[{"_1":2,"_99":-5,"_100":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,75,87],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":68,"_72":73,"_74":73},"mediaId",6521457,"mediaKeyId","5091881-71fb9cae39e746362a6ac77430f3cbb9","parentId",5091881,"title","Controller's work group urges targeted expansion of high-acuity behavioral-health beds; city lists funding and projects underway","audioSeconds",1372,"startMs",10644000,"endMs",12016000,"viewUrl","/Search/View?dp=1&key=5091881-71fb9cae39e746362a6ac77430f3cbb9&start=10644&end=12016","thumbnailUrl","https://assets.pipeline.soar.com/5091881-71fb9cae39e746362a6ac77430f3cbb9/thumbnail_10644000.jpg","articleUrl","/articles/6521457/San-Francisco-County/California/Controllers-work-group-urges-targeted-expansion-of-high-acuity-behavioral-health-beds-city-lists-funding-and-projects-underway","mediaUrl","https://secure.pipeline.soar.com/6521457-47a9b43c14fe8e59902eec17e7e0feff/orig.mp4?Expires=1771160701&Signature=fNfRH~KJpvJGHDAhCtli3bc3mcnYEJ01Vc38FIp7StFSuSjdi9v9BwA~bF4gsFZR7vQwdAak0qa0qRnTQVgby4xAub0rEz7501zehO2KfEWwYbmJczIjYcquAgazWBUpWJiCBr2JbcdCjcKwrHEXiWNdDMeaSPlaWfrXq~eNgmVtpSUXdpfEFouExLgrncKRQhc7m-VY671l4Hfs3mHufiTg08fhgYFllflWc0l1zgCYPyw~PT84DYeJxXq-PLuEN~LIW0SMKqJaqVsXCOuLfudVBt0pPMOzYrSTGVCYxE6-CA6eYQrgqQ1OJo2cgrRTl73OwiF-M7T26-dvgO5xGg__&Key-Pair-Id=KUT5TJCACFTXG","author","San Francisco County","date","2025-06-26T00:00:00Z","article","The Controller’s Office and a city work group on residential care and treatment recommended targeted expansion of high-acuity behavioral-health beds to better serve San Franciscans with the most complex mental-health and substance-use needs, and city health officials described capital awards, acquisitions and operational steps intended to add treatment and step-down capacity over the coming years.

Laura Marshall of the Controller’s Office summarized the work group’s January report, which concluded there is a measurable shortage of locked subacute treatment (often called “MERCs” or locked subacute) and specialized adult-residential (ARF/RCFE) capacity for clients who have combined medical, psychiatric and behavioral-complex needs. The report recommended a targeted addition of roughly 55–95 locked subacute beds and 20–48 high-complexity ARF/RCFE beds for harder-to-place clients, noting that those beds would likely require higher patch rates and would be largely non-Medi-Cal reimbursable operating costs borne by the local government.

Marshall and work group participants warned that even competitive county rates have not fully solved a market problem: operators sometimes deny placements for reasons beyond the city’s rate structure, leaving some clients medically or behaviorally complex and effectively unplaceable in the existing market. The work group urged state policy changes and better regional coordination, noting that San Francisco alone cannot meet statewide need.

Department of Public Health officials outlined a planning and implementation package. Director Daniel Tsai and Dr. Monica Kunins (presenting with DPH) told the committee the department plans to open about 190 treatment-and-recovery beds and roughly 100 step-down and ongoing recovery beds between 2025 and 2028, with a mix of new contracts, repurposed city buildings and state capital funding. Tsai said DPH estimates a local shortage of roughly 100–140 locked subacute beds overall and said the department had purchased or leased 48 out-of-county beds while pursuing in-county capacity.

DPH described specific projects: the department received about $28 million in one Prop 1 capital award for a Seventh Street dual-diagnosis site, and $21 million for locked subacute expansion at the Zuckerberg San Francisco General Hospital behavioral-health center (BHC). DPH said it has been awarded approximately $88 million in state capital for behavioral-health projects since 2022 under the Behavioral Health Infrastructure Program.

Officials said DPH intends to repurpose the first and second floors of the BHC at ZSFG to add more than 90 locked subacute beds in county, and that two purchased Laguna Street buildings (601 and 624 Laguna) would house assisted-living residents and other residential-care placements. DPH also described a forthcoming Marina Inn project to add transitional recovery beds and additional housing-based recovery services.

Marshall noted the work group’s modeling and operational analysis found large budget implications: depending on the configuration and whether higher patch rates are required for complex clients, the additional operating cost for the recommended expansion could range into the tens of millions of dollars annually; the work group estimated a potential general-fund cost in the range of $12 million to $24 million for the proposed ARF/RCFE additions, and DPH staff told the committee adding 100 locked subacute beds could cost roughly $20 million a year (with estimates up to about $28 million for larger scenarios).

