S.F. has not opened new addiction treatment beds in a year despite push to get people help (2025)

More than a year ago, San Francisco passed a law designed to boost the number of beds for those in the throes of mental illness and addiction, with then-Mayor London Breed saying at the time that the city “can’t allow delays and bureaucracy to get in the way of getting people help.”

But despite changes to streamline the system, the city has not added any residential treatment beds.

The law, unanimously approved by the San Francisco Board of Supervisors in February 2024, waived the city’s competitive bidding process with the goal of bringing new treatment beds online faster and reducing wait times for clients. The Breed administration said that the city was often forced to compete with other Bay Area agencies for a limited number of privately-owned and nonprofit-run beds in the region, and that the city’s onerous bidding process put it at a disadvantage.

The Department of Public Health said that although it has not yet added any residentialtreatment beds since the law took effect, it has helped the city “ensure continuity of existing beds for contracts that were set to expire.” The agency plans to leverage the law to add approximately 135 treatment and care beds this year. Those includea 16-bed stabilization unit offering short-term and urgent psychiatric and substance use treatment in the Tenderloin and a board-and-care facility for elderly people in Hayes Valley.

Since last spring, the public health department has funded more than 100 new transitional housing beds for people with behavioral health issues and 45 “safe sleep” beds for homeless people to rest on during daylight hours. The daytime beds are provided by the Gubbio Project, a nonprofit in the Mission neighborhood that does not provide on-site treatment but does help connect people to care.

Mayor Daniel Lurie, who succeeded Breed in January, has prioritized addressing street conditions by ratcheting up enforcement and trying to compel more people who are living on the streets with mental illness and addiction into treatment. Another ordinance proposed by Lurie and passed by the board earlier this year allows the administration to similarly bypass the typical competitive bidding process to enter into contracts that address the city’s addiction, homelessness and mental health problems. It remains unclear to what extent the law might help the city address bed and staffing shortages within its behavioral health system.

San Francisco voters in 2008 passed a mandate requiring the city to ensure that those ready for treatment receive it immediately. However, hundreds of people each year still are not getting into treatment the same day they seek it. The Chroniclerecently profiled a man who died of a drug overdose after being turned away from the city’s largest drug treatment provider, HealthRight 360, because he was reportedly too inebriated.

Board of Supervisors President Rafeal Mandelman, who co-sponsored the legislation, acknowledged that such process improvements were “at best going to be modestly helpful over time” but that “every hurdle or impediment you can take away is better than not.”

San Francisco in December requested $144 million from the state to add 175 treatment beds for people battling mental illness or addiction. California voters in March 2024 passed a $6.4 billion mental health bond, and the city is hoping to obtain a piece of that. The funding is not guaranteed and only covers capital costs. The state is expected to announce award recipients in May.

The public health department is seeking through the state funding request to add 40 addiction treatment beds, 50 locked subacute beds, 12 beds in San Francisco General Hospital’s psychiatric emergency department and 16 dual diagnosis beds for people with both addiction and mental health disorders. In partnership withUCSF, the city hopes the state will also fund 50 new locked subacute beds and six acute psychiatric beds to UCSF’s St. Francis campus in Lower Nob Hill.

Additionally, the city’s request included $12.2 million to relocate and expand the city’s Mental Health Service Center, but the city recently halted that plan following opposition from community members and Supervisor Matt Dorsey, who lives on the same block as the once-proposed relocation site at 1125 Mission St.

San Francisco had about 1,900 mental health and addiction treatment beds last year, with an additional 638 beds available as-needed, according to city estimates.

In August 2022, the city estimated that of the nearly 19,000 adults who experienced homelessness in the prior year, 9,000 were struggling with addiction or a serious mental health disorder. Those estimates did not include people who were in stable housing and battling similar problems.

The city stands to double its locked subacute beds if the state fully awards its request.

Breed pushed Gov. Gavin Newsom, who proposed the ballot measure, and lawmakers to allow the bond funding to be used for locked facilities. Proponents said it would help cities like San Francisco find placements for people under conservatorship, but mental health advocates were opposed.

Breed pushed the city to more aggressively compel more people into involuntary mental health and drug treatment following a new law that expanded eligibility for conservatorship. But San Francisco conservators previously told the Chronicle that despite the new law, they were still having problems finding appropriate facilities to place conservatees.

Editor's note: This story was updatedWednesday, April 1, to reflect that no residential beds have been opened in the past year. The city has funded more than 100 new transitional housing beds for people with behavioral health issues.

Reach Maggie Angst: maggie.angst@sfchronicle.com; X: @maggieangst; Bluesky: @maggieangst.bsky.social