San Francisco County Municipal Code Ch. 14C [expired]

Editor's Note: Former Chapter 14C ("California Benefit Corporation Discount") was enacted by Ord. 76-12, File No. 120082, Eff. 6/3/2012, Oper. 9/1/2012, which provided in part: "This Ordinance shall become operative 90 days from the effective date of the Ordinance and shall expire three years thereafter unless extended by ordinance of the Board. Upon the expiration of this Ordinance, the City Attorney shall cause this Chapter to be removed from the Administrative Code." See Ord. 76-12, Sec. 4. In accordance with the above quoted provision, the editor removed the text of this Chapter from the Code effective 9/1/2015.

(Added by Ord. 76-12, File No. 120082, Eff. 6/3/2012, Oper. 9/1/2012)

(Added by Ord. 76-12, File No. 120082, Eff. 6/3/2012, Oper. 9/1/2012; amended by Ord. 250-13 , File No. 130584, App. 11/8/2013, Eff. 12/8/2013)

(Added by Ord. 76-12, File No. 120082, Eff. 6/3/2012, Oper. 9/1/2012; amended by Ord. 250-13 , File No. 130584, App. 11/8/2013, Eff. 12/8/2013) CHAPTER 15:

MENTAL HEALTH SERVICE Sec. 15.1. Definitions. Sec. 15.10. Established Pursuant to State Law. Sec. 15.11. To Be Administered by Director of Health; Powers and Duties of Director. Sec. 15.12.5. Behavioral Health Commission – Staffing. Sec. 15.15. Services Which May Be Provided. Sec. 15.16. Mental Health Services. Sec. 15.17. Departmental Overdose Prevention Policies. Sec. 15.18. Alcoholism Programs – Administration. Sec. 15.19. Recovery First Substance Use Disorder Treatment Policy. Sec. 15.20. AIDS and HIV Policy. Sec. 15.21. AIDS Information and Education. Sec. 15.22. Responsibility of Director of Health. Sec. 15.23. Mental Health Services for Indigent and Uninsured. Sec. 15.100. Training Programs. Sec. 15.101. Volunteer Auxiliaries; Use of Space for Gift Shop and Other Facilities. Sec. 15.102. Agreements with Volunteers for Medical Services. Sec. 15.103. Agreements for Use of Emergency Medical Service Communications Center.

For the purpose of Chapter 15, certain words and phrases shall be construed as hereafter defined. Words in the singular include the plural, and words in the plural shall include the singular. Words in the present tense shall include the future. (a) Department. The term "Department" means the Department of Public Health of the City and County of San Francisco. (b) Director of Health. The term "Director of Health" includes the Director of Health, or his or her designee. (Added by Ord. 337-99, File No. 992043, App. 12/30/99)

There is hereby established the Community Mental Health Service in the City and County, pursuant to the provisions of Sections 9000 to 9058 of the Welfare and Institutions Code of the State of California (the Short-Doyle Act). (Ord. No. 193-58, Sec. 1; amended by Ord. 337-99, File No. 992043, App. 12/30/99)

DIRECTOR. The Community Mental Health Service in the City and County shall be administered by the Director of Health for the City and County. The Director shall have the following powers and duties: (a) Chief Executive Officer. The Director shall serve as chief executive officer of the Community Mental Health Service and shall be responsible to the Board of Supervisors. (b) General Supervision. The Director shall exercise general supervision over mental health services and facilities furnished, operated or supported as part of the Community Mental Health Service in the City and County. (c) Recommendations to Board of Supervisors. The Director shall recommend to the Board of Supervisors, after consultation with the Advisory Board, the provisions of services, establishment of facilities, contracting for service or facilities and other matters necessary or desirable to accomplish the purpose of the Community Mental Health Service. (d) Annual Report. The Director shall submit an annual report to the Board of Supervisors, reporting all activities of the Community

Mental Health Services, including a financial accounting of expenditures and a forecast of anticipated needs for the ensuing year. (e) Studies. The Director shall carry on such studies as may be appropriate for the discharge of duties, including the control and prevention of psychiatric disorders. (Ord. No. 193-58; Sec. 2; amended by Ord. 337-99, File No. 992043, App. 12/30/99)

