For weeks, Mayor London Breed and her Public Health Department had been tangled in a political mess over how they dealt with a troubled long-term treatment facility for the mentally ill.
Elected officials and union workers were battering the mayor and the department over a decision made quietly in 2018 to stop using many long-term care beds in a building at San Francisco General Hospital. The critics were incensed over a plan, made public in August, to transform part of the facility — where some clients have lived more than 10 years — into short-term beds, where people stay an average of 19 days.
There were rallies. A petition with more than 1,200 signatures. A protest so loud and disruptive that it shut down a city Health Commission meeting. The clock was ticking — changes at the facility were slated to begin in mid-October.
Then, on the afternoon of Sept. 20, the health department backed off. Officials said in a news release that the department would pause the changes until Breed and the Board of Supervisors came to an agreement on what to do with the facility.
But halting the plan has done little to appease its detractors, as it put San Francisco right back to where it started this summer: with 31 unused long-term care beds for the city’s most vulnerable and no clear plan to fill them, despite a mental health and homelessness crisis gripping the streets.
“I’m thrilled for now, but I don’t think it’s over,” said Karri Konczal, an evening team leader at the facility. “This is just a way of pacifying us so we don’t go march again.”
At issue is the department’s plan to reduce the amount of vacancies at the Behavioral Health Care Center by turning some of the long-term beds into temporary respite beds. The department said one facility in the building, the Adult Residential Facility, was at-risk of losing its license due to staff negligence and errors, and had little choice other than to stop admitting clients.
The Adult Residential Facility has a capacity for 55 beds. Today, 32 are used as long-term treatment beds, while 14 were turned into temporary respite.
Health officials argued that turning the long-term beds into short-term beds for people in crisis was better than having empty treatment spots. Mental health care workers called that an unequal trade.
The back-and-forth comes as the city health department faces intense scrutiny over its behavioral health care system and how it uses its existing resources. Critics said the department’s decision to stop admitting patients into the facility pointed to a lack of transparency and efficiency. Now, many see the delay as an emblem of City Hall’s failure to leave politics behind when it comes to caring for thousands of people suffering on the streets.
Dr. Paul Linde, who worked in the psychiatric emergency room at San Francisco General Hospital until 2016, said the department’s decision to suspend the transformation — rather than come up with a firm plan to move forward — was a “weak move” fueled by politics.
“It shows avoidance behavior on their part,” he said. “Rather than get a real plan going, they are going to sit back and see how the political winds are blowing before they jump out with a solution.”
Those familiar with the conversations say it was likely the pressure from the labor union — a powerful political force in the city — that prompted the department to halt its decision. Union representatives, from both SEIU 1021 and the San Francisco Labor Council, were emailing, calling and meeting with city officials, urging the department not to move forward with the changes.
Jim Ross, a local political consultant, said the controversy has put Breed between the department she oversees and the labor union, whose support would help her with her key priorities, such as an affordable housing bond on the November ballot.
He said her department’s seeming inaction has left room for Supervisors Hillary Ronen and Matt Haney to promote their own agenda in overhauling the city’s mental health care system through their March ballot measure, Mental Health SF. That ballot measure would consolidate the city’s mental health services and provide care to all San Francisco residents, whether they have private insurance or not.
Breed is opposed to that measure, and announced Wednesday that she is pulling out of the negotiations with the supervisors over “fundamental policy differences in approach.”
Ross drew parallels to last year’s fight on Proposition C, a ballot measure that levied taxes on big businesses to raise money for homeless services, which Breed opposed.
“Breed is in a position where she will either need to put her own measure on the ballot or oppose Mental Health SF,” he said. “She will be forced to be against something that is dealing with the biggest problem in San Francisco.”
According to Breed’s office, the department “has already begun to implement programs to get the most vulnerable of these people into housing and services” and will continue to expand those efforts.
Meanwhile, the department maintains that it had little choice but to stop admitting patients to the Adult Residential Facility, which has a long history of complaints, according to state records.
If the facility continued to admit clients, Kelly Hiramoto, director of special projects for the department, worried it would lose its license altogether. While the problems were isolated to just a few people, she said, it was difficult to fire the problematic employees because of strict union protections. Hiramoto said it was easier for the city to transform the beds into temporary respite spots instead.
The rest of the unused beds are at another facility in the Behavioral Health Center, called the Residential Care Facility for the Elderly. That facility has a capacity for 59 people. Only 37 are currently used. The department’s plan was to consolidate the two facilities and transform some of the beds into temporary respite. Under that plan, according to the department, all of the beds would be used — albeit for shorter stays.
If the department had its way, those beds probably would have opened over the next few months. Now, the beds will likely stay empty for even longer as the department waits for City Hall to hash out a plan.
But even members of the Board of Supervisors cannot agree on the best course of action. Two different pieces of legislation are making their way through the board. One, by Supervisor Rafael Mandelman, calls for the department to open the beds within two years. He said the department should be given time to take a step back and figure out how to best use the beds.
Meanwhile, his colleagues, Ronen and Haney, are taking a much more aggressive approach: Their legislation implores the city to open the beds as soon as possible. The legislation also directs the Department of Human Resources to assist the health department in hiring “qualified staff in an urgent and priority fashion immediately.”
While both measures would direct the department on how to act, there are not likely to be any legal ramifications if the department doesn’t comply. And even if the department decided to immediately fill all the beds at the facility, it would still take several months to iron out the existing staffing issues, and then hire enough mental health care workers to run the facility — a challenge around the country, as there is a shortage of such employees.
Ronen is pleased the department halted the decision, but said it is “unacceptable” that the city has no concrete plan yet to fill the beds.
The department “makes nonsensical decisions without talking to the advocates and workers, and therefore gets themselves into an absolute mess,” she said. “We need a vision and leadership coming from somewhere to fix our broken and disjointed system.”
Outside City Hall on a recent afternoon, Breed stood by her department’s decision to stop admitting patients into the facility over alleged safety concerns.
“Do you think that as hard as I’m working to add more beds to our system that I would take lightly the suspension of any of these beds for any particular reason if it were not for the safety of residents?” she told The Chronicle.
San Francisco spends nearly $400 million a year on mental health and addiction treatment, but thousands of people in crisis are still without sufficient care. In this ongoing series, Chronicle journalists investigate the failures of this complicated, costly system and explore solutions to the crisis.
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“We have to be very careful,” she added. “This is not something you play politics with.”
Trisha Thadani is a San Francisco Chronicle staff writer. Email: tthadani@sfchronicle.com Twitter: @TrishaThadani
