Mental Health Overview
At least 25% of the Our City, Our Home (OCOH) Fund must be appropriated for behavioral health services targeted to people experiencing homelessness. According to the OCOH Fund ordinance, this includes the purchase and operational costs of treatment beds, outreach services, case management, and behavioral health treatment programs for people experiencing homelessness. Many of these services continue to follow clients once they are placed into a housing program. City departments have established an array of programs aligned to the eligible categories of services included in the ordinance.
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.
Data notes and sources
Data notes and sources
Clients Served
The City provides behavioral health services at the client level, which differs from other OCOH fund service areas where data are reported at the household level.
This report includes clients in residential treatment facilities that received at least 20% of their funding from the OCOH Fund. 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 are still developing data systems and workflows to report on the number of clients served.
Case Management
Homelessness Prevention funds were used to support a portion of programming related to delivering behavioral health and clinical services in permanent supportive housing (included within the “Case Management” category across OCOH Fund dashboards). While the Homelessness Prevention portion of the funding is reported in those financial dashboards, information about capacity, clients served, and outcomes from this program are reported within the “Case Management” category in the Mental Health service area.
Assertive Outreach Services
Assertive Outreach Services includes the following programs: Street Medicine that is provided through SFDPH, as well as the Street Crisis Response Team (SCRT) and Street Overdose Response Team (SORT) that are delivered through the City’s Fire Department. The Fire Department previously reported on Assertive Outreach services by the number of “engagements” in FY23. In FY24, SCRT and SORT began collecting unique “client” counts. Client counts and demographic data are now available for these programs in this year’s report.
Treatment Bed Capacity Added
DPH added 56 treatment beds in FY24 and stopped supporting 20 beds due to the planned wind-down of a pilot project, for a net 36 new units supported by the OCOH Fund.
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, and the Managed Alcohol Program (MAP).
Justice-Involved Treatment Beds is a wider category of transitional housing and treatment that includes the following bed types delivered through the partnership of SFPDH and the San Francisco Adult Probation Department (APD): Minna Project and Health Evolving Radiant (HER) House.
Please visit the Glossary for additional terms and definitions.
The following program names were shortened in the chart visual:
- Overdose Prevention & Substance Use Treatment = Overdose Prevention
During Fiscal Year 2023-2024 (FY24):
- The City expended $74.2 million within the Mental Health service area. This represents a 22% increase from the prior year and demonstrates further implementation of funded programs since FY23.
- Due to new availability of client data from the SFFD’s assertive outreach programs and broader implementation of DPH’s services, Mental Health programs reached 18,383 clients in FY24 (112% increase from FY23).
- Expenditures supported 331 total treatment beds for Mental Health programs with 36 new units added in FY24.
The Department of Public Health (DPH), the San Francisco Fire Department (SFFD), and the Adult Probation Department (APD) delivered the programs included in the OCOH Fund Mental Health service area.
FY24 Implementation Updates
Treatment Beds
- The OCOH Fund supported 331 total residential care and treatment beds in FY24, a 12% increase over the number of beds supported by the OCOH Fund in FY23.
- APD launched 28 justice-involved treatment beds at HER House, a therapeutic residence for justice-involved women.
- DPH added 28 new substance-use treatment beds in the residential step-down (or “recovery housing”) program on Treasure Island. Since FY23, DPH added a total of 70 new beds in this category.
- DPH wound down a pilot project for out-of-county rehabilitative residential care facility (board & care) services, leading to a reduction of 17 beds.
- 2,320 total clients received care through a behavioral health treatment bed program in FY24, a 12% increase from FY23.
Assertive Outreach
The OCOH Fund supports outreach teams engaging with individuals experiencing homelessness with acute behavioral health needs. Programs in this category include the Street Crisis Response Team (SCRT) and the Street Overdose Response Team (SORT), which are operated by SFFD, and an expanded behavioral health focus within the Street Medicine program, which is operated by DPH. See the glossary for a more detailed description of these programs.
- Assertive Outreach programs served 9,298 clients in FY24.
- In prior years, SFFD only reported on encounters for SCRT and SORT and did not report on clients served. In FY24, SORT and SCRT reported serving 5,980 clients within the total client population of assertive outreach programs.
Case Management
The Case Management category includes funding for the Office of Coordinated Care and the Permanent Housing Advanced Clinical Services (PHACS) program.
- Across both programs, Case Management programs served 3,934 clients in FY24. This represents a 173% increase over FY23, when OCOH Fund Case Management programs served 1,440 clients.
