drop-in services, and overdose prevention and substance use treatment services. Expenditures supported the addition of 170 new residential care and treatment beds, as well as expanded service capacity among several case management, substance use treatment, and assertive outreach programs. The Department of Public Health (DPH) and the San Francisco Fire Department delivered the services funded through the OCOH Mental Health service area.

Spending on Mental Health Programs

Over the three years of the Fund, the City budgeted a total of $236.5 million on Mental Health programming and expended $103.2 million during that timeframe. By the close of FY22-23, the City had a remaining balance of $133.2 million that will carry forward for programming in FY23-24 and beyond.

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 expenses related to service delivery. A significant portion of the OCOH Mental Health service area budget ($130.6 million, 55%) has been appropriated for facility acquisition, with a total of $10.2 million expended by the close of FY22-23. 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 the three-year budget for the Mental Health service area inclusive of FY20-21, FY21-22, and FY22-23 (FY21-FY23). The cards at the top of the dashboard show the cumulative revised budget for OCOH-funded Mental Health programs, the total amount expended in these programs in the three-year period, and remaining balance as of June 30, 2023. The bar chart in the dashboard below shows the total spending for Mental Health acquisition and operations for each fiscal year.

Data notes and sources

Data notes and sources

The OCOH Fund is a special fund which allows unexpended fund balances to carry forward into the following year automatically. The cumulative budget includes prior-year carry-forward balances as well as any budget reductions made to account for revenue shortfalls during the three-year period.

The financial data included in the dashboard was extracted from the City’s financial system after the close of the FY22-23 books and all adjustments related to the year-end close occurred.

During FY22-23, the City spent $58.6 million of OCOH funding on the operation of Mental Health services. Expenditures increased from year to year in the three-year period for each of the program types in this service area, as seen in the dashboard below. The City expended the largest portion of OCOH Mental Health funding on Assertive Outreach services (see next section for a description of this and other programs).

The dashboard below displays the expenditures for operating costs within the Mental Health service area for the three years of the Fund (budget and expenditures for acquisitions are excluded from the dashboard below). The bar chart provides the total spending within each OCOH-funded Mental Health program by fiscal year.

Data notes and sources

Data notes and sources

 

The OCOH Fund is a special fund which allows unexpended fund balances to carry forward into the following year automatically. The cumulative budget includes prior-year carry-forward balances as well as any budget reductions made to account for revenue shortfalls during the three-year period.

The financial data included in the dashboard was extracted from the City’s financial system after the close of the FY22-23 books and all adjustments related to the year-end close occurred.

Implementation of Services and Capacity Added

During FY22-23, the OCOH Fund supported the implementation of new services as well as the expansion of existing services, including the addition of 170 new residential care and treatment beds made available through OCOH funding. Mental Health programs include Treatment Beds, Assertive Outreach, Drop-In Services, Case Management, and Overdose Prevention and Substance Use Treatment Services. See the Glossary at the end of the page for definitions of various programs and terms used here. 

Treatment Bed Expansion and Operation

The City used the OCOH Fund to add 170 residential care and treatment beds to its broader portfolio by June 2023. The capacity added in FY21-22 and FY22-23 resulted in a total of 301 residential care and treatment beds supported by the OCOH Fund.

The dashboard below shows the number of treatment beds added using OCOH Funds during FY21-22 and FY22-23. The cards at the top provide a total count of beds supported by the OCOH Fund by year-end and the capacity added in FY22-23 specifically. The bar chart shows the number of treatment beds added by program type in both FY21-22 and FY22-23.

Data notes and sources

Data notes and sources

Mental Health Treatment Beds is a wider category of residential care and treatment that includes the following bed types: Locked Sub-Acute Treatment (LSAT), Psychiatric Skilled Nursing Facility (PSNF), Residential Care Facility (also known as Board and Care), and Cooperative Living for Mental Health (Co-op).

Substance Use Treatment Beds is a wider category of residential care and treatment that includes the following bed types: Drug Sobering Center, Residential Step-Down, Justice-Involved Transitional Dual Diagnosis, and the Managed Alcohol Program (MAP).

Assertive Outreach

The City continued operations for several outreach teams designed to support individuals experiencing homelessness with acute behavioral health needs, including mental health and substance use crises. The City consolidated the Street Crisis Response Team (SCRT) with other City-operated street teams into an expanded team led by the Fire Department designed to respond to a comprehensive array of behavioral health crisis calls and wellness checks. With this change, DPH transitioned its role within the City's street response system to expand intermediate and longer-term follow-up care through the Office of Coordinated Care, described in the Case Management Services section below.

The City continues to operate the Street Overdose Response Team (SORT) as a partnership between DPH and the Fire Department, which engages clients after a non-fatal responses to suspected overdose. Within this program, team members assess situations, administer life-saving medication where appropriate, stabilize and engage clients, provide harm reduction supplies, start clients on medication to treat opioid use disorder, and connect clients to Street Medicine providers for follow-up engagement.

The City also continued to offer expanded mobile medical and behavioral health services for people experiencing homelessness via the Street Medicine teams.

