Mayor Breed Announces Budget Investments for Behavioral Health Efforts

The proposed budget builds on the work to address addiction and mental illness by expanding the Department of Public Health’s wide range of services
May 25, 2023

San Francisco, CA – Today Mayor London N. Breed announced her proposed budget investments to address mental health and substance use issues. This funding will build on existing programs and invest in new solutions to broaden the City’s response in how it addresses behavioral health issues impacting San Francisco.    

In the last year, the San Francisco Department of Public Health’s (SFDPH) Behavioral Health Services has provided mental health treatment to more than 16,500 individuals and upwards of 4,500 have received substance use treatment. More than 60% of those receiving substance use disorder treatment are people experiencing homelessness.    

To support those who are working towards health and well-being, SFDPH has increased the availability of care and treatment beds, adding more than 350 beds to the City’s already existing 2,200 care and treatment beds. The City has also increased access to buprenorphine and methadone, including expanding hours at clinics and pharmacies and deploying mobile strategies to dispense this lifesaving medication. Buprenorphine and methadone are the most effective treatments for opioid addiction and reduce risk of dying by up to 50%.     

The Mayor’s proposed two-year budget will continue this critical support and build on these efforts in key areas, including continuing residential treatment expansion, the continued implementation of Mental Health SF, enhancing overdose prevention efforts in targeted communities, coordinating a robust street outreach program, expanding abstinence-based treatment programs, launching CARE Court implementation, and opening wellness hubs.   

"San Francisco is a compassionate city that leads with services in our efforts to help people struggling with addiction and mental illness,” said Mayor London Breed. “We’ve expanded our resources significantly in recent years, but the challenges around fentanyl require even more support. While it’s critical that we focus on accountability, we also need to continue to find ways to get people into care and treatment.”   

 “We have seen the impact of Mayor Breed’s investments in behavioral health services in San Francisco; More people struggling with mental health conditions and substance use disorder are getting the care and support they need,” said SFDPH Director Dr. Grant Colfax. “These continued investments are funding the programs and interventions that get people on the path to recovery and wellness and, in many cases, save lives.”  

The Mayor’s proposed budget will advance these key investments while closing a $780 million two-year deficit. The Behavioral Health proposal will be included in the Mayor’s proposed two-year Budget, which will be submitted to the Board of Supervisors for review by June 1. Final numbers for all Departments will be available when the Budget is introduced.     

Key Budget Investments   

Expansion of Treatment Beds   

In 2021, Mayor Breed and SFDPH launched a plan to add 400 new treatment beds on top of the more than 2,200 beds San Francisco already had in place. Over the last two years, significant progress has been made, with over 350 beds added toward that goal. The City offers residential treatment for mental health care, substance use disorders, withdrawal management, and step-down care for people leaving residential treatment who want to continue care in a residential setting.  

“Untreated mental illness and substance use disorder continue to be among the most pressing challenges confronting our city,” said Supervisor Rafael Mandelman. “I am pleased and grateful to see Mayor Breed continuing to invest in critical outreach and treatment services, and I am especially gratified to see in her budget a renewed focus on dual diagnosis treatment beds and other interventions for people suffering from more acute mental illness.”    

The Mayor’s Budget will further advance key investments made over the last several years, including funding 30 new dual diagnosis beds. These latest beds will provide residential treatment care for people with co-occurring mental health and substance use disorders. By investing in these specific bed types, wait times will be reduced and many more people can be helped off the street and into care.     

Continued Implementation of Mental Health SF   

The Budget will also focus on the continued implementation of key priorities of Mental Health SF, including systematic follow-ups for individuals discharged from hospitals after involuntary psychiatric treatment holds (5150s) and expanding care management services for people with behavioral health needs who are transitioning from the justice system.     

