San Francisco has seen a 15% reduction in drug overdose deaths this year with 462 people dying in the first eight months of 2024. That is still an “alarmingly high” mortality rate and it may increase again, said Dr. Grant Colfax, the city Department of Public Health director.

Nevertheless, when asked at an overdose awareness day event in August what happened to the department’s plan to open safe consumption sites, Colfax said: “What our focus is right now is continuing to make sure that people have access to treatment.”  That’s despite research showing such facilities — also known as overdose prevention centers — save lives, reduce drug use in public, increase access to life-saving treatment and care and reduce public spending on emergency services.

Instead, the Department of Public Health is relying on a new 24-hour-a-day outreach initiative that provides unhoused drug users with the opioid dependency medication buprenorphine.

This “Civic” episode goes inside an overdose prevention center run by OnPoint NYC to hear from staffers and people who have received help with treatment for substance use disorders and other challenges associated with addiction.

Meanwhile, more cities and states are embracing overdose prevention centers. Last February, the Providence City Council in Rhode Island approved a state-sanctioned overdose prevention center. In April, Minneapolis nonprofit Minnesota Overdose Awareness opened a safe injection site thanks to legislation signed in 2023 by Gov. Tim Walz, presidential candidate Kamala Harris’ running mate. And in June, the Vermont Legislature overrode the governor’s veto of a bill to sanction an overdose prevention center in Burlington, an addiction hot spot.

But San Francisco appears to have abandoned the strategy, despite previously having the support of Mayor London Breed and city supervisors. Talk of overdose prevention centers has not come up in any meaningful way during election campaigning. And elected officials did not reply to calls and emails in August requesting an update.

At a mayoral candidate debate in June, Breed suggested city attorneys could face disbarment for enabling the launch of an overdose prevention center because of prohibitions under state law. But in New York City, the nonprofit organization OnPoint NYC worked with the city to skirt legal liability and opened two centers in November 2021. Their efforts have cleaned up surrounding neighborhoods and reversed more than 1,500 overdoses in less than three years with no deaths, according to OnPoint.

[Read and listen to our previous reporting on San Francisco’s overdose crisis and ongoing prevention efforts.]

A study published in the New England Journal of Medicine in April found that the centers kept people alive and kept them from consuming drugs in public. And a 2022 study published in the Journal of the American Medical Association found that the centers did not increase crimes recorded by police or calls for emergency services in the surrounding neighborhoods.

OnPoint’s efforts are also improving lives, said Sam Rivera, the organization’s director.

“The anecdotal things around reunification with children and reunification with families and becoming employable again — these are things that would never have happened for these folks,” Rivera said.

The success is in large part due to OnPoint’s dedication to treating each client with dignity, said Susan Spratt, OnPoint’s associate director of clinical services.

“We’re seeing people who are often not seen, they’re stepped over, literally, in the streets,” Spratt said. “This has been said to me more than once, to me and to multiple staff members in our clinic: ‘I feel like you’re really listening to me. I haven’t been listened to in a long time. So, thank you.’”

The post Overdose Prevention Centers — Nonstarter in SF, Despite Success in NYC appeared first on San Francisco Public Press.

Proposition O would strengthen access to abortion and reproductive care in San Francisco and protect the privacy of patients and health care providers.

Listen to a summary of what this ballot measure would do.

Support

States across the country continue to ban abortions, limit reproductive health care and try to control and punish women for the choices they make about their bodies. Proposition O’s proponents say it would strengthen local health services in San Francisco, and the privacy of the women seeking them, even if they came from out of state.

Mayor London Breed, who co-authored Proposition O with San Francisco Reproductive Freedom Act organizers, stood alongside allies at Planned Parenthood’s San Francisco facility at a June news conference to announce the measure.

Kimberly Ellis, director of the city’s Department on the Status of Women, said the measure was an example of “proactively contingency planning,” given the prospect of a Donald Trump and J.D. Vance administration. Both politicians have voiced support for a national abortion ban.

“We are battening down the hatches,” Ellis said. “Because if there’s one thing we have learned from the pandemic, and from the fall of Roe v. Wade, it is that this is not a drill.”

Among the measure’s endorsers are California Sen. Scott Weiner, Lt. Gov. Eleni Kounalakis, and U.S. representatives Nancy Pelosi and Kevin Mullin.

What it would do

Proposition O would create the Reproductive Freedom Fund to pay for reproductive care in case the federal government rescinded Title X of the Public Health Service Act, which provides those services at reduced or no cost to low-income people.

The San Francisco Department of Public Health would create a website listing facilities that offer full reproductive health care. The list would include two crisis pregnancy centers and describe them as offering “limited services.”

Crisis pregnancy centers, run by anti-abortion activists, aim to dissuade women from having abortions. The majority are not staffed by licensed medical professionals, as KQED reported in Napa. Some pretend to offer full reproductive health care services to deceive women into going through with unwanted pregnancies, according to the investigative podcast “Reveal.” The dishonesty of such facilities spurred California Attorney General Rob Bonta to issue a consumer alert about them in 2022.

In an attempt to address this pattern of deceptiveness, Proposition O would authorize the city’s health department to post signs outside two local centers stating that they do not provide abortions or emergency contraception, and describing where to get those services.

Proposition O would forbid crisis pregnancy centers, which often are not bound by patient privacy laws, from sharing individual and health provider information with states that have outlawed abortions, as several have attempted to prosecute people for terminating pregnancies.

The measure would permit reproductive health clinics to expand operations above ground floors in nonresidential districts, and to corner lots in residential areas.

Opposition

In the official argument against Proposition O, Melanie Salazar, executive director of nonprofit Pro-Life San Francisco, criticized governments for “increasingly castigating” what she called pregnancy resource centers — more commonly called crisis pregnancy centers — rather than “citing negative reviews or violations of the law” at specific locations. Planned Parenthood spokesperson Christian Garcia told the San Francisco Standard that he was unaware of instances when women had entered pregnancy centers in San Francisco and been misled into thinking they were accessing abortion services.

However, at the June news conference, Breed called out the two local centers for being “very misleading,” adding that women who have entered seeking information were told “you will go to hell.”

Salazar, who called Proposition O “abortion extremism,” said the measure’s rules and Breed’s disparaging comments would discourage people from “receiving quality care” at pregnancy resource centers.

Salazar also criticized the measure for requiring signage only outside pregnancy resource centers, referring people to abortion clinics — without requiring similar signage outside clinics, referring people to the centers.

The Archdiocese of San Francisco, which oversees Roman Catholic Church activities in the city, also opposes the measure, and created a page on its website urging people to vote against it. Their opposition may surprise no one after San Francisco Archbishop Salvatore Cordileone denounced House Speaker Nancy Pelosi in May for “the grave evil she is perpetrating” by supporting abortion rights, declaring that Pelosi must be denied Holy Communion.

Cost

If passed, Proposition O would likely result in a one-time cost to the city of about $4,000 to install signs outside two pregnancy centers, with annual maintenance costs up to $8,000, according to an analysis by the city controller.

Campaign finance

As of Oct. 7, the “Yes on O” campaign committee had raised $69,691, according to data from the San Francisco Ethics Commission. 

No group opposing Proposition O had reported fundraising activity to the city.

History and context

In 2022, the U.S. Supreme Court overturned Roe v. Wade, the 1973 court case that recognized abortion as a constitutional right. Since then, more than two-dozen states have banned or severely restricted abortions and women’s reproductive health care.

California voters, on the other hand, enshrined the right to abortion in the state’s constitution following the court’s ruling.

Dr. Nicole Barnett, the chief operating officer of Planned Parenthood Northern California, told the San Francisco Examiner that San Francisco is an increasingly popular destination for women seeking care they can no longer get in their home states, with 1,410 abortions performed between July 2022 and June 2023.

Nearly 1 in 5 patients across the country traveled out of state for abortion services in 2023, according to the Guttmacher Institute, a national nonprofit that supports abortion rights. California has seen abortions increase an estimated 17% since 2020.

If passed, Proposition O could be vulnerable to legal challenges, the San Francisco Standard reported. In 2018, the U.S. Supreme Court struck down a similar California law, which required crisis pregnancy centers to post information about available abortion and contraceptive services and to disclose whether their clinics had medical licenses. The court found that the law violated the centers’ First Amendment rights to free speech.

Proposition O differs from the state law in that it would direct City Hall workers, rather than the clinics, to post the signs.

Votes needed to pass

Proposition O requires a simple majority of “yes” votes to pass.

Click here to return to our full voter guide.

The post Proposition O — Protect Access to Reproductive Care appeared first on San Francisco Public Press.

Proposition B would let San Francisco borrow up to $390 million to carry out infrastructure and other projects, like upgrading health care facilities, creating homeless shelter, repaving roads and renovating Harvey Milk Plaza, the Castro neighborhood spot honoring the city’s first openly gay supervisor, who along with Mayor George Moscone was assassinated in 1978.

Listen to a summary of what this ballot measure would do.