(Added by Ord. 98-93, App. 4/13/93; amended by Ord. 337-99, File No. 992043, App. 12/30/99; Ord. 240-19, File No. 190497, App. 10/18/2019, Eff. 11/18/2019; Ord. 229-20, File No. 200951, App. 11/13/2020, Eff. 12/14/2020; Ord. 10-24, File No. 231076, App. 2/1/2024, Eff. 3/3/2024; amended and redesignated as Sec. 5.16-2 by Ord. 99-26, File No. 260217, App. 5/29/2026, Eff. 6/29/2026)

(Added by Ord. 98-93, App. 4/13/93; amended by Ord. 337-99, File No. 992043, App. 12/30/99; Ord. 240-19, File No. 190497, App. 10/18/2019, Eff. 11/18/2019; amended and redesignated as Sec. 5.16-3 by Ord. 99-26, File No. 260217, App. 5/29/2026, Eff. 6/29/2026)

The Community Mental Health Service may provide any or all the following services for the City and County: (a) Out-patient psychiatric clinics for those who are unable to obtain private care, including referrals by physicians and surgeons. (b) In-patient psychiatric services for those who are unable to obtain private care, including referrals by physicians and surgeons. (c) Rehabilitation services for patients with psychiatric illnesses for those who are unable to obtain private care, including referrals by physicians and surgeons. (d) Information services to the general public and educational services furnished by qualified mental health personnel to schools, courts, health and welfare agencies, probation departments and other appropriate public or private agencies or groups authorized in the approved plan for Community Mental Health Services. (e) Psychiatric consultant services to public or private agencies for the promotion and coordination of services that preserve mental health and for the early recognition and management of conditions that might develop into psychiatric illnesses. (f) Any other services which are now or which may be subsequently permitted by the Short-Doyle Act (Sections 9000 to 9058 of the State Welfare and Institutions Code). (Ord. No. 193-58, Sec. 5; amended by Ord. 337-99, File No. 992043, App. 12/30/99)

(a) Legislative Intent. By enacting this Section the Board of Supervisors declares its intent to more specifically delineate the long- range planning and budgetary uses of the San Francisco Community Mental Health Services Plan. This Section shall be construed as an expression of the policy of the Board of Supervisors with regard to the Community Mental Health Services Plan, but shall not be construed as an enactment of specific legal provisions. Nothing in this Section shall supplant existing law. Upon passage of this Section, the Department of Public Health and the Health Commission shall take whatever steps are necessary to implement the policies contained in this Section. (b) Standards. Prior to the submission to the Board of Supervisors of the City and County budget, the Department of Public Health