Case Management Services

The Office of Coordinated Care provides focused services for priority populations needing engagement and connections to behavioral health care. The OCOH Fund supports the centralized assessment of clients referred from system partners, including hospitals, crisis services, the City’s street response system, and Jail Health Services. It also supports several follow-up teams that engage and connect clients to care. Among these are the Bridge and Engagement Services Team (BEST), the Shelter Behavioral Health Team, and BEST Neighborhoods.

Beyond the Office of Coordinated Care, the City is expanding case management services in its behavioral health system of care through Mobile Outreach Teams and patient navigators who are being hired at outpatient mental health and substance use clinics to keep clients engaged in ongoing care. Additionally, in FY22-23, the OCOH Fund added resources to support staffing and expand capacity at four intensive case management and acute linkage programs.

The City continued operating the Permanent Housing Advanced Clinical Services (PHACS) program, which now provides both physical and behavioral health services at 66 permanent supportive housing sites. This includes mobile health care, case management and on-site consultations through integrated teams of medical and behavioral health providers, as well as linkages to services.

Drop-In Services

The OCOH Fund sustained extended hours at the Behavioral Health Access Center (BHAC) and the Behavioral Health Services (BHS) Pharmacy to include evenings and weekends. BHAC is an entry point into the substance use and mental health system of care. Staff members can assess clients and link them to outpatient services, specialty behavioral health services, and residential treatment. Using the OCOH Fund, the BHS Pharmacy also continued buprenorphine deliveries in permanent supportive housing and urgent care.

From June to December 2022, the City used the OCOH Fund to support operations of the Tenderloin Center (TLC). Several City departments delivered services at the TLC, including DPH, HSH, the Human Services Agency, and the Adult Probation Department. Over its period of operation, the TLC saw a total of 124,100 cumulative daily guests (view the TLC dashboard for more information).

Overdose Prevention and Substance Use Treatment

In FY22-23, the City implemented several Overdose Prevention and Substance Use Treatment services to expand the continuum of services for clients at risk of overdose, a goal of the City’s 2022 Overdose Prevention Plan. Strategies include improving access to medications for addiction treatment, expanding contingency management (a behavioral therapy using incentives to reinforce positive behavior),  extending service hours for critical substance use disorder clinics and increasing the distribution of naloxone to reverse overdoses.

Clients Served

In FY22-23, programs served a total of 8,686 clients and delivered 11,735 client engagements within OCOH-funded Mental Health programs.

Assertive Outreach programs operated by the San Francisco Fire Department report engagements, which are typically one-time, low-barrier interactions with individuals in crisis. Programs may or may not gather identifying details about the individuals served through engagements. As such, engagements from Assertive Outreach teams administered by the Fire Department have been pulled out as a separate measure of service in the data below.

DPH-operated Assertive Outreach programs served over 3,000 clients, the largest count of clients among OCOH-funded Mental Health programs. The expansion of residential care and treatment bed capacity supported more than 2,000 clients, and nearly 1,500 clients received case management services.   

The cards at the top of the dashboard below show the total number of clients served and the total number of client engagements for OCOH-funded Mental Health programs during FY22-23. The bar chart shows the number of clients served through each category of OCOH-funded programs.

Unlike the other OCOH Fund 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 behavioral health services at the client level.

Data notes and sources

Data notes and sources

This report includes clients in residential treatment facilities that received at least 20% of their funding from the OCOH Fund in FY20-21 and FY21-22. All clients served in those facilities during the reporting period are counted in this report. The City used the OCOH Fund during the reporting year to support additional facilities beyond those reported here; the clients served through those facilities have been excluded due to the OCOH Fund representing less than 20% of the overall City funding for the facility.

The number of clients served was un-duplicated within each program, but not across all Mental Health programs. Clients may receive services in more than one program. The sum of clients served by program may be greater than the total number of unique clients served. Some Mental Health programs that received OCOH Fund support in FY22-23 are still developing data systems and workflows to report on the number of clients served.

The City used OCOH funds drawing from both the Mental Health and Homelessness Prevention OCOH service areas to fund the “Permanent Housing Advanced Clinical Services (PHACS)” 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.

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. The FY21-22 OCOH Fund Annual Report acknowledged that DPH was in the process of designing and gathering data to report on “Key Performance Indicators” for Mental Health SF which would speak to outcomes for a large proportion of OCOH-funded programs and services.

In 2023, DPH published a collection of dashboards showing trends in drug overdoses and substance use services in San Francisco. These correspond to four of the Mental Health SF Key Performance Indicators. Through FY23-24, DPH will publish additional Mental Health SF Key Performance Indicators and other outcome data.

The OCOH Fund supports expanded capacity for some substance use services, such as medications to treat opioid use disorder and step-down housing for patients exiting residential substance use treatment. Other OCOH-funded investments aim to increase engagement in substance use services but are not directly tracked on the dashboards.

DPH has also provided certain operational data related to selected programs with relevant data available. For example, the PHACS program, which is grouped in the case management program category, provided behavioral health and clinical services to clients living in 66 permanent housing sites in FY22-23.