Support

Mayor London Breed and the full Board of Supervisors support the bond measure, which they describe in the official proponent argument as a “critical investment” in public health and safety infrastructure.

Other supporters include numerous local groups such as NICOS Chinese Health Coalition, Self Help for the Elderly and the San Francisco General Hospital Foundation. State Sen. Scott Wiener backs the measure, as do the Alice B. Toklas LGBTQ Democratic Club, Harvey Milk LGBTQ Democratic Club and other political groups.

Cost

If voters pass Proposition B, San Francisco may sell general obligation bonds to investors and use the funds for civic projects. The city would repay bondholders, with interest.

If all bonds were issued and sold, projected repayments would total $737 million, according to an analysis by the city controller. The city would fund repayments with property tax revenue, at an estimated rate of $6.90 per $100,000 of assessed property value.

Proposition B wouldn’t increase overall property taxes; it would replace taxes tied to a previous bond measure once they expired, after those bondholders were fully repaid. Moreover, landlords could pass half of their tax costs to tenants in the form of rent increases.

Opposition

The San Francisco Briones Society, a Republican group, opposes Proposition B. In the official argument against the measure, the group says the city should address issues like homelessness using its existing revenue rather than “burdening tax payers with additional debt.” Up to about 13% of the maximum bond revenue would pay for renovating and acquiring homeless shelters.

The San Francisco Apartment Association, which represents landlords and property owners, also opposes Proposition B. The group would like to see property taxes fall, rather than stay level due to a new bond measure, the group says in a paid argument.

What would it do

Most of Proposition B’s bond revenue would fund improvements at health care facilities, split almost equally among community health centers and hospitals.

If the sale of general obligation bonds produced the maximum expected revenue, about $71 million would pay for renovations at the Chinatown Public Health Center, which serves primarily low-income, uninsured, elderly and recent Asian immigrants in languages they understand. That would cover ventilation system upgrades and enable on-site mental health services. It would also fund the facility’s first major seismic upgrade since it was built over half a century ago; the center is one of San Francisco’s most earthquake-vulnerable clinics. During the construction work, services would move to the Chinese Hospital about two blocks away.

Additionally, $28 million would go toward acquiring property that would become the new site for the City Clinic, which provides treatment for HIV and other sexually transmitted diseases to youth and low-income residents.

Two hospitals would together receive $66 million in critical repairs and renovations, including fire-safety upgrades: Laguna Honda, which provides medical and rehabilitation services, and the Zuckerberg San Francisco General Hospital and Trauma Center, which handles 20% of the city’s inpatient care. The facilities would also get $40 million for seismic retrofits. At Zuckerberg hospital, the money would go to expanding mental health services.

The rest of the bond revenue would fund various other projects.

Public spaces would get $71 million in improvements. Of that, $41 million would help revitalize downtown by improving pedestrian areas and access to transit near Powell and Market streets. About $25 million would go toward Harvey Milk Plaza, enhancing accessibility for people with disabilities, upgrading the elevator at Castro Muni metro station and adding fixtures and landscaping. The remaining $5 million would improve infrastructure and recreational spaces at public parks.

About $64 million would pay for upgrading street traffic signs, redesigning arteries and sidewalks, repaving streets and adding roadway lighting.

Lastly, the city would use $50 million to acquire, construct and improve shelters for people experiencing homelessness.

An oversight committee would annually hold a public hearing on the fund’s implementation and report expenditures to the mayor and the Board of Supervisors.

Campaign finance

As of Oct. 7, the “Yes on B” campaign committee had raised $624,544, according to data from the San Francisco Ethics Commission. Contributors included health care organizations, with the greatest backing coming from the San Francisco General Hospital Foundation, which supports and funds the Zuckerberg hospital, at $100,000. Donations of $50,000 each came from Sutter Health, a nonprofit health care provider in California; Hudson Pacific Properties Inc., a real estate agency; and Diane Wilsey, a major Republican donor and the owner and chief executive officer of A. Wilsey Properties Co.

The “No on B” campaign committee had raised $172,000. The main contributor was the San Francisco Apartment Association Political Action Committee, which donated $50,000.

History and context

Over the past decade, San Francisco voters have approved three bond measures focused on bolstering public health facilities, including by upgrading outdated buildings.

Many of today’s needed improvements to health care facilities and infrastructure are described in the city’s latest 10-year capital plan, adopted last year, but Proposition B would not address them all. Proposition B’s architects excluded the renovation of the Silver Avenue Family Health Center, in the city’s southeast, from the measure’s funding targets because its cost projections exceeded earlier expectations, city staff explained at a public meeting in June.

The measure initially omitted the relocation of City Clinic, but drafters included it following community protest. 

Votes needed to pass

As a bond measure, Proposition B requires at least 66.67% “yes” votes to pass.

However, if voters this November approve California Proposition 5, which would reduce the threshold for passing housing and infrastructure bonds, Proposition B would need only 55% “yes” votes to pass.

Click here to return to our full voter guide.

The post Proposition B — Bonds to Enhance Health Care Facilities and Public Spaces appeared first on San Francisco Public Press.

The constant dust upset him. It also triggered his asthma, which he has had since he was a kid. 

“It’s hard to breathe,” he said. “But I haven’t really been feeling like that for the last month, basically since I got the air purifier.”

Britt was one of 50 low-income tenants to receive free air purifiers through a government-funded pilot program in July and August, the result of efforts by local organizations to cut red tape and make it easier to distribute the devices. Most recipients have respiratory conditions and live in single-room occupancy hotels, commonly called SROs. The initiative aims to ameliorate and help prevent health problems — early results are promising — and if enough people benefit then the government could keep funding the work, putting more devices in the hands of tenants who need them.

For Britt, the purifier is welcome relief in his home at the Clementina Towers, a building run by the Tenderloin Neighborhood Development Corporation for low-income and disabled seniors. 

“TNDC is pleased that Mr. Britt has been able to take advantage of the air purifier distribution program and that its use has helped ease his asthma,” said Edmund Campos, senior communications manager for the Tenderloin Neighborhood Development Corporation, in an emailed statement. He added that Britt had never reported excessive dust to the property manager, which Britt confirmed.

Structural causes of bad air

Britt’s portable air purifier cost about $100, which is out of reach for many SRO tenants. A 2021 Brightline Defense survey found that only about 18% of SRO residents could afford one. 

But they might be the San Franciscans who most need the devices. Adults living in SROs face asthma hospitalization rates that are twice the citywide average, and chronic obstructive pulmonary disease rates that are three times higher, according to a 2017 Department of Public Health report. 

That’s due in large part to the aging structures they live in. SRO buildings tend to be old, poorly maintained and lack modern heating and air conditioning systems, as well as effective ventilation. When tenants shower, humidity can build up and cause toxic black mold to grow. If unaddressed, the mold penetrates the surrounding wood and becomes a long-term problem.

Airborne pollutants from cat litter, candles and gas stoves can all accumulate indoors. Some tenants smoke methamphetamine and fentanyl in their rooms, and the exhaled, harmful chemicals linger in the air, said Sheyenne White, a community organizer with the Central City SRO Collaborative. 

SRO buildings are concentrated in the Tenderloin and other downtown areas that are dense with vehicles, which give off exhaust. Often, an SRO unit has a single window that opens to the street or is right above a ground-floor restaurant’s kitchen, which can produce smoke from cooking. Tenants face a difficult choice: Keep the window closed and let the indoor air fester, or open it and let other pollutants in. 

In a way, the choice is easier during hotter seasons — though the health consequences remain. SRO tenants throughout the Tenderloin have to open their windows to find relief, and their sills gradually blacken with soot, said Stephen Tennis, another organizer with the collaborative.

“Otherwise they would roast,” Tennis said.

Red tape hampered aid

Tennis and other members of the collaborative, as well as staff at local nonprofit La Voz Latina, are working with environmental justice organization Brightline Defense to carry out the pilot program.

The groups have spent years trying to put air filtration devices in tenants’ hands. At first, the work suffered from bureaucratic hurdles, said Carolina Correa, air quality program manager at Brightline Defense. 

Government funding paid for the purifiers but, to be eligible, recipients needed to attend two video interviews and obtain notes from doctors attesting to their respiratory conditions. Many people were too poor to seek regular medical care, so they didn’t have diagnoses. Others had limited physical mobility or no access to a car, so they couldn’t easily visit their doctors in person.

“It was a major barrier to get the paperwork in order,” said Peter Rauch, a tenant organizer at the collaborative. “It discouraged a lot of people and they didn’t follow through.” 

In 2021, roughly half the residents Brightline Defense helped apply for air purifiers ultimately did not receive one because they couldn’t meet the requirements, Correa said.

Members of the collaborative pushed to cut the red tape. In July 2023, a half-dozen tenant organizers made their case at the headquarters of the Bay Area Air Quality Management District, the regional government agency responsible for regulating air pollution and the funder of the air purifiers. The organizers persuaded the agency to test what would happen if it loosened requirements. 

