Health Commission outlines CARE Court rollout, rising overdoses and steps to expand treatment

San Francisco’s Department of Public Health on Tuesday briefed the Health Commission on plans to implement California’s CARE Court, expand residential behavioral‑health capacity and respond to a worsening overdose crisis.

Dr. Hillary Conins, director of behavioral health, said the county began implementing CARE Court (SB 1338) as part of an early cohort and that the civil process is designed to provide court‑ordered care plans of up to 12 months for people with untreated psychotic disorders. “This eligibility is for people with a psychotic disorder due to schizophrenia or other psychotic disorders,” Conins said, describing CARE Court as “a less restrictive alternative” intended to engage people earlier in treatment.

Conins described the city’s broader behavioral‑health expansion under Mental Health SF: an intended 400 new residential care and treatment spots, of which 350 are already open. She said the city estimates between 1 and 2,000 people in San Francisco may be eligible for CARE Court, though not all will be referred or accepted at once.

The commission also heard stark overdose figures. Conins said there were 563 preliminary overdose deaths in San Francisco from January through August 2023—about 40% higher than the same period in 2022—and that fentanyl was involved in roughly 80% of those deaths. “This is quite serious,” she said, and outlined steps the department is taking, including an overdose and treatment dashboard launched in September and expanded post‑overdose outreach teams.

Conins highlighted targeted efforts to reduce disparities: connections with 25 Black‑led or Black‑serving organizations, training programs and new residential and step‑down beds for substance‑use disorder treatment. She also described contingency management pilots—financial incentives for healthy behaviors—being funded under CalAIM and an awarded CDC ‘‘Overdose to Action’’ grant to expand navigation into treatment and improve data capture.

Commissioners pressed on measurement, access and workforce. Commissioner Guillermo asked how the city will ensure contracted providers produce measurable outcomes; Conins said DPH expects EPIC, the new electronic health record scheduled for rollout in May, to simplify reporting and outcome tracking. “We want to set our own benchmarks,” she said, pointing to an overdose dashboard and a future Mental Health SF dashboard the department is developing.

Public commenters and family members described difficulties accessing timely care. One parent told commissioners that efforts to reach mobile crisis services and specialty psychiatric care resulted in multi‑month waits and failed engagements. Dr. Teresa Palmer, a clinician who addressed the commission, warned against repurposing Laguna Honda nursing capacity in ways that could expose frail long‑term care residents to unsafe clinical mixes: “Laguna Honda is not a mental health facility,” she said, adding that care planning and safety must be safeguarded.

What’s next: the commission asked DPH to continue developing the overdose and Mental Health SF dashboards, report on measurable benchmarks for contracted providers, and provide updates on EPIC implementation and workforce strategies.

Sources: Public presentation by Dr. Hillary Conins and Director Grant Colfax to the San Francisco Health Commission, Oct. 3, 2023.