DPH outlines bed-optimization model and COVID-era priorities; supervisors press for care-coordination costs

San Francisco Department of Public Health officials told the Board's Public Safety and Neighborhood Services Committee that COVID-19 redirected staff and complicated behavioral-health workflows but also created operational footholds — including shelter-in-place (SIP) hotel clinical teams — that can be scaled toward the Mental Health SF blueprint.

"We have been in full response mode with the citywide COVID activation," Hallie Hammer, director of ambulatory care for the Health Network, told the committee. She described telehealth scaling from roughly 12 percent of encounters before the pandemic to more than 60 percent during the public-health emergency and said DPH has maintained contact with more than 85 percent of its established behavioral-health clients.

Dr. Anton Nagueusa Bland, the department's mental health reform lead, presented a discrete-event bed-optimization model that used FY2018–19 data and system inputs to identify bottlenecks and the number and types of beds that would reduce boarding times. Bland recommended adding multiple bed-types, coupling each bed investment with long-term housing placements and creating a continuous improvement process to repeat modeling annually.

"If we can make subacute beds available when those patients are ready for those services, the entire system will flow more smoothly," Bland said, summarizing the modeling approach and the recommendation to pair bed investments 1:1 with housing.

Supervisors adopted a sharply pragmatic tone: Supervisor Rafael Mandelmann and Supervisor Ronan pushed DPH for concrete near-term answers on where crisis teams would take people in psychosis or severe intoxication, how many beds and what types would be available, what the annual operating costs would be, and how the proposed bed investments fit with Mental Health SF implementation. DPH officials said a bond on the November ballot could fund some facility needs and that DPH met general-fund reduction targets without proposing behavioral-health cuts, but the department acknowledged it had not yet included major Mental Health SF expansions in the submitted budget and promised more specific cost figures.

Marlo Simmons, DPH acting director for behavioral health, described an incremental path for care coordination: start with a staffed linkage line for SIP hotels and other sites so on-site staff can call for clinical consultation and rapid response; expand relentless street-based outreach; and build data and quality-assurance functions so PES and outpatient providers can share client information and coordinate follow-up.

Public commenters largely urged fast implementation of Mental Health SF, more beds and expanded low-barrier, voluntary services; advocacy groups emphasized centering equity and avoiding further criminalization of people with mental health conditions. Callers also stressed the needs of families, non-English speakers and monolingual populations.

The committee voted to continue the COVID-behavioral-health hearing to the call of the chair so DPH can return with clearer cost estimates, bed-count plans and operational details linking outreach teams to intake and placement options.

What to watch: DPH returns with a budgeted plan for an Office of Care Coordination, concrete cost estimates for expanded street outreach and staffing for SIP hotels, and an update on the bed-modeling operational steps and proposed procurement timeline.