Following months of negotiating and opposing the idea, Mayor London Breed on Nov. 12 announced her support and co-sponsorship of legislation that aims to reform San Francisco’s mental health care system.

The bill, dubbed Mental Health SF, would have the Department of Public Health provide comprehensive access to treatment and affordable psychiatric medications for city residents with mental illnesses and substance use disorders. Those who qualify must be at least 18 years old and uninsured, and they must show signs of having a psychiatric condition. People enrolled in Healthy SF or Medi-Cal can also benefit.

“All you have to do is walk outside City Hall for a few blocks to see the shocking mental health crisis that now a daily part of all of our lives,” Supervisor Hillary Ronen said in a mayor’s office press release. “It’s the biggest crisis facing our city and working together is the only way we’re going to solve it.”

Four thousand unhoused people struggle with mental illness and addiction in San Francisco, according to a count by city public health officials Sept. 4. 

“Of those 4,000 people, 35% are African-American which means we have to make specific investments to support that population,” Breed said at the Nov. 12 Board of Supervisors meeting.

The current system, which serves some 30,000 people, currently costs San Francisco an estimated $400 million, according to city data. Even so, Breed said she was proud of San Francisco’s behavioral health system.

Supervisors Ronen and Matt Haney first introduced Mental Health SF in June to overhaul San Francisco’s behavioral health system. After months of negotiations fell through, Breed introduced her own dueling ballot measure, Urgent Care SF, in October to focus on delivering services specifically to unhoused individuals with mental health and substance use disorders. 

Last week, Breed agreed to co-sponsor the supervisors’ measure if the two adjusted their bill. Now that a decision has been reached, they will withdraw their respective ballot initiatives previously intended for the March 2020 ballot. 

Breed has stressed the costs but still hopes to build more mental health beds, acquire and expand boarding and healthcare facilities and enhance the facilities San Francisco already has with the help of Mental Health SF.

“We need a lot of additional revenue, and I have asked our capital planning committee to prioritize a bond, to pay for capital improvements on the November 2020 ballot,” Breed said at the meeting. 

The city must invest in upcoming budgets to fund Mental Health SF. Many elements of the initiative depend on identifying new revenue sources. 

Board of Supervisors President Norman Yee and Breed asked the city’s Office of the Controller to begin a process to reform the city’s business taxes, which could provide a new revenue stream for Mental Health SF. 

Breed and supervisors are still working to identify funding for the bill’s longer term elements.