shall establish a mental health service priority schedule to be included in its San Francisco Community Mental Health Services Plan. The Plan shall intend as a goal, the reduction of reliance on acute hospital care through the development of a comprehensive range of noninstitutional community services which meet the California Mental Health Services Act mandate of provision of services in the least restrictive settings. The County Mental Health Plan shall include: (1) A stratagem for addressing any current overuse of State hospitals, detailing specific steps necessary to assess the capacity of the City to operate within allocated State hospital patient days. This in no way is to preclude the City from arranging for increased State hospital allocations if required. (2) A proposed maximum number of acute inpatient beds, exclusive of those at State hospitals, per 100,000 City population. This proposed use level shall be consistent with accepted state-wide standards for inpatient use, and shall reflect current use levels as well as any factors which uniquely affect inpatient utilization levels for San Francisco mental health clients. (3) A proposed maximum number of skilled nursing care beds per 100,000 City population. The proposed use level shall be consistent with the policy to serve clients, to the maximum extent possible, within the City as well as the policy to serve mental health clients in least restrictive, community settings. (4) A description of the range and type of community programs and services necessary to achieve the goal of reducing reliance on acute hospital services and other institutional levels of care. Emphasis shall be made on the use of mental health services to achieve the highest degree of independent functioning by clients in the community. The description shall reflect a commitment to the development of services, at all levels, which are responsive to the needs of cultural and linguistic minorities including implementation of planning specifically for minority services. The range of service elements shall include, but not be limited to: (A) Emergency services, crisis intervention, screening and evaluation; (B) Levels of residential treatment services including acute alternatives, long-term residential services, transitional residential services, and cooperative housing programs; (C) Day treatment services; (D) Levels of vocational programs including pre-vocational services, transitional employment programs, and job placement; (E) Outpatient services; (F) Case management services which address the requirement for continuity of care and ongoing community support for a broad range of mental health clients; (G) Socialization services; (H) Housing programs, including support for clients who are living independently; (I) Advocacy, including ongoing assurance of clients' rights protection; and (J) Community outreach services, including consultation and education, community organization efforts. (5) For each type of service described, there shall be stated an estimated minimum level of service necessary to achieve the goals of this Section. This may be expressed in terms of beds per 100,000 population or full-time equivalent staff (F.T.E.) per 100,000. In addition, current levels of service in each category shall be compared to projected minimum level goals to establish areas of programmatic need. (6) The development of the full range of required levels of care, including the implementation of maximum bed levels described in (1) and (2) above, should be accomplished by July 1, 1990. This shall include an estimate of the cost of maintaining current levels of necessary services as well as required funding to provide the full range of required services described in the County Plan. This estimate shall include the identification of funding shifts from existing inpatient and skilled nursing categories to achieve the service goals for services described in Subsection (4) above. (7) At all levels of the County Plan, specific attention shall be paid to addressing the current capacity, and the projected need, to assure cultural, ethnic and linguistic relevance and responsiveness of City and County mental health services. Specifically: (i) All existing and new programs shall have bilingual and bicultural staffing in adequate proportions in relationship to their community population and need. At minimum, there shall be parity in terms of staffing on all levels including administrative, clerical and clinical. In addition, all non-minority staff who are involved in the provision of services to minority groups shall be qualified to do so. (ii) All programs shall indicate the cultural relevance of the treatment procedures including the availability of services or programming in culturally relevant languages, sensitivity toward particular elements within the cultures served, in-service training of staffing for administrative, clerical and clinical staff, and minority consultation and supervision. All changes in programming shall address the specific effects of such modifications on minorities both linguistically and culturally. (8) The range and type of services required to meet the special mental health needs of mentally disabled clients with substance abuse problems. Specific attention shall also be paid to the development of services to address the mental health issues related to AIDS and associated problems including mental health clients with AIDS or ARC and mental health clients with AIDS or ARC and substance abuse. (9) Programs serving children and adolescents shall follow the guidelines and principles set forth in this Section and, in addition,

shall meet the following criteria unique to this population: (i) The programs shall, to the maximum extent feasible, be designed so as to reduce the disruption and promote the reintegration of the family unit of which the child is a part; (ii) The programs shall have an education focus and shall demonstrate specific linkage with community education resources; and (iii) The programs shall contain a specific follow-up component. (10) The range and type of services required to meet the special mental health needs of geriatric clients and of children and youth. (11) A plan for addressing, at all levels of service, the mental health needs of individuals in the criminal justice system. (12) A plan for incorporating self-help concepts and significant involvement of consumer participation at all levels of service in the mental health system. (13) A management plan to develop and implement a method of coordination of the entire range of services so that all levels of care are reviewed and monitored to assure continual accountability of all program elements in the effort to achieve system goals. This shall include the coordination of inpatient services at San Francisco General and Laguna Honda Hospitals with the full range of community resources. (Added by Ord. 25-88, App. 1/28/88; amended by Ord. 337-99, File No. 992043, App. 12/30/99)

