Behavioral Health Policy Platform

Behavioral Health Policy Platform

I spent my twenties homeless on the streets of San Francisco, struggling with addiction and living with an untreated AIDS diagnosis. Nearly 16 years ago I got sober and rebuilt my life through this city's systems of care, from treatment to transitional housing to permanent supportive housing to a home of my own. I know how that ladder used to work, and I also know exactly how it breaks down today. Right now, we essentially ask the Tenderloin, SoMa and the 16th Street area of the Mission to carry the entire city's burden for services.

I have also spent my career on the other side of these systems. As Vice President of Policy and Public Affairs at HealthRIGHT 360, I worked to expand behavioral health and substance use treatment across eleven California counties, breaking down barriers to care and building up the unionized behavioral health care workforce. And as campaign manager for Speaker Emerita Nancy Pelosi's national Save Our Health Care campaign, I have led the fight against Republican attacks on Medicare, Medicaid, and the Affordable Care Act.

My plan is simple and will make a big impact across our city. We need to build Behavioral Health Campuses at our hospitals, starting at San Francisco General, so care is waiting where people are currently getting taken by ambulances.

Treatment at Hospitals

San Francisco General already has Psychiatric Emergency Services, psychiatric inpatient units, and is the city's only Level 1 trauma center. People in crisis are constantly arriving there, and it has overwhelmed the system. An adjacent campus next door would make it significantly easier to hand off treatment, rather than subjecting people in crisis to another ambulance ride, waitlist, or night on the street without care. Los Angeles County and Orange County have already built hospital-adjacent behavioral health campuses, and they are diverting thousands of people away from emergency rooms and jails and into care.

My plan:

• Build Behavioral Health Campuses at our hospitals, starting at San Francisco General on Potrero Avenue, using buildings and land the City already owns.
• Give each campus a single front door for mental health and substance use care, with psychiatric urgent care, crisis stabilization, sobering, residential treatment, outpatient clinics, and step-down housing on or next to the site.
• Follow the successful playbook from Los Angeles County's MLK Behavioral Health Campus and Orange County's Be Well campus, which were built to relieve exactly the pressures San Francisco faces.

More Treatment Beds

Our bottleneck and lack of treatment beds is still an issue even after people are out of an acute crisis. Patients are held in psychiatric emergency or medical beds when, frequently, no residential or locked treatment bed is available. We also see people who are ready for discharge forced back to the streets because no step-down bed exists.

My plan:

• Add treatment beds across the full range of care, from acute psychiatric beds to residential substance use treatment to the step-down and board-and-care beds.
• Bring conserved patients home to local beds instead of sending them out of county, away from their families and their community.
• Set a citywide treatment bed target, and publish the count every quarter.
• Cut behavioral health boarding hours in San Francisco General's emergency department and hospital in half within one year of the first campus opening.

A Home Base for Our Street Teams

Our street crisis and overdose response teams do heroic work, and then too often spend hours waiting in an emergency room lobby so they can hand a patient off. Every hour a first responder waits is an hour it is not helping the next person.

My plan:

• Make each campus the designated drop-off point for our street crisis, overdose response, and street wellness teams.
• Give the teams a real home base on campus, with staging space and a shared dispatch desk connecting 911, 988, and a behavioral health access line.
• Guarantee same-day and next-day follow-up appointments after every overdose response, so outreach leads somewhere.

Sharing the Load Across the City

For decades San Francisco has concentrated its crisis and drop-in services in a few dozen blocks of the Tenderloin, SoMa and 16th and Mission. The result has been predictable. People in need gather where the services are, and then dealers follow. As it stands now, our neighborhoods with the most children per square mile carry the whole city's weight. This is unacceptable, and Behavioral Health campuses at our hospitals are a realistic way to reverse that.

My plan:

• Build campuses across the city, from Potrero Avenue to the west side, so every part of San Francisco hosts part of the solution. This is about fairness, not exile.
• Move the highest-impact crisis and congregate services onto the campuses instead of adding more of them to the Tenderloin and SoMa.
• Keep everyday care local. Residents of every neighborhood can still access their clinics, pharmacies, and outpatient services close to home.

Accountability

The recent loss of the bulk of Baker Places treatment beds impacted our service and treatment capacity. On these behavioral health campuses, the City holds the assets that make care possible, and providers are accountable for results, not high overhead on facility leases or debt service on facilities the provider owns and maintains. Facility overhead costs aren't passed down through contracts to providers. When the City adds these beds, the City keeps these beds.

My plan:

• Ensure the City will own and maintain buildings and beds, so no departing service provider takes the entire system down.
• Keep a standing bench of pre-qualified backup providers, and give the City the right to step in and run a program directly, so there is never a risk of a gap in services.
• Publish a monthly public dashboard covering outcomes, site conditions, complaints, and staffing levels.

Paying for the Plan

San Francisco already pays for this care, at the emergency room, the ambulance, and jail, almost all of it from our own General Fund. The campuses will move the same people into the right setting and move much of the bill to federal and state programs that are already built to pay for it. This will save money and time, so work hours are returned to police officers, sheriff's deputies, firefighters, and our EMTs who we are currently stretching too thin.

My plan:

• Fund operations primarily through federal programs, including Certified Community Behavioral Health Center (CCBHC) funding.
• Build the campuses with state funding and bond dollars, with the potential for supplemental private funding.
• Direct the Controller's Office to publish the General Fund savings alongside the clinical results.
• Cut the overtime burden on the Police Department and the Sheriff's Office. Right now, officers and deputies are spending entire shifts waiting in emergency rooms and cycling the same people through jail and hospitals. Cutting overtime hours and dollars saves time and money.
• Let firefighters and EMTs focus where they are most critically needed. An easier campus handoff will be shorter and allow them back on the streets for fires and medical emergencies. Orange County's campus-linked teams saved law enforcement and first responders roughly 2,400 hours in a single year.