The Controller’s Office and DPH emphasized operational barriers beyond financing: facility procurement lead times, workforce shortages for specialized staff, regulatory licensing complexity for locked subacute settings and the need for the state to help with allocation of state-hospital beds and broader coordination.

Public commenters and service providers at the hearing urged urgency. Steve Fields, executive director of the Progress Foundation, said the city needs to pair top-down expansion of beds with stronger voluntary and early-intervention services and asked for more engagement with frontline providers on practical operational questions. Other commenters, including Carolyn Kennedy and community advocates, called for a faster rollout of locked subacute beds and for prioritizing the hardest-to-place clients.

What the city is doing now: DPH said it will continue to pursue Prop 1 and other state capital, use city-owned property where practicable, convert identified buildings and deploy contract waivers to speed openings. The department said bed-tracking and improved data infrastructure (including an Epic-based health record transition) will help refine demand estimates and optimize placement flows over time.

Supervisors and presenters agreed on two points: San Francisco needs more capacity at higher-acuity levels, and the problem cannot be solved entirely with local funds and procurement alone — state-level coordination, regulatory adjustments and fiscal support will be necessary to meet the full need.","mediaType","Video","parentTitle","San Francisco County - Video Open Video Only in Windows Media Player - Jun 26, 2025","oneSentenceSummary","The Controller’s Office work group recommended targeted expansion of high-acuity behavioral-health beds, and San Francisco health officials described capital awards, acquisitions and contract plans to add treatment and step-down capacity over 2025–2028.","taxTitle","San Francisco County, California","taxId",2862,"location","headline","","shortSummary",{"_33":76,"_35":36,"_37":38,"_39":77,"_41":78,"_43":79,"_45":80,"_47":81,"_49":82,"_51":83,"_53":84,"_55":56,"_57":58,"_59":85,"_61":62,"_63":64,"_65":86,"_67":68,"_69":70,"_71":68,"_72":73,"_74":73},6521462,"Supervisors push departments for clearer SB 43 outcomes as implementation yields modest conservatorship gains",9803,736000,10539000,"/Search/View?dp=1&key=5091881-71fb9cae39e746362a6ac77430f3cbb9&start=736&end=10539","https://assets.pipeline.soar.com/5091881-71fb9cae39e746362a6ac77430f3cbb9/thumbnail_736000.jpg","/articles/6521462/San-Francisco-County/California/Supervisors-push-departments-for-clearer-SB-43-outcomes-as-implementation-yields-modest-conservatorship-gains","https://secure.pipeline.soar.com/6521462-8078ee0d68de3a12a3dceb4d8fc1c292/orig.mp4?Expires=1771160701&Signature=BKX~oAwFXYgK6uD8hWB0hYN~ADhzei~8ehFtDBiyQoFyShNMWhwgHlHa3-o3XuwTR~87-yoy9L8ept2xKNCLL5nCkD5R4UaWdOfAwoGZWQPwQ13ZbtxdrheAIeGHcwPDNJNDWoHfQtD8IMf03iW0AZERtqPvsCqW3hRoIde66-fL3hP4hTzoL3HHtQb2GA5GR3AVT-Cg9Lzt3UfOpvYNNlx1T~O78kwcEGP0OLjGE4CmlYV6QeFT7dQWTDYitM4Yoltq2wK6cGMXMfcrbS~DENQlfMf-GobBiWU4rt8C~xfI4oiyfNWGGek2lKQKEstUZjjtr1IviFm-Ji2AV0OM7Q__&Key-Pair-Id=KUT5TJCACFTXG","San Francisco supervisors pressed city health and disability agencies on Thursday about the implementation of California Senate Bill 43, with elected officials and officials from the Department of Public Health and the Department of Disability and Aging Services agreeing that legal change alone has not produced broadly improved outcomes for people with severe mental illness or co-occurring substance use disorders.

President Rafael Mandelmann of the Board of Supervisors convened the hearing at his request and said SB 43 “was not my first ride on the merry-go-round” of conservatorship reform. Mandelmann told the committee, “SB 43 implementation in San Francisco has not been a success in my view,” and said he expected a candid assessment of what has worked and what has not.

Daniel Tsai, director of the Department of Public Health, and Kelly Dearman, executive director of the Department of Disability and Aging Services and public conservator, described a coordinated interagency rollout after San Francisco adopted SB 43 on Jan. 1, 2024. The definition of grave disability was expanded under SB 43 to include severe substance use disorder and inability to provide for personal safety or necessary medical care, in addition to inability to meet basic needs for food, clothing or shelter.

