A few days ago, I was on my way home from a sobriety group. I stopped when I spotted a person lying down on the cement next to a busy light rail platform. Four first responders encircled him as they tried to motivate the person to stand up and accept their offer to drive him back to the shelter where he lived. I recognized the man lying on the ground; Andrew and I had struck up a lively conversation a few weeks ago while riding the same light rail he was now lying beside. As a trained peer counselor with a community mental health nonprofit in San Francisco, I don’t consider myself more qualified than anyone else—but I have been trained in conflict de-escalation and motivational interviewing. These are two essential skills a counselor must provide along with trauma-informed care to best support a person experiencing a mental health crisis.
California is facing a critical issue of rising homelessness as the cost of living exceeds realistic levels for many of its most vulnerable inhabitants. Hand in hand with the competition for limited availability of affordable housing, is the deadly opioid epidemic which is claiming hundreds of lives each year at a steady rate. In San Francisco, the epidemic has been driven largely by the proliferation of the synthetic opioid fentanyl. Data obtained from the San Francisco Medical Examiner’s office shows the number of overdose deaths has dramatically risen to almost 3500 since 2020. San Francisco’s first responders often respond to and reverse unintentional opioid drug overdoses across the city. But due to a high volume of calls, and inadequate staffing it is unrealistic for every call to be answered in time.
To reduce demand on hospital emergency rooms, there is an urgent demand for overdose prevention sites where staff trained to recognize the signs of an overdose then administer the powerful life-saving drug Naloxone, which acts as a nasal analgesic to reverse an overdose until a person can seek further medical treatment at a hospital.
One solution to relieve the overwhelming pressure put on hospital emergency rooms for mental health-related visits was the establishment of The Tenderloin Linkage Center (TLC). In 2021, then-San Francisco Mayor London Breed declared an official state of emergency in the Tenderloin neighborhood. As a one-of-its kind experiment in radical hospitality, the purpose of the TLC was to provide low-threshold entry leads to opportunities to access services. Services offered at the TLC included basic needs, medical services, mental health, harm reduction and re-entry counseling support on-site from trained mental health clinicians and peer support specialists.
Due to a lacking a cohesive strategy among San Francisco’s Board of Supervisors to improve conditions for the City’s unhoused residents struggling with co-occurring mental health and addiction issues, the Tenderloin Linkage Center shut down permanently to the public on December 31, 2022. Critics of the TLC threw shade on it, calling it an official safe-injection site that enabled people who use drugs to openly consume them without facing criminal charges. Some of the major concerns raised were: “Will people overdose? Will people who overdose die there? Will there be an increase in public drug use and improperly discarded drug use equipment in the area?”
By housing multiple organizations in the same space, the TLC was able to provide a diversity of needed services. Over the course of its lifespan between January and November 2022, The TLC offered basic needs including breakfast, lunch, dinner, coffee/water, bathrooms, showers & on-site laundry services. It also provided a range of clinical needs like access to an Emergency Medical Technician, HIV, STI, Hepatitis testing & Covid vaccinations, wound care supplies, overdose prevention supplies like Naloxone/Narcan, and on-site referrals to low-barrier substance use treatment programs, including programs including methadone and buprenorphine access. The TLC offered free access to mental health treatment including psychotherapy and counseling. Other services offered by the TLC included reentry services (detox, case management, housing), housing and shelter assessments, help applying for public benefits like County Adult Assistance Program (CAAP), EBT/Food Stamps (CalFresh), Medi-Cal application assistance, employment services and free DMV ID vouchers. The patio allowed safe consumption of substances and an indoor Sober Living Room offered a sanctuary for abstinence-based art activities and offered guests a place to relax, use a computer, explore sobriety and access transportation to other services including respite care.
Although its closure confirmed the homelessness and opioid crisis are not a primary concern for City leaders, the TLC model proved that supporting people who are unhoused and in need of help is never confined to closed doors. Just because the TLC closed, it doesn’t stop the fact that progress was made on a historical level. It proved that agency-wide collaboration and transparency with services offered is an effective form of primary prevention. By capitalizing on the strengths of community and combining resources into a central access point, rather than remaining siloed in different neighborhoods, led to over five thousand referrals to services. These outcomes prove that a City like San Francisco is entirely capable on its own of supporting a rehabilitation system free from police violence and corrupt law enforcement. That’s why California lawmakers must protect and expand community-based services like the TLC. The opioid crisis won’t be solved by criminalization—but it can be cured by compassion, coordination, and care.
