San Francisco Sun

San Francisco, CA — Mayor London Breed and Supervisor Rafael Mandelman have unveiled the findings and recommendations from the Residential Care and Treatment Workgroup. The group was convened in May 2024 to address the shortage of long-term residential placements for individuals with complex behavioral health needs. Facilitated by the San Francisco Controller’s Office, the workgroup's report outlines how the city can expand residential treatment and secure new funding following the passage of State Proposition 1 in March 2024.

“This is a pivotal moment for our City and we must take full advantage of every tool, and funding source available to us, in order to best support one of our most vulnerable communities,” stated Mayor Breed. She emphasized that despite progress with over 400 additional beds, there is more work needed to prepare for when individuals at high acuity levels are ready to reintegrate into the community.

The tools discussed include CARE Court and California’s Senate Bill 43, which expanded conservatorship criteria to aid gravely disabled individuals with mental health and substance use disorders. The city continues to face challenges in placing clients with complex needs into suitable facilities. Key themes from the workgroup's findings include:

- **Need for More Placements:** The workgroup identified a need for an additional 75–135 beds over two years within long-term locked care and residential care settings. These facilities cater to adults with complex mental health or substance use disorders. "Locked care" involves secure environments mandated by court orders, while "residential care" offers less supervision but includes assistance with daily activities.

- **Budget Challenges Due to Lack of Reimbursement:** Unlike skilled nursing facilities where costs are often reimbursed through Medicaid or Medicare, San Francisco must rely on local funding sources due to state and federal limitations. Proposition 1 provides limited capital funds but operational costs remain a burden on county general funds.

- **Need for State Support:** Local jurisdictions face similar challenges in bed placement capacity, requiring proactive state involvement for regional solutions. “If we are going to solve San Francisco’s behavioral health crisis, we must have appropriate placements for the most severely mentally ill among us," said Supervisor Mandelman.

The Mayor’s Office collaborated with various departments including SFDPH and DAS along with experts from hospitals, labor groups, criminal justice representatives, and health officials. Dr. Hillary Kunins of SFDPH confirmed efforts to expand treatment capacity: “SFDPH is committed to expanding residential care and treatment capacity to better serve high-need clients."

In December 2024, San Francisco applied for over $140 million in capital funds through Proposition 1 Bond Behavioral Health Continuum Infrastructure Program (Bond BHCIP) which could add up to 100 new long-term locked treatment beds if granted.