Dearman summarized the conservatorship process under the Lanterman-Petris-Short Act (LPS): only the public conservator may file for conservatorship, which typically begins with a 30-day temporary conservatorship that can proceed to a permanent conservatorship if the court so orders. She said the public conservator accepts and petitions the court for about 94% of the justification-and-recommendation (JNR) forms received from clinicians and that nearly all temporary conservatorship petitions are granted; since 2023 the office had one denial from the court.

The departments reported that, from January 2024 through May 2025, the city had 186 temporary conservatorships granted after SB 43 implementation, including 50 granted since the start of 2025. Of those, 163 used the expanded grave-disability criteria to strengthen petitions; the departments said there have been no conservatorships granted solely on the new SB 43 criteria (severe substance use disorder alone). Departments also reported that 46 of the expanded-criteria cases were filed since January 2025.

At the same time, officials said placement capacity limits have constrained their ability to expand conservatorship use. Tsai and Dearman told the committee the city suffers a shortage of locked subacute beds and residential placements that can manage dually diagnosed clients who need both psychiatric and substance-use treatment. Tsai estimated San Francisco’s shortage of locked subacute beds at roughly 100 to 140 beds and said the city currently purchases or leases approximately 48 out-of-county beds for some clients.

To reduce reliance on out-of-county placements, the departments described a pilot that began in the prior month in which teams hold a shelter bed and layered clinical supports for specific cases when locked subacute beds are unavailable; Tsai said the pilot had identified five clients at the time of the hearing where a shelter bed plus intensive wraparound supports was being held as a placement plan.

Committee members pressed departments on other operational questions. President Mandelmann and Supervisor Connie Chan asked whether the city has an estimate of how many people in San Francisco meet clinical standards for conservatorship; officials said the need exceeds current capacity but declined to supply a single fixed number, noting that demand can grow when outreach and identification improve. Department data showed the monthly average caseload in 2025 rose 3% compared with 2023 but fell 1% versus 2024 — the departments said some of that decline reflects terminations when individuals stabilize and move to less restrictive interventions.

Concerns about short 5150 (72-hour) holds also emerged. Department officials said many people admitted on 5150 due to intoxication no longer meet hold criteria after a short period and are legally required to be released; hospital clinicians, they said, often must decide within hours whether someone continues to meet criteria. Officials said the departments have trained more than 1,700 staff in SB 43-related procedures and have created a centralized LPS review list for individuals who might be eligible; at the time of the hearing DAS reported 26 active people on that review list.

Jill Nielsen, deputy director at the Department of Disability and Aging Services and the city’s public conservator, said the city was seeing on average 90-day temporary conservatorship assessments and that the majority of temporary conservatorships involved unique individuals rather than repeated short-term re-referrals. Later in the hearing a staff member told the committee the observed reoccurrence (recidivism) rate for conservatorship re-referrals was approximately 5%.

Officials and advocates urged stronger state involvement. Departments and the Controller’s work group said SB 43 lacked state funding, technical assistance and an oversight body; speakers called for state-level coordination, regulation of placement denials and new financing. Clinicians also suggested possible legislative avenues such as assisted outpatient-treatment-like options that could permit community-administered long-acting antipsychotic medication under court supervision.

Public commenters at the hearing urged fuller and faster use of SB 43 and stronger coordination among street outreach, hospitals and the public conservator. Justin Saa, a San Francisco resident, told supervisors: “We have the law. We have the legal clarity to use it. What we need now is coordination, accountability, and your leadership.” Several commenters described people visible on public streets who they said met the expanded SB 43 criteria.

