A commission in charge of holding San Francisco accountable for its response to the drug and mental health crises hasn’t been able to hold a proper meeting for more than seven months as the city’s elected leaders neglect to fill its seats.
There are currently only six active members on the 17-person Behavioral Health Commission, an oversight body with the power to draft policy and conduct reviews of programs run by the city’s Behavioral Health Department. The department has a $592 million annual budget and is responsible for providing mental health and drug treatment services.
Because there are fewer than nine active members, the commission lacks a quorum and hasn’t been able to wield much of its power or hold meetings since February.
The term of the commission's co-chair, Balham Vigil, expired 10 months ago, but Vigil continues to serve; the city has failed to appoint a replacement. The commission is required by state law, and 16 of its 17 members are appointed by the Board of Supervisors.
A 17th seat is reserved for a member of the Board of Supervisors. But that seat has sat empty since January 2022. Supervisor Ahsha Safaí, who championed the creation of the Homelessness Oversight Commission, was the last Board of Supervisors member to fill the seat before Behavioral Health Commission members said he abruptly stopped attending. Safaí didn’t respond to a request for comment.
“The supervisors are just not appointing people,” said former commission member Geoffrey Grier. “You’ve got a lot of folks who want to be on the commission but they’ve got to wait a year? Nine months?”
Victor Young, a clerk for the Board of Supervisors, told The Standard there are eight people who have pending applications to serve on the commission. However, he said it’s difficult to find qualified members for the commission due to the types of experience needed for each seat.
Each of the 11 supervisors gets one appointee to the commission. The six other seats are appointed by the full Board of Supervisors, including the one seat designated for a member of the Board of Supervisors.
On top of that, there are other complicated rules. At least nine of the 17 commissioners are supposed to be mental health patients or family members of mental health patients. Two commissioners are supposed to be mental health “advocates,” two seats are designated for mental health professionals, and one seat is to be held by a person “serving the public interest.”
The commission currently has three seats occupied by mental health patients or their family members, two mental health professionals and one advocate.
The Behavioral Health Department is part of the Department of Public Health, the largest department in the city with a $3 billion budget. The Department of Public Health has at least four commissions overseeing its work.
Supervisor Matt Dorsey, who is chair of the rules committee, which evaluates commission applicants, said he’s working on legislation that would shrink the commission from 17 members to 11. He told The Standard the commission’s stringent eligibility requirements have imposed barriers for him and other supervisors to appoint commissioners.
Do Oversight Bodies Work? Some Supervisors Are Skeptical
In July, The Standard reported only one person working in City Hall was able to figure out how many departments, boards, commissions and advisory bodies the city has. A representative from the City Attorney’s Office eventually counted 53 departments, 56 boards and commissions, and 74 more advisory bodies, bringing the grand total to 183 different entities.
The revelation frustrated many who said the city is plagued by too many overlapping bureaucracies.
Supervisor Rafael Mandelman, who is one of five supervisors with active appointees on the Behavioral Health Commission, said the city should fill the vacant seats but was skeptical whether it would move the needle on solving city issues.
“If oversight bodies led to good government, we would have the best government in the world,” Mandelman said.
Supervisor Catherine Stefani called the commission into question in April 2020 when she alleged the body’s nonprofit fiscal agent may have improperly submitted invoices for administrative costs and the salaries of two staff members. The commission seat holders are unpaid and the body has since moved under the fiscal purview of the health department.
Some commission members have taken issue with working under the health department, contending it threatens their ability to independently provide oversight.
“We’re being overseen by the department that we're supposed to have oversight of,” Vigil said.
'Lives Are at Risk'
The city is in the midst of an overdose crisis that’s claiming over two lives every day, according to preliminary data from the Chief Medical Examiner’s Office. Meanwhile, people with mental illness cycle through the city’s hospitals and emergency services.
The Department of Public Health referred questions about the commission vacancies to the Board of Supervisors. Board President Aaron Peskin did not reply to a request for comment.
“They come out, dictate to us and leave,” commission member Liza Murawski said of the health department. “There’s no accountability.”
Murawski said she’s been awaiting data on the number of case managers in city-funded programs for several years, spending countless hours pleading with the department to no avail. She wants to know if the city has enough case managers to meet client demands and connect them with lifesaving services.
The commission is supposed to monitor contracts and outcomes of the city’s mental health services and report their findings to the Board of Supervisors and the state. However, commission members said the city’s reliance on nonprofit contractors has created a firewall that makes it impossible to obtain the data needed to evaluate the services.
In April, former commission member Terezie Bohrer resigned in an email to the clerk, explaining she thought she could be a better advocate “on the ‘outside’ with less governmental constraints.”
Others have accused the health department of being purposefully unhelpful in helping them obtain information necessary to do their jobs.
“They’ve been pretty much keeping us in the dark,” Vigil said. “People’s lives are at risk.”