To Address Drug Use and Mental Health, Cities Must Dig Deeper

On our last day in San Francisco, I came across an image posted in a health center that stayed with me. It read: “If we want to address mental health, we need to dig deeper.” It wasn’t an inspirational phrase. It was a stop sign. Something that, as governments, we could not ignore.

That message captures much of what we went to seek—and to learn—in the first City Learning Visit organized by the Partnership for Healthy Cities. We traveled from Buenos Aires to learn how San Francisco addresses drug use and mental health among people experiencing homelessness, and we returned with valuable lessons and questions that invite deeper reflection.

San Francisco, with nearly 800,000 residents, is actively working on complex challenges related to substance use, addiction, and mental health among people experiencing homelessness. The city combines data, strong public investment, an empathetic approach, and significant technical capacity. That combination makes it a particularly valuable case for city-to-city exchange.

One of the main lessons was the central role data plays as a tool for management and care in addiction and mental health policy. Information is not treated as a secondary input, but as a structural part of decision-making: it allows the city to segment health services, anticipate risks, coordinate interventions, and sustain what they call “system stickiness,” designed so that the most vulnerable people don’t fall through the cracks.

This approach resonates strongly with the path we are pursuing in Buenos Aires, a city of more than three million people, where 1,473 individuals currently sleep on the streets and 4,217 are staying in shelters.

In response to this challenge, we are advancing an integrated policy for people experiencing homelessness with addiction and mental health needs, combining outreach, specialized teams, and strong coordination with the health system. We have implemented Argentina’s first protocol specifically focused on addiction and mental health for people experiencing homelessness, along with a specialized outreach team and the country’s first shelter with psychiatric care, co-managed with the public university.

These innovations stem not only from urgency, but from a shared conviction: to support complex trajectories related to addiction and mental health, cities need strong systems, trained teams, and an approach that brings together evidence, humanity, and values. The exchange with San Francisco allowed us to validate that direction and enrich it through dialogue with other urban experiences. One insight stood out clearly: not everyone can enter formal services right away, and systems work best when they recognize that reality instead of fighting it.

In response, in Buenos Aires we are beginning to create intermediate, low-barrier spaces designed to meet people where they are. These spaces offer a first point of contact for rest, safety, and basic care for those who are not yet ready for more structured settings. We are currently piloting this approach so that the next shelter opening can include dedicated rest areas and facilities that reflect a more humane, step-by-step pathway into care.

And that is where the image comes back into focus. Digging deeper means recognizing that addiction and mental health cannot be explained solely through diagnosis or addressed through one-off interventions. Beneath them lie trauma, poverty, violence, lack of housing, discrimination, and exclusion—but also the absence, or fragility, of the community ties that sustain people when everything else begins to crack. For cities, the challenge is clear: treating the symptom is not enough if we do not also address the conditions that produce and sustain it, strengthening care networks that restore belonging, trust, and support.

This first exchange left us with a shared conviction: addiction and mental health policies work best when they combine solid evidence with deep empathy, when systems are designed to support people rather than simply manage cases, and when cities understand that digging deeper—together—is the path to more humane, effective, and sustainable responses.