For that pilot project, which began in October 2023, the organizers personally scoured the government-subsidized housing community to identify the best potential recipients. In their outreach, they prioritized people who said they had respiratory conditions, even if they lacked documentation. And to make things even easier, organizers had participants fill out just one survey about the purifiers’ impacts on air quality, rather than the two previously required. 

“It just made it much easier to get purifiers to people who need it, and that to me is the most important thing,” Tennis said.

Finding relief

Early surveys show that the purifiers are working. When asked to rate their homes’ air quality on a scale of one to 10, people who rated it “3-4” before receiving the devices are now rating it “8-10,” Rauch said. Residents report that they are coughing less, sleeping better and are less winded when walking up and down stairs, White said. People have noticed less soot in their rooms and that their allergies have subsided, added Correa of Brightline Defense. 

Once all surveys are completed, the results will inform the Bay Area Air Quality Management District’s decision on whether to continue funding the pilot program next year. 

The air purifiers are a crucial mitigation tool, but they don’t address the underlying causes of air pollution. To do that, big policy changes are needed, including widespread retrofits of San Francisco buildings, said Jacob Linde, Brightline Defense’s air quality organizer. The renovations, which local groups are trying in multi-unit apartment buildings, would help ventilate SRO buildings while reducing their carbon footprints, he said. 

Back in his SoMa studio, Britt no longer has to wage war against the dust in his apartment. He runs his air purifier 24 hours a day. His asthma symptoms feel milder. He only has to dust once a week now. 

Those small wins are deeply gratifying to Rauch, who wants his neighbors to be able to breathe safely in their homes. 

“Air is as precious as water. It’s what we humans rely on,” Rauch said.

The post Local Groups Cut Red Tape to Give Low-Income Tenants Clean Air appeared first on San Francisco Public Press.

Some providers are cutting back services even as more people queue up for free meals and bags of groceries.

“We’ve seen that line just grow and grow and grow,” said Humberto Pinon, senior health educator and communications coordinator for Curry Senior Center.

The pandemic spurred governments to pour money into nutrition programs that offered free meals and groceries, in large part to protect seniors — they no longer had to risk infection at crowded stores or fully contend with soaring grocery prices. But as emergency measures wound down, the subsidies dwindled, and recent local budget cuts to San Francisco service providers have further threatened food programs.

Nonprofits are scrambling to fill their budget holes and preserve their services in an environment where private funders are also pulling back.

“We’re just left holding the bag, to have to make up the difference through more and more fundraising,” said Winnie Yu, chief programs and compliance officer for Self-Help for the Elderly, which offers free meals and many other services like housing, case management and hospice.

“And it’s not just us. All of the nutrition providers throughout the San Francisco Bay Area and nationally have the same challenges,” Yu said.

Deficits in the millions

Local, state and federal funding cuts have forced the San Francisco-Marin Food Bank to significantly reduce services, according to an October press release. The organization faces estimated deficits of $2.1 million for last year and $6.6 million this year, said Keely Hopkins, associate director of marketing and communications.

The bank had expanded its Home-Delivered Groceries program during the pandemic to serve older adults who were more susceptible to the coronavirus, as well as other groups such as pregnant people and families with children who had disabilities. It served 13,000 households weekly at its height, but today that number is down to just under 8,000 households, said Seth Harris, the program’s associate director. By June 2025, the organization is also slated to close multiple food-distribution sites that opened in response to COVID-19, Harris said. The sites serve 18,000 households, Mission Local reported.

Budget cuts from City Hall last year forced local organization Bayview Senior Services to stop providing meals on weekends. This year it faces $500,000 in additional cuts, said Executive Director Cathy Davis, compelling it to stop offering take-out meals, though it will continue to offer home deliveries. Davis said she wishes she could scale up meal deliveries to meet demand, but the organization is “really not financially equipped to do much more unless we can increase our support.”

And the money the city gave the Curry Senior Center this year for one of its food programs, providing free weekly groceries, was about half what it gave last year, said Ruben Chavez, the organization’s deputy director. Facing a growing waitlist, staff have begun giving walk-ups groceries that are registered to people who are unable to pick them up, Pinon said.

‘Like squeezing water from a turnip’

Organizations are receiving less funding from private sources too.

With emergency pandemic measures phased out, the public perception is that nutrition programs are less essential, so organizations are receiving fewer donations from generous individuals, said Jim Oswald, director of marketing and communications at Meals on Wheels San Francisco, which delivers free meals to people with disabilities and adults aged 60 and over.

Self-Help for the Elderly is getting fewer voluntary contributions from the people who receive food through its dine-in and home-delivery programs. Before the pandemic, the nonprofit received 80% of the contributions that it budgeted for, but after the pandemic that fell to “10% on a good day,” Yu said, leading to $1 million in losses for the organization.

“Folks don’t have the capacity to give because everything is so expensive,” Yu said. “It’s like squeezing water from a turnip.”

Food insecurity for older adults — when they don’t have enough to eat and are uncertain how they will get their next meal — is not a “hot topic” for larger funders, Yu added. 

Corporate sponsors have helped fund the San Francisco-Marin Food Bank’s Home-Delivered Groceries program. When the organization lost sponsorship, it was a major factor forcing the bank to scale back the program.

Waning government contributions

In interviews with the San Francisco Public Press, many providers stopped short of criticizing City Hall for its cuts.

“The city’s done the best they can but we also understand they don’t have as much money as they used to,” Davis said.

City Hall is still struggling to financially recover from the pandemic, which created remote-work norms that emptied downtown offices and depressed commercial real estate values and tax revenue. Mayor London Breed signed a $15.9 billion budget on July 27 that closed a projected two-year deficit of nearly $800 million. 

That included shrinking the budget of the Department of Disability and Aging Services, which funds food programs for older adults and people with disabilities, said spokesperson Joe Molica. To maintain services at current levels, plans to expand certain programs were postponed. The department will invest nearly $30.5 million in food programs over the next year.

Food providers and recipients are still reeling from the loss of other public funding as the threat of COVID-19 has receded.

As the novel coronavirus threatened lives and incomes, the federal government increased funds to CalFresh, the state program formerly known as “food stamps,” giving people more money each month to buy groceries. When that emergency funding ended in April 2023, the monthly allotments decreased — for some people, by hundreds of dollars. A spike in food insecurity across the state followed, according to data from the California Association of Food Banks.

The federal government also pumped tens of millions of dollars into food programs serving San Francisco’s older adults and residents with disabilities, but most of that money stopped flowing in 2022. The main funding target had been the Great Plates Delivered program, which brought restaurant meals to homebound seniors and other adults who were especially vulnerable to COVID-19.

Disproportionate impacts of food insecurity

In the coming years, nutrition programs for older adults will only become more needed.

For decades, food insecurity in the United States has been on the rise for households with adults age 65 and older, according to a 2023 study by the U.S. Department of Agriculture. It is most common among seniors who live alone, at about 11% of those households, up from about 6% in 2001 — the percentage rose sharply amid the pandemic.

Adults 60 and older are the fastest-growing age group in San Francisco and will comprise over 30% of residents by 2030, according to the California Department of Finance. They can face barriers to obtaining healthy food that other groups might not, often related to their physical and financial limitations.

Mobility issues make cooking and shopping for groceries difficult for people who cannot drive or easily handle heavy bags on public transit.

Many older adults also rely on social security as their sole source of income, and those dollars don’t go as far as they used to. Grocery costs over the past four years have risen 25% even as chain supermarkets raked in enormous profits.

“When you’re living on less than $1,300 a month, you have to make some hard choices of what bills you’re going to pay,” said Oswald, of Meals on Wheels San Francisco. Nearly two-thirds of the people the organization serves live on less than that.

People with disabilities, another growing population in San Francisco, can face similar financial challenges when their sole source of income is disability insurance payments from the government. The average monthly payment is about $1,538.

Food insecurity disproportionately affects people of color. In California, mixed-race adults are the most food-insecure racial group, with 50% possessing that status, followed byAfrican Americans, at about 49%, according to a 2023 report by the UCLA Center for Health Policy Research.

People of color also suffer from diet-sensitive diseases at elevated levels. In San Francisco, Native Hawaiians and other Pacific Islanders are hospitalized for diabetes, hypertension or heart disease at rates nine times higher than the citywide average, according to a 2023 report by the Department of Public Health. African Americans are hospitalized about four times above the average. These are also the city’s racial groups with the shortest life expectancies.

‘We pick up the slack’

On a recent Wednesday morning at the Dr. George W. Davis Senior Center, several older adults stood outside, waiting for the doors to open so they could choose free produce at the organization’s pilot food program, which resembled a farmers’ market. They had lined up early because they were worried they might not get all the items they needed, said LaTonya Young, a case manager for residents living on site. She added that there was enough food for everyone that morning.

The free groceries were “a big help” to Rogelio Balbin, 60, and his wife, who recently immigrated to the United States and were still looking for jobs. Balbin had been coming to the food pantry for three months, he said. The grapes and apples were two of his favorite items.

