Every week, Annie Le, a nurse who runs San Francisco’s Dore Urgent Care Clinic, tries to help people in crisis.

Some are hearing voices. Others are grappling with grief or reeling from a panic attack. Most are homeless and seeking respite at the city’s only mental health urgent care clinic where people can rest for 24 hours. Clients get fed and talk to therapists and nurses who can provide medications, help with substance use withdrawal and check on their physical health.

Le looks forward to a day when none of her clients endlessly cycle through the city’s mental health care system. While the pandemic has complicated mental health treatment, the city has launched new resources over the past two years.

A new city team refers people from the streets to her clinic and follows up to provide long-term placement, for example. But while more people are getting connected to services, many still aren’t.

“There are long wait lists,” Le said. “We don’t have space for everybody.”

Frequently, people “find themselves in crisis again” and end up back ringing the clinic’s doorbell.

Two years ago, San Francisco passed pioneering legislation that aimed to fix the city’s broken mental health and substance use treatment system. MentalHealthSF aimed to fund more staff, beds and programs and create a comprehensive care system so that people wouldn’t keep cycling through services like Dore. A city report at the time found 4,000 people in the city were homeless and struggling with substance use and mental illness.

Kevin Killian, assistant director at Hummingbird Valencia, and Sarah Peters, clinical manager at Dore Urgent Care Clinic.

Amy Osborne / Special to The Chronicle

The city is spending $607 million this fiscal year on a behavioral health system that serves around 20,000 people. That includes $55.5 million going to MentalHealthSF. The city has made strides on the plan, adding Street Crisis Response Teams and opening 87 new treatment beds, a bit less than a quarter of what’s planned.

But architects of the plan and some mental health professionals are frustrated at slow progress on the bigger challenge of connecting a still-disjointed system of care. The city hasn’t yet opened a promised office to coordinate care across providers or fleshed out a centralized access center for referrals. The public health department and experts said the hurdles include pandemic and hiring delays in the city’s notoriously slow system.

Meanwhile, the crisis has only worsened. Mental health care professionals say the need for treatment shot up during the pandemic, colliding with a shortage in therapists. And last year, 711 people died of drug overdoses in San Francisco, with the death toll rising on par this year.

“We know that this crisis is perhaps the biggest one we’re facing in San Francisco right now,” said Supervisor Hillary Ronen, one of the architects of Mental Health SF. “If this is the No. 1 priority, why aren’t we further along?”

Supervisor Matt Haney, who wrote the legislation with Ronen, said MentalHealthSF has “already changed the way the system operates without a doubt,” but more needs to be done.

“There’s still far too many people in our city and on our streets who are not accessing care effectively and are being cycled in and out of our hospital rooms without effective placement or coordination,” he said. “That’s what MentalHealthSF is designed to fix and it hasn’t fixed that yet.”

The health department acknowledged in a statement that “the system can be difficult for clients and providers to navigate and improving care coordination is a top priority.”

The pandemic delayed the plan and its main source of funding — tax Proposition C — wasn’t available until December 2020. Plus, the health department didn’t have a permanent director of behavioral health until March, when Dr. Hillary Kunins took over.

Kunins said an “awful lot has happened” with the plan and the department is “taking every step to develop whatever elements we can to implement quickly.” She understands the urgency, but said there are structural challenges to fix.

“We are the inheritors here, not just in San Francisco, but nationally of a long underfunded and depleted system of care particularly for higher levels of hospital and residential care,” she said.