With San Francisco on track for more than 800 drug overdose deaths this year, several former city workers are trying to create a new treatment system that circumvents the wall of red tape many people with addiction issues encounter when trying to get help.
The Salvation Army’s Way Out initiative, spearheaded by several former Adult Probation Department employees, aims to bring users into a detox center where they would be greeted with a warm meal and a bed, then transferred after a week to a residential treatment facility. After up to six months, they could graduate to a transitional housing program where they stay for up to two years until they are deemed independent.
The catch?
The initiative’s leaders assert that the program's effectiveness will rely on the Department of Public Health funding the walk-in detox facility with city cash rather than relying on MediCal, which is California's version of Medicaid, a joint federal-state health coverage program for low-income individuals.
Currently, many of the treatment programs on offer in San Francisco are funded via MediCal, which requires clients to go through an extensive assessment process before receiving treatment.
The initiative hinges upon the idea that people should be treated for their addiction before having to undergo an extensive assessment to determine their eligibility. The group contends that it could run a one-week detox program with 14 beds that could serve up to 728 people per year for $634,500.
“Right now in San Francisco, treatment is based on funding, not need,” said Steve Adami, executive director of the Way Out project and former director of reentry services at the Adult Probation Department. “If somebody raises their hand and wants to access care, we need to be able to respond as a city.”
Adami is joined by former Adult Probation Department employees Destiny Pletsch and Adrian Maldonado in heading the project. Pletsch serves as deputy director of the Way Out project, while Maldonado is director of Salvation Army’s detox facility, called the Harbor Light Center.
In 1995, San Francisco’s Board of Supervisors passed an ordinance called Treatment on Demand that set a goal for the health department to provide addiction treatment at a moment’s notice for anyone who may need it. However, over 25 years later, the department appears to be falling short of that goal.
The most recent Treatment on Demand report found the city has an average 1.1-day wait time to enter residential substance abuse treatment for people leaving a “withdrawal management facility,” a hospital or jail. Drug users who are not coming out of such an institution wait an average of five to seven days for residential treatment.
The health department contends that wait times for its withdrawal management programs, the first step for many people seeking recovery, are less than one day. But for many people struggling with addiction, there may only be a brief moment of clarity when they are willing to accept help. Missing that moment, which can be as short as a few hours, can result in people continuing to use drugs.
Adami pointed to a detox facility called SoMa Rise as a model that could be expanded upon. Run by the nonprofit HealthRight360 and located on Howard Street in the South of Market neighborhood, the temporary detox facility allows people who are coming down from the effects of drugs to walk in without a referral and receive a bed, a shower and a meal. The facility is funded through a $9.9 million two-year contract using local funds.
SoMa Rise currently only allows 20 clients to stay for 24 hours at a time, at which point they return to the streets or are transferred to another program. Adami said that he envisions the Salvation Army’s Harbor Light Center employing a similar model in which clients are allowed to stay for up to two weeks.
The city currently funds 10 beds at the Harbor Light detox center, but only for people with a criminal record. Adami said there are 20 additional beds at the facility sitting empty due to lack of funding.
Vitka Eisen, CEO of HealthRight 360, agrees that the SoMa Rise program model should be expanded. However, she said there are good reasons the city funds many of its programs through MediCal, despite the additional bureaucracy it adds.
Eisen recalled how the city used to fund her programs solely through local tax dollars, which put her at the whim of the city’s elected officials and budget swings.
By tapping MediCal funds for many treatment programs, San Francisco can save its dollars for different services, Eisen said.
“It’s easy to have short-term memory issues and not remember what it used to be like to fight for money every year,” Eisen said. “I don’t want to live in a universe where I have to go begging for dollars.”
Department of Public Health Behavioral Health Director Hillary Kunins said using MediCal allows the city to create new programs with its own funds.
“The city does explore ways that we can implement evidence-based services where the budget allows,” Kunins said. “[But] federal dollars enable us to run a great number of treatment programs and not rely on local or general fund dollars to do it.”
Maldonado of the Salvation Army’s detox center argued the city could ultimately save money by footing the bill for more of its treatment facilities and removing the barriers that prevent people from receiving help.
The health department has a budget of roughly $3.2 billion in fiscal year 2024. Thirty-one percent of the department's budget comes from the city’s general fund, according to a 2020 report. The department spends $592 million of its budget on behavioral health services, including drug treatment, according to a budget document from 2023, but many of those contracts require the complex referral process that the Way Out Initiative is hoping to eliminate.
“The city is trying to save a penny, and it's costing us a dollar,” Maldonado said.
As part of the Way Out Initiative, the Salvation Army opened its first transitional housing program in April in the Mission District, called the Joseph McFee Center, equipped with a weight room, arcade games and a hot tub. The program currently houses 36 men in dorm-style rooms but aims to host 96 people, both men and women, by this time next year. The charity also aims to open several more facilities that will serve people at different stages in their recovery.
“The time is now for the Salvation Army to step into this and bring our programs into the current day,” said Salvation Army Divisional Commander Darren Norton. “Addiction has changed. The Salvation Army needs to adapt and change, too.”