SAVE THE ARF: When being loud pays off

by Mirjam Washuus

“The San Francisco Department of Public Health’s top priority is patient care. (…) We share the urgency to improve the lives of San Franciscans who are experiencing homelessness, mental illness and substance use disorder.”

These were the opening lines of a September 20 statement from Public Health director Grant Colfax in the wake of a prematurely adjourned Health Commission meeting three days earlier. It was shut down by a coalition of activists and nursing professionals who showed up with signs, slogans, and demands.

This was the second action in four weeks at which members of the community came together to bring attention to an inexpedient upcoming plan regarding the San Francisco General Hospital’s Adult Residential Facility (ARF).

The commission was meant to discuss the ARF and a conversion of 41 of its 55 long-term residential beds into 12 temporary, short-term shelter beds. The proposed ARF closure was just the latest threat to reduce the City’s supportive housing capacity for its most vulnerable citizens who are unable to live independently – since 2013, the City has seen an almost 50% decrease in board and care beds. The City has offered a myriad of explanations to why the existing beds stay empty: staffing shortage, laborious and time sensitive bureaucratic requirements, potential emergency admissions, infractions, and maybe more importantly, unclarity and dishonesty.

According to Jennifer Esteen, a psychiatric nurse with Public Health, the plan poses a series of problems ranging from an obvious loss in permanent, supportive solutions to bad ethics and broken promises. Earlier this month, the Mission Local published that ARF employees had been informed by management that the ARF and Residential Care for the Elderly were on probation due to infractions found within the facility, and thus precluded admittance of new patients.

Adding to this, Esteen explains that the upcoming changes were to be kept a secret from the residents; an approach that is “unethical and also unfathomable in the face a growing homeless population, many of whom are suffering with mental illness.” Often the residents of board and care facilities are too ill or impaired to attend treatment programs, let alone being transferred to temporary and independent housing options. This population is at greater risk of being nudged into a downward psychiatric spiral due to the stress of being transitioned into an unstable future.

So somewhere in the murkiness of the City’s explanations lies the reality that homelessness cannot and will not be reduced by displacing and destabilizing the most vulnerable San Franciscans.

Closing permanent mental health beds in the midst of this homelessness crisis just doesn’t add up.

While members of the audience at the Health Commission meeting physically blocked their ears to cut off the furiously loud chants, others have felt obliged to listen. Listen to the voices of experts: those experiencing homelessness, mental illness and substance use disorder, in need of support and housing, and the people working alongside them every day.

In Colfax’s statement, he explains that the changes at the Behavioral Health Center are on pause until Mayor London Breed and the Board of Supervisors reach an agreement on “how to proceed in a way that accomplishes our shared goals of patient safety, stability and expanded access to services.” Colfax explains that Public Health is willing to try new approaches and listen to the community in the coming months. Similarly, during the action Health Commission representatives stated that the commission is willing to hear from members of the community individually.

Yet, it seems that the department still had not succeeded at incorporating the fierce day-to-day expert voices until it was forced to. Following the traditional rules of offering public commentary at commission meetings and consistently providing necessary data/facts has yet to show a sincere effect on decision making. On the contrary, being furious and loud did.

The outcomes of last week goes to show that it is vital for public health professionals, doctors, nurses, families, advocates and other activists to come together with San Franciscans in need. These are experts on homelessness and mental health and their input must be heard and incorporated in the solutions to the problems the City faces. Only as a community it is possible to push loudly for supportive social change can be necessary in order to reach the common goal of “patient safety, stability and expanded access to services”.