Here’s how S.F. wants to spend $144 million from Gavin Newsom’s mental health bond

San Francisco has asked state officials for $144 million to create 175 more beds for people experiencing mental illness and addiction. 

The Department of Public Health submitted an application to the state this month in hopes of securing a portion of the $6.4 billion mental health bond passed by California voters in March. 

That bond, crafted by Gov. Gavin Newsom, was designed to fund the construction and acquisition of thousands of treatment beds and supportive housing units across the state. Newsom sold the measure as a critical funding mechanism to address the needs of homeless Californians with severe behavioral health issues and to reduce encampments.

The Department of Public Health wants to add 40 substance use 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 substance use and mental health disorders across sites it controls. The Department is also seeking $12.2 million to develop a new Mental Health Service Center. 

Additionally, in partnership with the UCSF, the city’s funding request includes adding 50 locked subacute beds and six acute psychiatric beds to UCSF’s St. Francis campus in Lower Nob Hill.

San Francisco had about 2,550 mental health and addiction treatment beds last year, according to city estimates. The city’s request for 100 new locked subacute beds would double its current beds in this category to serve people with severe mental illnesses. It would especially boost the city’s efforts to increase the number of people on conservatorships, a sweeping legal arrangement that lets the government make decisions for people deemed unable to care for themselves.

During the state legislative process, Mayor London Breed pushed the governor and lawmakers to allow funding from the bond to go toward locked facilities — a move that sparked backlash from mental health advocates. 

“Locked facilities remain one of the biggest needs for people who are the sickest,” Breed spokesperson Jeff Cretan said. “That’s why Mayor Breed insisted on it and why the city has proposed to dramatically expand our capacity in that area.” 

Incoming Mayor Daniel Lurie said Wednesday that he was “happy to hear that about the application going in.”

“These departments know my priorities and they’re all on board,” he said about getting more San Franciscans into treatment.

There are no guarantees that the city will receive all the funding it requested. San Francisco is competing against other Bay Area counties for a pool of regional funds. 

The California Department of Health Care Services is expected to announce funding awards in May. City officials would then need to identify funding to operate the new beds, as the state bond can only cover capital costs.

In order to cover the new operational costs, Lurie will need to make other trade-offs since the city faces an $876 million two-year budget shortfall. 

At the city’s Budget & Finance Committee meeting earlier this month, Supervisor Rafael Mandelman commended the Department of Public Health for “stepping up in a major way,” especially its plan to add more locked beds. 

“If we are going to address the evident need for long-term placements for people with severe mental illness that I think is obvious to anybody who spends any time on any sidewalk in San Francisco, it's really important that we focus on those higher levels of acuity beds,” he said. 

Although the city has added about 400 treatment beds in the past three years, Mandelman said the city has not focused on expanding capacity for its highest-needs patients because of funding and staffing challenges. The Department of Public Health earlier this year estimated that during the second half of last year 15%-20% of its short-term residential mental health beds went unused because of staffing shortages.

Over the past several months, Mandelman led a residential care and treatment workgroup that focused on identifying gaps in the city’s behavioral health treatment system and making recommendations on how to address them. A formal report from the group is expected in January. 

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