Report 2019-119 Recommendation 4 Responses

Report 2019-119: Lanterman-Petris-Short Act: California Has Not Ensured That Individuals With Serious Mental Illnesses Receive Adequate Ongoing Care (Release Date: July 2020)

Recommendation #4 To: San Francisco Department of Public Health

To evaluate and address shortages in the capacity of its treatment facilities, San Francisco should, by August 2021, conduct an assessment that determines the number and type of treatment beds that it needs to provide adequate care for individuals who require involuntary treatment. Once the county completes the assessment, it should adopt plans to develop the needed capacity.

1-Year Agency Response

As discussed in the previous reports, The San Francisco Department of Public Health has been working to implement bed expansion recommendations from the DPH/ Mosimtec simulation model. Bed acquisition and implementation is ongoing.

California State Auditor's Assessment of 1-Year Status: Fully Implemented

6-Month Agency Response

In alignment with bed expansion recommendations from the DPH/ Mosimtec simulation model, DPH is actively planning and initiating procurement of a minimum of 117 beds across the recommended levels of care. Securing properties within the County of San Francisco has been a limiting factor in developing immediate long-term beds; however, DPH is committed to providing interim support while permanent solutions are developed. We are pursuing temporary acquisitions of contracted beds in and outside of the county from various contractors. We anticipate that some beds will be available to clients as early as the second quarter of 2021. Estimated timelines for projects are as follows:

1. Locked Subacute Treatment, beds contracted and ready to serve clients by April 2021;

2. Mental Health Residential beds in May 2021,

3. Adult Residential Facility (ARF and RCFE, Board and Care) by December 2021, and anticipated opening of an interim program for both ARF and RCFE participants. Longer term ARF and RCFE planning in development;

4.Psychiatric Skilled Nursing by June 2022. Long term bed acquisition and service delivery will be further developed in the coming months.

An important note is the lack of availability of State Hospital beds as these have extensive waits and individuals in need of these beds are not able to be served at less restrictive options.

California State Auditor's Assessment of 6-Month Status: Partially Implemented

60-Day Agency Response

In early 2020 the DPH Mental Health Reform team engaged a simulation modeling vendor, Mosimtec, to answer the question: How many beds are needed in each behavioral health bed category to maintain consistent patient flow for adult clients in San Francisco with zero wait time? Through an in-depth analysis of patient placements in nearly 1,000 beds in the DPH behavioral health system of care in Fiscal Year 2018-2019, bed simulation modeling offered quantitative recommendations for improving patient flow. Recommendations include 1. Invest in additional bed capacity in Locked Subacute Treatment, Psychiatric Skilled Nursing Facilities, Residential Care Facilities (Board and Cares and facilities for the Elderly), and 12-month Mental Health Residential Treatment; 2. Complement all behavioral health bed investments one-to-one with long-term housing placements such as Permanent Supportive Housing to better serve people experiencing homelessness; 3. Create a robust wait time and patient placement data-tracking system to better understand the impact of operational barriers on patient wait time; and 4. Repeat bed simulation annually to understand trends and inform long-term planning, mitigate data limitations, and explore other interventions that would improve patient experience. The study, which included the bed needs of conserved individuals awaiting placement, resulted in a budget request for 117 additional beds at a cost of $10.6 million. This budget request was approved by the SF Board of Supervisors on 9/22/2020 and we anticipate its approval by Mayor London Breed on 10/1/2020. Next, DPH will identify a plan to achieve the additional capacity recommended by the study.

California State Auditor's Assessment of 60-Day Status: Partially Implemented

All Recommendations in 2019-119

Agency responses received are posted verbatim.