December 21, 2023, SEIU 1021 members at the City and County of San Francisco were invited to share their experiences and perspectives working on the frontlines of the addiction and overdose crisis as part of an hour-long panel on the KQED Forum radio show.

SEIU 1021 members Audrey Fisher, a registered nurse in the psychiatric emergency department at San Francisco General Hospital (SFGH), and Claudia Mendez, a behavioral health clinician for the SF Department of Public Health, were among the four guests on the show.

Along with a firefighter/paramedic and a stabilization supervisor for the Opiate Treatment Outpatient Program at SFGH, they shared what they are seeing each day on the job, their insights on what works, and their concerns about how short staffing, budget cuts, and new legislation impact the services they provide and the larger community.

“With the addition of SB 43, which is the change to the involuntary conservatorship, we’re now going to be including as of January 1 that severe substance use disorder is a cause for involuntary psychiatric holds,” said Fisher. ”Whatever you think about that, the truth of the matter is there’s nowhere for those patients to go. There are no locked substance use treatment programs in California outside of the prison system.

“Are we just going to be full for the next year, two years, until these programs can be built? We don’t know what we’re going to do with these patients when the law is telling us we have to hold them involuntarily, they want to leave, and there is no program for us to send them to.

“As everyone in this forum knows, there are not enough beds. Almost everyone experiencing homelessness that we see on the street might qualify under these criteria now, because they also are specifically tailored so that they disproportionately affect people experiencing homelessness and unsafe housing. We don’t have capacity even for them to be in a voluntary program.

“What’s most disheartening to me is that California didn’t offer patients reasonable outpatient services available to everyone or residential programs that are voluntary for everyone experiencing substance use disorder, and now we’re moving to this forced treatment that has not been proven to be effective in any way and can actually be dangerous if patients end up leaving with a lower tolerance and then overdosing upon discharge when they weren’t ready or wanting to stop using substances.

“From my perspective, patient autonomy is crucial, and people need to buy into their recovery if that’s what they’re ready to do. Evidence doesn’t show that forced or coerced treatment for substance use disorder is effective.

“I understand witnessing this crisis every day is absolutely draining and horrifying, and it absolutely shouldn’t be happening. But I think that we need to be focusing our efforts on prevention and providing treatment for patients who are ready for it. Because we’re going to just continue seeing more and more people entering homelessness and severe substance use disorder in California while they have no availability for low income housing, and we know that poverty is the #1 reason people experience addiction in this country.”

Claudia Mendez, who currently works in the drug court program but previously worked in homeless outreach, pointed out that the most effective strategies are not fast or easy. ”In street outreach, what worked in one of the new programs was Best Neighborhoods, was trying to bring familiar faces over and over to the same people in the community. We didn’t have enough staffing, which was one of the hard parts to make it really happen — to make it flourish like we wanted to see. But having people that cared, social workers, health workers, everyone in the community, build those relationships…

“There were some community members that kept declining services, declining care, any type of connection, until they kept seeing our team keep coming every day, checking in, having some good laughs, getting to know them beyond the addiction, past them experiencing being unhoused, getting to know who they were before, and us being OK with also talking to them while we know that maybe the area they’re in is not very clean and they haven’t showered in days. Some of our community members haven’t been able to have a regular conversation for a long time because of that, because people stay away from them, or the people who are coming are somehow abusing them or bringing them more substances or they’re being attacked by somebody.

“Having those conversations and building that rapport, eventually with some time, they accepted services. They accepted the tiny homes, which is one of our newer programs; it’s not perfect, but it’s way better than a lot of the shelters that are unsafe because there’s a lot going on. Having their own one room to kind of restart and be cared for in a different way gave them some hope.

“We had some community members come out on the news later on sharing their story how the City bringing workers to work in specific districts to build relationships with them and connect them with services actually changed their trajectory, got them into good shelter, helped them get a job.

“But it takes time; it can’t be forced, and it really requires a special touch. Addiction is not just the drug; sometimes it’s grief, pain, feeling alone. A lot of people come here because maybe they know we’re more open to supporting and they want that connection and support. Best Neighborhoods and the other teams are still out there. We’re just so short-staffed it’s very hard to make it happen. But they’re doing it.”

The work Fisher, Mendez, and thousands of other SEIU 1021 members at the City and County of San Francisco do is crucial to solving the City’s biggest problems. Yet amid dire budget projections, Mayor London Breed is calling for cuts to vacant positions that short-staffed departments desperately need to fill to be able to provide the public services in such high demand.

As we head into negotiations for our new contract this year, the need to retain and recruit workers for these positions will be in tension with the mayor’s calls for budget cuts and corporate demands for yet more tax cuts. 

Listen to the full program here.

Do you live or work in San Francisco? Come out to City Hall next Wednesday, January 17, at noon for our campaign kick-off with our labor partners. RSVP here.