Initial action based on report includes funding from Tipping Point to open 15 new Hummingbird behavioral health beds and a plan to pursue a managed alcohol facility for people suffering from alcohol use disorder

San Francisco, CA — Mayor London N. Breed today announced the next step in the City’s mental health initiative: a partnership with Tipping Point Community and the University of California, San Francisco (UCSF) to support behavioral health initiatives in San Francisco. Tipping Point, in coordination with the San Francisco Department of Public Health (DPH) and UCSF, released their “Behavioral Health and Homelessness in San Francisco” report, which is the result of a yearlong research project.

As an initial response to the recommendations in the report, Tipping Point will fund 15 new Hummingbird beds, which provide psychiatric respite and a place where clients can be linked to care, services, and treatment. The City will also pursue implementation of a managed alcohol facility to help those suffering from alcohol use disorder.

A key element of the Mayor’s recently announced mental health initiative—Heal Our City—includes leveraging partnerships to meet the needs of the City’s most vulnerable. Working with State partners as well as philanthropic, academic, and nonprofit organizations will help the City implement policies that are data-driven and based on the most current research and national best practices. The City is proud to work with Tipping Point and UCSF on addressing the behavioral health challenges of the 4,000 people who need care the most.

“The mental health crisis on our streets is too big of an issue for one agency or organization to address on its own,” said Mayor Breed. “As we create and implement policies to help those people who are experiencing homelessness and who suffer from mental health and substance use issues, we need to work together and build on the knowledge and experience of experts in academia, nonprofits, and philanthropic organizations. I want to thank Tipping Point, UCSF, and all the other community-based organizations that contributed to this report, and who will continue to partner with us as we move forward with our mental health initiative.”

“As we recommend reforms to support nearly 4,000 San Franciscans experiencing homelessness, mental illness and substance use disorder, we are grateful for the partnership of Tipping Point and UCSF,” said Director of Mental Health Reform Dr. Anton Nigusse Bland. “This report reinforces many of our own findings, and we look forward to working toward our shared goals in the months to come.”

“Progress on difficult public health problems does not happen in isolation. As with HIV, we know that forging behavioral health solutions for San Francisco’s homeless residents will take the concerted effort of many. We need researchers and clinicians, care providers and clients, philanthropists, City leaders, advocates, community partners and the support of the public to reach our goals,” said Dr. Grant Colfax, Director of Health. “Organizations like Tipping Point and UCSF play a key role in accomplishing improvements to the community’s health and wellbeing.”

Tipping Point Report

As part of its Chronic Homelessness Initiative, Tipping Point and the UCSF Department of Psychiatry came together to share expertise and strategies about how to improve outcomes for San Francisco residents experiencing long-term homelessness who also have behavioral health care needs. This project focused on:

• Identifying critical gaps that exist in the current system, including in services and treatment; coordination across agencies and providers; and data availability;
• Access and outcome disparities based on race, ethnicity, LGBTQ status, and other demographics that correlate with disproportionate homelessness;
• Identifying existing and planned efforts to address these gaps; and
• Making recommendations for where philanthropic, private and/or public investment could have an impact, including prioritization based on cost, impact, and urgency.

At the beginning of this project, Tipping Point and its report partner, John Snow, Inc., convened an Advisory Committee composed of experts, agency leaders, and key stakeholders connected to the homelessness and behavioral health system in San Francisco. Advisory Committee members included representatives from UCSF, DPH, the Department of Homelessness and Supportive Housing, Hospital Council, Positive Resource Center, and HealthRight360.

The key findings include three general categories:

• Enhancements to data tracking, data sharing, and development of shared outcome goals could promote increased coordination and accountability.
• Although there are many resources available, there are gaps in treatment and bed shortages in some levels of care.
• Outreach, engagement, and effective care transitions are critical to stabilization.

“Improving our behavioral health system is core to our work to reduce chronic homelessness, which disproportionately impacts our Black and LGBTQ+ neighbors,” said Daniel Lurie, CEO and Founder of Tipping Point Community. “These improvements will help more people exit homelessness and access needed supportive services. Through the collective effort and expertise of the Mayor and the Department of Public Health, UCSF, John Snow, Inc., and local service providers, we have developed a road map to do exactly that. It’s going to take all of us—the philanthropic, private, and public sectors—to make the changes we need to build a more comprehensive behavioral health care system for people experiencing homelessness.”

“We’re proud of our 150 year partnership with the City and are pleased to lend our faculty expertise and financial support to this important report, which provides guidance for how to improve the delivery of behavioral health services for the San Franciscans who need it most,” said Dr. Sam Hawgood, Chancellor of UC San Francisco.

Hummingbird Beds

DPH’s analysis and Tipping Point’s report determine that more mental health beds are needed in order to serve the number of people who need health care services. Hummingbird beds have been successful at providing psychiatric respite and connecting people with the services they need, and the City is investing in expanding the number of Hummingbird beds. With funding from Tipping Point, DPH will work with a community-based organization to open a new Hummingbird site with 15 beds in the community.

Hummingbird Place is a Behavioral Health Respite Center primarily serving homeless individuals who may be thinking about entering into treatment or care settings, but have not yet enrolled in these voluntary services. There is currently a 29-bed facility for adults on the Zuckerberg San Francisco General Hospital campus. The program offers low-threshold entry, which permits participants to stay with partners and keep their companion animals and belongings with them. Hummingbird Place is a Navigation Center model providing services with laundry facility on site, access to shower facilities, food/snacks, recreational activities and pre-engagement level program activities. The program also operates a day drop-in for up to 25 participants and can expand these services to emergency overnight placements for urgent needs. The program admits all qualified San Francisco residents who have ongoing behavioral health needs.

In Fiscal Year 2018-19, Hummingbird Place served over 500 distinct individuals, providing over 7,000 overnight stays and serving about 5,000 day clients. It is a safe place for clients to rest and engage with trained counselors to discuss treatment options, maybe for the first time not in an emergent setting, and supports breaking the cycle of using urgent and emergent services.

Managed Alcohol Treatment Program

DPH’s analysis determined that 95 percent of the 4,000 most vulnerable individuals in San Francisco suffer from alcohol use disorder. Dr. Nigusse Bland and DPH are exploring ways to address the needs of that population and provide alcohol substance use treatment. The Tipping Point report recommends the creation of a managed alcohol treatment program, which is an innovative and evidence-based solution that the City will pursue implementing moving forward.

Heal Our City

On Wednesday, September 4, Mayor Breed and DPH announced the launch of a mental health reform initiative, which includes a plan to help the approximately 4,000 homeless San Franciscans who have mental illness and substance use disorders. Of this group, San Francisco’s data shows that 41 percent frequently use urgent and emergent psychiatric services, compared to 15 percent of homeless people overall who use these services. This population also suffers greatly from alcohol use disorder and all of them have a history of psychosis. Examining this population through an equity lens, African American people represent 35 percent of these residents, while they make up just five percent of the overall population of San Francisco. The initial steps of the new initiative will provide enhanced care coordination, create a multi-agency program to streamline housing and health care for the 230 most vulnerable members of this population, and increase access to behavioral health services by expanding hours of the City’s Behavioral Health Access Center.

The full Behavioral Health and Homelessness Report released today by Tipping Point, UCSF and DPH can be found here.

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