Supervisors step up pressure on mayor, DPH to reopen long-term mental health beds
San Francisco Examiner - 9/4/2019
Adding to political pressure on the mayor and health department officials, Supervisor Rafael Mandelman on Tuesday requested legislation to ensure that 41 long-term care beds serving patients with severe mental illness at the Zuckerberg San Francisco Hospital will be reopened.
The San Francisco Examiner reported last month that only 14 beds will remain inside of the Adult Residential Facility — a unit inside the hospital's Behavioral Health Center with 55 permanent beds serving patients unable to care for themselves. The Department of Public Health plans to relocate at least 18 residents by October.
More than half of the beds inside the ARF have been held empty for at least a year.
On Tuesday, Mandelman requested that the City Attorney draft legislation requiring the Department of Public Health to "open and fill" all 55 ARF beds by June 30, 2021 — the date on which the suspension on the 41 beds will be lifted, he said.
The legislation would also require DPH to present a report on the "barriers to operating the ARF at full capacity, including any necessary legislative, regulatory, budgetary or policy changes and a plan to achieve full capacity at the ARF" to the Board of Supervisors, and require semi-annual updates after that initial report.
DPH officials have justified the decision to suspend the residential treatment beds as a means to add 27 short-term shelter beds for mental health patients at the hospital's Hummingbird Place, a psychiatric respite and drop-in center where the length of client stays averages about 19 days. They have cited staffing issues inside the ARF as a reason for suspending the beds.
Shortly after taking office, Mandelman authored legislation to stabilize private residential board and care beds that also serve mental health patients in need of assisted living services but that are shuttering at alarming rates, and more recently supported efforts to tighten conservatorship laws in San Francisco. Among adult patients receiving treatment in the ARF are a number of individuals who have been conserved, a DPH spokesperson confirmed previously.
Mandelman said that there is a clear need for The City to "maintain and expand" its portfolio of city-operated residential care beds, which is currently limited to the hospital's Behavioral Health Center.
"Allowing the department nearly two years to restore the ARF should be enough time to solve any staffing or regulatory issues, although I am mindful that, again, the ARF has not operated at full capacity for many more years than that, and I believe DPH staff when they say they have been trying," said Mandelman. "They need to try harder, and this ordinance will put the full weight of the Board of Supervisors and I hope the mayor behind the effort."
Supervisor Hillary Ronen also addressed the matter on Tuesday, calling for a hearing on the events that led up to the decision to suspend the beds within "two to three weeks."
"DPH quietly decided to place 41 long term beds on indefinite suspension. The department already removed 14 of those beds last year [and is] using them as short-term navigation center beds at Hummingbird Place and was about to remove 27 more," said Ronen, adding that the decision came despite a clear need for long-term residential treatment beds.
Ronen said that she was made aware of the issue by nurses who work inside of the hospital's Behavioral Health Center. The nurses allege they were told that the beds were kept empty because the hospital was in violation of its license, but Ronen said DPH officials told her the "redistributions" stemmed from staffing issues within the unit.
Ronen noted that The City, which contracts with private board and care providers, has lost some 40 percent of those beds in recent years.
"There are people in locked facilities, they are incarcerated despite the fact that they don't have to be incarcerated, because there are no board and care beds to send them to," Ronen said.
She added that the loss of ARF beds has "serious implications for people being conserved."
"We recently passed legislation expanding the number of people The City can place into conservatorship. At the same time we are removing precious beds we control that could serve people who they conserve," said Ronen. "This would have been information I would have loved to know when voting for conservatorship law."
Ronen called Mandelman's request for legislation "misguided" and called for more immediate action, including filling the beds within the month to ensure that "our city's most mentally ill are not abandoned on the streets for the next two years." She said Mandelman had developed his approach without consulting with the nurses and other hospital employees.
"These beds have scandalously been empty for a year. That is an outrage," Ronen said at Tuesday's meeting. "We as a city need to be doing everything in our power right now to hire the labor force necessary so that those beds go online next month — that is the urgency I have around this crisis when people are incarcerated in jail or in a locked facility."