Mayor London N. Breed today announced the first steps in a long-term plan to provide care for people who have severe mental illnesses and substance use disorders and who are also experiencing homelessness—with a focus on a population of nearly 4,000 people. The initial steps of the new initiative will provide enhanced care coordination, create a multi-agency pilot to streamline housing and health care for the most vulnerable, and increase access to behavioral health services by expanding hours of the City’s Behavioral Health Access Center.
Through in-depth analysis of public health data, San Francisco’s Director of Mental Health Reform Dr. Anton Nigusse Bland and the Department of Public Health (DPH) began the reform effort by identifying a select population of nearly 4,000 people who demonstrate the highest level of service needs and vulnerability, and who require specialized solutions to reach stability and wellness. San Francisco is believed to be the first city in the nation to use the behavioral health diagnoses of people experiencing homelessness to identify a population and tailor solutions to its needs.
Of that population of 4,000, the 230 most vulnerable behavioral health clients experiencing homelessness will immediately begin receiving enhanced care coordination. The City will also launch a new multi-department effort to streamline housing and health care for these 230 individuals in order to ensure the City’s highest-risk residents can succeed in permanent supportive housing. This pilot will serve as a model to address the larger population of 4,000. The City will also expand hours at its Behavioral Health Access Clinic so that this high-need population will have more access to services when needed.
“Our City is experiencing a mental health and substance use crisis, and thanks to the thoughtful and in-depth analysis done by Dr. Nigusse Bland, we now know exactly who the most vulnerable people are that we need to help,” said Mayor Breed. “By developing solutions based on these data, we can get people treatment, get people housing, and get people healthy. We can focus our resources and our efforts on those who need it most, and we can make a difference in these people’s lives and in our City.”
The analysis done by Dr. Nigusse Bland identifies specific challenges, inequities and needs for this population. For example, of the nearly 4,000 people identified,
- 41% are high users of urgent and emergent psychiatric services. This is compared to just 15% of the overall homeless population who are high users of these services.
- 95% suffer from alcohol use disorder.
- 35% are African-American – despite the fact that African-Americans make up just 5% of the overall City population.
In March 2019, Mayor Breed appointed Dr. Nigusse Bland to serve as Director of Mental Health Reform for DPH. Dr. Nigusse Bland’s responsibilities include reviewing San Francisco’s approach to behavioral health care and making recommendations for reforms. This includes strengthening programs that are proving effective, reallocating resources away from programs that are not, and finding solutions to gaps in the current continuum of mental health and substance use services. This data analysis and initial recommendations are just the first steps in a multi-year, multi-phase effort to include improved care coordination designed to achieve successful placements in housing; low-barrier access to welcoming, high-quality behavioral health care; and a system of care that is evidence-based, reduces harm and increases recovery.
“It is far too complicated for this population to figure out how to get into care. We need to make our system easier to navigate and more transparent,” said Dr. Nigusse Bland. “I’ve been having extensive conversations with stakeholders to really understand what we need to change so that the system better engages and serves populations most in need. My recommendations will also be driven by evidence that harm reduction works and that persistent racial inequities fuel poor behavioral health outcomes.”
In the coming months, Dr. Nigusse Bland will continue gathering community input on his recommendations for reform and building the partnerships necessary to enact them. Many of DPH’s nonprofit partners and care providers are already contributing expertise that will help improve the transparency of our behavioral health care system and advance innovative harm reduction efforts.
“I appreciate Mayor Breed’s leadership in bringing this plan forward and tackling the most important issue facing my constituents and the entire city,” said Supervisor Rafael Mandelman. “Addressing the street mental health crisis is the moral challenge of our day. By prioritizing the needs of the sickest and most vulnerable among us we can save lives and focus our resources to have the biggest impact.”
“The San Francisco Department of Public Health has a legacy of using data-driven practices to prioritize and address seemingly intractable crises such as the HIV epidemic,” said Dr. Grant Colfax, Director of Health. “With Dr. Nigusse Bland, DPH is entering a new era of partnership with other agencies and community-based organizations to focus the city’s compassion and resources on this population experiencing the intersection of homelessness, mental illness and substance use disorders.”
"HSH is honored to collaborate in a meaningful way with DPH to use shared data to prioritize housing and services for those who are most vulnerable in our community,” said Jeff Kositsky, Director of the Department of Homelessness and Supportive Housing. “HSH launched this national best practice—called Coordinated Entry—in San Francisco over the last two years and is grateful to DPH for its partnership in effort. We know that housing is key to health, mental health and recovery and so having our systems work together in this way is essential."