By no later than December 31, 2021, and every year thereafter, the Department of Public Health, the Department of Homelessness and Supportive Housing, the Healthy Streets Operation Center through the Department of Emergency Management, and the Human Services Agency shall each submit to the Board of Supervisors a departmental policy describing how the department and its grantees that provide direct services to clients who use drugs will promote strategies to reduce drug overdoses (“Overdose Prevention Policy”), along with a resolution to accept transmission of the policy. Each departmental Overdose Prevention Policy shall, to the extent applicable to the department’s activities: (a) Address how departmental programs will provide drug treatment and harm reduction programs and services; (b) Describe where the department will post the following materials to ensure that they are available and accessible to all clients: (1) Up-to-date information about the location and schedule of syringe access and disposal services; and (2) Up-to-date referral information about naloxone access and the schedule of overdose prevention and naloxone distribution services; (c) Include an onsite overdose response policy that describes the steps the department will take in the event that an individual overdoses on property managed by the department or in the presence of department personnel; (d) Ensure that department staff who work with people who use drugs receive training in overdose prevention strategies; and (e) Describe the process by which the department will ensure that grantees that manage property on behalf of the department and/or provide direct services to people who use drugs implement overdose prevention policies that contain the information required in subsections (a)-(d) of this Section 15.17 as applied to the grantee. (Added by Ord. 84-21, File No. 210304, App. 6/25/2021, Eff. 7/26/2021) (Former Sec. 15.17 added by Ord. 467-87, App. 12/3/87; amended by Ord. 337-99, File No. 992043, App. 12/30/99; repealed by Ord. 177-11, File No. 110809, App. 9/21/2011, Eff. 10/21/2011)

The Department of Public Health of the City and County of San Francisco is designated as the agency with the responsibility for the administration of alcoholism programs in the City and County of San Francisco pursuant to Section 11800 of the California Health and Safety Code. (Res. No. 591-68, App. 8/27/68; codified by Ord. 193-74, App. 4/18/74; amended by Ord. 337-99, File No. 992043, App. 12/30/99)

(a) Title. This Section 15.19 shall be known as the “Recovery First Substance Use Disorder Treatment Policy.” (b) Definitions. For purposes of this Section 15.19, the following terms have the following meanings: (1) “Remission” means overcoming the illness of Substance Use Disorder to the point of living a self-directed and healthy life, free from illicit drug use. (2) “Recovery” means the process by which an individual suffering from Substance Use Disorder strives to make positive changes that become part of a voluntarily adopted healthy lifestyle. Recovery may include participation in: a Medication-Assisted-Treatment program administered by a licensed healthcare provider in accordance with applicable laws and medical guidance; an outpatient or residential substance use treatment program; a contingency management program; or other program determined by the program participant to support their efforts to be in Remission. (3) “Substance Use Disorder” has the meaning set forth in the 5th edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, as may be amended or revised from time to time. (c) Policy. Long-term Remission of Substance Use Disorders for individuals, with the help of fully supported and staffed evidence- based Recovery and behavioral health services, shall be the primary goal of the City’s Substance Use Disorder treatment policy. (Added by Ord. 76-25, File No. 250190, App. 5/23/2025, Eff. 6/23/2025) (Former Sec. 15.19 adde by Ord. 337-99, File No. 992043, App. 12/30/99; repealed by Ord. 177-11, File No. 110809, App. 9/21/2011, Eff. 10/21/2011)

It is the policy of the City and County of San Francisco to reduce the spread of AIDS and HIV infection and to increase employees general understanding of the nature of the transmission and the illness associated with the infection. (Added by Ord. 4-88, App. 1/7/88; Ord. 337-99, File No. 992043, App. 12/30/99)

The heads of the various departments, offices, and commissions of the City and County, shall make available information about educational programs on, and for the diagnosis, prevention, and control of, acquired immune deficiency syndrome (AIDS) to all City and County employees. (Added by Ord. 4-88, App. 1/7/88; Ord. 337-99, File No. 992043, App. 12/30/99)

The Director of Health, or his or her designee, shall be responsible for implementing and assessing an educational program about AIDS addressed to City employees. Funds for this program shall be from existing sources. All departments, officers and employees of the City and County of San Francisco shall assist the Director of Health in the implementation of this ordinance. (Added by Ord. 4-88, App. 1/7/88; Ord. 337-99, File No. 992043, App. 12/30/99)

