ELECTION 2020
Before COVID turned the world upside down, Mayor London Breed and two supervisors had competing proposals to address San Francisco’s mental health crisis that was most evident on, but not confined to, city streets. Their compromise created Mental Health SF, an overhaul of the city’s mental health system to provide care to all, regardless of ability to pay. “SF was ready to move forward on this when the pandemic hit, and that money evaporated,” says Debbi Lehrman of the Human Services Network.
That’s why mental health providers are looking to the Health and Recovery Act, known as Proposition A on November’s ballot, to help them out.
The $487.5 million bond requires two-thirds voter approval. More than half would go toward parks, open spaces, and street improvements. But the other $207 million, tacked on in June when the pandemic threatened to blow a $1.5 billion hole in the city’s two-year budget, would help build mental health facilities and bolster services.
Millions of state and federal dollars come to the city for homelessness, but they’re restricted to providing specific services, and don’t allow for the purchase of buildings to house people, says HealthRIGHT 360 vice president of communications and government affairs Lauren Kahn. (HealthRIGHT360 operates Walden House, the Haight-Ashbury Free Clinics, and other services across the city.)
“Acquiring new sites is just wildly expensive,” Kahn tells The Frisc. “These grants don’t even cover the start-up costs of opening up a place for people.”
Opponents of the bond worry about the lack of restrictions for the money, all while critics say oversight of the city’s mental health programs is a mess. Kahn says that spending flexibility is entirely the point. “Having unrestricted funds allows us to do things that make more sense as a city and as a nonprofit,” Kahn says.
The need for more facilities and housing looms even larger, now that the city plans to move homeless people out of more than 2,400 hotel rooms by June 2021. The city began renting them in April as an emergency response to the pandemic. (The Chronicle reported this week that the Department of Homelessness and Supportive Housing (HSH) will start moving 500 people next week with no clear destination.)
The city’s biennial count, last conducted in early 2019, tallied more than 8,000 unsheltered San Franciscans, a figure that has likely grown, especially with the pandemic. The next official count comes in January. (When bolting on the $207 million in mental-health funding to Prop A in June, official documents cited a much higher homeless number which the New York Times had reported in late 2019 — and which city officials then disputed.)
‘Permanent supportive housing is necessary and very successful in bringing the chronically homeless inside and keeping them housed.’
— Rob Avila, GLIDE Center for Social Justice
Mental health issues aren’t limited to the homeless, of course, but that population has drastically acute needs. While group shelters and tent sites that offer some services will remain sleeping options, the city wants to lean more heavily on permanent supportive housing units. There are currently 8,000 units, and plans call for 2,255 more by the end of 2021, a significant jump but still not enough to meet the demand.
Paying to keep the lights on
Buying property in San Francisco is tough enough. Getting a building ready to house people and provide addiction and mental health services adds another layer of regulation that can break the bank for many nonprofits. State regulators must inspect facilities to make sure they’re “safe, legitimate, and good, so you have to be ready to go before you can be evaluated,” Kahn explains.
She agrees this makes sense to ensure a place meets safety standards for clients seeking services and housing. Unfortunately, it can take 180 days or longer for an inspection to come through. “Meanwhile, we’ve had to power and light everything while waiting,” Kahn says.
San Francisco’s small businesses face this issue, too, waiting and waiting to open while paying for the building, electricity, water, and gas. A business can, at least theoretically, adjust prices once open to make up for the downtime, says Kahn, but a nonprofit like hers doesn’t have that option: “When we have to maintain an empty space, we can’t do any responsive pricing to help recoup costs.”
What’s more, they can’t cover for the “empty space” costs with state and federal funding — those dollars must be spent on the services they provide to their clients.
Consider Prop A bridge money, then, to help groups like Walden House pay for the gap between acquiring a new facility and opening it up. And those roofs and walls are crucial in solving the homeless crisis, especially for the “chronic” people whose lives on the streets, cycling through emergency room visits and other city services, are bad — and more costly — for everyone.
“Permanent supportive housing is needed, necessary, and is very successful in bringing the chronically homeless inside and keeping them housed,” says Rob Avila, spokesman for the GLIDE Center for Social Justice.
The cost of doing business
Prop A would also give organizations flexibility in the type of care they provide. For instance, there are no resources for fathers to live with their children while they’re being treated for addiction, Kahn says: “You need [funding for] childcare for two years while a father gets better and gets a job. There are not a lot of resources for something like that.”
The opposition to Prop A is mainly an argument against taking on debt and giving more money on the parks-and-streets side to city agencies embroiled in corruption scandals. But the Libertarian Party’s opposition highlights the same problem that Kahn surfaces: Whether you’re a for-profit business or nonprofit service, it costs extra money to operate in San Francisco because of building restrictions, permitting waits, and other red tape. Fix that, the libertarian argument says, instead of throwing more money at the problem.
There is growing acknowledgment of the red tape. Prop H is asking voters to ease rules for small businesses and some nonprofits. And a city task force that includes a broad political spectrum recently issued dozens of recommendations for COVID economic recovery; paring back onerous rules and bureaucracy was a dominant theme.
This summer, city officials used some tenuous assumptions (will the feds really reimburse pandemic expenses at the level expected?) to hammer out a balanced budget and avoid layoffs. They’re also expecting help from Prop A. For example, Mental Health SF will receive $17 million to help fund four teams of mental health workers to respond to some 911 calls instead of police, the importance of which is tragically underscored by the recent police killing of a bipolar man in Philadelphia.
It’s a new approach, and one desperately needed. And so is the money to make it possible, say Prop A advocates like HealthRIGHT 360’s Kahn: “You can have the most creative and innovative solutions, but without funding, you’re hamstrung every time.”
Kristi Coale (@unazurda) is a San Francisco-based freelance writer and radio producer for various outlets, including KALW’s Crosscurrents and the National Radio Project’s Making Contact.