Proposition T - Substance Abuse Set Aside

What it does

Proposition T is an ordinance measure that would make two changes to the level of funding and services provided for substance abuse programs in San Francisco. First, it would require the Department of Public Health to prepare a report to the Board of Supervisors by February 1 of each year that includes its estimate of the demand for substance abuse services. The report would also include a plan detailing how the department would meet the identified demand.

Second, it would place into the City Administrative Code language that the DPH must provide free or low-cost substance abuse treatment programs at a level sufficient to meet the demand for such services in San Francisco. Demand in the measure is defined as the both the sum of filled substance abuse slots (medical and residential) plus the "total number of individuals seeking such slots."

The measure does not identify how the potential increase in substance abuse services will be paid for, nor does it set aside a portion of the General Fund to pay for the increase.

Unless demand for substance abuse treatment were to decline, the measure would in effect prevent the DPH from reducing funding for substance abuse treatment and would require it to meet the mayor's target for the department's budget without cutting funding for such services.

Why it is on the ballot

Four members of the Board of Supervisors placed Prop. T onto the ballot. As an ordinance, this measure could have been passed as regular legislation.

Since 1996, San Francisco has increased expenditures on substance abuse services for drug addicts by more than 200 percent. In 1996 the Department of Public Health began a redesign of their substance abuse treatment services with the goal of providing more treatment. Since beginning implementation of the redesign, the department has moved away from an abstinence only approach and has made available a wide-range of substance abuse services in an effort to meet the needs of those suffering from addiction.

While other cities across the U.S. have witnessed an increase in the number of deaths from drug overdoses, San Francisco has experienced a significant decline in drug-related deaths since 1996.

Pros

Arguments in favor of Prop. T:

• Demand for substance abuse residential programs far exceeds the number of available slots in such programs. To the extent that this measure results in increased delivery of substance abuse services, it will be effective in helping meet that demand and in bringing services to those currently on waiting lists for residential treatment and other substance abuse programs.
• Substance abuse treatment is much less expensive than incarceration for drug users. It is also effective in reducing overall drug use which, in turn, saves money for both the criminal justice and public health systems.
• San Francisco is widely known as a compassionate city that provides a level of services far greater than most other communities. Ensuring the city is able to maintain the current level of service delivery for substance abuse treatment reflects the importance placed on serving the most vulnerable citizens.

Cons

Arguments against Prop. T:

• It is irresponsible legislation to require an increase in services without identifying any potential source of funds for added services, nor to describe the trade-offs inherent in increasing one service at the expense of another.
• This policy functions like a set-aside, since the Department of Public Health would have to cut services elsewhere in order to maintain or increase funding for substance abuse. In effect, this could result in a transfer of funds from mental health services to substance abuse treatment given that mental health is also funded through discretionary dollars. Much of the other spending at DPH is subjected to limitations of cost sharing by state and federal rules.
• Unfunded mandates limit the ability of a department with many legitimate needs to appropriately choose the level of funding for services on an annual basis.
• This measure opens the City up to potential litigation if its spending on substance abuse is not consistent with the perceived level of demand, even if the City faces a budget crisis and is forced to make cuts throughout city government.
• A better model of treatment on demand would be to ensure that DPH is able to provide a minimum level of service to all those who seek treatment for substance abuse. The benefit of such a model is that DPH would have leeway to decide how to most effectively allocate limited resources.

SPUR’s analysis

While treatment for substance abuse is significantly more humane than incarceration as an approach to addressing drug addiction, this measure fails in its inability to identify how increasing substance abuse services "on demand" will be funded. This is, in essence, a service level set-aside, yet presented without any discussion of the trade-offs. Increasing substance abuse funding with the public health budget could inadvertently result in cuts to other equally important health and social services that are discretionary and not protected by a set-aside (such as mental health funding). In addition, this measure does not allow the DPH any flexibility in crafting an appropriate level of services across its many needs. A more effective alternative might have been to require DPH to ensure all individuals who request treatment receive a basic level of service but give DPH flexibility to determine what that level of service would be. On balance, while we agree with the overall goals of increasing substance abuse services, we do not support strict funding mandates without any identification of revenue sources.

SPUR recommends a "No" vote on Prop. T.