San Francisco supervisors press DPH on case manager vacancies, data sharing and housing coordination

San Francisco — The Board of Supervisors’ Homelessness and Behavioral Health Select Committee on July 28 took an in-depth look at the Department of Public Health’s behavioral health case management system, focusing on staffing shortfalls, service intensity and barriers to information sharing.

Supervisor Hillary Ronan, chair of the committee, opened the hearing by saying case managers are central to connecting people with mental illness and substance-use disorders to treatment and housing. “Case management is extremely hard work,” Ronan said as she introduced the Department of Public Health presentation.

Imo Momo, director of managed care at the Department of Public Health, told the committee the city’s intensive and linkage case management programs have about 221 budgeted full-time equivalents and a roughly 28% vacancy rate — about 63 funded but unfilled positions — and serve close to 4,000 individuals. Momo said caseloads vary by intensity: low-intensity case managers may carry up to 50 clients (1:50), intensive case managers about 1:17, and the most intensive “linkage/stabilization” managers about 1:12.

Momo emphasized contact frequency also varies: for high-acuity clients, case managers aim to interact one to four times per week, while lower-acuity clients are seen monthly or biweekly. DPH described most case manager activity as field-based and noted that about 55% of DPH case managers work in civil service clinics and roughly 45% are based at community-based organizations (CBOs).

The department flagged workforce challenges driven by a statewide behavioral-health staffing shortage, competition from neighboring counties and private health systems, and relatively low nonprofit pay. Momo described new hiring tactics used by Behavioral Health Services, including a BHS operations unit working with HR, continuous posting of clinical positions, batch hiring and outreach events. He said civil-service salary ranges for case managers run about $104,000 to $126,000, while CBO ranges are roughly $75,000 to $95,000. Momo also said some CBO programs report vacancy rates up to about 45%.

DPH described efforts to improve interagency coordination and information sharing — including a planned memorandum of understanding among the Department of Homelessness and Supportive Housing (HSH), Fire, the Department of Emergency Management, DPH and the Mayor’s Office — but said federal and state privacy laws limit what can be shared and the MOU will identify specific authorized staff who may access shared data. Momo said the department is implementing a new electronic health record (EPIC) to provide more centralized, real‑time case visibility.

The presentation included program details and planned procurements: Momo said the Mental Health SF expansion (legislation enacted in December 2019) added roughly 45 budgeted FTEs to the Office of Coordinated Care and 13 FTEs to other programs; DPH plans to publish an $1,800,000 request for proposals to create about 100 intensive outpatient treatment slots (estimated to yield 5–7 new FTEs), and noted a grant from Bridge Housing to add staff in shelter health. DPH also named a forthcoming RFP for a program called FACS (Prominent Housing Advanced Clinical Services) to add case managers supporting permanent supportive housing.

Supervisors pressed DPH on whether new FTEs would meaningfully reduce workload given current vacancies, and asked for a breakdown of the roughly 63 vacancies between civil-service positions and nonprofit roles. Ronan said the city should coordinate hiring across OEWD, central HR and DPH to address nonprofit salary disparities and recruitment. Momo said filling vacancies would help but noted outcomes also depend on clients accepting services and on improving workflows with hospitals and jail health services; DPH described IT workflows that flag 5150 evaluations and jail discharges for follow-up but said night and weekend discharges remain a challenge.

A chamber public commenter raised broader criticisms of the pace of housing production and urged mandatory treatment and stronger environmental supports; no callers participated from the remote queue during the item.

Ronan announced three follow-up actions from the hearing: (1) push a citywide emphasis on the workforce problem and coordination with OEWD and central HR, (2) examine nonprofit salary parity and options to improve recruitment and retention, and (3) convene a joint follow-up hearing with HSH and DPH to review housing prioritization and coordination timelines. Ronan moved to continue the hearing to the call of the chair; the committee approved the motion unanimously on a roll call (Mandelmann: aye; Walton: aye; Ronan: aye).

DPH provided numerous figures and program names during the hearing; where staff could not provide a specific breakdown at the time (for example, civil-service vs. nonprofit share of the 63 vacancies), supervisors requested those details as follow-up. The committee set a follow-up hearing after the legislative break to press for those clarifications and timelines.