{"id":367628,"date":"2026-06-19T21:17:13","date_gmt":"2026-06-19T21:17:13","guid":{"rendered":"https:\/\/www.newsbeep.com\/us-ca\/367628\/"},"modified":"2026-06-19T21:17:13","modified_gmt":"2026-06-19T21:17:13","slug":"inside-sfs-senior-mental-health-clinic-marked-for-closure","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us-ca\/367628\/","title":{"rendered":"Inside SF\u2019s Senior Mental Health Clinic Marked for Closure"},"content":{"rendered":"

Rosa Josephson has struggled for years with her mental health, especially after a series of strokes. She\u2019s 86, and has often felt isolated, anxious, and depressed. But on a recent Monday afternoon, Josephson was lit up.\u00a0<\/p>\n

She and a small group of seniors, all Latinas 60 and older, sat around a table playing loter\u00eda, or Spanish bingo at the South East Mission Geriatric Clinic. Their laughter filled the room.\u00a0<\/p>\n

The session was one of the mental health services offered at the clinic, which is on Mission Street just south of Holly Park. Josephson has participated in one-on-one and group therapy there for 17 years.<\/p>\n

\u201cShe gets depressed,\u201d said Ellie Menendez, Josephson\u2019s daughter. \u201cI see the difference with her coming here.\u201d\u00a0<\/p>\n

But by October that\u2019s going to change. The Department of Public Health (DPH) has marked South East Mission Geriatric and two Tenderloin youth clinics for closure amid a $643 million deficit and what city officials call<\/a> \u201cthe most difficult budget since 2008.\u201d\u00a0<\/p>\n

The clinics have become a rallying point<\/a> for unions and others against Mayor Daniel Lurie\u2019s budget cuts. DPH says the three sites serve too few clients to justify keeping them open. But South East Mission\u2019s employees, all of whom will be reassigned to other city-run sites, question the rationale. They say the seniors can get therapy elsewhere but risk losing a sense of community, an invaluable balm for their increasingly isolated age group.\u00a0<\/p>\n

\u2018Change can be difficult\u2019<\/p>\n

June is budget season in San Francisco. Threats of cuts swirled around City Hall leading up to the mayor\u2019s two-year budget proposal<\/a> to start this month. Some, like widespread layoffs beyond an initial 127 in April<\/a>, haven\u2019t materialized. The city has more than 34,000 employees.<\/p>\n

Other cuts, like closing the three DPH-run clinics, remain on the table. The mayor\u2019s team and supervisors will now negotiate through the month, but changes will be along the margins of the proposed $16.9 billion budget.\u00a0<\/p>\n

\"ProtestersOn June 17 at City Hall, members of Service Employees International Union (SEIU), which represents South East Mission\u2019s clinicians, protested budget cuts to city programs that impact seniors. (Taylor Barton)<\/p>\n

South East Mission is being shuttered because of what DPH calls \u201cvery low utilization\u201d \u2014 about 14 clients a day or 200 clients a year. Closing it and two other DPH clinics and reassigning their 15 workers will save $2.5 million, according to a recent presentation<\/a> at a supervisors\u2019 hearing.\u00a0<\/p>\n

\u201cSFDPH and the Mayor\u2019s Office worked together to shield core services from the full effect of those reductions,\u201d said a DPH representative in a statement emailed to The Frisc. \u201cRecognizing that change can be difficult, the department wants to reassure clients and their families that SFDPH will continue to provide the same high-quality mental health care and support services for older adults and all populations that it serves.\u201d\u00a0<\/p>\n

\"CommercialThe South East Mission Geriatric Clinic serves about 200 patients with specialized care. (Taylor Barton)<\/p>\n

DPH says the seniors can get services at Mission Mental Health, the OMI Family Center, and Sunset Mental Health. All are city-run clinics with larger capacity. Mission Mental Health sees about 900 clients a year, and OMI Family Center about 650. Numbers were not immediately available for Sunset Mental Health. \u201cThese clinics will offer the same services as South East\u202fMission,\u201d the DPH representative said.\u00a0<\/p>\n

South East Mission workers and patients worry those alternatives will fall short in a number of ways.\u00a0\u00a0<\/p>\n

First, they aren\u2019t exclusively for seniors. Patricia Fernandez, 71, has been coming to the South East Mission clinic for a decade and worries about going somewhere \u201cmore crowded\u201d with \u201cpeople we don\u2019t know.\u201d\u00a0<\/p>\n

\"WomanSouth East Mission patient Patricia Fernandez, 71, worries about moving clinics and not knowing anyone. (Taylor Barton)<\/p>\n

Geography is another challenge. Many South East Mission patients live in the Outer Mission and Bayview and depend on taxis or public transit. Mission Mental Health and OMI Family Center aren\u2019t that far away \u2014 about eight-minute drives from South East Mission \u2014\u00a0 but staff\u00a0say the Mission Mental Health location (Mission between 23rd and 24th streets) makes it tricky for pickups and drop-offs.\u00a0<\/p>\n

