DPH outlines behavioral health expansion: access center, medication treatment and naloxone distribution

DPH gave a broad briefing on March 19 describing the city's behavioral health system, its goals and metrics to expand access and reduce overdose deaths.

The department reported about 100,000 annual connections to prevention, care and treatment and roughly 20,000 people served in specialty behavioral health programs. DPH said it has opened about 350 of the 400 planned residential treatment spots identified in its bed-utilization study and has expanded access points, including a behavioral health access center that is open seven days a week.

DPH highlighted efforts to increase availability and retention in medication treatment. The presentation cited roughly 2,500 people receiving buprenorphine annually and about 2,300 people receiving methadone; DPH also said it was distributing over 120,000 naloxone doses through providers and programs and expanding evening hours at some clinics and methadone services to improve access.

The department outlined a continuum of care that includes prevention, crisis services, access/navigation, outpatient and residential treatment, and recovery housing (up to 24-month transitional placements). It identified gaps the department intends to address, including specialized placements for people with forensic involvement and residential care for older adults with cognitive impairment.

DPH officials also described measurement work: using state-required structured assessment tools (CANS/ANSA), new HEDIS measures for substance use and efforts to quantify both fatal and nonfatal overdoses. The department noted limitations in some data — for example, difficulty estimating the total number of people with opioid use disorder in the city (the denominator) — and said it is contracting with UCSF to develop better denominators and targets.

Commissioners asked about retention metrics, staffing for intensive case management and differential outcomes for people referred from jails versus community referrals. DPH said confidentiality rules (42 CFR Part 2) and staffing shortages complicate data linkage and service capacity; they committed to follow-up on requested breakdowns.

Next steps: DPH will continue to expand access points and data systems, pursue regulatory and programmatic work to improve methadone availability in jails and at certain city sites, and return with more detail to the commission on outcomes and contracted performance measures.