- 2,967 clients connected with case management services through the Office of Coordinated Care in FY24.
- The Office of Coordinated Care expanded to include the Shelter Behavioral Health and BEST Neighborhoods outreach teams in FY24 and implemented a new centralized data collection system to support future reporting on these services.
- PHACS provides healthcare and linkage services to residents in permanent supportive housing.
- In FY24, the program expanded to serve all site-based permanent supportive housing (approximately 7,000 units) and served 967 clients.
Overdose Prevention and Substance Use Treatment
Overdose Prevention programs enable clients to receive medication, treatment, and resources to treat opioid use disorder through targeted services at community clinics, Zuckerberg San Francisco General Hospital and the Behavioral Health Service Pharmacy.
- These programs served 1,049 clients in FY24.
- DPH does not yet provide structured outcome data that can be reported on consistently across OCOH Fund programs in the Mental Health service area. However, the department provides certain selected outcome measures related to specific services. DPH publishes a collection of dashboards showing trends in drug overdoses and substance use services in San Francisco, which are updated on a regular basis.
Drop-In Services
The OCOH Fund enables the Behavioral Health Access Center (BHAC) and the Behavioral Health Services (BHS) Pharmacy, both located at 1380 Howard Street, to offer extended hours (weekday evenings and weekends). BHAC links clients to outpatient services, specialty behavioral health services, and residential treatment. The BHS Pharmacy fills prescriptions for behavioral health clients, including dispensing medication for opioid treatment. BHS pharmacists also deliver medications to permanent supportive housing residents and urgent care clinics.
- BHAC and the BHS Pharmacy served 1,782 clients during the extended hours.
- Another drop-in program, the Community Living Room, provided overdose prevention education, on-site case management, and health services.
- This program only reported on encounters in FY24, not clients served. The Community Living Room recorded 41,050 encounters in FY24.
Client Demographics
Data notes and sources
Data notes and sources
Department of Public Health (DPH) was unable to report on demographics for Overdose Prevention & Substance Use Treatment programs.
Race and Ethnicity
Programs delivered by the Fire Department and Adult Probation Department offered clients a multiracial category as an option.
DPH clients may select multiple race/ethnicity categories to describe their race/ethnicity, and DPH does not offer a multiracial category as an option. However, current DPH reporting templates only provide a single race/ethnicity selection for clients even if a client selects multiple races/ethnicities; therefore, multiracial data for DPH programs is not available for this report.
Gender Identity
Heads of households who identify as Questioning or Non-Binary are coded in the Genderqueer or gender non-binary category.
The following gender categories are combined in Unknown: Other, Choose not to disclose, Unknown, Not listed, Decline to answer.
Age
Residential Step-Down treatment beds use different categories for age. In these instances, age data from these programs has been excluded.
Sexual Orientation
Not all treatment bed programs collected sexual orientation data, and clients in these select programs are excluded from this dashboard. In addition, assertive outreach programs managed by the Fire Department, Street Crisis Response Team and SORT, do not collect sexual orientation data on clients.
The following sexual orientation categories are combined in Data not collected: Questioning/Unsure, Other/Not Listed, Not Listed, Other, Missing data, Decline to answer, Data not collected, and Prefers not to answer.
The City collects demographic data about the clients served through OCOH-funded Mental Health programs where data is available. Demographic categories include race and ethnicity, age, gender identity, and sexual orientation.
DPH demographic data only provides a single race and ethnicity, even if clients have selected more than one race. Therefore, multiracial data is currently not available from DPH. DPH’s multiracial clients may appear under another race or ethnicity category. However, data from other departments included in this category, such as SFFD, does contain a multiracial category option.
DPH was unable to report on demographics for Overdose Prevention & Substance Use Treatment programs. Not all programs collected sexual orientation data. See the Data Notes for additional details.
- 42% of clients served in OCOH Fund Mental Health programs identify as White, with clients identifying as Black or African American making up the next largest category, at 25%.
- Programs served over 5,000 clients in the 35 to 44 age range, representing 29% of clients served. Younger clients aged 25 to 34 represented the next largest age group, with 23% total clients in this category.
- Two-thirds of all clients served by Mental Health programs identified as male and 30% as female.
- Most clients identified as straight or heterosexual at 62%, while 30% identified under one of the following categories: Data not collected, Questioning / Unsure, or Other / Not listed.
Spending on Mental Health Programs
Data notes and sources
Data notes and sources
balances as well as any budget reductions made to account for revenue shortfalls.
