The story of progress regarding the Tenderloin linkage center exists in the eye of the beholder. Early numbers appear to show the center is largely failing in its mission, with critics saying it is inadequately connecting people to drug treatment and housing. But for people living on the fringes of downtown San Francisco, the center is offering a rare glimmer of hope in a neighborhood where optimism is almost always in short supply. And the latest data set released by the city shows that things on at least one front seem to be trending in a slightly more positive direction, albeit at a snail's pace.
In the last two weeks, the number of guests receiving housing, shelter or a referral for housing assessment doubled; however, that still only accounts for 5.5% of visits. Note that because the city does not take the last names of visitors, there is no data on the number of individuals entering the center, only the total number of visits, meaning that the percentage of people actually being linked to housing might be higher.
However, out of 4,458 visits to the center in the last two weeks, only four people completed a linkage into substance abuse programs. And since it started operating, only 1.8% of total visits to the center resulted in the successful linking of people to services.
Critics say that the lack of meaningful participation at the linkage center is the result of the city’s over-investment in harm reduction—a hands-off treatment model that relies upon the gradual building of trust between provider and client, the latter of whom can continue to use drugs. In the first month of operation, reports from the linkage center reveal that over 80% of visits resulted in a client refusing services.
Others add that the linkage center has been set up to fail because of a lack of housing resources to connect people to.
“They’re helping people, in that they’re giving them a hot meal and access to bathrooms and showers. That’s all good,” said recovery activist Tom Wolf. “But are they really helping people? … They have [treatment] beds wide open, just sitting there for free that could be filled.”
Thus far, the Department of Emergency Management has requested $9.4 million under Mayor London Breed’s Tenderloin emergency declaration, and more money may have been allocated from other reserves, according to the City Controller’s office. The Department of Public Health will be taking over operations of the linkage center from the Department of Emergency Management in March, but officials say they are unable to provide an estimate for the facility's total budget.
City providers argue that employing harm-reduction techniques and allowing people to use drugs within the site premises creates a more inclusive environment that will ultimately reach more people in need of services. The Department of Public Health is also constrained by the restrictions of Medicaid, a federal program that provides health coverage for people with low income, which doesn’t consider sober living an eligible method of treatment.
"I want to encourage all of us not to fall into a false dichotomy of abstinence versus harm reduction," said Hillary Kunins, who leads the Health Department’s behavioral health programs, at a Board of Supervisor's meeting Feb. 8. “All of these providers are aiming to support people in recovery to stop drug use."
For an unhoused man diagnosed with autism named Bam, the harm-reduction method was successful—he was one of the small fraction of guests connected to housing.
Bam said he was initially hesitant about the linkage center and was the first of his friends to go inside the building. He said his experiences in shelters and other support services have been traumatizing. Sometimes, he said, he speaks angrily to the voices in his head and his unintentional outbursts have led to physical altercations with city workers.
“I’ll sleep in the gutter, I don’t care. But I want to get into housing for him,” Bam said, pointing to a 9-year-old pitbull mix sleeping on the ground beside him. “[The linkage center] decreased the obstacles so I could actually accomplish the thing I’m trying to do.”
Others who have been inside the center say that the lack of engagement on the client side may be because it's not sufficiently clear what services are available.
A young man named Corey, who stressed how difficult it is to kick a fentanyl addiction, said he wasn’t made aware of drug rehab services connected to the linkage center. He and his friends only go to the center so they can get high in privacy, he said.
“They should definitely be more vocal about recovery options,” Corey said. “As far as I’m concerned, that’s the most important thing to be offering there.”
The Department of Public Health’s treatment dashboard shows that 73 substance-use disorder beds were available at the time this story was published. Many more remain available amongst private providers.
David Sjostedt can be reached at email@example.com