Sunset Mental Health is on the city\u2019s west side, at least 20 minutes from South East Mission by car or nearly an hour on public transit.\u00a0<\/p>\n

\u201cThe ladies here get so depressed,\u201d says Menendez. \u201cIt takes a lot of work to get out of the house.\u201d Adding commute time will mean some just stop coming, therapists say.\u00a0<\/p>\n

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The clients tend to linger beyond the hours of formal therapy, because they often \u201chave nothing to do at home,\u201d says Francisca Oropeza, a South East Mission therapist for 25 years. \u201cA lot of these people don\u2019t have community around them, because some of them are very difficult. Family, after you get older, they don\u2019t want to \u2018deal with\u2019 you.\u201d\u00a0<\/p>\n

South East Mission\u2019s focus on Latino seniors is also important. According to Oropeza, nearly everyone there speaks Spanish. The clinic also offers culturally familiar services, like loter\u00eda, that help these seniors feel less isolated.\u00a0<\/p>\n

Limited capacity<\/p>\n

South East Mission is the last city-run outpost specifically for senior mental health.\u00a0<\/p>\n

The city has 569 mental health workers per every 100,000 people according to a 2023 study<\/a>, and many are open to seeing seniors. But they are often in private practice, which can be expensive and less likely to accept Medicare, the public insurance for people 65 and older. Especially for South East Mission\u2019s clientele, almost all lower income, this is prohibitive.\u00a0<\/p>\n

The DPH representative notes that \u201cnonprofits contracting with the city can be a viable option.\u201d A few nonprofit clinics focus on the senior population and accept MediCare, meaning services are more accessible.<\/p>\n

\"Woman\u201cA lot of these people don\u2019t have community around them,\u201d says Francisca Oropeza, a therapist at South East Mission. (Taylor Barton)<\/p>\n

But the same problems with location and specialization exist with these nonprofits too. And it\u2019s uncertain how much capacity they\u2019ll have to absorb the 200 South East Mission clients.\u00a0<\/p>\n

For example, the Curry Senior Center in the Tenderloin has four clinicians, and only one speaks Spanish. It typically only takes on around five new clients per month, according to behavioral health supervisor Jack Spohn, who added that even 20 new patients would overwhelm the center. \u201cWe\u2019re a smaller nonprofit. We\u2019d love to get to all of them, but we are limited with our own staff.\u201d<\/p>\n

\u201cNo single organization can replace the role of a specialized public clinic,\u201d said Miki Lamm, director of the Jewish Family and Children\u2019s Services\u2019 Seniors At Home program. She said that changes like the coming closure \u201cemphasize the importance of having a strong network of providers serving older adults in San Francisco.\u201d\u00a0<\/p>\n

Nonprofits are also facing budget cuts<\/a>. Curry is slated to lose nearly $181,000 in city funding by fiscal year 2027-28. The Felton Institute\u2019s program for socially isolated older adults will be cut by the same time, saving DPH nearly $1 million.\u00a0<\/p>\n

\u2018Numbers game\u2019<\/p>\n

Critics say DPH\u2019s use of low patient volume to justify the clinic closures relies on faulty data.\u00a0\u00a0\u00a0<\/p>\n

The problem is with Epic, the billing software widely used in health care, according to South East Mission\u2019s Oropeza and her colleague Stephanie Gonzales. They said the billing codes don\u2019t accurately capture the scope of their work, and now they\u2019re being penalized for it. \u201cWe\u2019re getting closed down because we don\u2019t bill enough,\u201d said Oropeza. \u201cIt\u2019s really this numbers game.\u201d<\/p>\n

It\u2019s easy to bill for mental health services like therapy, but it\u2019s harder to accurately log (and therefore be paid for) case work outside of therapy sessions, like taking clients to the grocery store, helping them cash checks, or making sure they understand their medical doctors. The hours add up, but Oropeza and Gonzales said they cannot bill for travel time.<\/p>\n

\"WomanSouth East Mission\u2019s Stephanie Gonzales says that the clinic\u2019s billing software doesn\u2019t allow workers to accurately log the services they provide. (Taylor Barton)<\/p>\n

Epic provides these options for billing, says Garen Corbett, director of UC Berkeley\u2019s California Health Benefits Review Program, but it\u2019s up to the organization \u2014 in this case the city or county health service \u2014 to customize it properly.\u00a0<\/p>\n

Other clinics like Curry successfully capture these nuanced tasks in Epic. But Curry has dedicated staff for these tasks and their hours are billed differently than a clinician\u2019s, says Spohn, the behavioral health supervisor from Curry: \u201cIf I were to take a client to the DMV, how the heck would I bill for that?\u201d<\/p>\n

Gonzales says no one from the city trained them to use a mental health or social work version of Epic \u2014 only a medical version, geared toward doctors and nurses, which she describes as \u201cslapped together.\u201d (Some DPH savings in the proposed budget come from completing a switch to Epic from a different billing software, saving $300,000 by fiscal year 2027-28, plus another $5 million in IT reductions.)<\/p>\n

