A bill to give California counties, including San Francisco, more flexibility to spend state money on drug-and-alcohol-free recovery housing seemed like it would land on the governor’s desk this year without a hitch.
But last week, the momentum came to a halt, and it could complicate local efforts to expand so-called sober living facilities, which several officials including Mayor London Breed have been pressing for as the city struggles to stem a deadly epidemic of drug overdoses.
As first drafted, the bill would have let California counties spend up to 25 percent of their state supportive housing funds on homes for people who want a sober environment.
“The options that we have right now for people entering supportive housing are too limited. They are essentially one-size-fits-all,” said the bill’s co-author, Assemblymember Matt Haney, who represents the eastern half of SF.
Under current law, counties can only spend state funding on supportive housing that abides by Housing First rules, which means putting people into a stable living situation without holding them to sobriety rules or certain other conditions.
All projects funded by the Homekey Program, for example, must follow Housing First principles. Homekey launched during the pandemic to get people quickly off the streets, part of more than $20 billion the state has spent on housing and homelessness over five years.
Going hand-in-hand with Housing First is harm reduction, an approach toward substance abuse that emphasizes keeping people alive (with supervised consumption or the availability of overdose reversal drugs) while waiting for them to recover on their own terms.
Both Housing First and harm reduction are official policies in California and San Francisco, but there’s movement to boost funding for alternatives.
San Francisco set a grim record of 806 overdose deaths last year, mainly driven by fentanyl. In 2020 and 2021, at least 166, or 14 percent, of the city’s overdose victims were people in housing, not living on the street, according to a Chronicle report.
Keith Humphreys, an addiction specialist and psychology professor at Stanford University, says the prevalence of the deadly drug defies current policies: “Its challenge specific to harm reduction is that we can’t make fentanyl use safe no matter what we do.”
The bill “doesn’t mean throwing out harm reduction environments entirely,” said Haney, whose co-author is Assemblymember Chris Ward of San Diego. ”But it does mean providing options that don’t exist now if someone is on a deadly drug like fentanyl that can kill them.”
While many health officials and homelessness advocates say Housing First, with its body of evidence, is the only proven model, Mayor London Breed, other SF officials, and some recovery advocates have been pressing for more sober recovery residences. The city has put $20 million into seven programs, Breed said during the June 12 mayoral candidate debate. (A spokesperson later corrected the figure to six programs; all involve transitional housing.)
“We are not just using harm reduction to help people with treatment,” Breed said. “We are using abstinence-based treatment, which was never a part of our public health response.”
What Breed didn’t mention: her administration’s recent plans for a sober recovery home near Chinatown sparked neighborhood protests, and Breed quickly pulled the plug. It would have been SF’s first city-funded sober living “pilot program,” according to Emily Cohen, deputy director for communications and legislative affairs at the SF Homelessness and Supportive Housing Department.
Last week, two city supervisors, Rafael Mandelman and Matt Dorsey, said they were working on a bill to mandate more funds for abstinence-based housing, anticipating the Haney-Ward state bill would provide a more welcoming environment.
It was inauspicious timing: The day after their announcement, a powerful state senator from the Bay Area watered down the Sacramento bill.
Dorsey told The Frisc that his bill skirts current state law because it can draw from city and state funds that don’t require Housing First requirements. However, Mandelman acknowledged that the amended state bill, if it becomes law, could make it harder for his own bill to reach its goal of at least 25 percent of all SF supportive housing to be abstinence-based.
“In the short term, there’s no way we’re going to come close to the 25 percent goal,” said Mandelman, “and that’s too bad.”
Skinner amendments
This spring, an earlier version of the Haney-Ward bill, AB 2479, sailed through the state Assembly with unanimous approval. But in the Senate, Housing Committee chair Nancy Skinner — a Democrat who represents part of the East Bay — made three amendments. The committee passed the amended bill last week, and Haney has been trying to find silver linings.
One amendment cut the amount of state funds counties can spend on sober living from 25 percent to 10 percent. Haney said the cut was a result not of wide opposition, but rather “driven by the view of the chair of the committee.” While he wasn’t happy about it, he told The Frisc in a phone interview that he still thinks it will create more opportunity for recovery housing.
In the short term, there’s no way we’re going to come close to the 25 percent goal, and that’s too bad.
sup. rafael mandelman, on how the haney-ward bill amendments will affect his own proposal for more sober-living funding in san francisco
Another big change is related to eviction protection for residents who relapse. The bill says eviction from a sober residence “shall occur only when a tenant’s behavior substantially disrupts or impacts the welfare of the recovery community in which the tenant resides.” (They can reapply for admission “if expressing a renewed commitment to living in a housing setting targeted to people in recovery with an abstinence focus.”)
Skinner added language that if a tenant is “no longer interested” in sober living or “at risk of eviction,” the residence program “shall secure the tenant a permanent housing unit at a partner or other housing program operated with harm-reduction principles.”
At first, Haney called the change “unworkable” because it seemed to require an available bed in a harm reduction facility for every person in sober living. That wouldn’t be practical, he said, due to long wait lists at harm reduction facilities.
However, a representative for Sen. Skinner said the language only meant an individual who enters sober living must be made aware of harm reduction housing, and if they relapse cannot be evicted until a spot opens for them. Haney told The Frisc he could support that interpretation and would work with Skinner’s office to clarify the language.
Diversity vs. diversion
The eviction protections are “helpful and a positive direction,” said Jennifer Friedenbach, executive director of the Coalition on Homelessness. But she stressed that diverting any money from Housing First facilities “creates a barrier for a portion of the housing units to individuals who are suffering the effects of a substance use disorder.”
Several studies over the last decade have demonstrated that Housing First is the most effective way to get people off the streets and, as a result, to kick addiction. Not only are they starting with a roof over their head, say proponents, but they are also more likely to get better on their own volition when treatment isn’t mandatory.
Stanford addiction researcher Humphreys counters with a study that found mandated treatment resulted in similar outcomes compared with voluntary patients. He also cites evidence that communal, recovery-based housing increases positive outcomes for drug users. “The question isn’t whether Housing First works, but whether it works for everybody such that no diversity in service provision is needed,” Humphreys said.
Another opponent of the bill, Corporation for Supportive Housing director Sharon Rapport, disagrees with Humphries’ call for “diversity in service.” The ideal Housing First model, Rapport says, should include intensive, individualized services like assertive community treatment, case management, psychiatric care, and more.
“The biggest problem with Housing First is that we don’t have enough money for the service provided in the housing. It’s not the model that’s the problem, it’s the execution of the model,” Rapport said.
Even if the bill passes in its altered form, it isn’t guaranteed to increase sober living facilities in San Francisco. As a city supervisor, Haney tried to compel all SF neighborhoods to host their share of a certain type of homeless shelter. He acknowledged the bill “doesn’t change anything about the challenges of getting neighborhoods to accept supportive housing of any type.” Supportive housing should be “by-right,” he said, and not subject to vocal opposition.
At the North Beach Hotel in Chinatown, Breed capitulated to angry neighbors at the start of what’s shaping up to be a bruising reelection year. Cohen of the homelessness department said a search for a replacement site is about to start, and general-use funds are in place to pay for it.
“There’s no solving the problem by just saying those people can’t be living here, because they just end up on our streets, in our jails, our prisons, and our hospitals,” Haney said. “I’m of the view that the state needs to ensure that housing that people desperately need is not so easy to stop.”
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