Dr. Hilary Coonens, director of Behavioral Health Services, updated the San Francisco Health Commission on Thursday about new operational authorities, budget priorities and program expansions in the city’s behavioral health system.

Coonens told commissioners that the department will begin training community paramedics this month so they may initiate involuntary psychiatric holds (commonly known as 5150s) in coordination with the Fire Department, and that the city expects those paramedics to begin carrying out 5150 orders in July. “Our main and central goal is to ensure that a person who is in crisis is able to receive the most appropriate intervention,” she said.

Why it matters: Expanding who can initiate 5150 holds changes how first responders and health staff triage mental‑health crises and is intended to speed access to care. Commissioners asked how the department will track outcomes after a 5150; Coonens said DPH is validating a connection‑to‑care tracker and will share validated data when ready.

Key details: Coonens described several concurrent initiatives. The city is a first‑cohort early adopter of California’s Care Court, a state statute establishing a court‑based pathway for assessment and treatment of people with specified severe psychiatric disorders; San Francisco is one of seven counties in the first cohort. She said some state start‑up and bridge housing grants are available but ongoing funding levels were not yet clear.

Coonens also highlighted progress under Mental Health SF, a voter‑funded measure to add local behavioral‑health capacity: “We have opened 350 of the 400 beds funded under Mental Health SF,” she said, and the department recently brought 70 new residential “step‑down” beds online for people leaving substance‑use treatment.

On funding, Coonens noted the city attorney’s roughly $230,000,000 opioid settlement with Walgreens and said the bulk of those dollars will be delivered over multiple years, with approximately $57,000,000 due in the first year; allocations are being set through the mayor’s budget process.

Commissioner concerns and follow‑up: Several commissioners pressed the department on workforce and provider capacity, noting San Francisco’s high cost of living and reliance on a limited number of large providers. Coonens acknowledged ongoing vacancies, described continuous‑hiring efforts and said the department is expanding use of nontraditional clinicians (for example, clinical pharmacists prescribing buprenorphine) and peer workers as part of recruitment and retention strategies. Commissioners asked for further data on who is reached by programs and on treatment refusals; staff agreed to return with additional metrics and follow‑up analysis.

What’s next: Coonens said the department will continue to validate and share post‑5150 connection‑to‑care data, pursue competitive bridge‑housing grants for Care Court participants, and brief the commission on budget proposals tied to the mayor’s two‑year budget.