The program is funded through June 2025, and it’s unclear whether it will continue beyond that. As other organizations pare back or shutter their own food programs, it’s likely that this line will fill with more people like Balbin.

For now, “we pick up that slack,” said Young, who takes joy in her work.

“What motivates me every day,” Young said, “is the seniors and seeing their stories. Some come from being homeless but still use the vegetables, and we provide hot meals as well. It’s a wonderful thing to see what we’re doing.”

The post Budget Cuts Threaten SF Food Programs for Seniors and Adults With Disabilities appeared first on San Francisco Public Press.

Osbaldo Varilla-Aguilar rarely worried about his health. As a construction worker, he had enough gigs to earn more than $500 a week under the table, allowing him to rent a studio for $600 a month with two other Latinx construction workers in San Francisco’s Mission District. Despite working nearly full-time, he was barely able to make ends meet. So, when the pandemic hit, Varilla-Aguilar continued working. He got critically sick in December 2020. To this day, Varilla-Aguilar still wonders whether he got COVID on the job, or at the grocery store.

Either way, it landed him in a coma — for more than three months.

“It was such a difficult time,” said his sister Araceli Aguilar-Perez. “To see him like that, it affected me a lot.” Aguilar-Perez said the doctors recommended disconnecting Varilla-Aguilar from the ventilator after two months. The family refused. Hoping for a miracle, Aguilar-Perez talked to her unconscious brother through a hospital monitor via Zoom calls every week. Then, in March 2021, Varilla-Aguilar woke up. “When I opened my eyes, it felt like a few days [had passed],” said Varilla-Aguilar. “But they told me it had been three months … It was a shock.”

Today, more than three years after he was discharged from the hospital, Varilla-Aguilar still depends on the oxygen respirator next to his bed. He has since moved out from his shared Mission District studio, and lives in Sunnydale in a shared home with other Latinx workers.

He and his housemates are among the community that was hardest hit by COVID in San Francisco: immigrants, especially those working unprotected essential jobs. As the devastating impact of COVID in Latinx communities in the Mission District and Bayview is increasingly documented, the lingering, and sometimes extreme, symptoms of infection are much less understood.

Weeks after being discharged from the hospital, Varilla-Aguilar noticed his vision was going blurry while waiting at a bus stop. Within four hours, his left eye went permanently blind.

“[COVID] can cause many things, one of them being thrombosis,” said Dr. Hector Bonilla, a clinical infectious disease expert and associate professor at Stanford University. According to medical research, critically ill COVID patients like Varilla-Aguilar are especially at risk for severe health outcomes like thrombosis, or blood clots. “It can happen any place [in the body],” said Bonilla. “Maybe this can explain what happened in the eye.”

Combined with his deteriorated eyesight, Varilla-Aguilar also endures fatigue, brain fog and depression, which are among the more common symptoms cited by people who experience long COVID. He said he also never fully recovered the strength he lost during his months-long coma, despite a year in physical therapy.

“I don’t have the strength that I used to, and I run out of breath when I try,” said Varilla-Aguilar. “So it’s hard finding steady work.” Despite his physical weaknesses, he continues to take on physically demanding jobs like landscaping, and on occasion, roofing gigs. “I have no choice, I need to pay the rent. If I don’t do it, who else is going to help me?”

According to the 46-year-old, doctors have not been able to determine why COVID took an extreme toll on his health. Instead, doctors have prescribed him several prescription pills to help reduce some of his ongoing symptoms. Still, he believes this hasn’t been enough, and that the cost of medication is expensive. His experience is one faced by millions of long COVID patients across the country as researchers continue to look for the underlying causes of the mysterious symptoms.

Amid medical uncertainty, Varilla-Aguilar, like other sufferers of long COVID, has turned elsewhere for solutions. Previously skeptical of alternative medicine, Varilla-Aguilar agreed to his sister’s “baño de pies” after months of coping with numbness in his feet. The foot bath was infused with herbs like Santa Maria, rue, rose buds and eucalyptus, which his sister blended into a bucket of hot water. The effort was meant to reduce stress and inflammation. After a few treatments, he said he was shocked to have gained back sensations in his feet.

Since then, Varilla-Aguilar uses and advocates for natural remedies rooted in Indigenous practice, including the consumption of teas, herbs, and whole foods. He is also a member of “Somos Remedios,” a Mission-based grassroots research group that documents Latinx solutions to treating long COVID.

Though Varilla-Aguilar now makes his health a priority, he admits that he will never be the same again. “Everyday there is an effort to live, to work, and to have enough money to eat,” said Varilla-Aguilar. “I found [strength] within myself, [when] there was nowhere else to find it.”

The post After Months-Long Coma, This Latino Immigrant Worker Is Still Fighting Mysterious Symptoms appeared first on San Francisco Public Press.

Sign up for the MindSite News daily newsletter here.

The first time Keith B. walked through the door of Rypins House, a residential treatment home for older adults run by the Progress Foundation in San Francisco, he thought to himself: “Where is everyone?”

A former luxury car salesman and behavioral health worker, the 60-year-old had spent years cycling in and out of institutions — detox centers, hospitals, homeless shelters. They were usually crowded and noisy, with lots of yelling. He was always on alert, afraid people would steal from him. Keith lives with bipolar disorder and took to self-medicating with street drugs back in the 90s. But as he aged, he wanted a calm space to sort his life out. Start making plans to get a hip replacement. Acquire his real estate license. Go back home to Philadelphia.

Keith came to Rypins House in August last year after a drug relapse that left him on the streets of San Francisco for four days, unable to sleep. He first sought help from the Dore Urgent Care Clinic, another Progress Foundation facility that offers a place for people to stay and get help for a few days when they’re in a crisis. It’s a gentler, cheaper alternative to an emergency room visit. From there, he was given a bed for up to six months at Rypins, a butter-yellow Victorian house in a neighborhood far from the Tenderloin, where he doesn’t owe drug dealers money and has a better shot at staying clean.

More than 1 million California adults like Keith — and 19.4 million Americans — live with both a serious mental illness and substance use disorder. In fact, roughly half of all people with severe mental illness are thought to also have a co-occurring substance use disorder. Traditionally, treatment programs target one of these populations or the other. Progress Foundation is one of the few across the country serving people who have both — so-called dual diagnosis patients. What’s especially unusual is that two Progress homes are reserved for people 55 and older.

One of his first nights in the house, Keith was sitting in the living room all by himself watching ‘Coming to America.’ He put the movie on pause to go to the bathroom and when he came back, nobody had sat in his chair or taken the remote control.

“It just hit me like, ‘Wow, I’m really in a peaceful, quiet environment,’” he said. “I’d almost gotten used to the chaos of the street and institutions. They’re not good places to heal. This place doesn’t feel like a program. It feels more like a home.”

Rypins House: A respite from the storm

Progress Foundation was founded in 1969 on the belief that recovery is possible at any age. It began as an alternative to medical models that largely rely on hospitalization and clinical treatment. Instead, it employs a social rehabilitation approach, and has created a variety of programs to meet people’s needs at different stages. Nurse practitioners rotate between the programs, and clients can take medication they administer themselves. All of the programs provide clients with a home-like environment where they can learn independent-living skills.

“Our clients are constantly being told, ‘You’re gonna be ill the rest of your life,’” says Progress Foundation Executive Director Steve Fields, who has led the organization since co-founding it. “We’re trying to show them a pathway out of thinking so narrowly about themselves. We’re saying, who knows where you can end up? You may have episodic crises, but that’s not your definition. We can work with you on a recovery plan because we believe that you can reach a level of functioning in the community.”

Rypins House and the Foundation’s ten other residential programs — each tailored to a different need — all attempt to address a huge problem in the mental health system: the lack of places people can go after they’ve been treated for a crisis. Fewer than 50% of patients discharged from a hospital following emergency mental health treatment are seen by a therapist or other provider within seven days, according to data gathered from health plans, and that number drops below 30% when it comes to Medicare patients.

There simply isn’t enough capacity to meet the need, says Tom Insel, a psychiatrist and former director of the National Institute of Mental Health. This is due to a shortage of beds, workers and safety net services as well as residential treatment programs. “The problem isn’t just people entering the hospital. It’s how they leave. There’s no practical plan for most people when they are discharged,” he says.

Progress Foundation is funded primarily through county health departments, and in San Francisco, that means it prioritizes clients who come from the inpatient unit at Zuckerberg San Francisco General Hospital as well as nursing homes that serve patients on Medicare or Medicaid. The agency also receives referrals from the jail system, as well as people like Keith who come from other Progress programs. This is the Foundation’s attempt to create a true continuum of care — a system that can help address the needs of patients at different stages and with different needs.

“We don’t see addiction as being something separate from mental health,” says Jim Roberts, director of residential treatment, supported living and permanent housing. “If anything, we see some of these substance abuse issues as a symptom and behavior of their mental health.”

