San Francisco's PES faces staffing challenges while addressing involuntary hold cases

The San Francisco County government meeting on July 4, 2025, focused on critical issues surrounding mental health services, particularly the challenges faced by the Psychiatric Emergency Services (PES). Key discussions revolved around the effectiveness of conservatorships for individuals with severe behavioral health issues and substance use disorders, as well as staffing shortages within the PES.

During the meeting, officials highlighted the complexities of managing patients who often experience relapses. While some individuals have benefited from long-term care after being placed under conservatorships, outcomes have varied significantly. The discussion revealed that many patients discharged from PES against medical advice often do not return for further treatment, raising concerns about the judicial system's role in these decisions. Despite the PES team's efforts to advocate for extended hospital stays, judges occasionally deny requests for involuntary holds, which can lead to mixed results in patient recovery.

Staffing challenges were another major topic. Karen Hill, the director of staffing for the Department of Public Health, reported that while there are currently two vacancies in PES, efforts are underway to fill these positions. The staffing situation has been complicated by the ongoing impacts of COVID-19, which has led to both planned and unplanned absences among staff. The PES unit is budgeted for a specific number of full-time equivalent positions, but reliance on per diem staff has increased during this period.

Overall, the meeting underscored the ongoing struggles within San Francisco's mental health services, particularly in balancing patient care with legal and staffing constraints. The discussions highlighted the need for continued efforts to improve treatment outcomes and address staffing shortages to better serve the community's mental health needs.