President Mandelmann asked that the committee revisit implementation progress in six months. Chair Matt Dorsey moved to continue the item to the call of the chair to allow follow-up work; the committee approved the motion by roll call (Member Sauter, aye; Vice Chair Mahmood, aye; Chair Dorsey, aye).","A committee hearing on California Senate Bill 43 found San Francisco increased temporary conservatorships after adopting the law but departments and advocates said capacity gaps — especially locked subacute beds and dual-diagnosis placements — have constrained further gains.",{"_33":88,"_35":36,"_37":38,"_39":89,"_41":90,"_43":91,"_45":92,"_47":93,"_49":94,"_51":95,"_53":96,"_55":56,"_57":58,"_59":97,"_61":62,"_63":64,"_65":98,"_67":68,"_69":70,"_71":68,"_72":73,"_74":73},6521465,"Committee forwards ordinance to streamline entertainment permits to full Board",611,105000,716000,"/Search/View?dp=1&key=5091881-71fb9cae39e746362a6ac77430f3cbb9&start=105&end=716","https://assets.pipeline.soar.com/5091881-71fb9cae39e746362a6ac77430f3cbb9/thumbnail_105000.jpg","/articles/6521465/San-Francisco-County/California/Committee-forwards-ordinance-to-streamline-entertainment-permits-to-full-Board","https://secure.pipeline.soar.com/6521465-cb9bcac1b50eea042728011eb82ad8d4/orig.mp4?Expires=1771160701&Signature=J6ZoXRwbwGUtw44M73uHJDIJqYn-1sYCUeu3YFSmYPQ7THjdO7Ye~yEaWUk3uBbVrh83PHLD2gv5NjlqffYS1TGdJF84tPmFXS2w9xoAUx3I36WBw44qxRwIo6ngblxUEpN60SDk289SdXMf8HYMpyb7ZHb~lNipHRUc-7E8PFZI4-mnq7jzM0Qaa9EH881jTPi19ZytfAfoHwI~3gycRVQjQrZ6HxbySVKgzmViAaGST7xo-Dakp1wNym2xjiUe0rOlfDRPpaeo9VuPU7vkdcqTsG3-kFYCwGy3pdssjeG9ixrH1cNxxLch3LDc5JxauXNzqc-GlKOvX3kLtVL1yA__&Key-Pair-Id=KUT5TJCACFTXG","The Public Safety and Neighborhood Services Committee of the San Francisco Board of Supervisors voted 3-0 Thursday to forward to the full board an ordinance that would revise city police-code permitting for entertainment venues and one-time outdoor amplified sound events.

The committee approved the motion to forward with Vice Chair Bilal Mahmood, Supervisor Danny Sauter and Chair Matt Dorsey voting aye. Supervisor Danny Sauter made the motion to send the item to the full Board with a positive recommendation; roll call recorded Member Sauter, aye; Vice Chair Mahmood, aye; Chair Dorsey, aye.

The ordinance, sponsored by the mayor’s office and cosponsored by Supervisors Connie Chan and Danny Sauter, would change multiple elements of the Entertainment Commission’s permit rules. Maggie Wyland, executive director of the Entertainment Commission, told the committee the package is part of the citywide “PermitSF” effort to “cut red tape and modernize entertainment permitting while maintaining essential health, safety, and zoning protections.”

Wyland said the ordinance would remove some referrals that she called duplicative: place-of-entertainment and extended-hours permits would no longer require referral to the Department of Building Inspection; limited live-performance and fixed-place outdoor amplified sound permits would no longer require referral to the Planning Department. “These referrals often delay applications,” Wyland said, adding that both Planning and DBI supported the change.

The measure would also replace an outdated 30-day leaflet requirement with a two-week written notice, retain the code requirement for a 30-day large yellow facade posting and change the filing fee for a one-time outdoor amplified sound permit to a flat $5.58. The ordinance would eliminate permit requirements for “long obsolete” activities such as ball-or-ring-throwing games, masked balls and dance-hall keeper permits, and would align city noise-enforcement definitions with modern sound-measurement practices and national standards.

Supervisor Danny Sauter, a cosponsor, said the changes aim to remove redundant steps that slow small businesses and venues. “Operators and small businesses are fine with going through a process, but they need to know what that process is,” Sauter said, adding that consolidating referrals under one department can reduce last-minute restarts of the permitting process.

The Entertainment Commission’s presentation said the ordinance would change how the commission treats frequent applicants: rather than counting past permits on a rolling 12-month window, a hearing would be required if an applicant had obtained 12 or more permits in the same calendar year. The ordinance would also relax some public-notice requirements for applicants and the Entertainment Commission while keeping existing facade-posting rules.

Wyland said fee-waiver pathways would continue, including waivers tied to city grant funding, and she described the changes as drawn from stakeholder feedback and years of operational experience. “Each change in the ordinance was mapped to a real barrier,” she said.

No members of the public spoke during the committee’s public-comment period for this item. After the presentation and brief discussion, Supervisor Sauter moved to forward the ordinance to the full Board of Supervisors with a positive recommendation. The committee’s clerk recorded three aye votes; the motion passed.

What happens next: the ordinance will appear on the Board of Supervisors agenda on July 8, 2025 unless otherwise stated by the clerk’s office. If the Board adopts the committee recommendation, the code amendments would proceed through the normal ordinance-adoption process.","San Francisco supervisors’ Public Safety and Neighborhood Services Committee voted 3-0 to send an ordinance that would simplify entertainment permitting — removing some referrals, eliminating certain obsolete permits and changing notice and fee rules — to the full Board of Supervisors with a positive recommendation.","actionData","errors"]

Article not found

Controller's work group urges targeted expansion of high-acuity behavioral-health beds; city lists funding and projects underway

Supervisors push departments for clearer SB 43 outcomes as implementation yields modest conservatorship gains

Committee forwards ordinance to streamline entertainment permits to full Board