Controller's work group urges targeted expansion of high-acuity behavioral-health beds; city lists funding and projects underway

The Controller’s Office and a city work group on residential care and treatment recommended targeted expansion of high-acuity behavioral-health beds to better serve San Franciscans with the most complex mental-health and substance-use needs, and city health officials described capital awards, acquisitions and operational steps intended to add treatment and step-down capacity over the coming years.

Laura Marshall of the Controller’s Office summarized the work group’s January report, which concluded there is a measurable shortage of locked subacute treatment (often called “MERCs” or locked subacute) and specialized adult-residential (ARF/RCFE) capacity for clients who have combined medical, psychiatric and behavioral-complex needs. The report recommended a targeted addition of roughly 55–95 locked subacute beds and 20–48 high-complexity ARF/RCFE beds for harder-to-place clients, noting that those beds would likely require higher patch rates and would be largely non-Medi-Cal reimbursable operating costs borne by the local government.

Marshall and work group participants warned that even competitive county rates have not fully solved a market problem: operators sometimes deny placements for reasons beyond the city’s rate structure, leaving some clients…