Addressing the overdose and mental health crisis in San Francisco
The mental health and overdose crises unfolding on our streets demand a comprehensive, evidence-based approach. In shaping this platform, I have consulted with a wide range of experts and stakeholders, from researchers and public health professionals to social workers and neighbors in the Mission, Bernal Heights, and Portola neighborhoods. It's clear that we need a new direction, one grounded in data-driven policies and medical advice. San Francisco deserves solutions that save lives and reduce costs.
As Supervisor, here’s what I will do to address the overdose and mental health crisis:
Declare a Mental Health and Overdose Emergency
With 2023 as the deadliest year ever for drug overdoses, we must acknowledge the urgency of the mental health and overdose crises by declaring a citywide emergency.
Mirror the emergency response used during the COVID pandemic to address these pressing issues. We need the entirety of our government to be coordinated and focused on addressing mental health and harmful substance use, and cut through any red tape hampering our efforts.
Coordinate resources and mobilize multiple departments under a unified action plan. This involves implementing the rest of the City’s 2022 Overdose Prevention Plan, which included the participation of key community leaders, researchers and other overdose prevention experts.
Establish “Wellness Hubs” as a cornerstone of the City’s efforts, which will provide overdose prevention services and resources, services to improve health, and linkages to treatment.
Provide True Treatment on Demand so that anyone, at any time, can access effective, affordable treatment services whenever they request it. We must reduce wait times, remove bureaucratic hoops, enhance linguistic and cultural competency, expand points of entry, staff-up our behavioral health system, and remove barriers to treatment everywhere possible.
Revolutionize our approach to substance use disorder
Define substance use disorder as a public health crisis with holistic approaches and adopt empirically-driven, evidenced-based strategies instead of ineffective reactionary approaches. We must stop treating harmful substance use as a matter of morality instead of an issue of public health.
Address the social and structural determinants of substance use disorder by tackling poverty, homelessness, and social stigma which makes harmful substance use more prominent and deadly. We need to support the foundations of recovery with stable housing, education equity, job training, and comprehensive social services.
Eliminate barriers to treatment and overdose prevention measures by getting life saving medication into the hands of lay people; supporting more licensed doctors and mobile clinics in dispatching medication-assisted therapies, such as methadone and buprenorphine, and contingency management; and working with state and federal officials to amend laws such as extending Medi-Cal coverage for substance abuse treatment programs that are longer than 90 days.
Reduce racial inequities in harmful substance use and mental health treatment. Native Americans are more likely to report drug abuse than any other ethnic group; Black San Franciscans are five times more likely than the overall population to die from an overdose; and Latinos face multiple barriers to accessing life-saving tools such as naloxone. We need investments in culturally competent and data-driven treatment programs, and for Hispanic and Mayan-speaking residents, translated information in Spanish and Mayan dialects is key.
Adapt treatment programs to accommodate evolving drug use patterns and co-occurring conditions. Many people suffering from substance use disorder also suffer from mental health issues related to being veterans, foster youth, and victims of childhood abuse, domestic violence, gender violence, poverty, discrimination, and other forms of trauma. We can’t address one issue, without addressing the others. Research, data, and an integral approach to mental and physical wellness should help us evolve our treatment services as a city.
Build a Stronger Mental Healthcare Infrastructure
Recognize the unique needs of people with both mental illness and substance use disorder (dual diagnoses) and provide intensive, integral treatment that can help the many individuals who have co-occurring or dual diagnoses such as schizophrenia and substance use disorder.
Collaborate with the state to secure resources for building community-based behavioral health housing and treatment facilities. With Prop 1 funds, we must ensure that state resources come to San Francisco to address local needs.
Develop regional behavioral health facilities, ensuring access for patients regardless of background, medical condition, or insurance coverage. With Bay Area counties working together, we can provide more and better treatment.
