Here’s where S.F. wants to put money to address drug crisis and ODs

San Francisco’s potentially painful budget cuts this year won’t hit one of the city’s top priorities: services to help people struggling with mental illness and drug addiction who are at risk of a fatal overdose.

While Mayor London Breed’s administration must fill a $780 million shortfall over two years, officials stressed Thursday that her upcoming budget would increase investments in treatment beds, overdose prevention, case management and addressing racial disparities in drug deaths.

The city will also fund the opening of up to three “wellness hubs” — drop-in centers with services for drug users that might include space for a supervised consumption site, similar to the Tenderloin Center that operated last year. Breed’s administration pulled back on opening two supervised consumption sites, where medical professionals can reverse overdoses, by the end of last year, arguing without a greenlight from the federal government the sites remain illegal. Officials said they will only open the supervised portion of the site if nonprofits operate and fund them.

“San Francisco is a compassionate city that leads with services in our efforts to help people struggling with addiction and mental illness,” Breed said in a statement Thursday, two days after declaring in a fiery speech that the city’s “compassion is killing people” by allowing them to use drugs and die on the streets without compelling them into treatment. “While it’s critical that we focus on accountability, we also need to continue to find ways to get people into care and treatment.”

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A mobile Street Crisis Response Team van arrives to check in with a homeless man in distress and assess his needs near the corner of 16th and Mission streets in San Francisco, Calif. Tuesday, May 11, 2021 after receiving a 911 call from a passerby for a wellness check on the unhoused person. Mayor London Breed’s upcoming budget for 2023 will include continued investment in street outreach teams.

Jessica Christian/The Chronicle

2of3Andy Berger, left, gestures as friend Spencer Gray prepares a fentanyl injection inside a tent in San Francisco, California Tuesday, Jan. 10, 2023.Stephen Lam/The Chronicle

3of3Peter Taylor, 23, smokes fentanyl on Minna Street near the shuttered Minna Hotel in the SOMA district of San Francisco, California Tuesday, March 22, 2022. Taylor, who is originally from San Jose, has been using fentanyl for about 10 months.Stephen Lam/The Chronicle

Thursday’s announcement comes as the mayor faces intensifying pressure to address an escalating overdose crisis, with deaths hitting record highs this year, and the problem of open-air drug markets. Breed is trying to get a handle on the crisis as the city grapples with the budget deficit resulting from dwindling emergency pandemic support, weaker tax revenue due to a struggling downtown and extra spending on street cleaning and police overtime.

Breed also faces criticism from both sides of the political spectrum, with some residents and officials arguing she’s not doing enough to crack down on lethal drug sales while others protest her methods as too coercive and punitive. A pilot program that will be announced as part of her budget to intervene with drug users who are a danger to themselves or others already met pushback. One supervisor said the program will involve arresting people using drugs, prompting critics to protest that any criminalization will only worsen a public health crisis.

Breed’s office did not share dollar amounts about the new investments, saying details were still being worked out ahead of her budget announcement next week. The Board of Supervisors will then debate and approve her proposal. Last year’s spending plan for the city and county was nearly $14 billion.

New funds will be spent on creating 30 new residential treatment beds for people with substance use and mental health disorders, at least 30 beds for women exiting the criminal justice system and at least 10 transitional beds for people coming out of treatment, on top of more than 2,550 existing beds.

The need for treatment is great. Last year, the health department found 8,758 people who were homeless and struggling with either substance use and mental illness in San Francisco. Of those, 3,070 had both diagnoses.

To address the drug crisis, Breed and her health department announced a first-of-its-kind overdose prevention in September, but the deadline to meet the first goals isn’t until September 2024.

Reducing disparities was a key goal. New funding will go to overdose prevention among the Black community, which represents 28% of overdose deaths over the past two years despite being less than 6% of the city’s population.

Other investments include increasing case management services for people coming out of jail or discharged from the hospital after being held on involuntary psychiatric treatment, a notorious gap in the system.

The city will now open its Behavioral Health Access Center over the weekends, not just weekdays, where people can walk in for some treatment and services, although detox won’t be open on the weekends.

Funds will also expand a women’s abstinence-based therapeutic community. While abstinence-based usually means no medication offered to treat substance use disorder, medication will be an option at this program.

A contingent of elected officials and community advocates have been pushing back against the city’s decades-long policy promoting harm reduction, meeting people where they are in their drug use and recovery journey, arguing the city must offer more options and take a firmer stance.

Finally, the city will put funds toward implementing a mandate from Gov. Gavin Newsom to open CARE Court by Oct. 1 that aims to get people with severe mental illness who don’t accept help into services. The program applies to people who aren’t eligible for more restrictive conservatorship that mandates treatment, but the state isn’t funding an expansion of those services for CARE Court clients.

City officials earlier this year decried that the state only gave them $4 million to set up CARE Court, which they estimated will cost $51 million in its first year. The state pointed out San Francisco is set to receive an additional $32.3 million in funding for behavioral health housing, on top of hundreds of millions in new and ongoing funding.

While many families desperate to help loved ones with severe mental illness have hope for CARE Court, city officials and experts were largely skeptical that it would make a huge difference on the streets since San Francisco won’t expand treatment or housing specifically for the program.

Reach Mallory Moench: mallory.moench@sfchronicle.com

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