program. and, again, it took us 7 years that this was an important pilot, along with santa cruz county acseeds in san francisco, but also shares throughout the country. on housing area, you've heard a lot about the housing area. direct access to housing, supportive housing is about 17 and we still have some in the pipeline coming. emergency stabilization bids have been very important for us. in the aspect of trying to get somebody the more stabilized, getting the benefits on board, getting their ids to be qualified, in the past what we've done is come back to you a couple of days later, take you to dmv and you're still in the streets. we're able to try to get as many people into emergency stabilization and move them on to the next level of supportive housing.

through mhsa dollars there has been a problem of behavioral health and traditional housing. and then [speaker not understood]. >> supervisor mar? >> i know that bevan dufty mentioned in his costs and the mayor has said lord's law -- he's looking into that. and i know mr. dufty said there is the possible proposal for a pilot project -- you could talk about the schizophrenic illness supports. if you could talk about what that process is going to be like. there have been pro and con, different concerns especially from community based mental health providers. could you give us a little built of what to expect as that goes forward. >> in working with the mayor's office, in his model of looking at community stakeholders, he's

very much supportive of bringing people together. i've been directed to bring a stakeholder group together. everything's on the table. we have over 7 years ago, we did this before. where laura had come up with we developed a stakeholder group and a community placement program. i can go into details with you at a later date. lori's law will be on the table. lori's law will serve a population and what we want to look at is the large of this, and if lori law can serve a need, what i like about [speaker not understood] we have so many family members concerned about their loved ones and don't have a real pathway ensuring they get.

~ their support. and then you have providers that feel the same way. so, we have all those processes and we're going to look at it from a stakeholder prosakes and try to see what the best kind of plan and recommendations we can get from community benefit in the field and ultimately what the mayor [speaker not understood]. >> thank you. >> just some demographics. over 32% have experienced homelessness. the average age is [speaker not understood], 10% over 60. largely the male population 23%. and we just started looking at -- relooking at how to identify and ensuring that particularly the transgender community is counted and identified. and, so, you'll see this number may grow because we're trying to -- thises was never asked in the past in our demographics.

so, we've been working on this for several years trying to identify and count people who are important to us to ensure their care. supervisor mar, you talk a lot about african americans, disproportionate number in our system. i'm concerned about that as well. we will be rolling out an african-american health initial ans. 50% we have african americans presented in our programs. as we did many years ago. we treat it like a man system. we may not have the appropriate cultural programming for this and i want to look at that. and ensure our cbos are focused on this population and are we diverse, do people see themselves as they are getting served. so, it's a initiative i'm hoping to work with other departments as well, too, to

make sure the african-american community is served well. we have our goals -- i left our executive meeting today where we're looking at outcome measures, whether that's heart disease, how do we look at violence and some of the top health conditions for african americans. so, i just want to assure you that is an area we definitely acknowledge and one we want to really everyone sure that african americans get the best care in our system. [speaker not understood]. same area of psychosis and depression, high use of history of alcohol and drug use. and what's disturbing for me and that's an area that we pry orx ties is those with [speaker not understood] mobility. those are all three conditions and we have a core group of people that have that. we see a high mortality rate. we are trying to focus. this is one of the directions we give to our hot team. we know where they are and

where they are and try to get them the case management and supportive services. we feel they'll get out of it, many of the individuals with these three issues also in our urgent and emergency services and trying to get them stabilized services and case management. and 3% have had history of mental health conservatorship. this is an area we will be looking at as our stakeholder group. estimated about $135 million in total annual dph expenditures. again, looking at the fact that we're a very large department, so, we're looking at how many homeless individuals are served by the hospital and by distinct areas. and we figure about $12,000 per person for all dph services. but some of our [speaker not understood] will go up to $75,000. when we see we provide case

