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San Francisco Department of Public Health

Grant Colfax, MD
Director of Health

City and County of San Francisco


London N. Breed
Mayor

September 16, 2019

Dear Team DPH,

The spotlight has been shining on us for the past few


weeks. You may have seen the news stories about our
behavioral health system. Some of the coverage has been
positive, highlighting new efforts to make reforms that
bring care and services closer to the people in our city who
need it most. Some of the coverage has been critical of
the Department’s decisions and programs. While the swirl
of news stories can be distracting, I want us to focus on
what is important: we are providing quality behavioral
health services and continuously improving our system of Mayor London Breed announces a partnership to
care. I know that commitment is shared throughout the address behavioral health and homelessness, with (l-r)
Department, including among the hardworking staff who Health Director Grant Colfax, Tipping Point CEO Daniel
Lurie, Director of Mental Health Reform Anton Nigusse
every day care for and support people with mental health Bland, UCSF Chancellor Sam Hawgood.
and substance use disorders.

With so much going on, it is sometimes hard to keep track of it all. The city’s most recent budget
included $50 million in new investments in behavioral health beds and services. Here are a few
additional areas of recent attention that will continue to develop and evolve over the coming weeks
and months.

First, Mayor Breed, Dr. Anton Nigusse Bland, Director of Mental Health Reform, and the
Department announced the launch of Heal Our City. That is a new initiative with a population-based
focus on addressing the issues of homelessness and behavioral health – using similar approaches
that have proved successful in addressing the city’s HIV epidemic, for which infections have hit a
record low.

Heal Our City will prioritize the approximately 4,000 homeless San Franciscans identified by a
recent DPH analysis as having mental illness and substance use disorders. Most of this population
(95 percent) suffers from alcohol use disorder, a key finding that will help to guide programming
decisions. Only 10 percent are currently working with a case manager. We also found that 35
percent of these 4,000 residents are Black/African Americans, reinforcing the need for an equity
focus.

As part of Heal Our City, for the first time, DPH and the Department of Homelessness and
Supportive Housing (HSH) have a shared priority list of clients who have serious behavioral health
issues and need housing. The initiative creates a multi-agency program emphasizing a “whatever it
takes” approach to streamline housing and health care for the 230 most vulnerable members of the
group. What we learn from this pilot will be applied to better serve the larger population of 4,000.

SFDPH │101 Grove Street, Room 308, San Francisco, CA 94102


San Francisco Department of Public Health
Grant Colfax, MD
Director of Health

City and County of San Francisco


London N. Breed
Mayor

Heal Our City also recognizes the urgent need to make services more available for everyone who
needs them. That’s why, early next year, we will expand operations at our Behavioral Health
Access Center at 1380 Howard from 40 to 65 hours per week.

Second, last week we announced a partnership among the City, DPH, Tipping Point Community
and UCSF to address the intersection of behavioral health and homelessness. Mayor Breed led the
September 12 announcement at City Hall with Tipping Point CEO Daniel Lurie. Tipping Point
released its new report on homelessness and pledged up to $3 million to support additional low-
barrier respite beds in the community for people with behavioral health issues, the “Hummingbird”
model. We are currently looking for a suitable space to invest the Tipping Point funds to expand this
program.

Hummingbird Place is an innovative, low-barrier psychiatric respite program that has been very
successful. It fills a gap in our services, providing a safe and healing environment for clients who
have had behavioral health crises and need a break from the streets to consider their next move
toward wellness and recovery. The current program, located in the Behavioral Health Center (BHC)
on the ZSFG campus, has been very popular with clients, and always full.

Not everyone in our community has agreed with growing Hummingbird Place at the BHC. What is
important is that no client is losing a place to live, and no staff are losing employment. Some people
have expressed concern that some long-vacant board and care beds will be turned into short-term
respite beds in the interest of using those resources as quickly and effectively as possible.

For years, DPH has had vacant beds at the facility. The BHC has many excellent, caring
employees - - I know, because I have met and talked with many of them. Nevertheless, the board
and care programs have had problems with safety, quality, and staff complaints, which have been
reviewed by the state and resulted in a Plan of Correction. We will continue to address them, and I
have asked for a performance improvement plan to ensure we make the necessary changes as
soon as possible. We have the option to expand the board and care programs to their full capacity
once we have addressed these underlying issues.

Certainly, stabilizing board and care facilities is a priority. There are 314 board and care beds
throughout the City, and some 250 more beyond, that provide services for San Franciscans to allow
them to live independently in the community. Most of these are run by independent providers, and
the bed supply has been dwindling. Because many San Franciscans rely on these services, the
Mayor announced several steps the City will take to help San Francisco board and care operators
continue to provide these services, including increasing funding and exploring the purchase of
existing buildings that are at risk of closure.

To be successful, we must continue to listen to diverse stakeholders and be responsive to their


collective wisdom while setting priorities and implementing new programs. We learned that lesson
when we united to address HIV. I am optimistic that we can build an outstanding system of care to

SFDPH │101 Grove Street, Room 308, San Francisco, CA 94102


San Francisco Department of Public Health
Grant Colfax, MD
Director of Health

City and County of San Francisco


London N. Breed
Mayor

address the behavioral health needs of the San Francisco community.

With gratitude,

Grant

SFDPH │101 Grove Street, Room 308, San Francisco, CA 94102