City puts closure of long-term mental health beds on hold
San Francisco Examiner - 9/21/2019
In response to public outrage over a proposal to suspend 41 permanent mental health beds at the Zuckerberg San Francisco Hospital campus, the Department of Public Health on Friday announced that it will freeze planned changes to give city leaders time to address the issue.
For years, the 55-bed Adult Residential Facility (ARF) located within the hospital's Behavioral Health Center has provided permanent beds for San Franciscans with severe mental health disorders who are unable to live independently. The San Francisco Examiner first reported in August that the department planned to suspend 44 of the ARF beds to allow for a 27-bed expansion of a shelter program offering short-term psychiatric respite in the same building.
Friday's announcement comes on the heels of three pieces of legislation proposed in the past month by city supervisors urging the health department to reverse its plan, and after dozens of health department employees shut down a health commission hearing on Tuesday in an effort to "save the ARF."
Frontline nurses who work with the 18 ARF patients who received 60-day relocation notices in August criticized the health department for destabilizing and displacing some of The City's most vulnerable residents. On Tuesday they presented a petition opposing the plan with over 1,200 signatures on it and denounced the department's lack of transparency in making the decision to supsend the beds.
"We have chosen to pause changes at the Behavioral Health Center while the Mayor and Board of Supervisors have a conversation about how to proceed in a way that accomplishes our shared goals of patient safety, stability and expanded access to services," health department Director Dr. Grant Colfax said in a statement posted to the department's website on Friday. "We restate our commitment to ensure the long-term stability of board and care services, including the [ARF]."
The health department has cited staffing shortages and state regulatory issues related to "staff behavior" as reasons for reducing the unit to just 14 beds, and has stated repeatedly that none of the patients within the ARF would go homeless. Many affected patients were asked to relocate to another psychiatric unit reserved for elderly patients within the behavioral health center.
"It is not correct to say we have 'closed' or planned to close the ARF. No one is or will be 'evicted' at the ARF. All the residents there have a choice, and if any of them would prefer to move to an equivalent facility in the community or elsewhere at the Behavioral Health Center, we will work with them to do so," Colfax said Friday. "Further, no DPH staff are losing their jobs at the Behavioral Health Center. These have been our principles all along, and they have not changed."
But opponents of the plan said that the city was not transparent in its decision making and argued that it jeopardized critical long-term care in exchange for temporary shelter beds. The nurses advocating to keep the beds open were also angered when the health department appeared to blame the decision to reduce services in the ARF on workers within the unit.
Continued tensions over the past weeks prompted city leaders to step in. Supervisor Hillary Ronen, who immediately denounced the ARF bed reductions upon learning about decision, called for a hearing on the issue, and along with Supervisor Matt Haney introduced an ordinance that would require the City to operate 55 residential mental health beds at all times and to develop an urgent hiring plan for the unit.
Earlier this month, Supervisor Rafael Mandelman introduced an ordinance that would require the health department to open and fill all 55 ARF beds by June 30, 2021, among other things.
On Tuesday, Ronen and Haney, who criticized the timeframe listed in Mandelman's ordinance, introduced a resolution that aimed to immediately protect the ARF residents by stopping the transfer of patients while officials work out long-term solutions.
In a joint statement issued Friday, Ronen and Haney criticized Mayor London Breed and health department leaders for dragging their feet on the issue.
"It shouldn't have been this hard to get the Mayor and the Department of Public Health to change an obviously flawed policy decision, but sadly it took us introducing legislation and direct action by front line nurses and health care workers for them to rescind eviction notices for severely mentally ill people, who would otherwise be on the street," Ronen and Haney said in their statement.
They added that "this situation is yet another example of why we need drastic reform."
"We must repair our broken mental health system. We are putting Mental Health SF on the Ballot because we need to ensure that these ill-advised, reckless policy decisions do not happen in the future," they said, referring to their proposed initiative proposed for the March 2020 ballot that would offer free mental health care and substance use treatment to any San Francisco resident in need.
On Friday, Colfax acknowledged gaps in the city's mental health system and promised that reforms are underway, citing "$50 million in new investments in behavioral health beds and services" in The City's recent budget as well as an initiative announced by Breed this month that promises to streamline housing and health care series for some 4,000 eligible individuals.
With some 500 board and care beds currently operated by independent providers within and outside of San Francisco, The City has also promised this month to provide greater support to these operators to ensure their longevity.
Jennifer Esteen, a ZSFGH nurse who has spearheaded advocacy around keeping the ARF beds open and filling them to capacity, on Friday demanded that the health department rescind the patients' relocation notices entirely, and pointed out that the department has not indicated "timelines or next steps beyond talking."
SEIU Local 1021 and Local 21, the unions representing the hospital workers, said in a joint statement Friday that their members "remain concerned for the long-term welfare of their patients, and continue to hope the pause will bring the DPH to a solution that will be mutually acceptable to patients, staff and stakeholders."