Develop new models of housing integrated with care for people experiencing mental health and substance use disorders. People with high acuity need more clinical care than what is provided in Permanent Supportive Housing (PSH), which only provides basic case management. San Francisco needs new options that provide an appropriate level of clinical care for those with more intensive needs so that they do not simply lose the housing provided to them and end up back on the streets. This could include mental health co-operatives, step-down housing, shared housing, and short-term respite care homes such as Hummingbird.
More accountability from every level of government
Establish a unified and publicly transparent system to track all services and funding streams.
Collaborate with the state to create metrics for evaluating program effectiveness.
Improve accountability by tracking key indicators such as rates of incarceration, recidivism, homelessness exits, employment, overdose reversals and fatal overdoses.
Ensure accountability for drug dealers, from kingpins to street-level dealers with a primary focus on rehabilitation rather than incarceration. Norway's experience in the 1990s, where a shift toward rehabilitation led to a 50% reduction in recidivism rates, serves as a promising model. San Francisco should allocate resources to prioritize rehabilitation, especially for first-time offenders.
Support Research and Innovation
Partner with local research institutions to conduct research on substance use disorder and mental health. More research is needed in these intersecting fields, which are often treated separately, and the city should partner with local public research institutions where possible to innovate its approaches.
Encourage innovation in treatment and recovery programs. Shifts in attitudes towards harmful substance use are what gave us the research to create life saving medication such as narcan, withdrawal management, and medication-assisted therapies. More breakthroughs are possible.
Provide life-saving Narcan and free Fentanyl Testing
Establish more Overdose Prevention and Treatment Centers. The City has opened one sobering center that gives homeless people with substance use disorders a place to sleep, as well as detox opportunities and referrals to treatment programs, but one center will not serve the entire city. We need more Wellness Hubs to get people out of the streets and into stable locations where their likelihood of overdosing is significantly reduced in the presence of trained professionals who can also provide connections to treatment programs.
Offer free drug testing services for fentanyl. Fentanyl is being increasingly mixed into street drugs and sold as heroin, and other drugs recreationally used by young people. The city already gives free test strips and naloxone through the Community Behavioral Health Services pharmacy in SOMA and many nightlife establishments have such resources as well. However, individuals of all walks of life need multiple places in the community to get drugs tested, get supplied with and trained on life-saving narcan, build trusting relationships with treatment center staff, and get connected to rehabilitative programs if they need them.
Provide life-saving Nalaxone and Narcan training to lay people and people who use drugs. Still too few San Franciscans are equipped to recognize a person overdosing and intervene with life-saving Narcan if necessary. We need resources for cultural affinity groups and CBO’s to partner with programs that distribute and train on Naloxone use.
Ensure treatment centers are extremely low-barrier and accessible during evenings and weekends to accommodate individuals seeking help outside regular hours. This will require staffing up to ensure enough treatment professionals can be on standby to receive people seeking treatment at all hours of the day, 7 days a week.
Fix the Staffing Crisis
We need to address our city-wide staffing shortage of medics, behavioral outreach workers, 9-1-1 dispatchers, licensed clinical therapists, and emergency room nurses. To combat this crisis, we must offer competitive wages and benefits to city employees while ensuring our city’s HR department is taking measures to reduce the hiring and onboard timeline.
Endowment for social, behavioral, and public health workers. We can source talent among local graduates and support their college finances through an endowment, so long as they serve in these careers in the city afterward.
Provide housing subsidies for students to attract talent and support the next generation of San Francisco’s frontline workers.
Expand workforce housing options and resource programs to offer competitive salaries to attract and retain substance use and mental health treatment professionals.
Expand Mobile Clinics
Implement mobile clinics and street outreach teams to reach individuals suffering from homelessness, mental illness, and substance use disorder. When Portugal reduced the number of people who harmfully used heroin in their country by 75%, they staffed up mobile teams who distributed clean syringes, life saving medications, information about treatment, and primary care.
Distribute clean syringes, life-saving medications, treatment information, and primary care. We need to meet individuals where they are, ensuring they have access to vital resources.