Every Wednesday at 15th and Julian streets, you can spot the social workers and staff therapists with the Harm Reduction Center: They’re standing around a colorful van, blasting upbeat music, as patient after patient drops by for clean needles, free counseling, a warm meal — or even a massage.
Each week, from 2:30 to 5 p.m., the center’s staff is on deck for whoever needs to drop in and get treatment.
“We offer free therapy, integrated mental health and substance abuse treatment to folks who might not be able to access it in traditional ways,” said Anna Berg, director of programs at the center.
Although founded in 2000, the center’s mobile services weren’t launched until 2018. There are currently four locations where their vans set up: The Mission, South of Market, the Tenderloin, and Bayview.
To each location weekly, the center sends a team of five licensed therapists who come ready to lend a listening ear and offer therapeutic guidance.
Support also extends beyond substance treatment and talk therapy: Attendees have access not only to clean needles and pipes, but also to food and water, immediate medical assistance, and massage therapy.
According to clinical social worker and staff therapist Joe Sciarrillo, who works at the Mission location, the pop-up provides about 150 meals every week; a similar number of people drop in weekly. Between all four locations, more than 600 people visit the clinics each month, about two-thirds of whom make return visits. Staff make contact with individuals some 5,000 times, either first-timers or folks who return time and again.
“Our guiding principle is ‘Come as you are,’” Sciarrillo said.
That, said Berg, is what harm reduction is: “It’s asking what the person in front of you needs, how you can best meet those immediate needs, and then how do you do that over and over again.”
All services offered by the center are free. This includes mobile-site care, private care, and referrals to rehabilitation centers. Importantly, services are highly personalized, no one needs an appointment and there are no waitlists. The center is funded by city and county grants as well as through training events for other groups for which they charge.
“Some people want to stop by just to say hello and check in, some people want to jump into a van and close the door and talk there, and some ask for private care and meet us in other clinic spaces,” said Berg. “We’re down for any and all of it. The goal is really to build connection and trust and, over time, help empower people to figure out what they want to do and then help them do it.”
Maintaining both flexibility and consistency, Berg said, is one of the most important aspects of the center’s operations. “If you want to reach vulnerable people who have a lot going on, you have to be flexible and adaptive to each person’s individual needs, while also being very stable.” The center walks this line by consistently being at the same locations every week, at the same times, with the same providers.
The absence of safe-consumption sites in San Francisco is a pressing concern for the center’s staff. Although there was a safe-consumption site proposed by St. John’s Evangelist Episcopal Church at 15th and Caledonia streets, right next to the Center’s Mission pop-up location, plans for that were delayed.
“We’ve been really disappointed in the city of San Francisco and the governor. The evidence around the effectiveness of safe-consumption sites is through the roof,” said Berg.
The effectiveness of safe-consumption sites, she said, comes not only from their ability to immediately save lives, but also because people who access safe-consumption sites are more likely to detox and seek long-term addiction treatment. “When people go to these sites, they’re building relationships with people there, and thus know who to ask for help when they’re ready,” said Berg.
“Right now, there’s no easy access to help where people are treated with kindness and not judgment,” she added. “Harm Reduction Therapy Center tries to provide kinder care, but we’re just in a few small neighborhoods on certain afternoons. We need more help.”
Berg is quoted: “The effectiveness of safe consumption sites, she said, comes not only from their ability to immediately save lives but also because people who access safe consumption sites are more likely to detox and seek long-term addiction treatment. ” The article she quotes as evidence is dated 2007, which means the data are from well before. Fentanyl has changed everything. There is no evidence, compelling or otherwise, that consumption sites correlate to treatment. In SF, Portland, and Vancouver, about 1% of addicts are connected to treatment through these sites, and there is no follow up on them.
“Meeting people where they are” has come to mean: “Use as much as you want, take your time, no hurry to get clean. We’ll be there with Narcan if you get too close to the edge.” This does not save lives; it prolongs death, frequently for people who are in terrible physical condition with no intention of seeking care. This is not a long-term strategy.