The Progress Foundation’s wide network

Dore Urgent Care Clinic — where people can stay up to 23 hours to avoid unnecessary hospitalization — is on one end of the spectrum. On the other end are the foundation’s transitional programs where people can stay for between three months and one year.

There’s not much research on the benefits of longer stays for people who have dual diagnoses, but a 2001 study showed that while people in short-term dual-diagnosis programs tend not to remain long in the programs or fare very well, those in long-term programs did better: They were more apt to reduce their substance use and less likely to become homeless afterward.

The foundation also has a handful of cooperative living apartments and three independent living apartment buildings. Clients need to be enrolled in or applying for Medi-Cal, and to be San Francisco residents in order to receive the more intensive services. Undocumented immigrants are now eligible too, since, as of January 1, a new state law provides Medi-Cal to all low-income residents, regardless of immigration status.

The program is a bargain, Fields says. He estimates that a bed at a Progress residential treatment program costs around $300 per day compared with $1000 to $2000 at a hospital — or more.

The foundation’s homes for seniors are especially important since older adults throughout the country are the fastest-growing age group experiencing homelessness, according to an October 2023 report from the U.S. Department of Health and Human Services. In California, most older adults on the streets had never been homeless before age 50, when life circumstances such as an illness, a work accident or a cut in their work hours cost them their home and left them priced out of the market. In the San Francisco Bay Area, adults over 55 are estimated to make up half of the homeless population.

The co-ed program for seniors started nearly 40 years ago with six beds at Carroll House in San Francisco’s Bernal Heights neighborhood. Shortly after, to keep pace with demand, Rypins House opened with six more beds. As far as Fields knows, they are the only such programs in the country for seniors with dual diagnoses.

Both are almost always full, and the need continues to grow. In the first 11 months of 2023, an estimated 316 people over 55 died of an overdose in San Francisco, 42% of all the overdose deaths, according to the San Francisco Medical Examiner. Overdose deaths are rising rapidly among older people all across the country.

Progress Foundation takes a harm reduction approach. Clients are encouraged — but not required — to be sober. The location of Carroll House in sleepy Bernal Heights, a place where people can’t easily buy drugs or alcohol, is ideal for sobriety. Keith, for one, hopes to start attending AA meetings again. It’s part of the individualized plan that he’s created with the staff, reflecting a core belief at Progress Foundation that clients take ownership of their recovery.

“We’re there to provide guidance and support,” Roberts says. “We treat the clients themselves as the expert, and collaborate with the individual we’re serving to meet the aims they’ve defined for themselves.”

That doesn’t mean they’re on their own, however — staff members are available 24/7 if clients need them for health problems or other needs.

During the daytime, group meetings take place, tailored to the needs of the clients living in the house at the time. On the Friday I visited, the group met in a cozy living room at Rypins House, surrounded by books and a piano. Led by nurse facilitators from the University of California San Francisco, clients brainstormed ways of getting social support. Keith said he was going to get a library card to read autobiographies, and that he wanted to start playing chess again.

Staff encourage these kinds of activities as a way to develop social connections. They also help clients connect to case management, psychiatry appointments, housing, and more — everything they need to be independent. As part of its contract with San Francisco County, Progress Foundation must help a minimum of 80% of clients to move to a lower, less intensive level of support identified in their treatment plan, a number they have consistently met, says Fields. But it’s complicated.

“Am I happy with all of the choices as time goes on that are available to people? No,” he says. “At least they’re not in the hospital.”

In the past year, only two out of 32 clients from the seniors program were rehospitalized during the course of their stay; the rest were able to make it through and enter one of a variety of housing choices when they left the hospital.

Some of those include traditional apartments, single room occupancy hotels, and board and care homes, which are slowly disappearing. There’s also Hummingbird Place, a psychiatric respite center that will work with clients to find a path to permanent housing after they leave. It’s a huge challenge, given California’s sky-high housing costs, especially for those who don’t have Social Security. And the age of the unhoused is rising in California.

Fields worries that as people move between different programs and facilities, each operated by a different organization, no one person or agency is looking out for people at all stages and taking responsibility for their progress.

“Who’s responsible for John Smith, who may enter the system at the emergency room, go to Progress Foundation’s acute diversion, then Rypins House for six months, and move on to a supportive housing program run by another agency?” he says.

What’s needed, he says, is essentially a system-wide super case manager, who can follow a person through all levels of the system, no matter which program they’re in.

Staff at Rypins and Caroll try to set clients up for success by helping them learn how to navigate living with roommates — odds are, they’ll have to do so in the future for financial reasons.

Rebuilding a life

Andrea Q came to Progress Foundation after living in a single room occupancy hotel in the Tenderloin, where she stopped taking her bipolar disorder and anxiety medications because there was nobody to hold her accountable. “That’s the first thing that went out the window,” she told me.

Then the 62-year-old relapsed with her husband, with whom she’s been using substances and off for 30 years. In June last year, she overdosed — and almost died after injecting a combination of Xanax, methadone, and fentanyl. Her heart stopped beating — only to be revived with a shot of Narcan. It was the wake-up call she needed to come to Carroll House.

“We’ve pretty much had it with that life. I can’t tolerate any kind of drugs anymore. It would be like a death sentence,” she says. “I wanted somewhere I have to be held accountable.”

These days, Andrea spends most of her time developing a routine outside the house that she can continue once she leaves — like swimming at a nearby pool and being part of a writing group. She gets Social Security and hopes someday to move with her husband, who’s in another treatment facility, to “a nice place” outside San Francisco.

For now, Andrea likes being around people her own age who won’t mind hearing about her osteoporosis. She enjoys the camaraderie with her roommate the most, an older Latina woman who dyed Andrea’s bob hot pink — and in the process, dyed a patch of her own hair when she touched her temple with a stained hand.

With their matching pink hair, they sat with their housemates on a Friday evening in August to dine on Andrea’s cheese and tomato quesadillas. Eating together builds community and encourages responsibility, and clients take turns making meals. Cooking can be challenging for Andrea, and sometimes provokes anxiety. So she keeps it simple — quesadillas or ravioli.

These two senior homes are in high demand, especially in the spring. When beds open up, program staffers go to hospitals, jails, and other programs to interview potential clients. One thing they let prospective residents know is that staying there means learning to navigate conflict.

Just ask Andrea. One night not long ago, one of her housemates didn’t show up for dinner. He came into the kitchen a bit later and declined Andrea’s offer of a quesadilla. He made a bowl of Ramen instead, and spilled it all over the microwave.

“Are you going to clean it up?” Andrea asked.

“How?” he said. “What do you clean it up with? Water?”

“No, with paper towels,” Andrea said. “You know how to clean up.”

“I’ll do it in a little bit.”

He sat at the table in his flannel shirt and slurped the noodles, saying little. Andrea was irritated, but said nothing more. Then the man took his bowl to the sink, tore off some paper towels, and wiped the microwave clean. Andrea thanked him, a tinge of pride in her voice.

“Good for you,” she said. “Good job.”

Reporting for this story was supported by the California Health Care Foundation and the National Institute for Health Care Management.

The post After the Crisis: Unique Program Helps Older Adults Grappling With Both Addiction and Mental Illness appeared first on San Francisco Public Press.

Bystanders might wonder how to summon help from the city — and what will happen if they do.

We created a flow chart to answer those questions, though it does not capture all possible outcomes. Scroll down or click here to find it.

Cases traverse a tangle of pathways, through handoffs between dispatchers and myriad public workers. The person in crisis might spend days or weeks tumbling through the criminal justice system or health care facilities. They might get a reprieve from the outdoors in a sobering center or a communal recovery setting, where they can access food and information to help them seek social services. Their path depends on many factors, like the availability of the Street Crisis Response Team, what the bystander tells city personnel and whether responders can calm them.

Often, the person returns to where they started: the streets.

San Francisco emergency dispatchers can receive tens of thousands of calls per year about mental health incidents, including suicide attempts. According to a recent study by a city working group, there were nearly 13,700 recorded involuntary psychiatric detentions in the fiscal year that ended in 2022 — a conservative tally as the analysis did not include some facilities in San Francisco. The study found that African American residents were detained at disproportionately high rates, and unhoused people were frequent users of psychiatric emergency services.

(Click the link below the chart to see a version that allows you to zoom in.)

The San Francisco Public Press spent months investigating how people can be detained involuntarily due to mental health crises and what happens to them afterward. The psychiatric detentions are commonly called “5150” holds, a nod to the section of state code that defines the criteria for this intervention. We examined hundreds of pages of call records, department procedures and training documents, and interviewed staff at numerous city departments directly involved in crisis response to map the city’s system of care.

A single phone call about an incident can trigger responses from multiple departments. Major responders include the Department of Emergency Management, Fire Department, Police Department, Sheriff’s Department, Department of Homelessness and Supportive Housing, and Department of Public Health.

