Mayor London Breed’s 90-day emergency declaration to make big changes in the Tenderloin just hit the one-month mark. Much of the attention has focused on police — largely thanks to Breed’s “no more bullshit,” law-and-order rhetoric — and on a new services center.
But like slow streets, outdoor dining, and other COVID-era changes made possible via emergency order, the Tenderloin plan also creates space for broader reforms that advocates have long championed.
When Breed unveiled the order on Dec. 17, it was short on details. Two supervisors who helped pass 2019 legislation to overhaul SF’s mental health care system immediately pushed to use the emergency to cut red tape and hire more mental health workers — a shortage has stunted the city’s efforts to combat homelessness, as The Frisc reported last year.
Mental health care, including treatment for substance abuse, must be addressed if San Francisco is to save lives, reduce homelessness, and get people into stable housing. The flood of fentanyl, deadly even in tiny doses and working its way into other drugs, has made the situation even more urgent. SF overdose deaths tripled from 2018 to 2020, hitting a grim tally of 711. (The 2021 tally was “only” 650.) Nearly 1 in 4 overdose deaths in SF occurs in the Tenderloin.
“We need a permanent system of care to address this crisis,” said Sup. Hillary Ronen during a 10-hour special Board of Supervisors meeting two days before Christmas. The supervisors approved Breed’s emergency order 8 to 2.
Ronen and colleague Sup. Matt Haney were able to pass Mental Health SF in 2019, adding the mayor’s support after she dropped her own version, but funding it has been another story.
Pushed by Ronen during last month’s marathon meeting, Department of Public Health (DPH) director Grant Colfax said the Tenderloin plan would serve as a springboard to fuller funding. First is the immediate hiring of up to 250 mental health workers at DPH. (At a Jan. 20 meeting, DPH officials revealed there are 276 staff vacancies.)
Staffing in a hurry
Typically DPH takes an average of seven months to hire a staffer. Everyone must take a civil service exam and submit to background checks.
But with the clock ticking in the Tenderloin, the emergency order lets the department fast-track hiring of candidates already in the process and suspend the civil service exam. The order also lets city departments pay for goods and services without approval of a contract.
DPH says the plan is working: As of last week, 84 new hires have either accepted a job or started work since mid-December. These positions include clinicians to work at SF General Hospital and on the Street Crisis Response Team, an alternative to law enforcement when responding to mental health-related situations.
(Since the emergency order, the police have also made 34 arrests related to drug sales through Jan. 23 and seized 3,217 grams of fentanyl and 5,027 grams of other narcotics. Outreach workers have had more than 1,200 encounters with people on the street and have referred 86 of them, or 7 percent, to shelter.)
Staffing up city-run services is only half the battle, though. As The Frisc has reported, much of the city’s homelessness-related work is performed by nonprofit contractors.
Finding and keeping employees was already tough before the pandemic, according to Brett Andrews, CEO of PRC, which runs two special shelters that offer longer-term stays, as well as health and other treatment centers. “We’ve had a devil of a time getting fully staffed in behavioral health,” Andrews told The Frisc. “You have low salaries, long hours under challenging conditions — there’s not a big pool of folks who will do that work.”
After COVID hit, PRC had to suspend services at Jo Ruffin Place, a residential treatment program, because it couldn’t maintain the legally required ratio of counselors to clients. Residents were relocated to other facilities.
Housing provider Dish, which runs eight SF properties, still has unsafe ratios of one caseworker to every 25 residents, director Lauren Hall told The Frisc.
One big problem is that nonprofits often compete for employees with DPH, HSH, and other city departments, which offer better pay. That’s why, as part of the Tenderloin plan, the city controller will analyze the service providers’ wages to “target areas where we can close the gaps with our nonprofit partners and the city so we can all recruit,” said DPH chief financial officer Greg Wagner at a recent supervisors’ committee hearing.
Places to go
The emergency lets officials cut red tape and hire faster. It’s supposed to do the same to put roofs over people’s heads, whether temporary or permanent.
If there’s no place to go, it’s hard to convince people to get help, as one service provider noted last year after the first outreach teams approved under Mental Health SF hit the streets. “If these teams are riding around the city but there are no beds to connect to the people they reach out to, how are they facilitating access to housing?” said Mary Kate Bacalao, director of external affairs and policy at Compass Family Services.
In San Francisco, even money that seems ready to flow sometimes gets stuck.
The first facility to open under the emergency rules is the well-publicized linkage center on Market Street at the edge of the Tenderloin, operating 12 hours a day for now because there aren’t enough staff to run it 24/7. During its first week, the center had 1,180 visits, and 33 resulted in some kind of verified placement, according to city records.https://sf.gov/sites/default/files/2022-01/TL%20Emergency%20Initiative%20SitRep%20OP6%20FINAL%20DRAFT.pdf
The model — showers, food, a walk-in health clinic, plus connections to housing and other services — resembles the center described in the Mental Health SF legislation.
There are other parts of Mental Health SF that will get a jump start with the Tenderloin emergency, and that’s why Ronen said she was willing to vote for it Dec. 23.
(SF’s homelessness agency has a $1.2 billion budget, and that doesn’t include hundreds of millions of dollars allocated via DPH to mental health and homelessness-related services.)
In San Francisco, however, even money that seems ready to flow sometimes gets stuck. In 2018, voters approved Proposition C, a business tax that would fund homelessness services and housing. After a two-year legal battle, a judge struck down a challenge and freed the funds. But some facilities that would add treatment beds have yet to receive their Prop C funding, PRC’s Andrews said.
The pandemic has played a role in delays too, and there’s always the threat of neighbors or elected officials blocking or stalling projects.
Despite all the tension between the moderate mayor and the board, some progressive supervisors are scrambling so that the opportunities afforded by the emergency don’t go to waste. “If all this all goes away,” Ronen observed before casting her vote in December, “then any progress we have made will be down the drain.”
Staff writer Kristi Coale writes about homelessness and more for The Frisc.