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A San Francisco Clinic Shows Promise in Treating Drug-Fueled Public Breakdowns

A former Goodwill thrift store now houses an urgent care clinic for people experiencing mental health breakdowns in public.

A new facility at 822 Geary Street in San Francisco includes small bedrooms, medical exam rooms and a laundry area.Credit...Minh Connors for The New York Times

Nov. 9, 2025, 5:00 a.m. ET

For years, they have been a disturbing part of daily life in San Francisco. People stumbling into rushing traffic. Screaming incoherently. Threatening strangers on sidewalks or while riding the bus.

What has never been clear is where to take people in the throes of a mental health crisis or drug-fueled hallucinations.

Emergency rooms are crowded and chaotic. Jails are intended for people who commit crimes, not those having breakdowns. Sobering centers can provide a space to rest, but do not always offer longer-term care. All of those places often send people back to the streets after a few hours, their cycles of despair continuing.

But now, San Francisco is trying something new. In a city known for bureaucracy, it is remarkably straightforward. And if its early success continues, the program may serve as a model for other communities trying to find a middle ground between “live and let live” and “lock them up” as they try to address drug addiction and mental health issues on the street.

A facility at 822 Geary Street — in a neighborhood locals call “the Tendernob” because it sits north of the gritty Tenderloin and south of fancy Nob Hill — has morphed from a shuttered Goodwill thrift shop into an urgent care clinic for people having public breakdowns.

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The observation area at 822 Geary Street.Credit...Minh Connors for The New York Times

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San Francisco paramedics responded to a 911 call about a woman splayed unconscious on a sidewalk. They roused her and offered to help, but she declined and walked away. Credit...Minh Connors for The New York Times

It is always open. It is always staffed with a nurse and several mental health specialists. A doctor is always on call. Police officers, paramedics and street crisis counselors can drop off people who need help at any time. People in crisis can walk in themselves, or be brought in by family members or friends. As of Oct. 1, the state has certified it as an alternative to emergency rooms, which means that ambulances can drop people there.

The facility is voluntary, and people can leave whenever they want to, but the aim is to make the patients feel comfortable and decide to stay. The staff also treats patients’ low-level medical needs, prescribes anti-psychotic medication, gives them access to laundry facilities and showers, and provides space to rest. Case managers can connect people to longer-term help, such as a methadone or buprenorphine prescription to fight opioid addictions or a bed in a residential treatment center.

The stories of people the clinic has helped so far are heart-rending. There was a homeless woman addicted to methamphetamines who had climbed down onto subway tracks searching for cigarette butts. She hears voices and yells in public without knowing she is doing so, she told caregivers at 822 Geary. They said she is now in a 90-day residential treatment program and on medication.

A homeless man, also addicted to drugs, was having delusions related to artificial intelligence and the Church of Scientology, but is now sticking to a treatment plan that includes medical care and counseling, staff members said.

The city is partly reimbursed by Medi-Cal, California’s health care program for low-income people, and also uses funds from a business tax approved by voters to pay for homeless services.

The facility opened in late April, and new data from its first five months showed that 344 people were admitted, and 88 went on to enter residential treatment programs, a higher percentage than other city programs achieve, the mayor’s office said.

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Tests for drugs, pregnancy and Covid-19 laid out in an examination room.Credit...Minh Connors for The New York Times

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An examination room.Credit...Minh Connors for The New York Times

The rest returned to their own homes or the homes of family members, or entered a homeless shelter or hospital. Twenty-six people left against medical advice, and 45 were cleared to be discharged, but did not say where they were headed.

Keith Humphreys, a Stanford professor who specializes in psychiatry and behavioral health, said most cities offer people experiencing mental health crises and drug addictions just two extreme options: emergency rooms or sobering centers without medical care. He said he was not aware of other cities offering this kind of middle ground.

“Innovations that work seem obvious in retrospect,” he said.

Mayor Daniel Lurie won his seat after promising to make the city’s streets safer and cleaner. The Covid-19 pandemic and the fentanyl epidemic had proved to be a double whammy, emptying downtown office buildings and turning some sidewalks below them into open-air drug markets and homeless shantytowns. Two people, on average, were dying every day of drug overdoses, a number that remains stubbornly high. There were 38 drug deaths in the city in September.

Mr. Lurie insists that sometimes simple solutions work the best for problems that seem intractable.

“For years, we’ve overcomplicated things in San Francisco,” Mr. Lurie said in an interview. “We want to meet people where they’re at, and if they’re ready to get treatment, we want them to have it quickly.”

London Breed, the former mayor who lost to Mr. Lurie last year, purchased the building that now contains the clinic in late 2021 for $6.3 million. She said it would house the city’s first supervised consumption clinic, where drug users could smoke or inject under supervision.

The idea was to get drug use out of public view and to avert potential overdose deaths by having trained specialists on hand with Narcan. But the city attorney told Ms. Breed that the idea was legally dubious, and she never opened the clinic.

Her administration instead came up with the idea for an urgent care clinic for people having public breakdowns. But she did not open that version either, fearing it might anger neighbors and harm her re-election chances. So the building sat empty until April.

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Isaac James, a paramedic, speaks with a person seeking help for addiction in San Francisco.Credit...Minh Connors for The New York Times

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A person seeking help with addiction checks into 822 Geary Street.Credit...Minh Connors for The New York Times

Supervised consumption sites exist in New York City and Providence, R.I., and Burlington, Vt., is close to opening one. But they have not advanced elsewhere in the United States, and Mr. Lurie said San Francisco will not open one on his watch.

“It’s not legal,” he said. “It’s not happening.”

President Trump has pushed states to go in the opposite direction: opening involuntary treatment centers for homeless drug users. Utah is developing such a plan.

Mr. Lurie has tried to avoid antagonizing the president, and said last month that he and Attorney General Pam Bondi have agreed to form a partnership to “combat fentanyl and hold drug traffickers accountable.”

The refusal to consider a supervised consumption site and the commitment to a partnership with the Trump administration are part of the Lurie administration’s shift to more moderate drug policies. Mr. Lurie has also supported more arrests of dealers and users and has ceased the practice of handing out free fentanyl smoking supplies unless counseling is included. He has also stressed that recovery is the city’s top goal when it comes to drug policy.

Without the patients, 822 Geary Street could be mistaken for a nail salon. Two lines of blue lounge chairs sporting throw pillows and blankets face each other under exposed beams and high-end lighting. It sounds like a library, with people talking in hushed voices.

There are a couple of small bedrooms, medical exam rooms and a laundry area. Lockers up front store people’s belongings — no street drugs or other contraband are allowed inside.

On a recent day, two women slept in lounge chairs under blankets, both with the red, bloated hands and arms that are telltale signs of injection drug use. A man sprawled on a couch watching TV.

Isaac James, a paramedic who has assisted people having public breakdowns in San Francisco for several years, said that it helps to have a new place to take people in crisis.

“It’s not the hamster wheel just moving people from one place to the next,” Mr. James said on a recent afternoon, as he sat shotgun in a van that zipped from one street crisis to the next, answering 911 calls.

At 3:30 p.m., the team received a call: A man who suffered from schizophrenia and bipolar disorder said he was spiraling. He was trying to stay off drugs and feared that he was about to relapse. The paramedics took him to 822 Geary Street.

“Thank you, guys,” the man said. He and Mr. James fist-bumped their goodbyes.

The man entered a treatment facility the next day.

Heather Knight is a reporter in San Francisco, leading The Times’s coverage of the Bay Area and Northern California.

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