Supervisors hear wide-ranging testimony on 'treatment on demand'; DPH outlines expansions and data gaps

A San Francisco Board of Supervisors hearing on the city’s Treatment on Demand annual report drew hours of testimony Thursday on how to speed and sustain access to substance use treatment.

The hearing, requested by Board President Rafael Mandelmann and convened by the Public Safety and Neighborhood Services Committee, featured presentations from Department of Public Health leadership, the Fire Department’s community paramedicine unit, Adult Probation, the Public Defender’s Office, providers and several community coalitions. The department laid out recent steps to reduce barriers and expand capacity but officials acknowledged persistent measurement gaps and subpopulations — notably people with co‑occurring severe mental illness and substance use disorders, monolingual non‑English speakers and justice‑involved individuals — where access remains limited.

“From the street you can see with your own eyes what is working and what is not,” Director Daniel Tsai said, calling the situation “an epidemic and a crisis” and noting the city is averaging “close to two people a day dying from overdoses.” Tsai described four priorities: speeding entry into care, expanding capacity across stabilization, treatment and recovery, improving access to medication‑assisted treatment, and strengthening “stickiness” — patient retention across levels of care.

Daniel Tsai and Dr. Hillary Conners (Director of Behavioral Health Services) summarized recent operational changes and investments. Officials said the city…