The financial data included in the dashboard was extracted from the City’s financial system after the close of the fiscal year books and all adjustments related to the year-end close occurred.
Mental Health
Mental Health acquisition funds are reserved for behavioral health acquisition, renovation, and construction projects. Although the remaining acquisition fund balance at the end of June 2024 was $83.2 million, approximately $28.7 million has already been reserved for projects that are in the planning, permitting, or construction process:
- DPH transferred Mental Health acquisition funds to San Francisco Public Works (DPW) for the construction of the Crisis Stabilization Unit (CSU) at 822 Geary Street. As of June 2024, there was $10.9 million remaining in the CSU construction budget, which DPW expects to fully expend in FY25.
- After the end of FY24, DPH used acquisition funds to purchase a 56-bed residential care facility, 624 Laguna Street, for $13.8 million.
- DPH has reserved $4.0 million in acquisition funds for the future maintenance needs of facilities purchased using one-time OCOH funds.
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.
The dashboards aggregate the prior four fiscal years of budget and expenditures for the Mental Health service area (FY21-FY24). The cards at the top of the dashboard show the cumulative expenditures for OCOH-funded Mental Health programs and the total amount expended in these programs FY24.
- The City budgeted a total of $294.5 million in this service area over the four-year period.
- As City Departments implemented service offerings aligned with the voter-approved ordinance, expenditures increased 22% from $61 million in FY23 to $74.2 million in FY24.
- The remaining balance of approximately $117 million carried forward for programming in FY25 and beyond. This balance will be used to support one-time building acquisitions and to offset the structural shortfall between the Mental Health spending plan and projected revenue.
Acquisition Costs
There are two types of costs within the Mental Health service area: acquisition and operating costs. Acquisition costs relate to the purchase and rehabilitation of facilities to support OCOH-funded programming.
- As of FY24, the City appropriated 32% of the OCOH Fund Mental Health service area budget for facility acquisition ($96.2 million) with a total of $13 million expended from FY21 through FY24. Many of these expenditures relate to due diligence on potential properties, including for one facility purchased with OCOH Fund support following the close of FY24.
- Financing for new facility acquisition can take time to implement. Though not yet encumbered through a contract, DPH indicates that 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.
Data notes and sources
Data notes and sources
Allocated Costs
This term refers to an allocated proportion of the cost to administer the services funded by OCOH, including information and 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.
Case Management
Homelessness Prevention funds were used to support a portion of programming related to delivering behavioral health and clinical services in permanent supportive housing (included within the “Case Management” category across OCOH Fund dashboards). While the Homelessness Prevention portion of the funding is reported in the financial dashboards above, information about capacity, clients served, and outcomes from this program are reported within the “Case Management” category in the Mental Health service area section of this report.
The following program names were shortened in the chart visual:
- Overdose Prevention & Substance Use Treatment = Overdose Prevention
Operating Costs
While the prior dashboard showed all OCOH Fund expenditures in the Mental Health service area, this dashboard only shows expenditures related to Mental Health Operations and excludes acquisition expenditures from the totals. The cards at the top of the dashboard show the cumulative (FY21-FY24) expenditures on operations of OCOH Fund Mental Health programs and the total amount expended in these programs FY24. The bar chart shows FY24 operations expenditures for each Mental Health program.
- Operating costs include personnel, contracts with service providers, and other expenses related to service delivery.
- During FY24, the City spent $70.4 million of OCOH funding on the operation of Mental Health services, a 20% increase over FY23.
- Expenditures increased significantly for treatment bed operations (71% increase from FY23) as DPH ramped up services in FY24 to fully implement residential programs that began in FY23. At the same time, expenditures decreased for drop-in services (62% decrease from FY23) and, less significantly, for overdose prevention & substance use treatment programs (13% decrease from FY23).
- Short-term programming in prior years, including the Tenderloin Center, which closed in December 2022, led to a temporary increase in drop-in service expenditures in FY23 that did not continue into FY24. Other spending on drop-in services remained steady.
- Case Management costs include expenditures related to the PHACS program. This program receives OCOH Funds via both the Mental Health service area and the Homelessness Prevention service area. Comprehensive costs of Case Management services (inclusive of both service area expenditures) totaled $13.9 million in FY24. Compared to comprehensive FY23 expenditures of $8.3 million, this represents a growth in spending of 67% year over year.
Explore the Annual Report
View the OCOH Fund FY24 Report:
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