San Francisco, CA — Mayor London N. Breed and Supervisors Hillary Ronen and Matt Haney announced today that they have reached an agreement on a comprehensive plan for reforming San Francisco’s mental health care system. After months of negotiations, Mayor Breed is co-sponsoring Mental Health SF, which overhauls the City’s challenged mental health system and guarantees mental health care to all San Franciscans who lack insurance or who are experiencing homelessness. As part of the agreement, Mayor Breed and the Supervisors will withdraw their respective ballot initiatives intended for the March 2020 ballot and will instead introduce Mental Health SF legislation at today’s Board of Supervisors meeting.

“We all agree we need to work immediately to address the serious mental health and substance use challenges on our city’s streets,” said Mayor Breed. “By collaborating and doing the work in City Hall, we can make real and effective solutions to improve our system of behavioral health care. As we work to reform our entire mental health system, we’ll continue prioritizing the most vulnerable people, and providing targeted services to those who are experiencing homelessness, mental illness, and substance use disorder.”

Prior to reaching this agreement, Mayor Breed and Supervisors Ronen and Haney had submitted separate initiatives for the March 2020 ballot—UrgentCareSF and Mental Health SF. UrgentCareSF focused on delivering services for the 4,000 people who are homeless and have both mental health and substance use disorders, while Mental Health SF created a universal mental health care system providing mental health care to any San Franciscan with serious mental illness.

“All you have to do is walk outside City Hall for a few blocks to see the shocking mental health crisis that now a daily part of all of our lives. It’s the biggest crisis facing our city and working together is the only way we’re going to solve it,” said Supervisor Ronen. “I’m proud that we’ve been able to take our differing viewpoints and found ways to make this legation even better. With the Mayor’s support, Mental Health SF will change how San Francisco deals with severe mental illness and addiction.”

Talks between the Mayor’s office, the Supervisors, community stakeholders, and union leaders representing front-line workers led to three major changes to Mental Health SF that have allowed Mayor Breed to co-sponsor the measure.

Prioritizing People Experiencing Homelessness

The new Mental Health SF will now focus first on serving people who are homeless with serious mental illness or substance use disorders and will prioritize getting people off the street and in to care. Resources will be especially focused on people experiencing homelessness, serious mental illness, and substance use disorders.

Behavioral Health Access Center (BHAC) to become Mental Health Center

Mental Health SF calls for the creation of a 24/7 Mental Health Center that would serve as an access portal for uninsured and homeless San Franciscans seeking access to mental health care. As part of the compromise, rather than building a new facility, the existing BHAC building located on Howard Street will become the site of the new Mental Health Center. Planning for the new center will beginning immediately, with rehabilitation work following as funding is identified.

Office of Private Insurance Accountability

As it was initially drafted, Mental Health SF provided mental health care to all San Franciscans who needed it—including people with mental illness who had insurance but were not able to access mental health care through their providers because of barriers such as high deductibles and long wait lists. Rather than the City paying for services for these individuals, the compromise creates an Office of Private Insurance Accountability that will advocate for insured people with mental illness to make sure that they receive the care to which they are legally entitled.

“Mental Health SF will make San Francisco the first city in the country to provide universal access to coordinated mental health care and substance use treatment. If you are homeless, uninsured, and diagnosed with a serious mental illness or substance use disorder, Mental Health SF will ensure that you get the medical treatment you need, and if you are insured but not getting the care you are entitled to, the City will help advocate on your behalf,” said Supervisor Haney. “Every day, people who are mentally ill or severely addicted are abandoned on the streets, cycling in and out of emergency rooms, leaving our residents and neighborhoods to deal with the consequences. I will not stop fighting until Mental Health SF is fully implemented, funded, and effectively gets people off the streets and into treatment.”

Under the new agreement, Mental Health SF will move forward as legislation in City Hall rather than at the ballot, allowing for more expedited implementation of the initiative. Mayor Breed has committed to fast tracking implementation when the legislation passes and will prioritize the hiring of a new Director of Mental Health SF by next summer. Additionally, an implementation working group will be impaneled to begin the process of developing recommendations on how best to reform and expand the City’s mental health services.

Mayor Breed and Supervisors Ronen and Haney have also committed to working together to secure the approximately $100 million annually needed for Mental Health SF’s implementation. The City will continue making investments immediately and in the upcoming budget to meet the goals of Mental Health SF, however, several elements of Mental Health SF will be dependent on identifying new revenue sources. Mayor Breed and Board of Supervisors President Norman Yee have asked the Controller to convene a process to reform the City’s business tax, which could provide a new revenue stream for Mental Health SF. The City Administrator and the Capital Planning Committee are also looking at moving up a Public Health Bond for the November 2020 election to help pay for capital improvements. 

As the Mayor and Supervisors work to identify funding for the longer-term elements of Mental Health SF, the City will continue providing mental health and substance use treatment services to as many homeless individuals as possible.

This immediate action includes continuing to prioritize healthcare and housing for the most vulnerable of the 4,000 who are experiencing homelessness, and have both a mental illness and a substance use disorder, as identified by the Department of Public Health. As part of the compromise agreement, the City will continue to expand treatment capacity and reduce administrative barriers to eliminate wait times for services. This will include adding new behavioral health treatment beds, creating new meth sobering centers and managed alcohol facilities, expanding access to existing City services, and ensuring there are navigators and case managers to help people get into care. These improvements will be folded into Mental Health SF as the new program becomes operational. 

“The Department of Public Health thanks Mayor Breed and Supervisors Ronen and Haney for reaching this agreement that unifies the City and reinforces our ongoing work to serve the San Franciscans in greatest need,” said Dr. Grant Colfax, Director of Health. “With transformative investments in our workforce, evidence-based solutions, and our community partners, we will help our neighbors experiencing homelessness, mental illness and substance use disorders to achieve wellness and recovery.”

“Anyone who lives in or visits our city knows the condition of our streets is unacceptable,” said Assemblymember Phil Ting, an early supporter of Mental Health SF. “Making a real difference will take all of San Francisco’s leaders working together to help those struggling with mental health challenges in public and behind closed doors. That’s why I am encouraged by today’s partnership, which will ensure every San Francisco resident who needs it has access to affordable, quality mental health services and treatment.”

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