management services and that's why this affordable care act is important for us. that is why it is important to give every individual in our city [inaudible]. just a little bit about s.f. hot, had a lot of focus today. it has been continuously in operation. it is an evolutionary program. it will move and respond to the needs as we see it. i think trent talked a lot about the skill being needed that needed lifting and having higher levels of skills. we also agree with that and we're looking at that for the future. in fact, you'll see this year mayor's office did help us increase some of that, those areas. but of the 530 clients served in 12-13, 90% of them were [speaker not understood], 35%

of them were terminally housed. again, they are part of the pipeline as we go through. so, when we do open up new facilities as part of the referral program for the youth, one of the most important processes we try to get as individuals to receive the financial benefit. you can see they worked really hard at sfi school. let's remember, jim, as the affordable care act, many individuals unless you're greatly disabled before january 1st of this year, you would not be put on medi-cal. you have to be greatly disabled and that is no longer flu on january 1st. individual can be put on medi-cal and insurance plans. the benefit issue is ssi is still based on disability, but not the medi-cal component of that. and i believe over 13, 14 a beesers were kicked off of ssi because they were seen as not eligible for that because there was a story and some data that

showed they were using the dollars for drug abuse and they were kicked off literally, not off ssi, but off medi-cal. i know in groups like coalition and ourselves really worked hard getting people back onto medi-cal, but we had to become greatly disabled to do that. with the affordable care act they don't do that. now are qualified and that's why it's important for us to work closely with that population. we did a street survey recently at the request of supervisor farrell just to get a sense and get a little bit closer to the issue. [speaker not understood] went out and touched 100 individuals in haight, [speaker not understood], found that 80% were living outdoors. 50% of them met the criteria

for chronic homelessness. 90% have -- >> let me ask you a question. there are staggering stats earlier on as well, have they been in our [speaker not understood] 10 plus years or in the streets? >> the detail is not there in the survey whether or not they were homeless in santa cruz, monterey is -- we can't say they are homeless in san francisco. we did not do that. 20% were under 30 years old, particularly in the haight stanyan area. 5% over 60 in the mission was 12%. and over 70 in embarcadaro. 25% female in the mission. there was some indication that was an area we needed to focus, female outreach. and we know that the city of

mayor knew about somewhat surprised [speaker not understood]. 30% report health concerns, but we observe 60% and that's one of the things we find when we look at an individual, their health status. they many times don't know that they're sicker and have reported their homelessness due to finances and other half reported it due to their health and social reasons. just to let you know a future initiative in the department. again, i talked a lot about the affordable care act. we want every homeless individual to have a primary care home. we have done some work around crisis residential. last year in the budget we did a good job of repurposing our behavioral health center because what we found was that the federal government is now changing what is acute in psych

for psych beds. and, so, those who were -- so, we have a large group of people who were not acute in the hospital at the very expensive level of care. so, we wanted to build some layers of care that were more appropriate for them and, so, we are going to be opening up 23 psych respite bed so those who are not acute in january san francisco general in the psych area, they'll be transferred over to the psych respite area so they can continue to get care, not acute. we won't have to spend the dollars on an acute hospital and we can still provide the kind of stabilization that they need before their next level of consider. we just [speaker not understood] they will open 12 crisis beds in merger with medical respite. we'll have 60 additional direct access to housing units.

and in this year we have expanded our hot team to 50 stabilization rooms and additional social worker, three case managers, and one outreach worker. we will be looking at an rfp to increase our social workers and our staffing model and we've been working a lot with our business improvement district through the support of bevan who is out there with these businesses and we're looking at trying to have them support us by helping us hire staff to focus directly on the areas that they're concerned about. we're opening one in union square in 2014. and as i've said, one of the areas that we really wanted to have the hot team focus on is targeting outreach to our managed care i don'teder nation of high users of multiple systems. the department is going to be very challenged. we're a fee for service. so, any time anybody came into our health area, any time they came in, if they came in five times a week, they would get

