Where are the empty treatment beds in SF? The health department wants to find out – San Francisco ChronicleNews
San Francisco health officials are rolling out a plan to fix a confounding problem: Many treatment beds in the city sit empty every night, despite thousands of people struggling with homelessness, mental illness and drug addiction on the streets.
Mayor London Breed and Dr. Anton Nigusse Bland, the city’s director of mental health reform, plan to launch an online tool that will show, in real time, which of San Francisco’s hundreds of treatment programs have open slots. The lack of a centralized database to track open beds has made it more difficult for those seeking help to get it.
While the database won’t solve the many other hurdles people face in trying to get care for mental health and substance abuse, Nigusse Bland hopes it will at least add more transparency to the system.
“It will answer the question, ‘Where are the treatment beds, and what do I need to get into one of those?’” said Nigusse Bland. “People need to know when these resources are available.”
The rollout comes as the city’s public health department faces heightened criticism over its behavioral health care system and how it uses its existing resources. The department faced intense scrutiny last month when news surfaced that about 40 long-term mental health treatment beds at S.F. General Hospital’s campus had been unused since 2018. The Chronicle then found that empty beds have been pervasive around the city — beyond those at the public hospital.
Nigusse Bland said the department has been working on addressing the vacancies, and the new tool — which he hopes will launch in November — is just one step toward fixing those issues. He said when short-term residential treatment providers have a vacancy, they will immediately report it to the Behavioral Health Access Center, which will then update the public database. Anyone, including case managers and clients, will be able to access the information online.
The database will start tracking programs that offer withdrawal management and substance use treatment, and then eventually move to mental health treatment programs. When it is complete, the database will show how many of the city’s 350 short-term behavioral health treatment beds are available on a daily basis.
“It will help reduce vacancies overall because we can update it in real time,” he said. “This is going to be a robust change for the system.”
San Francisco’s behavioral health care system is disparate and disjointed, and difficult for many to navigate. It’s made up of hundreds of different treatment programs, most of which are run by nonprofits. Some programs are for drug detox or mental health issues, while others are for both. There are programs just for women, just for men, or exclusively for those with children.
Adding to the complexity is that there’s no centralized database to track open beds. Case managers say they waste hours calling around to different treatment programs trying to find a slot for their client. Some clients — many of them homeless, mentally ill and drug addicted — just wander over to a treatment program, only to be turned away at the door.
“People just assume the beds are full,” said Lizz Cady, a case manager in the Tenderloin.
But sometimes, that’s not the case. There were several nights this year where there were between 27 and 70 open beds across three programs run by HealthRight 360, a large addiction treatment program, according to data shared with The Chronicle this month. Two other major nonprofits in the city — Progress Foundation and PRC Baker Places — say they also struggle to fill all of their beds on a given night.
There’s a range of reasons behind the empty beds, from staffing shortages to arduous intake processes that can sometimes last up to a day and a half. Other times, facilities intentionally leave beds open for clients who are expected to arrive within the next few days. Drug treatment programs, such as HealthRight 360, were particularly impacted when the city opted into a new federal- and state-funded substance abuse treatment that increased paperwork and altered entry requirements for certain clients.
Lauren Kahn, a spokeswoman for HealthRight 360, said she does not have enough details to know how the new tool will help the facility address the other admitting hurdles — but she welcomes the innovation.
Kahn said HealthRight 360 has been able to whittle down its vacancies as staff members have figured out how to work with the new requirements over the past few months. The nonprofit is also working to expand its intake hours beyond normal business hours, as people often need treatment at night or on the weekends.
“It’s not going to be the magic key for us, but we are interested in learning more details about this project and seeing how it works and how people use it,” she said. “Once you centralize this information, you can show where the gaps are in the system and lay groundwork for more fixes in the future.”
Cady, the Tenderloin case manager, said the new system is a “positive step” that would save her a lot of time in placing clients.
“This will save me a 10-minute hold, two transfers and another hold while someone figures out who to talk to — only to learn at the end that there are no beds available,” she said.
But, she said, the city needs to go beyond just reporting vacancies.
“If we can do this, maybe we can start tracking who was referred and why they didn’t get a bed,” she said. “If the bed information is public, it will put pressure on the agencies.”
This announcement is one of the first major rollouts by Nigusse Bland, who was hired by Breed earlier this year to recommend changes to the city’s mental health care system.
San Francisco spends nearly $400 million a year on mental health and addiction treatment, but thousands of people in crisis are still without sufficient care. In this ongoing series, Chronicle journalists investigate the failures of this complicated, costly system and explore solutions to the crisis.
But, he said, being able to see where the systemic gaps are is a critical step.
“The goal is to reduce the amount of empty beds,” he said. “This is really about us being able to use our data to make a decision about where we need to add more services.”
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