No on F: F is for “Fail”

In what has to be one of the dumbest, most desperate yet conniving pre-election moves this publication has seen in years, Mayor London Breed put an initiative on the March ballot that will dramatically drive up homelessness while wasting valuable public resources. 

This brain fart has been labeled Proposition F. While the Mayor has failed in addressing the overdose crisis, with more people dying from accidental overdoses than ever, she has come up with a plan to cut those suspected of drug use off of welfare. 

Yes, you heard right. No, the plan is not to increase treatment options. No, the plan is not to look at evidence-based research. No, the plan is not to even implement her health department’s own very smart overdose prevention plan. No, No, No. 

Clearly those who have died mean very little. Because as Mayor Breed said at a forum on this initiative, “this is not about the data, this is not about the numbers.” God forbid policy be about science when we are talking about a public health emergency. Instead, it is all about politics—and bad politics at that. Readers know the routine: Talk to your billionaire buddies and see what will pique their interest. Maybe do a poll or two. Put out some lies. See what voters fall for and—voilà!—we have a policy agenda! This is what we call a “wedge issue.” Who gets demonized? Oh, welfare recipients? Perfect! Throw in some demonization of drug users? Even better: double whammy! This will fill the campaign coffers for real and drive conservatives to the polls. 

How would this bozo proposal work? Under the measure, those profiled as people using drugs who receive public benefits from the County Adult Assistance Program (CAAP) will be assessed, and will be required to enter treatment or lose county assistance. At any point, if the individual misses appointments or services, they will also lose their assistance immediately. This increases the likelihood that people who depend on welfare assistance to keep a roof over their head will add to the ranks of San Francisco’s unsheltered population.

At a February 8 press conference, local medical professionals and licensed treatment providers announced their opposition to Prop F, citing the likelihood the local ballot measure will increase the unhoused population in San Francisco.

Gary McCoy, vice president of policy and public affairs at HealthRight 360, a non-profit provider of substance use disorder treatment, mental health services and primary care, told the media at the press conference that front-line workers disapprove of the proposed measure and foresee repercussions if it passes. 

“Let’s be clear: Substance use disorder treatment providers who are licensed and certified are overwhelmingly opposed to Proposition F,” he said. “The City’s Human Services Agency has already acknowledged that many will lose their benefits under this measure. Prop F only layers on punishment, shame, and social isolation, while stripping people of resources to stay housed and stay alive.”

Oh, and get this: Proposition F defies accepted best practices for addressing substance use disorders and homelessness and will have deadly results. Research by public health experts shows indisputable evidence that mandated treatment is ineffective and counterproductive. Mandated treatment often leads to increased rates of return to substance use, overdose deaths and even suicide. 

Dr. Marlene Martín, associate professor of clinical medicine at UCSF and director of its addiction care team, joined experts who agree that the measure would foster welfare recipients’ suspicion of human service providers—and potentially destabilize their lives.

“Proposition F threatens the very safety net that keeps people who are on the brink of becoming unhoused housed,” she said. “It threatens the trust it takes for someone to disclose their substance use without fear. It threatens access for the people seeking addiction treatment today who may not come knocking again tomorrow. I have seen addiction and overdose worsen when people lose support systems and that is what Proposition F threatens to do.”

Under Proposition F, San Francisco’s already overtaxed Human Service Agency workers will be made to do more with less. They will need to pre-screen clients suspected of drug use and, while they already make referrals to treatment, they will have to monitor compliance and terminate benefits. Prop F will thus likely result in more people being turned away for treatment as clinicians are diverted to assess welfare recipients.

We have a clinician shortage that is prolonging waits for care and treatment. So let’s get this straight: We are going to take valuable clinician time to conduct an assessment with a client, who if they have a substance use issue and are honest about that issue will possibly lose their benefits, because they will be forced to navigate even more requirements. Are these really the conditions under which we want clinical assessments to take place? And what clinician with a bit of integrity would want to do these assessments?

“Prop F is a cynical waste of resources that will materially harm very vulnerable people and increase homelessness in San Francisco,” said Laura Thomas, senior director of HIV and harm-reduction policy at San Francisco AIDS Foundation. “This measure does not in any way increase access to needed substance use disorder treatment. That is why we are opposed to Prop F and we are proud to stand together with the San Francisco Democratic Party, SPUR, SF Black Wall Street, SEIU 1021, the League of Pissed Off Voters and many others.”

Oh, and another thing: We all know how HSA will play this. The mayor will want to make sure there is plenty of treatment available under the political spotlight so instead of doing the hard work of expanding treatment, her administration will take the easy way out and set aside treatment spots for this population—only for it to sit empty. We see this over and over again with political priorities. The system goes all screwball to please the King. 

Right now, folks are encouraged to seek substance-abuse treatment services because CAAP recipients are spared the duty of cleaning buses if they go to treatment. Yes, everyone, except people with disabilities, has to earn their paltry welfare check by cleaning Muni buses. This change would discourage folks from seeking treatment because admitting they have an issue means they risk losing housing, shelter and money for food.

This initiative plays on classist images of welfare recipients, the infamous welfare queen trope. It feels like 1994 again, when Republican Pete Wilson said, “I wouldn’t begrudge you a 6 pack of beer,” when he proposed cutting welfare by 25 percent.

The reality is, studies show folks use their welfare for things like housing and food. Necessities. And the money is soooooo little. If you are housed you get a bit over $700 per month. If you are unhoused, you get a little over $100 a month. About 20% of the 5,000 welfare recipients are homeless, and of those, about 400 are in shelter, dependent on assistance. If they lose assistance, they lose shelter. About 30% are in permanent supportive housing under the City’s Care Not Cash housing program. About a third of their income goes to rent. Many people today get evicted because they lose their benefits for some stupid reason, like missing an appointment. This initiative would pile on more appointments, and with that, more reasons to lose assistance and even more evictions. 

About half of people in CAAP pay for some other type of housing arrangement. Reality flash: Poor folks in SF live in housing where they don’t have a lot of rights. They rent from roommates or family members. If they don’t pay, they gotta go. That is how homelessness happens. Worse, whenever welfare adds more requirements, more people lose their benefits. It is just another budget-saving trick. Another requirement. Another setup. Another place to trip and fall. The Human Service Agency is COUNTING on that, and that is how they hope to pay for the clinicians. So what kind of hell are they building? Can we solve homelessness and not keep exacerbating it for some cheap political thrill? 

Oh, and get this. A bunch of billionaires are pouring in money to support. Do they want to kick welfare recipients off aid? We don’t know. It’s so cold. We do know an initiative like this is a way for a politician who is running for office to dump a bunch of money and avoid candidate campaign spending limits while putting their face out there. Mayor Breed’s face is all over the literature. While it might sell her political brand, she has no excuse for this madness.
For a list of organizations and individuals who have endorsed “NO on Prop F” go to