People witnessing a crisis generally request help by calling either 911, the city’s emergency line, or 311, for general services and assistance. Dispatchers do their best with the information the caller provides to quickly determine whether the distressed person poses an immediate danger to themselves or others.

Calls about mental health crises often ping-pong between 911 and 311 as details emerge, said Burt Wilson, president of the union chapter that represents the city’s emergency dispatchers.

Many unhoused people carry weapons to defend themselves at night, and they might struggle with drug addiction or be mentally unstable, Wilson said.

“I don’t know how you differentiate, on the phone call, who to transfer to 311 and who to transfer to the police,” Wilson said. “Most of the 311 calls end up coming back to our call center because 311 just has to say a certain trigger word like, are they ‘aggressive?’ And then it comes right back to us.”

The Department of Emergency Management dispatches police in cases of calls about people threatening violence or wielding weapons; that doesn’t include people who are merely yelling, said Officer Robert Rueca, a spokesperson for the San Francisco Police Department.

But what qualifies as “violence?” The Department of Emergency Management could not say.

“‘Violent’ is not something we have a concise definition for,” a spokesperson said. “It will vary based on circumstances and the level of information the reporting party is providing.”

And a “weapon” is broadly defined as “anything that can be used as a weapon,” according to department guidelines. For many types of small weapons, such as pocket knives, possession alone is not considered a threat.

If a person is in severe crisis, police and medical personnel can put them on a 5150 hold.

But involuntary hospitalization can be harmful, said Sarah Gregory, a senior attorney at Disability Rights California. The organization advocates for community-based services for people with mental health disabilities, as an alternative to forced stays in hospitals or psychiatric wards.

Gregory called it a “traumatic” experience when someone “who’s already having a mental health crisis calls for help, and then receives a response that takes away the person’s rights.”

“Client after client says, ‘I came out of there worse than I went in,’” Gregory said, referring to places where patients were involuntarily detained.

When a person in mental distress is not an immediate threat, the call goes to medical personnel like the Street Crisis Response Team, Fire Department or paramedics. The crisis team is one of many created in recent years as San Francisco and other cities have shifted away from a law enforcement response following high-profile police killings, including those of Mario Woods, Tony Bui and George Floyd, in which the officer was convicted of murder.

The San Francisco Police Department “would never be dispatched to a medical call” even if the Street Crisis Response Team or an ambulance were unavailable, said the spokesperson for the Department of Emergency Management. The police were the crisis team’s backstop in its early years, but that stopped in June 2022, they said.

The team uses de-escalation strategies to calm a person in distress, like speaking softly, asking questions to get to know them, and offering snacks or water. When the person regains composure, the team might connect them to treatment or follow-up care with the Office of Coordinated Care, Homeless Outreach Team or Post Overdose Engagement Team, the spokesperson said.

The team might also simply leave the scene once the person is no longer in distress.

People who engage with the city’s crisis-response system might benefit most from having long-term case managers who can help them fully resolve problems with their health or living situations, said Mark Salazar, chief executive officer of the Mental Health Association of San Francisco. The organization provides case management and peer support services at courts, jails and Zuckerberg hospital after someone is released from a 5150 hold.

“But the shortage of support and funding is really a challenge,” Salazar said. “Without having continued support after being 5150’d, or [receiving] forced treatment, you’re just setting up someone for more failure.”

Support for people struggling with their mental health

San Franciscans struggling with their mental health can call many local and national hotlines. To learn about the resources that are available, and potentially speak with counselors, reach out to the organizations below. 

Mental Health Association of San Francisco: Talk to a peer about your feelings and get information about available mental health services.

• Warm line is open 24/7
• Call or text 855-845-7415

San Francisco Behavioral Health Services: Find local mental health or substance use services that meet your needs.

• Clinicians are only available Monday-Friday from 8 a.m. to 7 p.m., and Saturday-Sunday from 9 a.m. to 4 p.m.
• Behavioral access helpline is open 24/7
• Call 415-255-3737 or 888-246-3333

Harm Reduction Therapy Center: Speak with someone if you are experiencing homelessness and seeking peer counseling or harm reduction services.

• Community helpline is open Monday-Friday, from 10 a.m. to 8 p.m.
• Call 415-863-4282

San Francisco Night Ministry: Speak with counselors trained in trauma-informed care, interfaith spiritual support, suicide prevention and crisis management.

• Care line is open every day from 8 p.m. to 2 a.m.
• Call 844-467-3473

Mobile Crisis Team: Speak with clinicians who can help someone experiencing a crisis. The team may visit the person to assess whether they meet the criteria for involuntary psychiatric detention, and they can request support and transportation by paramedics or police.

• Helpline is open 24/7
• Call 628-217-7000

SF Suicide Prevention Hotline: Speak with a counselor if you or your loved one are considering suicide. Counselors can provide referrals for mental health, HIV and addiction services.

• Hotline is open 24/7
• Call 415-781-0500 or text 415-200-2920

Other resources

California Peer-Run Warm Line

• Warm line is open 24/7
• Call or text 855-600-WARM (9276)

California Suicide Prevention Lifeline

• Hotline is open 24 hours
• Call 988

Crisis Text Line

• Crisis counseling is available 24/7
• Text HOME to 741741
• Visit their website to connect via online chat or WhatsApp

Like many media organizations, the San Francisco Public Press is experimenting with artificial intelligence (A.I.) tools that aid the creation of images for use in some stories. Nearly all our visual content is produced by humans.

The Public Press is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center, The Center for Public Integrity and newsrooms in select states across the country.

See our related article, The Often Vicious Cycle Through SF’s Strained Mental Health Care and Detention System

The post You Report an Unhoused Person in a Mental Health Crisis. This Is What Happens Next appeared first on San Francisco Public Press.

Uncertain what to do, we dialed 311, San Francisco’s non-emergency helpline. Seventeen minutes later, a red van arrived, carrying members of the city’s Street Crisis Response Team. Jay told them he was schizophrenic. The paramedic recognized him from previous calls and greeted him. Looking at Jay’s digital records, a member of the group realized his prescription had been refilled about two weeks prior, but Jay didn’t remember picking it up.

As they spoke, it became clear that Jay had previously been placed under involuntary psychiatric detention, also called a “5150 hold.”

That fall day, Jay asked to be detained again.

[ Read also: “You Report an Unhoused Person in a Mental Health Crisis. This Is What Happens Next” ]

That was how he had gotten a dose of Benadryl, one of two medications he used to manage his condition, he said. Benadryl is among the antihistamines that can help control anxiety. Schizophrenia requires lifelong treatment, even when symptoms have subsided.

“They give me my pill with a 5150,” he said.

The paramedic bristled. “That’s a lot of resources just to get one pill.”

Jay was one of thousands of people last year who fell into San Francisco’s complex, reactive, strained system for treating severe mental health and drug-related crises. As with many of the people who enter that system — including those who are unhoused or are detained without their consent following a call from an alarmed observer — Jay had received temporary care, entailing multiple involuntary psychiatric holds, that failed to address his long-term problems. That left him back on the streets to fend for himself or, with the help of passersby, try again to get the help he needed.

Since the start of the COVID-19 pandemic, much of the public discussion about homelessness and mental health in San Francisco has focused on the people who desperately need care, but who reject it. Jay’s story diverges from this common narrative.

“When’s the last time you were at Gen?” the paramedic asked, referring to the emergency room at Zuckerberg San Francisco General Hospital and Trauma Center, the facility in the city with the highest number of beds for people on 5150 holds.

“Today,” Jay said. He had gone there seeking medication, then waited in a hallway for four hours before staff gave him a dose of Risperdal, an antipsychotic that he did not usually take. It had not been effective.

Who responds to mental crisis calls

Emergency service providers may not legally turn people away. For many San Franciscans, this is their only option for accessing medical care.

City officials have made recent efforts to improve the crisis care system. A few years ago, police might have been dispatched to Jay’s call and that would divert them from situations they might be better trained to handle. Today, the city routes mental health-related calls to other teams instead when there is not an immediate safety threat, said a spokesperson with the Department of Emergency Management.

One alternative is the Street Crisis Response Team. It was created in late 2020 and aims to offer trauma-informed care to people facing mental health crises or minor medical issues, potentially reducing unnecessary emergency room visits.

When team members arrive on the scene, they address the person’s immediate needs first — for example, food or a warm blanket — and might connect them with other services and take them to a shelter, sobering center or health clinic.

The many units that respond to the city’s increasingly visible street-level crises cost millions of tax dollars each year: The Street Crisis Response Team’s budget will be $12.3 million for the fiscal year ending in 2025; the Homeless Outreach Team’s budget for the same year will be $8.9 million; and the Homeless Engagement Assistance Response Team was authorized last year to receive one-time funding of $3 million.

City dispatchers must decide which team to send — they might send more than one — relying on the caller’s description of the scene. Calls about mental health crises often ping-pong between 911 and 311 as details emerge, said Burt Wilson, president of the union chapter that represents San Francisco’s emergency dispatchers.

“It’s a huge amount of resources,” Wilson said.

