Public health officials will release a grim tally Wednesday identifying some of San Francisco’s most vulnerable residents: Those who struggle with homelessness, mental illness and addiction. The new data are intended to direct the city’s efforts to confront a worsening behavioral health crisis.

A review of city records revealed nearly 4,000 people are suffering the perilous trifecta. Of those 4,000, 41% are frequent users of urgent and emergency psychiatric services.

The numbers will be gathered in the first of a series of reports expected this year from the city’s director of mental health reform, Dr. Anton Nigusse Bland. While officials hope the data will encourage greater collaboration between health and homelessness officials — the report holds no answers on how many more beds the city needs to add, how many more employees it will take to deliver the increased care, or any timeline for improvements.

The report also laid bare that city departments have not adequately collaborated to help the most vulnerable among the 4,000 — about 200 of the sickest people — despite officials identifying its neediest cases over many years.

Nigusse Bland didn't have an exact plan yet for how the city will find stable housing and provide medical services for the 4,000 identified in the report except that it will be a “multiphase, multiyear effort.”

“But we have to start someplace, and we want to start with people that are most severely affected and begin getting their services coordinated as quickly as possible,” Nigusse Bland said.

Since Mayor London Breed appointed him to the newly created position back in March, Nigusse Bland has been reviewing the city’s broken behavioral health care system.

Bland’s report comes amid heightened scrutiny of the Department of Public Health, and particularly its practices around behavioral health care for the homeless. Some supervisors have expressed frustration at the department’s slow pace of reform. Supervisors Hillary Ronen and Matt Haney are pushing for a complete overhaul of the system through a ballot measure — intended for March — called Mental Health SF.

“It is urgent and overdue that the Department of Public Health and mayor admit that we require massive systems change in how we respond to mental illness and substance abuse from top to bottom,” Haney said.

Another critic questioned why the city isn’t working more urgently on solutions rather than continuing to point out the obvious problems.

More Information 4,000 Number of people suffering from homelessness, substance abuse and mental illness in S.F. 95% Percentage of that group suffering from alcohol use disorder. 41% Share who often use urgent and emergency psychiatric services. 35% Share who are African American. Source: Department of Public Health Broken Care: About this series San Francisco spends nearly $400 million a year on mental health and addiction treatment, but thousands of people in crisis are still without sufficient care. In this ongoing series, Chronicle journalists investigate the failures of this complicated, costly system and explore solutions to the crisis.

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Jennifer Friedenbach, executive director of the San Francisco Coalition on Homelessness, said the city should focus on expanding its services, rather than spend time pulling together data that spell out what most people know intuitively about the homelessness and behavioral health crises.

“These resources would be better spent trying to expand services instead of assessing how many people are outside of them,” she said. “We know what the need is — everyone on the front lines sees it every day. We need beds and we need permanent stability for folks. That’s not rocket science.”

But even some critics of the health department said identifying the population of people was an important first step toward getting people shelter and the treatments they need.

“It is critical that they identify this population,” said Dr. George Bach-y-Rita, a former medical director of psychiatric services at Seton Hospital in Daly City and a director of the Mission Neighborhood Health Center, a federally funded organization that operates several clinics in San Francisco. “The question becomes — what are you going to do with them?”

To that end, city health and homelessness officials plan to immediately address the 230 worst-off people within the broader population they’ve identified. They’re considered particularly vulnerable due to a combination of the length of time they’ve been homeless and the severity of their substance abuse disorders and mental illnesses.

Those 230 people will be prioritized for medical treatment and, crucially, housing services, whether that means residential treatment facilities, permanent, supportive housing or other types of interventions.

“So we now know who we want to reach and we have a dedicated team of people that will be outreaching specifically to those clients to try and get them, and encourage them, to come into services,” Nigusse Bland said.

Starting next month, once one of the top-priority people comes in contact with city services — through an emergency room visit, contact with a member of the homeless outreach or at a shelter — they’ll be provided with a coordinator to shepherd them through the city’s complex patchwork of care.

The care coordinator will also develop a plan for how to, eventually, get each person off the streets and into a stable living situation, such as permanent supportive housing units. But since the majority of the city's programs are voluntary, there is little the coordinator can do if someone doesn't accept the care. Only a handful of the city's mentally ill and drug-addicted qualify for involuntary care under a new law passed by the Board of Supervisors this year.

In an attempt to lower the barriers facing people trying to get help, the city will expand hours at the Behavioral Health Access Center on Howard Street from 40 hours a week to 65, including weekends — but not until next year. The center helps people find slots in treatment programs, enroll them in benefits like Medi-Cal and connect with other services.

But increasing the number of care coordinators and hours of the access center will require hiring many more mental health professionals, which has already proved difficult for the department.

As the cost of living soars and salaries remain stagnant, San Francisco has struggled to recruit and maintain enough mental health care workers, including case managers and caregivers. Such staff shortages also make it difficult for some care facilities to operate at full capacity.

Nigusse Bland recognized this is a prickly issue for San Francisco, and said he is working with the department to figure out how to increase hiring, but offered no specific solutions.

When it comes to housing, the city currently operates just under 8,000 permanent, supportive housing units, according to data from the mayor’s office. About 820 additional units will be available by the end of the 2021 fiscal year thanks to a bevy of recent budget investments. Approximately 10% of the units turn over every year from people dying or moving out.

Cataloging the most at-risk people in the city isn’t a new endeavor. The Department of Homelessness and Supportive Housing has for years been working to register and track the people who come in contact with the city’s homelessness services to ensure the most intensive services are provided for the worst-off on the streets.

But in an example of how the city’s splintered bureaucracy can hobble progress, the agencies working to combat San Francisco’s homelessness and behavioral health crises have never before worked from a shared list of top-priority people.

“This is the next evolution of the work we set out to do when the (homelessness) department was formed. And our collaboration with DPH is going to be critical to helping the sickest and longest-term homeless people get off, and stay off the street,” said Jeff Kositsky, director of the city’s homelessness department.

Breed likened the city’s current response to homelessness and mental illness to its mobilization around the AIDS epidemic in the 1980s. In a statement, she said: “When faced with a devastating, overwhelming crisis, all of us can come together to save lives. We can and we will help those who are suffering on our streets. ... We will break the cycle of continued trips to our hospitals and jails, and get people housed and healthy.”

Dominic Fracassa and Trisha Thadani are San Francisco Chronicle staff writers. Email: dfracassa@sfchronicle.com tthadani@sfchronicle.com Twitter: @dominicfracassa @TrishaThadani