DPH publishes a monthly report on client engagements and outcomes for the Street Overdose Response Team (SORT) and the Post Overdose Engagement Team (POET), which are programs in the Assertive Outreach category. In FY22-23, SORT responded to 997 calls that included an overdose, 809 clients accepted harm reduction supplies, and 81 calls included in a buprenorphine start. Buprenorphine is a medication that is used to treat opioid use disorder by preventing withdrawals and reducing cravings. Both SORT and POET’s providers administer buprenorphine to clients. 

The Street Crisis Response Team publishes a monthly report on client engagements, outcomes, and Office of Coordinated Care follow-up. Since the March 2023 reconfiguration of SCRT, this report has been published by the Department of Emergency Management using data collected by the San Francisco Fire Department and DPH.

Client Demographics

The City collects demographic data about the clients served in OCOH-funded Mental Health programs where data is available. Demographic categories include race and ethnicity, age, gender identity, and sexual orientation. Demographic data is unduplicated within each program.

Approximately one-third of clients served in OCOH-funded Mental Health programs identify as White, with clients identifying as Black or African American making up the next largest category, at about 25%.

Over 2,100 clients were age 35 to 44, representing the largest age category, with younger clients aged 25 to 34 making up the next largest group. Nearly two-thirds of all clients served by Mental Health programs identify as male. Most clients identified as straight or heterosexual, with a large number of clients with unknown sexual orientation in the data.

Client Demographics: Race and Ethnicity 

The following dashboard shows the race and ethnicity of clients served through OCOH-funded Mental Health programs during FY22-23, where data was available. 

Data notes and sources

Data notes and sources

Race and ethnicity are reported in the same visuals to align with DPH guidelines on reporting client race and ethnicity together. No demographic data is available for clients served in Overdose Prevention and Substance Use Treatment programs, and these clients are excluded from this dashboard. 

Client Demographics: Age

The following dashboard shows the age range of clients served through OCOH-funded Mental Health programs during FY22-23, where data was available.  

Data notes and sources

Data notes and sources

No demographic data is available for clients served in Overdose Prevention and Substance Use Treatment programs, and these clients are excluded from this dashboard. Residential Step-Down treatment beds use different categories for age and therefore, some data from this program is excluded from this dashboard.   

Client Demographics: Gender Identity

The following dashboard shows the gender identity of clients served through OCOH-funded Mental Health programs during FY22-23, where data was available. 

Data notes and sources

Data notes and sources

No demographic data is available for clients served in Overdose Prevention and Substance Use Treatment programs, and these clients are excluded from this dashboard.  

Client Demographics: Sexual Orientation

The following dashboard shows the sexual orientation of clients served through OCOH-funded Mental Health programs during FY22-23, where data was available. 

Data notes and sources

Data notes and sources

No demographic data is available for clients served in Overdose Prevention and Substance Use Treatment programs, and these clients are excluded from this dashboard. Not all treatment bed programs collected sexual orientation data, and clients in these select programs are excluded from this dashboard.

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.

Allocated Costs

This term refers to an allocated proportion of the cost to administer the services funded by OCOH, including information technology, human resources, database and data management, finance and administration and other program supports. In most cases, the OCOH Fund is not the only source of funding for programs described here, and the allocation of administrative costs to run these programs accounts for mixed sources.

Assertive Outreach Services

Programs designed to support individuals experiencing homelessness with acute behavioral health needs, including mental health and substance use crises.

  • Street Crisis Response Team (SCRT) provides rapid, trauma-informed response to people experiencing a behavioral health crisis to reduce law enforcement encounters and unnecessary emergency room use.
  • 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 naloxone to reverse overdoses, medication for opioid use disorder, supportive counseling, and guidance getting substance use treatment, housing, or shelter.

Case Management

Among behavioral health programs, case management includes supportive services provided by a social worker or peer counselor who assesses the client’s needs and arranges, coordinates, and advocates for various services to meet those needs. The OCOH Fund supports case 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

Behavioral health services available without an appointment on a walk-in basis.

Overdose Prevention and Substance Use Treatment

The expansion of Overdose Prevention services is guided by the City’s 2022 Overdose Prevention Plan to increase the availability and accessibility of the continuum of substance use services for clients at risk of overdose. Programs receiving support from the OCOH Fund in FY22-23 include:

Treatment Beds

Beds accommodating patients receiving behavioral health care. There are eight types of residential care and treatment beds that expended OCOH funding in FY22-23, which are defined as follows:

  • Mental Health Treatment Beds
    • 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.
    • 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.
    • Residential Care Facility (also known as Board and Care) beds provide 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.
    • Cooperative Living for Mental Health programs provide small-site housing (e.g., an apartment or shared home) paired with mental health treatment services.
  • Substance Use Treatment Beds
    • Drug Sobering Center (SoMa Rise) is a 24/7 program for people experiencing homelessness with drug intoxication, providing short-term stays and linkage to services.
    • Residential Step-Down beds provide a sober living environment for clients coming out of residential treatment programs.
    • Justice-Involved Transitional Dual Diagnosis (Minna Project) 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.
    • Managed Alcohol Program beds provide medically supervised care for people with chronic alcohol dependency.