Involuntary detention’s disproportionate impacts

Dispatchers received at least 24,000 calls about mental health crises or attempted suicides in 2023, including calls from bystanders as well as police, based on a Public Press analysis of government records. In many cases, responders couldn’t find the people in crisis.

In the most serious instances, crisis responders put people in 5150 holds, named after the section of California’s Welfare and Institutions Code that defines this procedure. The law permits police and trained medical personnel to detain someone for up to 72 hours if their mental health disorder is making them a danger to themselves or others, or it leaves them unable to provide for their basic needs.

The city recorded nearly 13,700 psychiatric holds for the year that ended June 2022 — but that figure, the most recent available, captures a fraction of the total situation. The number was calculated in a report by a city working group, which found that not all hospitals reported detentions and that the available data did not allow for robust analyses of patient characteristics like race, gender or housing status.

Some people were put on 5150 holds multiple times at Zuckerberg hospital. Using data from that facility in its analysis, the working group found that 425 people received at least two psychiatric holds, 86 had at least four holds and 13 had eight or more. African Americans, despite making up only 6% of the city’s population at the time, accounted for over 42% of people detained four or more times.

Most people who received emergency psychiatric services from the hospital, including 5150 holds and voluntary visits, had experienced homelessness in the prior year.

Numerous service providers told the Public Press that people are more likely to cycle repeatedly in and out of crisis-care facilities when they don’t have access to preventive or non-emergency care, because small problems can become larger ones that require hospitalization.

Experts said also that it’s vital for people to receive culturally competent care — for example, when the health worker speaks the patient’s language or knows which medical guidance will conflict least with social norms.

Underfunded care system

San Francisco has seven designated psychiatric facilities with a total of 187 beds for patients on psychiatric holds, according to the California Department of Health Care Services, which approves facilities for this use.

But not everyone on a 5150 hold gets a bed. The crisis care system is notoriously underfunded, with inadequate capacity and staff. When no bed is available, someone is detained in an emergency room for up to 24 hours.

The 2023 passage of state Senate Bill 43 might further strain the system. The law modified the eligibility criteria for 5150 holds for the first time in decades, making it possible to detain people gravely disabled due to substance use. In response, San Francisco has acquired additional beds. Many other counties are waiting to implement the policy, saying they need more guidance and resources from the state to comply.

Meanwhile, Proposition 1, a separate package of state policies that voters approved by a razor-thin margin in March, could add treatment beds to the system, including those for 5150 holds. The proposition forces counties to redirect a large portion of their mental health spending to housing programs, many of which must benefit unhoused people and veterans. A coalition of mental health organizations and disability advocates opposed the ballot measure, fearing it would cause cuts to vital community-based programs. 

Among its many mandates, Proposition 1 authorized the sale of $6.4 billion in government bonds. Of the total bond revenue, $4.4 billion is slated to pay for building behavioral health facilities. Gov. Gavin Newsom, who campaigned for Proposition 1’s passage, has said it will enable adding more than 11,150 behavioral treatment beds.

For people who are able to get beds, their problems are far from solved.

“There’s a perception that if you put someone on a hold, something good will happen for them, like something miraculous,” said Dr. Maria Raven, chief of emergency medicine at the University of California, San Francisco. People might think that an intervention by psychiatric workers would set in motion a process that leads to long-term treatment or, for those experiencing homelessness, permanent housing, she said.

“That doesn’t really happen,” Raven said. Instead, “you just put someone where there’s a bed.”

[ Read also: “Mental Health Advocates Call for Voluntary Treatment as Spears Conservatorship Ends” ]

Back on Market Street, the Street Crisis Response Team was trying to find help for Jay in this overburdened system. As they made phone calls to locate a facility that could fill Jay’s medication, one team member tried to comfort him with snacks and water, which he was hesitant to accept.

“Every time I drink something, bad stuff happens,” Jay said.

“You can drink it,” the paramedic told him calmly. “We’re not going to leave you.”

After about 15 minutes and at least four unfruitful calls to multiple agencies, the paramedic suggested that the outreach workers try the Westside Crisis Clinic. They checked its operating hours but found conflicting information online. A call revealed that it was closed for the day.

“It’s very unfortunate that the city runs on banking hours,” another team member said.

Finally, the team found a bed at the Dore Clinic, which provides psychiatric urgent care. Jay could stay there for up to a day. He would have a bed and access to a shower and a phone. That would enable him to call his sister, who could pick him up and help him obtain his medication.

“You can get all your meds tomorrow, something that we can all look forward to,” the paramedic said.

Like many media organizations, the San Francisco Public Press is experimenting with artificial intelligence (A.I.) tools that aid the creation of images for use in some stories. Nearly all our visual content is produced by humans.

The Public Press is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center, The Center for Public Integrity and newsrooms in select states across the country.

See our related article You Report an Unhoused Person in a Mental Health Crisis. This Is What Happens Next

The post The Often Vicious Cycle Through SF’s Strained Mental Health Care and Detention System appeared first on San Francisco Public Press.

Todos los sábados, Aurelia Ramírez llena una bolsa con folletos sobre servicios locales de apoyo social, compra unas docenas de pan dulce y una caja de café, y camina por su vecindario del Distrito de la Misión, conectándose con personas que viven en la calle.

“Nuestro trabajo es verificar si las personas están bien,” dijo Ramírez, quien se mudó a San Francisco desde México hace 23 años.

Ramírez es embajadora comunitaria de la Oficina de Participación Cívica y Asuntos de Inmigrantes de San Francisco. Dijo que quería un trabajo que le permitiera ayudar a la comunidad Latina – especialmente gente de ascendencia maya de Yucatán, como ella.

“Es triste,” ella dijo. “No saben qué pueden hacer. Especialmente la gente de Yucatán.”

Mientras ofrece café y comida, ella comparte información sobre dónde va para recibir atención médica, servicios sociales, refugio, baños y lugares para lavar la ropa. Dijo que la pandemia causó un sufrimiento profundo en su comunidad y muchos nunca se recuperaron.

“Ellos perdieron un trabajo, perdieron la casa. No tienen dinero. ¿Qué pueden hacer?” dijo Ramírez. “Ya sabes, la gente que vende drogas te la dan gratis la primera vez, pero después tienes que pagar. Eso es el problema. Y ahora algunas personas, ya no están bien.”

De hecho, la tasa de muertes por sobredosis entre los mayas de Yucatán que viven en San Francisco ha aumentado lo suficiente desde la pandemia de COVID-19 como para alarmar a la Cónsul General de México en San Francisco, Remedios Gómez Arnau, quien procesa el certificado de la muerte de los ciudadanos mexicanos locales antes de su repatriación.

[ Leer también: “Proveedores de Servicios Exigen Acceso a Reclusos Latinos” ]

En un día inusualmente cálido y soleado de febrero, Ramírez despertó a la gente de sus casas de campaña y parecieron agradecidos por el café, la comida y la información sobre cuando estaría abierta una clínica dental gratuita.

Instó a los yucatecos a llamar a sus familias en Yucatán desde una oficina en Daly City llamada La Casa Del Yucateco que fue inaugurada por el gobernador de Yucatán, Mauricio Vila Dosal, en octubre pasado para brindar servicios gubernamentales a los yucatecos en San Francisco y sus alrededores.

Varias personas sin hogar le dijeron a Ramírez que lo que más necesitaban son viviendas e ir a un refugio estaba fuera de la discusión porque tenían miedo a la violencia y los robos. Ramírez explicó que cuando las personas que conocen están interesadas en recursos, ellos también enfrentan obstáculos.

“A veces, tienen listas de espera: listas de espera por refugio, listas de espera por ayuda,” dijo Ramirez. “Y ellos no quieren esperar. Quieren la ayuda al mismo tiempo.”

Buscando una vida mejor

En la Península de Yucatán, México, los indígenas mayas enfrentan discriminación sistémica, y acceso limitado a la educación, atención médica, oportunidades económicas, y representación política.

La situación lleva a muchos a buscar mejores oportunidades en otros lugares. Y durante generaciones, han estado emigrando a San Francisco y el Área de la Bahía, según Lydia Candila Chan, directora ejecutiva de la Asociación Mayab, una organización en San Francisco que ofrece recursos comunitarios esenciales, educativos y culturales.

Posiblemente, hasta 70,000 mayas yucatecos viven en la ciudad y sus alrededores, pero nunca ha habido un recuento oficial; es una estimación que Candila Chan obtuvo del Instituto para el Desarrollo de la Cultura maya con sede en la capital de Yucatán, Mérida.

Candila Chan dijo que los mayas yucatecos vienen a San Francisco en busca de oportunidades financieras “para darles a sus familias una vida mejor.” Pero la barrera del idioma puede ser un obstáculo grande para encontrar trabajo porque para muchos el español es una segunda lengua. Más de 500,000 mayas de Yucatán hablan la lengua indígena maya, según el último censo mexicano.