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South East Mission workers say they raised this concern last year but were told, \u201c\u2018Don\u2019t worry about Epic, don\u2019t worry about your numbers, just practice.\u2019 This was email after email and staff meeting after staff meeting,\u201d says Oropeza.\u00a0<\/p>\n

She and others say that not logging these extra hours helping clients outside the clinic has led to the low numbers used to justify the closure.\u00a0<\/p>\n

She showed The Frisc a May 22 letter from DPH acknowledging the problem and waiving some of these case management performance metrics. But by then South East Mission was already slated to close.\u00a0<\/p>\n

Asked about the Epic problems and the May 22 letter, a DPH representative told The Frisc that the department \u201cconducted a full and thorough analysis of service utilization at all SFDPH mental health specialty clinics prior to making the difficult decision.\u201d\u00a0<\/p>\n

Cuts and shifts<\/p>\n

DPH director Daniel Tsai told supervisors this week that the majority of cuts to his department are driven by HR 1, the 2025 Republican \u201cBig Beautiful Bill\u201d that came with substantial MediCal reductions.<\/p>\n

\"DanielDaniel Tsai, director of DPH, addresses the Board of Supervisors at a hearing about the budget cuts on June 16. (Courtesy SFGovTV)<\/p>\n

In response, the city is rearranging its dollars in complicated fashion. Total DPH funding is actually increasing from $3.3 billion to $3.7 billion to keep services afloat, including $39 million more for behavioral health. Some of this will be used to help immigrants kicked off of MediCal move to the city\u2019s public health care plan.<\/p>\n

\u201cThat is a huge amount of support that San Francisco is putting into the safety net and public health, without which we would be tanking,\u201d Tsai said. But he added that the boost \u201cwon\u2019t be felt,\u201d because it\u2019s going to be used to backfill the loss from federal and state cuts.<\/p>\n

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Amid all this, Oropeza and Gonzales fear the senior mental health specialization is being subtly stripped away from San Francisco\u2019s publicly-funded offerings.\u00a0<\/p>\n

They and other South East Mission workers have gotten their reassignments but say they\u2019re not allowed to take\u00a0their clients with them. Spreading out the services is \u201cdiluting and in effect eliminating\u201d their specialization. DPH says that\u2019s not so: \u201cIf their patients wish to follow their clinician to the new clinic, they may do so.\u201d<\/p>\n

DPH emphasizes that the South East Mission clinic closure does not mean any loss of specialized jobs, just reassignments: \u201cAll of the SFDPH clinics impacted by the consolidation already provide specialty mental health care services to older adults \u2026 Bringing staff together will help strengthen services, improve coordination, and support a smooth continuation of care.\u201d\u00a0<\/p>\n

The workers are part of a weeklong rally at City Hall to protest budget cuts, but there\u2019s been no sign of change to the decision to close the clinic. It leads the clinic\u2019s Stephanie Gonzales to make an appeal that most people can relate to: \u201cThere\u2019s one thing that we all have in common in this world, and that\u2019s that we\u2019re all going to get old one day,\u201d she said. \u201cGod forbid this should happen to your mother.\u201d<\/p>\n

Correction (6\/19\/26): The original version of this story misstated when South East Mission staff could bill for travel time.<\/p>\n

\n\tMore from The Frisc…<\/p>\n","protected":false},"excerpt":{"rendered":"Rosa Josephson has struggled for years with her mental health, especially after a series of strokes. She\u2019s 86,…\n","protected":false},"author":2,"featured_media":367629,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30],"tags":[4020,149092,4752,149093,179,149094,636,69904,4735,536,149095,149096,405,149097,149098,3011,15768,2093,149099,582,5751,149100,101,103,102,45435,386,104,106,105,149101,149102,13528],"class_list":["post-367628","post","type-post","status-publish","format-standard","has-post-thumbnail","category-san-francisco","tag-big-beautiful-bill","tag-california-health-benefits-review-program","tag-city-hall","tag-clinics","tag-community","tag-curry-senior-center","tag-daniel-lurie","tag-daniel-tsai","tag-department-of-public-health","tag-donald-trump","tag-dph","tag-epic","tag-government","tag-jewish-family-and-childrens-services","tag-loteria","tag-medical","tag-medicare","tag-mental-health","tag-mission-mental-health","tag-mission-street","tag-nonprofit","tag-omi-family-center","tag-san-francisco","tag-san-francisco-headlines","tag-san-francisco-news","tag-seiu","tag-seniors","tag-sf","tag-sf-headlines","tag-sf-news","tag-south-east-mission-geriatric-clinic","tag-sunset-mental-health","tag-tenderloin"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/posts\/367628","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/comments?post=367628"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/posts\/367628\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/media\/367629"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/media?parent=367628"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/categories?post=367628"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/tags?post=367628"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}