(a) Findings. The City and County of San Francisco is committed to protecting public mental health services for indigent and uninsured mentally ill residents of San Francisco. If timely, effective and coordinated mental health treatment is not provided to indigent and uninsured residents who are not seriously mentally ill, those residents are at risk of becoming seriously mentally ill and hence requiring more expensive and comprehensive mental health care from San Francisco. (b) Standards. The Department shall provide a single standard of mental health services access and care for indigent and uninsured residents of the City and County of San Francisco and Medi-Cal beneficiaries who are residents of the City and County of San Francisco. (Added by Ord. 194-05, File No. 051030, App. 7/29/2005)

The Director of Health, subject to the approval of the Health Commission, is authorized to enter into agreements with the authorized representatives of any educational program having accredited programs of instruction for medical workers in the allied health professions. Such agreements shall provide that the Department will accept only that number of students at each facility, for any period of time, that can be trained without interference with the normal functioning of each facility; and that the Department will not be responsible for travel or other expenses of students or their instructors by reason of this relationship. (Added by Ord. 337-99, File No. 992043, App. 12/30/99)

The Director of Health, with the approval of the Health Commission, may authorize the use of space at San Francisco General Hospital by the San Francisco General Hospital Volunteer Auxiliary, at Laguna Honda Hospital by the Laguna Honda Hospital Volunteer Auxiliary, and at other Community Health Network institutions for the use of their volunteer auxiliaries for administrative offices and the operation of gift shops, snack shops, and other concessions as approved by the Director of Health. Such space may be provided free of rent or other charges. The Director of Health may authorize the Volunteer Auxiliaries to make modifications and improvements to such space and to install appropriate fixtures and equipment. The Volunteer Auxiliaries shall maintain sufficient insurance for the use of such space and for their activities at the hospital or institution. All net proceeds from the operation and sales from such concessions shall be used solely for the benefit of the patients, staff, and visitors of San Francisco General Hospital, Laguna Honda Hospital, or the relevant Community Health Network institution. Each Volunteer Auxiliary shall file an annual report with the Director of Health and the Health Commission which sets forth the proceeds received, the disbursements thereof, and the number and type of volunteer hours donated for the year. In addition, each Volunteer Auxiliary shall have an independent audit performed each year and shall provide a copy of the audit report to the Director of Health and the Health Commission. (Amended by Ord. 265-85, App. 5/30/85; Ord. 337-99, File No. 992043, App. 12/30/99)

The Director of Health is hereby authorized to enter into and execute written agreements on behalf of the City and County of San Francisco with persons who agree to provide services voluntarily to the homeless or to patients treated at Department of Public Health Facilities, including hospital facilities, under the clinical supervision of a City employee, including but not limited to physicians providing medical care. These agreements may provide that the volunteer is an employee of the City and County of San Francisco for purposes of the Tort Claims Act. The Director of Health shall, on an annual basis, report to the Risk Manager the circumstances under which the volunteers are selected, the protocols under which they operate, the location of operations, and any other information suggested by the Risk Manager to enable the Risk Manager to assess the City's potential liability for operation of this medical services program. (Added by Ord. 531-88, App. 12/16/88; amended by Ord. 418-89, App. 11/17/89; Ord. 337-99, File No. 992043, App. 12/30/99)

CENTER. The Director of Health, with the approval of the Health Commission, is authorized to execute agreements with hospitals and ambulance companies permitting communication by said hospitals and ambulance companies by voice and radio telemetry through City and County's communications center. (Amended by Ord. 265-85, App. 5/30/85; Ord. 337-99, File No. 992043, App. 12/30/99)

New Ordinance Notice Publisher's Note: This section has been ADDED by new legislation (Ord. 300-19 , approved 12/20/2019, effective 1/20/2020, operative conditional, see Sec. 3 of ordinance). The text of the section will be included below when the enacting legislation is effective.

(Added by Ord. 29-97, App. 2/7/97; amended by Ord. 337-99, File No. 992043, App. 12/30/99; redesignated as Sec. 21.43 and amended by Ord. 176-14, File No. 140596, App. 8/7/2014, Eff. 9/6/2014)