SF May Have Swept Up for APEC, But Fails In Long-Term Response to Street Crises

City Hall Digest is TogetherSF Action’s weekly dispatch from San Francisco’s City Hall, broken into bite-sized pieces—because understanding local government is your fundamental right.

Treatment On Demand Hearing Finds Treatment Is Not Actually On Demand

A recent Board of Supervisors hearing on the Department of Public Health’s (DPH) annual Treatment on Demand report found that DPH is actually getting worse at getting people into treatment. This report evaluates DPH’s capacity for and delivery of addiction treatment, and reports data on the department’s performance over the last year. District 8 Supervisor Rafael Mandelman has called for this same hearing in 2019, 2021, 2022 and 2023, and yet nothing substantive has changed. 

In fact, DPH reported the median wait time for residential addiction treatment actually increased to five days this year, up from four days in 2022. Dr. Hillary Kunins, the Director of Behavioral Health Services (BHS) for DPH, said this was because demand had gone up and the department was facing staffing issues. Whatever the case may be, DPH has consistently claimed that people with substance use disorder can receive treatment with little-to-no wait—and that’s clearly not true.

While BHS says that the increased wait time for people seeking treatment is due to staffing shortages, staffing problems are compounded because BHS doesn't even have accurate data to know the demand for addiction treatment services in San Francisco. According to Dr. Kunins: “We measure demand based on who is seeking care, but we also recognize that there is more need in the community than what is reflected in the number of people seeking treatment… which may not be visible in our data.” This is important—accurate data is needed for the best delivery of services. If BHS doesn’t know how many people in San Francisco need addiction treatment services, how can they accurately plan staffing to meet demand?

With drug overdose deaths on track for a record-setting year, the city and DPH need to ramp up efforts to staff up, and the Board of Supervisors should support these efforts in the budget and legislative process however possible. Service providers say the major issue keeping them from full staffing is the fact that they can’t pay competitive wages to behavioral health workers. That can be solved by larger contracts for service providers. The Board of Supervisors can assist here by implementing better contracting practices or by adjusting next year's budget to include money to cover cost of living adjustments necessary for these workers.

Public health and drug treatment is San Francisco’s responsibility. We applaud Supervisor Mandelman for holding the Department of Public Health accountable, but they shouldn’t need their feet held to the fire constantly to make positive changes. Our That’s Fentalife! campaign this summer pressured City Hall to add extra funding for drug treatment and recovery services—funding should be available to meet demand. It’s time for DPH and BHS to put those funds to good use and fulfill their mission.

Too Many Street Teams, Too Few Results

On November 7, the Board of Supervisors Budget and Legislative Analyst Office (BLA) published an audit of the various street teams San Francisco created over the last few years to deal with the city’s escalating homelessness and mental health crises. The report's findings? It’s a mess out there.

San Francisco currently has at least eight street teams working on the streets, many launched in 2020 as a response to worsening street conditions. These teams are meant to connect people to services, keep streets clean, and de-escalate conflicts. But the BLA’s audit found that the city had zero infrastructure to support these teams at launch, which made it impossible for the teams to collaborate and ultimately succeed. Additionally, the data used to manage and record street team encounters are spread across eight separate systems that don’t talk to each other. 

The report also found contracting issues: the audit alleges that the nonprofit Harm Reduction Therapy Center performed work for the city’s Street Overdose Response Team for over 18 months without a proper contract with the Department of Public Health. 

This is a pattern we see time and again in San Francisco. The street teams are a good idea, implemented poorly. They do important humanitarian work. Instead of letting them fail, the City of San Francisco needs to examine consolidating these teams and making a single department—not several—accountable for their performance. There’s no reason eight street teams should receive taxpayer funds to do the same work, especially when those teams can’t even coordinate to magnify their impact and improve client care.

City Gets Its Act Together for APEC—Can it Last?

As San Francisco welcomed President Joe Biden, Chinese President Xi Jinping, as well as hundreds of other high-profile guests for the Asia-Pacific Economic Cooperation Convention (APEC), residents noticed the city’s efforts to clean up its streets.

In the weeks prior to APEC, the city cleared dozens of downtown homeless encampments, scrubbed graffiti from building facades, and disposed of sidewalk litter. It was a commendable effort from city workers, and city departments did an good job of coordinating to maintain safe and clean streets in the weeks leading up to and during the convention. It was a frankly stunning transformation for many downtown blocks that had long been plagued by a host of problems.

But many residents felt the effort raised the question of why San Francisco city departments can’t coordinate like this year-round. Of course, clearing homeless encampments for one week isn’t the same as solving the root causes of homelessness, so it may be naive to assume that this would last longer than a week under current conditions. But the idea that this level of coordination could (and should) be present in all the city’s ongoing endeavors to improve street conditions is not to be overlooked. Shouldn’t residents’ quality of life be just as strong an incentive as impressing high-profile visitors?