San Francisco expands office of coordinated care amid staffing challenges

The San Francisco County government meeting on July 4, 2025, focused on the current state of the county's case management system, particularly in relation to mental health services. Key discussions highlighted the challenges faced by the Office of Coordinated Care, which was established under the Mental Health San Francisco legislation approved in December 2019. This office aims to provide comprehensive support for individuals with mental health needs, especially those experiencing homelessness or transitioning from institutional settings.

Currently, the county has a budgeted full-time equivalent (FTE) staff of 221, but a vacancy rate of 28% leaves approximately 63 positions unfilled. This shortage impacts the ability to serve nearly 4,000 individuals effectively. The case manager-to-client ratios vary significantly, with one case manager handling up to 50 clients for those with lower intensity needs, while the ratio drops to 1 to 12 for clients requiring the most intensive support.

The meeting also addressed the operational aspects of the case management system, including the frequency of interactions between case managers and clients. For clients with high needs, case managers typically engage 1 to 4 times a week, while those with lower needs may only receive monthly or biweekly contact. Most case managers are strategically placed within community-based organizations (CBOs) to meet clients where they are, with 55% located in civil service clinics and 45% in CBOs.

Despite the establishment of the Office of Coordinated Care, the meeting underscored ongoing challenges, including high caseloads leading to potential burnout among staff and difficulties in recruitment due to a statewide workforce crisis in behavioral health. The county is competing with larger counties for qualified personnel, and many case managers are not receiving differential pay for the demanding nature of their work.

The meeting concluded with a recognition of the hard work and dedication required to support clients effectively, emphasizing the need for continued efforts to address staffing shortages and improve service delivery in the face of increasing demand for mental health services.