California’s Proposition 1 has given San Francisco a significant opportunity to update its behavioral health system. In addition to providing new funding to address the state’s homelessness crisis, Prop 1 requires local governments to seek community input as they redesign their behavioral health programs to align with Prop 1 mandates.
San Francisco has already taken steps toward reform, with many aligning with community advocates. To assess some of these ideas, San Francisco Public Press spoke with several experts, including Steinberg Institute CEO Karen Larsen. Drawing on her experience as the former director of Yolo County’s Department of Health and Human Services and her deep understanding of California’s public behavioral health system, Larsen offers a grounded, implementation-focused perspective on what real change could look like.
San Francisco’s behavioral health system has long struggled to provide timely, accessible care, often leaving people without support until they’re in crisis. By then, individuals may have already lost housing, employment, or become involved with the criminal justice system. One solution discussed in the article is diverting people from psychiatric emergency room detentions to less restrictive, longer-term treatment settings that support rehabilitation and community reintegration. Larsen agreed that it was necessary, emphasizing that it aligns with statewide best practices. “In a perfect world, somebody in a mental health crisis wouldn’t go to an emergency department for the most part,” she said, “because that’s a pretty chaotic place.” One key example of these types of services is Full-Service Partnerships (FSPs), wraparound community-based programs designed to serve individuals with the most complex behavioral health needs. “They’re absolutely the types of services that the state would want to see funded with Prop. 1 dollars,” Larsen noted to SF Public Press.
Expanding access to FSPs is also the focus of AB 348, a bill sponsored by the Steinberg Institute. AB 348 would establish presumptive eligibility for FSPs, allowing providers to enroll people based on clinical criteria immediately. This would remove barriers that have long prevented the state’s most vulnerable individuals from receiving critical care. On Wednesday, June 11th, AB 348 passed the Senate Health Committee on a 9-0 vote. It now heads to the Senate Floor for a full vote.
The article discusses additional ideas for system improvement, outlined below:
- Assign case managers to individuals rather than programs to improve continuity of care;
- Create a centralized web portal to help service providers and case managers easily find and select available programs and placements for clients;
- Rebuild long-term communal housing options for individuals with ongoing needs; and
- Address structural barriers, including the lack of affordable housing and outdated Supplemental Security Income (SSI) rates.
While these proposals present logistical and funding challenges, Larsen emphasizes that both practical experience and meaningful community involvement must drive successful implementation.
Read the full article at SF Public Press.