San Francisco officials press DPH for rapid hiring to implement Mental Health SF

San Francisco supervisors on Jan. 20 pressed the Department of Public Health to move faster on staffing and facilities needed to implement Mental Health SF, the 2019 law that aims to create a coordinated citywide system of care for people with serious mental illness and substance-use disorders.

"We are in a major, push right now to hire at least 200 behavioral health and mental health SF positions by March thirtieth of this year," Greg Wagner, chief operating officer of the Department of Public Health, told the Government Audit and Oversight Committee. The department said roughly 276 positions remain in its hiring pipeline and that 84 positions have been onboarded or have tentative start dates.

Why it matters: Supervisors said staffing shortfalls have delayed all parts of Mental Health SF, because the law's four components'a 24/7 mental health service center, an Office of Coordinated Care, expanded beds, and a street crisis response team'are interdependent. Without more case managers, supervisors warned, people will continue to cycle between the street, emergency rooms and jails.

What the department said: DPH officials told the committee that civil-service exam backlogs and national workforce shortages have slowed hiring for psychiatrists, psychologists and linguistically capable clinicians. To shorten timelines, DPH requested emergency hiring authority for 79 positions and plans a mix of emergency hires and regular civil-service appointments. DPH also said it is working with the Controller's Office on a wage analysis this year to evaluate pay differences between city jobs and community-based organizations.

Questions from supervisors: Committee members asked for more precise performance metrics, including current wait lists for intensive case management (DPH said more than 100 people have waited for ICM services), caseload targets for each case-management tier, and the geographic distribution of new hires and street teams. Supervisor Hillary Ronan asked the department to deliver the staffing and wage analysis in time to influence upcoming budget deliberations.

Facilities and beds: Supervisors also pressed DPH on acquiring and renovating sites for new beds and residential programs. DPH said it is negotiating purchases for several large residential sites and expects a target program of about 400 additional beds of various types; leaders acknowledged real-estate timelines and renovation needs remain a major implementation constraint.

Next steps: The committee "filed" the hearing for the record, and supervisors directed further work on the budget committee to monitor DPH's hiring progress, wage study and the development of the Office of Coordinated Care. DPH officials said they will provide further detail on caseload standards and a timeline for bringing new sites online.

Ending: With supervisors and department leaders acknowledging the scale of the challenge, the committee left the matter to follow-up oversight and budget hearings aimed at ensuring DPH meets the March hiring target and builds the staffing infrastructure Mental Health SF requires.