Resolution No. 01-04:

Accepting the Recommendations of the Mental Health Rehabilitation Facility (MHRF) Blue Ribbon Committee  and Authorizing that the Changes in MHRF Staffing Be Submitted for the Department of Public Health 2004-05 Budget and that Changes in MHRF Licensure Be Pursued

WHEREAS, the Mental Health Rehabilitation Facility (MHRF) was licensed as a 147 bed Distinct-Part Skilled Nursing Facility (SNF) under the San Francisco General Hospital since 1996 to provide diagnostic evaluation and treatment services for residents with severe and persistent mental illness that do not meet criteria for acute hospitalization but have complicated behavioral and medical issues; and,

WHEREAS, the Department had proposed for FY 2003-04 the reprogramming of the MHRF from a SNF into an Adult Residential Facility (ARF) for persons with mental illness in order to respond to the worst financial crisis the City has experienced in ten years; and,

WHEREAS, the reprogramming of the MHRF to an ARF would have provided much needed housing for persons with mental illness, including persons who were at the MHRF awaiting this level of care, but would have also required transferring patients out of the MHRF to out-of-county facilities who require treatment at the SNF level; and,

WHEREAS, the MHRF was able to remain open as a SNF for one additional year (FY 2003-04) due to the generosity of the Departmentís unionized staff, who gave up salary increases and picked up their employee retirement contribution in order to bridge the difference between the cost of running the MHRF as a SNF, compared to the cost of running the MHRF as an ARF; and,

WHEREAS, the Mayor charged a Blue Ribbon Committee in September of 2003 to determine the future of the MHRF beyond FY 2003-04 and the optimal programmatic design of the MHRF, given the available services and unmet needs of persons with mental illness in San Francisco; and,

WHEREAS, a Committee representing unionized staff, Friends and Family of the MHRF, mental health experts from community and institutional programs in San Francisco and other counties, the Department of Aging and Adult Services and academia, met nine times over the course of four and a half months to review information about the mission, history, functions, financing, successes, and challenges of the MHRF; and surveyed existing models for providing services to persons with chronic mental health problems; and,

WHEREAS, the Committee listened to presentations from 12 mental health experts and over 67 public comments from MHRF staff, MHRF patients and their families, advocacy groups, and union representatives; and,

WHEREAS, the Committee came to consensus and recommends that the MHRF provide multiple levels of care, adding to skilled nursing a mental health rehabilitation center, a residential care facility and a residential treatment facility that offers day treatment in order to:  1) meet the clinical needs of complex psychiatric and medical patients, 2)  provide treatment and housing options for patients needing less restrictive care, and 3) provide a continuum of care with easier transitions for clients to progress or return from one level of care to the next; and,  

WHEREAS, the Committee proposes that the third floor with 47 beds would be licensed as a mental health rehabilitation center by the California Department of Mental Health and would focus on psychosocial rehabilitation of clients with severe and persistent mental illness and allow for seclusion and restraint, if needed, to address behaviorally complex patients; and,

WHEREAS, the second floor with 59 beds would maintain licensure as a distinct-part skilled nursing facility regulated by the California Department of Health Services that would continue to provide care for residents with complex medical needs, including geriatric and neurobehavioral patients; and,

WHEREAS, the first floor would have 27 beds of residential care licensed by the California Department of Social Services for patients ready to transition to community housing and 14 beds for residential and day treatment to be offered to clients that need counseling and a more structured therapeutic environment; and,

WHEREAS, the Committee also recommends a transition team that includes unionized staff, Friends and Family of the MHRF, and community and institutional mental health program administrators to assist in implementing and evaluating the conversion of the MHRF; and,

WHEREAS, the proposed model responds to the Cityís budget constraints and reduces the General Fund by approximately $2 million; now, therefore, be it

RESOLVED, that the Health Commission of the City and County of San Francisco accepts the recommendations of the Mental Health Rehabilitation Facility Blue Ribbon Committee; and, be it

FURTHER RESOLVED, that the changes in MHRF staffing be submitted for the Department of Public Health 2004-05 budget and that changes in MHRF licensure be pursued.

I hereby certify that the San Francisco Health Commission at its meeting of January 20, 2004 adopted the foregoing resolution.

Michele M. Olson, Executive Secretary to the Health Commission