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Behavioral‑health update: Prop 1 planning, Epic migration, care coordination and bed‑need estimates
Summary
DPH presented a behavioral‑health briefing covering Proposition 1 implementation planning, the May Epic EHR migration for behavioral health, the Office of Coordinated Care’s referral tracking, and estimates that San Francisco has about 2,500 residential care beds but needs additional specialized beds, including locked subacute and elderly behavioral‑complex placements.
San Francisco Department of Public Health staff presented a multi‑part behavioral‑health update to the Health Commission covering state policy changes, a major electronic health‑record migration, new care‑coordination infrastructure and estimated residential‑care bed shortfalls.
Dr. Conners told commissioners that Proposition 1 (approved by California voters in March) revises and renames the Mental Health Services Act to the Behavioral Health Services Act, changes allowable allocations and includes a $6.4 billion statewide bond. She said counties have time to align local allocations and that state guidance on allowable categories remains forthcoming; the new allocation framework does not need to be in effect until July 2026.
Conners reviewed the BHS migration onto the shared Epic electronic health record (the behavioral‑health join occurred May 22), describing the implementation effort, ongoing “at‑the‑elbow” clinician support, and remaining challenges for substance‑use records protected under federal confidentiality rules (42 CFR Part 2), which require some substance‑use treatment records to remain separate from the routine Epic record unless the patient consents.
The Office of Coordinated Care, Conners said, has launched referral tracking in Epic and is capturing referral volume since November 2023. That office now includes care‑management teams embedded in neighborhoods, street teams, and shelter supports designed to increase successful connections to outpatient care.
On residential capacity, Conners provided citywide estimates of approximately 2,500 residential care and treatment beds (about 1,800 mental‑health beds and 690 substance‑use beds) and identified gaps: an estimated need for roughly 50 additional mental‑health residential treatment beds, between 55 and 95 locked subacute beds, and an additional 20–40 residential beds for elderly patients with behavioral‑complex needs. She said some beds are contracted “as‑needed” rather than fixed for San Franciscans and that procuring higher‑medical‑complexity withdrawal management beds remains a challenge.
Commissioners asked for clarification about the 95‑percent planning benchmark (Conners said it was a statistical target for average wait times to approach zero and not intended to exclude the most complex patients) and pushed for public emphasis on bed‑type shortfalls to attract providers and funders. Conners said a mayor’s office–led work group is convening stakeholders to identify procurement strategies for difficult‑to‑place beds and that the department will continue refining bed models and timelines.
Conners also described overdose prevention work, ECM (enhanced care management) integration, and programs to provide culturally congruent care for Black/African‑American communities. She said the department will return with more targeted data and outcome measures as Epic reporting and CalAIM billing mature.
The commission did not take formal action on these briefings but asked staff for follow‑up on timelines, data and plans for adolescent and under‑12 capacity.