I don’t see any good alternatives to harm reduction and safe consumption sites. The recent “lock em up to refer them to treatment that doesn’t exist” is jusst resulting in more overdoses. Those who are critical don’t seem to have any legal or humane ideas.
In the old days, if you had a meth habit, you could maintain a normal life for years, as undesirable a situation that may have been. Fast forward to 2023 and the cartel meth we face today? It is straight to psychosis within weeks.
There will be pain, there will be suffering, there will be death. Gosh, just how are these massages supposed to be working out for those large open infected wounds that people get from tranq.
It’s not pretty, and the sooner we stop pretending it could be, the better for all. Except of course for those who are invested in “harm reduction”, i.e. with an interest in perpetuating the status quo.
There is little causal evidence that the current approach has anything to do with overdose rates. Overdoses were rising at the start of the pandemic where there was a drastic expansion of housing first hotel shelter through SIP (along with an eviction moratorium), and ODs were also rising while the “harm reduction” Tenderloin Center was open.
There is no evidence to suggest that drug prohibition and punitive enforcement are successful in lowering rates of drug use. Drug use is a public health concern and should be treated as such. The war on drugs has been a failure since its inception. Evidence supports safe consumption sites decreasing fatal overdoses and helping people make the decision to detox. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685449/
(Double checks). Yes, not The Onion.
They’re kidding with this…… right? Have we actually come to this level?
The level of basic human compassion for our neighbors? My goodness, I hope so!
One is hesitant to classify people but, these folks are not “neighbors”.
In spite of societal pressure to acknowledge as such.
I have neighbors. They don’t lay an egg on my doorstep, operate chop shops, block the entire sidewalk, leave a debris field wherever they may alight, etc…
On the flip side – this temporary respite for those at the very bottom is commendable.
Just a speculation based on subjective observation – many of these humans are not going to get “affordable housing” or “services” and may never come close to achieving a level of life stability.
Sometimes it seems we’ve resigned ourselves to letting them die on the street.
Like – how many times do we sidestep around a body lying on the sidewalk without a second thought?
Ah yes, “services”, as the mayor is committing a crackdown and “tough love” with nothing to show but increasing overdose numbers. Twice. And the second with state resources and feds.
“Services” as the Coalition is winning a lawsuit judging the city for a lack of “services”.
I don’t think our money is really going into “services”.
Just a speculation based on subjective observation.
Even for me, it seems we’ve resigned ourselves to letting them die on the street.
“Between all four locations, more than 600 people visit the clinics each month”. Can some one share the cost per visit by this approach, as well as the outcome (number of people who have been successfully directed into sustainable drug treatment programs)?
“Harm Reduction” is not reducing harm at all! It is only increasing harm, not just to the addicts (who are not given the chance to get well, only enabled to continue doing harm to themselves) – but most importantly, the harm done to the surrounding low-income working-class communities of color is immeasurable! The inner Mission is a working-class neighborhood with many families who are recent immigrants and therefore unable to stand up for themselves with a vote against this insanity. Since “Harm Reduction” has become the standard practice in the Mission (and in SF in general), the quality of life has rapidly deteriorated. Filthy streets, passed out fentanyl addicts, crazed methamphetamine users, homes and automobiles broken into, and tents blocking every sidewalk in the neighborhood causes immeasurable pain and suffering to poor folks who are really just trying to raise their families and survive…Can we please stop the insanity, and instead use the funds that are now being “invested” into this flawed policy and fund actual treatment instead? Services that don’t include passing out needles and pipes? Portugal and Portland are both starting to wake up to the fact that Harm Reductionists have been lying all along about the data on the effectiveness of their approach. Sorry – in reality, it does not work.
How can Hawaiians hate tourists, but San Franciscans are forced to love vagrants? We can’t even ignore them, let alone hate them.