San Francisco will add 90 residential beds for patients with mental or behavioral health issues to its health care network, including about 50 beds in a locked facility that will be used for patients under conservatorships, according to Mayor Daniel Lurie’s office and the San Francisco Department of Public Health.
The beds for patients under court-ordered conservatorships will be at Zuckerberg San Francisco General Hospital’s Behavioral Health Center at 887 Potrero Ave. and will double the number of beds available at the facility for patients who require ongoing treatment.
The beds will provide space to treat patients experiencing subacute mental or behavioral challenges — including substance abuse — that need ongoing treatment, and are differentiated from acute mental health crises, which are more immediate and severe episodes that are often treated in emergency rooms.
The remaining roughly 40 new beds will be part of two new assisted living facilities in Hayes Valley that will provide 24-hour care for residents who need long-term support, including about 45 residents who will move from the General Hospital’s Behavioral Health Center to free up the beds, according a news release from the mayor’s office.
Locked beds ease conservatorship bottlenecks
Department of Public Health Director Daniel Tsai said in a press availability Monday that the facility will still have space to operate as an adult assisted living facility.
Director of Behavioral Health Services and Mental Health SF Hillary Kunins said during the news conference that the city decided to utilize the existing facility because it was the most efficient way to create bed space for this category of patient, which require locked facilities that can be expensive to acquire.
“These beds are highly specialized and medically supervised for individuals with the most complex behavioral health needs. These include individuals with severe mental illness and also require a secure therapeutic environment.”
Hillary Kunins, Director of Behavioral Health Services and Mental Health SF
The increase in specialized beds at the locked facility will still cost about $21 million, which was awarded by the state as part of a round of funding from the state’s Proposition 1. The law, passed by voters in 2023, raised money to invest in mental health resources for cities and counties.
“These beds are highly specialized and medically supervised for individuals with the most complex behavioral health needs,” Kunins said. “These include individuals with severe mental illness and also require a secure therapeutic environment.”
Tsai said those patients often have co-occurring issues that often make them hard to place with private providers, including potential behavioral health issues those providers would rather not be responsible for, or are not staffed to handle.
More care capacity offers compounding benefits
A Residential Care and Treatment Workgroup that was convened in 2024 by then-Mayor London Breed and Supervisor Rafael Mandelman determined that private facilities denying patients sent to them, even when they had space available, was creating bottlenecks in the system.
The working group determined that creating more capacity at this level of subacute care could potentially have a compounding benefit as patients could be more reliably directed to facilities that will take them.
The workgroup called the gaps in the system a “market failure” that needed to be addressed by the city.
Lurie said the new beds represented a big step in improving the health care system for those with mental health or substance abuse disorders.
“San Franciscans who are struggling with severe behavioral health challenges need a clear path to stability. The new locked beds at BHC will give people the treatment and support they need, and they will help us move faster to connect individuals to the right level of care,” Lurie said in a statement.
The workgroup from 2024 and the new beds are part of an effort to prepare for increased numbers of patients who could be forced into substance abuse treatment as part of the state’s expansion of conservatorships through the passage of Senate Bill 43 in 2023. The city that year also established its local CARE Court, which is an alternative court for those with mental or behavioral health issues that offers diversions from incarceration.