ABC7 news visited the Tenderloin around noon Friday as police were doing a wellness check of a couple who seemed unresponsive.
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"You guys alright, you guys alright?" asked one of two officers.
A young man finally emerges but there's concern that his partner may need help.
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"Here. Give me my papers!" yelled the woman who appeared to be combative.
Police eventually leave after she refuses to request assistance from a street crisis team.
For years, treatment for drug users and those needing mental health care has been the focus of conversation among city officials.
"Our goal, as I've said is consistently, (is) to get people into treatment and support that they need," said Mayor London Breed.
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"Let's focus on, first, recovery," said Supervisor Ahsha Safai.
"They are the ones that are most at risk for fatal overdoses. We should be doing everything we can," said Supervisor Matt Dorsey.
Expect that, where are they planning to house all these people who need treatment and how is the city able to afford the care that they need?
"This is the Harbor Light Withdrawal Management program. There are a total of 40 beds," said Steve Adami who showed us their facility.
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Of the 40 beds, 10 are funded by the San Francisco Department of Public Health and five by the Adult Probation Department. Their community partners sponsor another five beds. That leaves 20 empty beds.
LYANNE MELENDEZ: So, you're saying that there are 40 beds here, and the health department funds only 10, when they could be funding more?
STEVE ADAMI: "Correct."
MELENDEZ: "Why don't they?"
ADAMI: "That's a good question."
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It is the same question that Supervisor Catherine Stefani asked the health department during a recent hearing.
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"I'm just wondering. I know there are 20 uncontracted withdrawal management beds at Harbor Light and wondering if DPH has considered purchasing those?" Stefani said.
"I think we are looking at multiple options including that," said a health department official.
According to the Salvation Army's Harbor Light Center, if the health department were to fund those 20 extra beds, there would also be extra revenue to hire more staff to meet the demand for care. Kind of like the "chicken and the egg."
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As of today, those 20 beds are not being used. It's a citywide problem.
"Not enough of the right kind of places for people and then not enough of the right kind of staff to staff those places," said Supervisor Matt Dorsey.
"I think we should fund the beds at Harbor Light. There is definitely a need for it when you look at our overdose death rate. They are just getting worse," said Stefani during a sit down interview with ABC7 news.
On the other hand, the health department has invested in the only substance use sobering center in San Francisco called SoMa RISE. Coincidentally, the number of beds available there is 20.
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SoMa RISE is operated by the nonprofit HealthRight 360, with a $7.4 million budget over two years. This means that each bed, whether occupied or not, ends up costing $506 a day.
The Salvation Army's Harbor Light Center points out that each bed in their Withdrawal Management Program costs the city $110 a day.
"They work hand in hand, but they are not the same," said Dr. David Pating of the San Francisco Department of Public Health.
He has a point. Harbor Light takes in people who have already made the decision to get clean and they support them through that rough period, while SoMa RISE only serves people who are using drugs the moment they walk through the door.
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MELENDEZ: "So let's be clear. They are not here to seek treatment."
"Some people come in to seek treatment, but I will tell you, because this is such a low-barrier program, most folks who are coming here initially are just looking for a safe place to rest, to stabilize from their drug use, take a break, a pause in their daily routine," said Gary McCoy, policy director for HealthRight 360.
We were invited inside, but with the condition that we not take any video of the patients -- something we would never do.
Instead, they provided us with some of their photos.
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At SoMa RISE, a medical technician is there to make an initial health assessment.
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Patients are then fed, offered a warm shower and a chance to sleep it off, while being monitored in case of a possible overdose. Patients are only allowed to stay for 24 hours.
At that point they can ask for help to get into treatment, otherwise, they are back on the streets. Nothing is mandated and nothing comes with conditions.
MELENDEZ: "So to make the argument, if you did not exist, what would happen to the people who are using drugs out here?"
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"Well, they would be in isolation, in alleyways, they'd be on the streets, they would be on the sidewalks, and they would be in crisis from substance use," McCoy said.
The health department also makes the argument that the cost per bed is much lower than if they were to end up in the emergency room.
"We know emergency rooms are extremely expensive and make it difficult for other people to access care," Pating said.
They say, from January to June of this year, they have referred 250 patients to a withdrawal management treatment program and 90 people to offsite residential treatment centers.
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Meanwhile, Harbor Light allows patients to transition from the withdrawal management program to residential treatment, right there onsite.
"So they can literally show up to our door, ring the bell, come into our withdrawal management program, stabilize for a couple of days and then transition to longterm care at our residential treatment program on this campus," Adami said.
There, we were invited to meet Zack Wolff, a recovering Fentanyl addict who says he was ready to take his own life.
"I went out and stole a whole bunch of stuff from a store, and I was going to use it to fund the money to overdose and kill myself. As I'm going to sell my stuff, I got arrested, because I had a warrant for missing court, and I kind of see that as divine intervention and God was doing for me what I couldn't do for myself, which was to put the drugs down," said Wolff who has been sober for nine months.
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Another outspoken supporter of so-called mandated treatment is Tom Wolf.
"I was already in jail facing accountability for the crimes that I was committing and then I was given an option to go to treatment as a way to get out of jail," he told ABC7 News.
MELENDEZ: What's it going to take in San Francisco for this to not exist?
"That's a good question. I don't have an answer for that. I've seen the data. We've got a huge problem. In fact, I would ask what's it going to take for San Francisco to continue opening more of these programs," McCoy said.