INITIAL PROGRAMMATIC STEPS
Enhanced Care Coordination for Most Vulnerable
The initiative will begin by connecting the 230 most vulnerable people in San Francisco with care coordinators who partner with them to navigate unfamiliar services and ensure warm handoffs to service providers and housing. Beginning immediately, DPH will assess each person’s health needs and will then develop and implement individualized care plans. This program will be a multi-phased, multi-year approach to enhanced care coordination that will be expanded to other subsets of the 4,000 population.
Streamlining Housing and Healthcare through Multi-Department Collaboration
Starting in October, DPH, in collaboration with the Department of Homelessness and Supportive Housing (HSH), the Department of Aging and Adult Services (DAAS), and the Human Services Agency (HSA), will launch a pilot project to streamline housing and health care for those 230 most vulnerable people. The Departments will assign each person a care coordinator, create individual street-to-home plans, and provide timely access to treatment slots, disability services, housing navigation services and benefits so that the highest-risk and highest-need clients can succeed in permanent supportive housing.
Expanding Access to Services
As part of the initiative, the City will expand hours at the Behavioral Health Access Center (BHAC), located at 1380 Howard St., 1st Floor. BHAC is a standalone facility that provides low-barrier, centralized access to the behavioral health system and helps San Franciscans find the appropriate mental health and substance use care for their needs. Staff triage and assess clients’ needs, help them enroll in benefits such as Medi-Cal, find placements in treatment programs, and connect clients to other services like medical screenings and primary care. Residents of San Francisco are eligible for services at BHAC.
Starting next year, the BHAC will expand operational hours to 65 hours a week, up from 40 hours a week. Additionally, the City will provide on-call transportation to the BHAC. Currently, the facility is open Monday – Friday from 8:00am – 5:00pm. In expanding service hours by over 60%, BHAC will be open on nights and weekends to better meet the growing demand for access to its services outside of regular office hours.
Mayor Breed is committed to helping people with behavioral health and substance use issues. The recently signed City budget contains an increased investment of over $50 million over two years to support the expansion of behavioral health and other health services. This funding will support over 100 additional behavioral health treatment and recovery beds at multiple different levels of treatment, including Dual Open Residential Treatment beds, Behavioral Health Respite beds, and Behavioral Health Assisted Living beds. These beds are in addition to the 100 treatment beds that opened in the last year, which together constitute the largest expansion of behavioral health beds in a generation.
In addition to funding over 230 treatment beds since taking office, Mayor Breed has allocated $5 million over two years to support behavioral health programs at risk of closure and the City’s existing residential care facilities, including funding to support existing Residential Care Facilities for the Critically Ill and continued financial patches to support Board and Care programs.
With support from a $3.2 million grant from the California Department of Health Care Services, the City has expanded behavioral health outreach through the Healthy Streets Operation Center (HSOC). The grant funds clinicians, social workers and peer navigators at Psychiatric Emergency Services; augments the street-based behavioral health services of the Harm Reduction Therapy Van; and extends hours of operations for programming and services to include more nights and weekends so there is greater coverage for those on the streets.
Mayor Breed has also identified $1.9 million to expand the San Francisco Fire Department’s EMS-6 unit to divert high users of the City’s public services. The EMS-6 team launched in January 2016 to work in conjunction with existing services to respond to incidents involving clients with high 911 utilization and refer them to non-emergency resources to stabilize.
The Mayor expects that some of the people served will be stabilized for the long term in Permanent Supportive Housing (PSH). HSH supports the City’s approximately 7,809 units of PSH as well as its rapid rehousing program for time-limited rental subsidies and support services. In 2019, the City added funding for 300 new units of PSH with the FY 2017-18 and FY 2018-19 Educational Revenue Augmentation Fund allocations. The FY 2019-20 and FY 2020-21 adopted City budget continues to fund services and operations in those units for an additional year, and adds funding for 520 new units of PSH.
The Behavioral Health Access Center can be accessed by calling (415) 255-3737 or (888) 246 3333, or by visiting 1380 Howard St., 1st Floor. Individuals who are hearing impaired can also use the TDD line at (888) 484-7200. BHAC provides support in accessing services in all languages, free of charge.