San Francisco extends Crestwood contract for 200 mental health rehab beds until 2028

The San Francisco County government meeting held on July 4, 2025, focused on critical discussions surrounding mental health care services, particularly the extension of a contract with Crestwood Behavioral Health. The meeting began with an overview of the existing partnership, which provides essential mental health treatment through approximately 200 beds, primarily located out of county.

The first agenda item addressed the need for a resolution to approve the first amendment to the Department of Public Health's (DPH) contract with Crestwood. This amendment extends the agreement from June 2023 to June 2028 and increases the contract's maximum amount from $77.3 million to $224.2 million. The increase is largely attributed to a 53% average rise in bed costs over the past three years. The beds are designated for individuals on LPS conservatorships requiring stabilization before reintegration into the community.

Supervisor Marr raised concerns regarding the scarcity of subacute care beds in San Francisco and the implications of relying on out-of-county facilities, which are often located far from the city. The DPH representative acknowledged the limited number of comparable beds available locally, citing approximately 100 beds within San Francisco. The representative explained that the challenge of securing appropriate facilities for mental health rehabilitation within the city has led to the reliance on Crestwood's out-of-county options.

The discussion highlighted the ongoing efforts to enhance local mental health services, with the DPH aiming to strengthen lower levels of care to reduce dependency on locked acute facilities. The meeting also touched on the historical context of the contract, noting that the partnership with Crestwood has been in place since at least 2008, with fluctuations in bed availability over the years.

Public comments included concerns about the treatment of vulnerable populations, particularly in light of past issues at Laguna Honda, where the mixing of different patient demographics raised significant ethical questions. A caller emphasized the trauma experienced by seniors transferred out of local facilities, underscoring the need for responsible management of mental health care resources.

In conclusion, the meeting underscored the urgent need for expanded mental health services in San Francisco, with a focus on maintaining local care options while addressing the challenges posed by rising costs and limited facility availability. The DPH's ongoing partnership with Crestwood is seen as a critical component in meeting the city's mental health needs, but there is a clear call for a long-term strategy to increase local capacity and improve care for residents.