Algunos mayas alcanzaron el éxito y, para muchos, dijo Candila Chan, gracias a sus reconocidas habilidades culinarias.

“Son los mejores cocineros aquí en San Francisco,” ella dijo. “En cualquier restaurante al que vayas, verás a una persona de Yucatán.”

La representación de la población en los restaurantes la hizo excepcionalmente vulnerable durante la pandemia, cuando se cerró la industria.

“El sueño americano a veces les resulta muy triste,” dijo Candila Chan. “Están tan decepcionados entonces cuando sus amigos dicen ‘Vamos a tomar una cerveza y hablar,’ empiezan a empezar más y más. De repente, están viviendo en la calle. De repente mueren. Veo muchos.”

Candila Chan hace lo que puede para ayudar ofreciendo programas que brindan recursos esenciales, así como actividades culturales que unen a la comunidad de una manera saludable.

Más de 250 familias se benefician de la despensa semanal de alimentos de la Asociación Mayab. El centro también ofrece clases y presentaciones de jarana, el baile tradicional de Yucatán, artes y artesanías, capacitación en interpretación maya, y una liga de béisbol que ha crecido hasta incluir ocho equipos y 144 jugadores.

La población indígena no recibe advertencias sobre el fentanilo

Gómez Arnau, cónsul general de México en San Francisco, preguntó al socio comunitario Jorge Zepeda, director de salud latina de la Fundación Contra el SIDA de San Francisco, sobre la tasa elevada de muertes por sobredosis que estaba observando entre los indígenas mayas.

En ese momento, Zepeda estaba consultando con el Departamento de Salud Público de San Francisco para evaluar la salud de las poblaciones latinas en viviendas de un cuarto. Le dijo a Gómez Arnau que estaba viendo la misma tendencia y se dijo al departamento de salud.

“Le dije ‘¿Sabes cuántas personas que hablan español y maya han muerto por sobredosis?’ Dijeron ‘No estamos seguros,’” dijo Zepeda.

Desde enero de 2020 hasta diciembre de 2023, 2,955 personas murieron por sobredosis accidentales en San Francisco, según la Oficina del Médico Forense Principal. De ellos, 456 fueron categorizados como latinos. Pero es imposible obtener tasas de mortalidad de subgrupos de la población latina, ya que las autoridades de salud de las agencias municipales, estatales y federales agrupan a todos los latinoamericanos.

Eso no tiene en cuenta la diversidad de idiomas que existe dentro de sus subgrupos, lo que significa que es posible que información vital, como advertencias sobre los peligros del fentanilo y dónde obtener ayuda para los trastornos por uso de sustancias, no lleguen.

Categorizando a todos los latinoamericanos juntos también lleva otros problemas, según defensores como el Dr. Seciah Aquino, director ejecutivo de la Coalición Latina para una California Saludable. La organización fue parte de una campaña de años para intentar que los departamentos estatales recopilen y desagregaran datos más detallados para las comunidades latinas e indígenas.

“No somos un monolito,” dijo Aquino. “Necesitamos comprender y recibir datos que detallar más en esos subgrupos específicos. Si no lo hacemos, entonces estamos perdiendo datos de calidad que podrían llevarnos a tomar mejores decisiones en términos de los fondos que se asignan a la comunidad, a la región y cómo se distribuyen.”

La senadora estatal Lena González de Long Beach presentó el año pasado un proyecto de ley de equidad demográfica para fortalecer la colección de datos estatales. La Legislatura aprobó el proyecto de ley, pero el gobernador Gavin Newsom lo vetó en octubre pasado, diciendo que era inapropiado porque la Oficina de Administración y Presupuesto de los Estados Unidos estaba actualizando los estándares federales para recopilar información sobre raza y origen étnico.

El 28 de marzo se anunciaron estándares federales actualizados que no tenían en cuenta a las poblaciones indígenas latinas. González volvió a presentar su proyecto de ley el 27 de febrero y está avanzando en el Senado estatal.

Necesidad extrema de concienciación sobre las drogas y servicios de salud

Después de descubrir la brecha en la conciencia sobre el uso de drogas entre los latinos y los latinos indígenas, Zepeda se asoció con Laura Guzmán, directora ejecutiva de la Coalición Nacional para la Reducción de Daños, y el Dr. Carlos Martínez, investigador de antropología médica y salud pública de UC Santa Cruz, para realizar un estudio con financiación del Departamento de Salud Pública de San Francisco. El informe de su estudio, “Unido/xs Contra La Sobredosis,” se publicó en septiembre de 2022.

Descubrieron que la mayoría de los latinos e latinos indígenas de San Francisco que consumían sustancias intentaban llevar a cabo un objetivo específico y sabían muy poco de los riesgos asociados con esas sustancias.

“Sabían el efecto que quería, como seguir trabajando, relajarse o dormir,” dijo Zepeda. “Cuando les preguntamos: ‘¿Saben el nombre de la droga?’ ‘No. Pero puedo obtenerlo de una persona que conozco.’”

Concluyeron que para minimizar las sobredosis y los daños relacionados con las drogas en las comunidades latinas e indígenas, la ciudad debe educar a poblaciones específicas sobre los tipos de drogas, impactos del uso de drogas y conciencia de que las drogas a menudo están contaminadas con el opioide fentanilo, que puede causar una sobredosis letal.

El estudio también reveló una brecha evidente en la disponibilidad de servicios de tratamiento. Dijo que la mayoría de los proveedores comunitarios que prestan servicios a la comunidad latina “no se sentían cómodos” haciendo una derivación a un proveedor de servicios de salud por uso de sustancias en San Francisco porque no tenían la capacidad de interactuar con personas que hablan español o maya.

Zepeda dijo que ha visto un progreso desde que se publicó el informe, incluido que las solicitudes de propuestas para la salud conductual han incluido programas en español y maya recientemente.

Los funcionarios del Departamento de Salud Pública rechazaron las solicitudes de entrevista. En un correo electrónico, el departamento afirmó que ofrece 10 camas en el Managed Alcohol Program para pacientes latinos e indígenas. Y acaba de lanzar una iniciativa que se llama Health Access Point, que da servicios de reducción de daños a clientes latinos a través de un programa liderado por el Instituto Familiar de la Raza, el Mission Neighborhood Health Center y la Fundación Contra el SIDA de San Francisco.

Además, el departamento anticipa que una expansión planificada de 33 camas de un centro de tratamiento de salud mental y uso de sustancias para mujeres que han sido arrestadas, acusadas, condenadas o encarceladas será competente en español.

Necesitan programas culturalmente sensibles

Sin embargo, los proveedores de servicios dicen que la competencia lingüística no es lo mismo que los programas culturalmente sensibles y que son casi imposibles de encontrar para las comunidades latinas. The Latino Commission es la única organización que da ese tipo de tratamiento residencial en San Francisco y solo tiene 10 camas.

La directora ejecutiva de la Latino Commission, Debra Camarillo, dijo que conectarse con la propia cultura es fundamental para la sanación.

“Entramos en recuperación y podemos conectarnos y encontrar un sentido de nosotros mismos,” dijo Camarillo. “Y al encontrar ese sentido de uno mismo y desarrollar ese amor propio, surge un valor que al final entendemos que, como humanidad, como seres humanos, somos sagrados. En eso está lo sagrado.

“Si puedo entender ese lugar y puedo vivir en ese lugar, entonces mis acciones serán diferentes. No voy a tratarte como quizás te hubiera tratado en el pasado. No voy a tratarme a mí mismo y no voy a aceptar un tratamiento que quizás haya aceptado en el pasado.”

Para aumentar los programas sensibles lingüística y culturalmente para las poblaciones latinas necesitan a más médicos latinos, dijo la Dra. Marlene Martin, profesora asociada de UCSF y coautora de un estudio, publicado en el Journal of General Internal Medicine en enero de 2022, titulado “Falta de diversidad racial y étnica entre los médicos especializados en adicciones.”

Los autores del estudio concluyeron que diversificar la fuerza laboral médica requeriría una mayor financiación para las facultades de medicina en comunidades desatendidas, ayuda financiera para estudiantes sin acceso a la riqueza generacional, políticas de pago de préstamos más integrales y programas para exponer a los estudiantes a las carreras médicas.

Martin también es director de iniciativas de adicción en el Centro de Excelencia Latinx de UCSF, que está ayudando a satisfacer la necesidad de un tratamiento culturalmente sensible. Se han asociado con la Coalición Nacional para la Reducción de Daños en la educación sobre el uso de sustancias para organizaciones comunitarias latinas en San Francisco.

Sylvie Sturm informó esta historia mientras participaba en la beca de datos 2023 del Centro de Periodismo de Salud de la USC Annenberg, que brindó capacitación, tutoría y financiación para apoyar este proyecto.

Traducido al español por Cassandra Garibay.

The post Las Muertes por Sobredosis entre los Mayas en San Francisco Muestran la Necesidad Urgente de un Tratamiento Culturalmente Sensible appeared first on San Francisco Public Press.