Additionally, to give greater access to services whenever someone seeking help is ready to ask for it, the Mayor’s Budget continued to budget to expand hours to weekends at the Behavioral Health Access Center (BHAC), where people can walk in for treatment and services. This year, hours at BHAC were expanded from 40 hours a week to 50 to include weekday evenings.   

Enhanced Investment in High-Risk Overdose Communities   

While the African-American community represents less than 6% of the San Francisco population, they represent 28% of overdose deaths over the last two years.    

To address the City’s disproportionate overdose deaths among African American people and people experiencing homelessness, the Budget will support a focus on culturally congruent programs tailored to serve at-risk communities, as well as expanded overdose prevention education, overdose prevention champions, and links to care, including abstinence-based treatment.    

“As a member of the recovery community, I understand the urgency for expanded services to treat addiction and substance-use disorder, particularly when it comes to tackling the devastating impact of fentanyl and preventing overdose tragedies,” said District 6 Supervisor Matt Dorsey. “Investing in more behavioral health programs is a necessary step in the right direction in ensuring the health and safety of our residents.”    

Coordinated Street Outreach  

The Budget will continue to fund the City’s Street Response Teams, coordinated by the Department of Emergency Management (DEM). The City’s multi-department approach to help people in crisis on our streets coordinates Police, Fire, Public Health, and Homelessness and Supportive Housing. As of April 2023, over 18,000 calls have been diverted from police to our street response teams.   

SFDPH’s neighborhood-based street care teams have expanded to five neighborhoods with the largest numbers of unhoused people and overdoses working seven days a week to get people into care. The Street Medicine team, serving nearly 3,000 patients a year, will continue to provide medical and behavioral health care to people experiencing homelessness in streets, parks and encampments. The City will continue to expand buprenorphine distribution by emergency responders and medical professionals in community. More than 5,000 San Franciscans get access to buprenorphine or methadone annually.   

  Abstinence-Based Treatment Programs   

This Budget expands the continuum of care and treatment options for people experiencing substance use disorder. Specifically, this Budget will continue the expansion of a women’s abstinence-based therapeutic community, which supports those exiting the criminal justice system who have experienced addiction, domestic violence, and family separation and will support additional abstinence-based treatment services.   

CARE Courts Implementation   

San Francisco is among the first seven counties across the State of California to implement Community Assistance, Recovery and Empowerment (CARE) Courts. This program is designed to bring people into care who are not ready to voluntarily engage but not eligible for programs like conservatorship.    

CARE Courts allow family members, healthcare providers, or first responders to petition for an individual to enter the programs. In these procedures, a Care Plan is established and a judge can use court orders to with support such as short-term stabilization medications and beds, as well as wellness and recovery offerings.  Mayor Breed’s Budget will fund engagement and assessment staff; increased capacity for treatment and housing; and outreach and educational efforts.     

New Wellness Hubs   

The Budget funds the opening of up to three Wellness Hubs over the next two years to support the City’s efforts to improve the health and wellbeing of people who use drugs, including those experiencing homelessness, and reduce public drug use. These sites will provide low- to no-barrier:   

  • Overdose prevention services and resources  
  • Resources to improve a person’s health, including basic needs as housing, food assistance, and basic medical services  
  • Connections to outpatient and inpatient residential treatment   

Any possible inclusion of safe consumption would be funded by private entities.    

Mental Health Services for Children, Youth and Families   

This Budget continues to support more than 100 programs delivering behavioral health services to children, youth, and families across San Francisco County. This includes a range of services offered within SFUSD that range from prevention, early intervention, outpatient care and intensive services.   

Advocating for Additional State Resources   

The Mayor continues to support efforts to identify more state funding for mental health and substance use treatment. This includes advocating for Governor Newsom’s proposed 2024 ballot initiatives to improve how California treats mental illness, substance use disorders and homelessness.     

This plan would build thousands of new community behavioral health beds in state-of-the-art residential settings to house Californians with mental illness and substance use disorders, which could serve over 10,000 people each year.