SF Has a Chance to Reinvent Its Mental Health Care System

SF Public Press by Noah Arroyo, June 11, 2025

When Chuan Teng looks at San Francisco’s approach to behavioral health care, she sees a fundamental flaw.

“Jail, the streets, psychiatric emergency services — these end up being the points of entry into the city’s mental health care treatment,” said Teng, a private consultant who until recently was the chief executive officer of PRC, formerly called Positive Resource Center, a local provider of mental health care and other social services.

She called it “mind shattering” that often, because that system of care can be difficult to access, people with addiction and mental health disorders might get help only after they’ve deteriorated. By then, their conditions could have cost them jobs or housing, or caused them to land in the criminal justice system.

“Why is it that people can’t just go out and find care, if they need it?” Teng said.

She and a cadre of San Francisco-based service providers see an opportunity to help that happen.

Over the next year, counties throughout the state must draft three-year plans to redesign their systems of care in accordance with California’s Behavioral Health Services Act, an element of Proposition 1, which voters passed in March 2024. Changes at the local level must aim to reduce involuntary detainment and treatment, ameliorate homelessness, and increase government transparency and accountability. The ballot measure also authorized billions of dollars to fund treatment and housing for people living on the streets and facing behavioral health challenges.

As San Francisco health officials have begun thinking through their plan, Teng and other service providers have been advocating for it to include systemic changes to help people who keep falling into crisis — many of them cycling between homelessness and inadequate treatment interventions.

Ideas include diverting more people from emergency rooms, changing caseworkers’ roles to help them keep clients on track with treatment, and creating tools that let nonprofit staffers quickly place people in programs that fit their needs.

The state mandates that San Francisco Department of Public Health officials hear the groups out. In fact, the city legally must seek public input to ensure that a range of perspectives influences local health care.

The health department declined to comment for this story.

“Given that the County Integrated Plan includes a community planning process and stakeholder involvement,” a department staffer wrote via email, using the plan’s official name, “as well as public comment and feedback period on the draft Integrated Plan, we believe it is too early to interview.”

San Francisco’s behavioral health system is already changing, in response to pressures from within City Hall.

Since taking office in January, Mayor Daniel Lurie has reorganized and redirected street teams, restricted how nonprofits distributed paraphernalia for drug use, and tried to alter the city’s image to discourage the sale and use of hard drugs in public.

And Lurie aims to create 1,500 shelter and treatment beds by September. Last month, the state committed to giving San Francisco $27.6 million, authorized by Proposition 1, to establish 73 beds. Most of the beds will be converted from other purposes, and the health department has promised to first relocate the seniors who now use them to other long-term beds. Lurie is also trying to redirect money from permanent housing to homeless shelters, a move that critics say could backfire because many shelter occupants would have nowhere to go once their stays concluded.

Facing dire budget concerns — the city must close a two-year deficit of roughly $781.5 million that could grow to nearly $2 billion, depending on federal cuts — Lurie this month proposed slashing $200 million in funding to nonprofits, including those that serve people with behavioral health problems. He is also seeking deeper shifts in local bureaucracy to streamline service delivery.

Some of those structural changes seem to align with ideas from Teng and others who have met regularly since October, including with health officials, as part of the Behavioral Health Provider Collaborative.

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