Supervisors press DPH over inconsistent wait‑time data and bed access as mental‑health budget requests move forward

San Francisco supervisors on Wednesday pressed the Department of Public Health to fix long‑standing gaps in how the department records and reports wait times and placement outcomes for mental‑health and substance‑use services, saying inconsistent data undercuts the board’s ability to set the city budget.

The Budget and Finance Committee’s third budget‑priority hearing on mental health and substance use opened with a presentation by the Budget and Legislative Analyst’s office, which highlighted three priorities: outreach (including expanded night coverage), crisis services and residential treatment. BLA staff noted that in fiscal‑year 2017–18 about 2,667 people were held involuntarily through 5150/5250 holds and that the division does not systematically track wait‑list information for residential placements.

Supervisors repeatedly asked DPH officials to explain how the report’s wait‑time chart was measured — specifically, when the clock starts and stops — and to reconcile widely differing answers supervisors said they had previously received. "We are getting wildly different numbers,” Supervisor Hillary Ronan said, adding that people recently discharged from San Francisco General sometimes “walk around the Mission with their wristbands still on.”

DPH officials acknowledged the shortcomings. Kelly Hiramoto, director of transitions, said placement tracking currently relies on a manual Excel spreadsheet that records the date a placement request is received and the authorization outcome but does not capture when a clinician first recommended a step‑down level of care. "There is nobody who tracks from the moment a physician decides a different level of care is needed to when the placement request is sent to transitions," she said.

Interim Behavioral Health Director Irene Sung told the committee the department’s behavioral‑health budget is about $366 million, with roughly 809 budgeted civil‑service FTEs and more than 80 community‑based contractors providing direct services. Sung described recent and planned capacity expansions — adding peer navigators tied to the Hummingbird respite program, expanding drop‑in hours, and creating 72 new residential step‑down beds for substance use — but she also acknowledged a workforce vacancy rate she described as substantial.

City health leaders said they are working with a vendor for an electronic placement product (SF GetCare) to capture more granular timestamps — the date a referral was made, when a complete referral package arrived, and whether delays are driven by bed scarcity or paperwork. "We're trying to fine‑tune the front end so we can get a decision from a facility within two days," Hiramoto said.

Supervisors said the data fixes must come with specific timelines and staffing plans. Roland Pickens, director of the San Francisco Health Network, said recruiters in human resources will prioritize filling mental‑health vacancies and that the city can provide a recruitment plan within a week.

Community presenters — including legal and provider organizations, nurses at San Francisco General and people with lived experience — urged immediate budget investments in supportive and scattered‑site housing, expansion of intensive case management and outreach teams, wage increases for community‑based staff, and pilot funding for overdose‑prevention services. "Housing is health care," Bill Hirsch, director of the AIDS Legal Referral Panel, told the committee.

Chair Feuer and members of the committee asked DPH for follow‑up data and pledged to continue the item to the call of the chair so the department can return with the requested metrics and a recruitment plan. The committee continued the hearing to the call of the chair and adjourned without a final vote on budget items.

What’s next: DPH agreed to provide the committee with clarified wait‑time definitions, a timeline for implementing SF GetCare placement modules and a staffing/recruitment plan; supervisors said the board will use that information when reviewing FY 2019–20 budget proposals.

Quotes that illustrate the dispute: "I don't trust the data that you've given me — you've given me wildly different numbers." — Supervisor Hillary Ronan "We collect it in an Excel spreadsheet. There is nobody that tracks the physician‑decision timestamp to the transitions request." — Kelly Hiramoto, DPH transitions director

Votes and procedural outcome: The committee continued the item to the call of the chair for follow‑up rather than taking final budget votes at the hearing.