the same reimbursement. in the future we only get one reimbursement a month so we really have to care manage and ensure people are case managed so we can be more financially feasible in the future. i talked a little bit about shelter connect. and i'm in conversation with the public health nurses to really look at how to -- we can't really set up -- it's not as efficient to set up many clinics in the shelters, but we certainly can have public health newerctiones in our shelter. we're looking at that for 114 now who has done a fantastic job at many of the shelters. we need to give her support to assure she's providing linkage for those in the shelter needing care. and as i said, we are looking at convening a stakeholder group to review the behavioral health needs for the entire city. >> so, thank you so much for

your presentation, for all of your hard work again, and working together. you've been a great person to work with and thank you for all of your efforts. >> thank you. take care. >> colleagues, any questions at this point? okay, all right, thank you very much, ms. garcia. >> thank you. >> last but not least, we have jennifer friedenbach from our coalition on homelessness to speak for a few minutes. and thank you for being here and all the work you do as well. >> thank you for having me. i appreciate it. jennifer friedenbach. so, i'm the director of coalition on homelessness. i've worked at the coalition for 19 years, 19 very long, sometimes acutely painful and often very inspiring years. sometimes they're in the same year, bolt of them. i was also part of the ten-year implementation planning council and so we really got very specific read backs progress on the plan.

what i went through today is i went through the original plan and tried to outline what the successes have been, losses have been, some policies for the future. i wanted to talk a little before that how coalition of homelessness works to put it in context. we do community organizing which means we organize homeless and poor people to create permanent solutions to poverty and homelessness while protecting the civil and human rights for folks who remain on the streets. we do a ton of outreach to folks who are homeless and poor between four and eight outreaches every week. that is an attempt to keep ourselves accountable. we truly represent people who are impacted by the housing crisis. that a lot of time puts us right in line with what city officials is trying to do with homelessness and puts us in an

oppositional place. beforehand i make these comments, i can say we've had the most successes when we worked together and tried to develop consensus and moved away from divisive issues and came up with amazing solutions. we've been able to do that collectively as a city. some of the successes, you know, there are more than 1400 units, new units of permanently affordable housing for homeless men, women and children. it's been hugely helpful. we've had a mass expansion and prevention effort to keep san franciscans in their homes. last year the board and the mayor put a million dollars into expanding prevention. they've shaved off displacement for 1200 households. amazing. we doubled efforts. we'll see. that only met 15% of the need. as we talk about this, we put all this stuff in homelessness. why does homelessness persist. that is what i'm going to try to deconstruct today.

it resulted in 300 families exiting homelessness. we opened critical psychiatric services. we moved a bay from line bay systems. we hope in the next couple weeks we'll be having a more accessible shelter system for single adults. there's been a lot of work integrating substance abuse and mental health treatment. we passed a housing trust fund. all of these have been milestone perspectives with regard to homelessness. since 2004 we've lost about a third of our shelter beds. there's been, you know, now of course talk of expanding in the bayview and lgbt shelter that will open up hopefully soon. we've lost about half of our drop-in capacity since 2004. i did an analysis that i talk about a lot in 2011 around the department of public health

cuts. and between 2007, which is when we first started doing some pretty dramatic cuts, to that time we had about $40 million in direct service cuts to behavioral health. the reverse of all three of these things, i can't really put into words. i mean, it's been very dramatically negative. we've seen increased a queue it, deteriorating health, the impact on the combination of those cannot be overstated ~. we've also had huge losses in housing funding. so, when we look at homelessness and we kind of go back to the early homeless crises days, we often talk about the 74% kudo in hud that happened between '78 and 1983 that created this huge homeless crises. we've had really huge losses over the last 10 years and -- in housing from the feds. we've lost construction for seniors and people with disability housing. section 8 has been seriously cutaway at.

we've lost federal funding for public housing. we've seen serious deterioration for public housing as a result. many of us believe was trying to eliminate public housing. we've seen huge losses in cdbg. we've seen funding losses in redevelopment. of course we tried to replace that with housing trust fund. ideally we would have the housing trust fund and redevelopment so we could augment this huge housing crisis we're facing. we've lost, you know, state funding through the affordable housing bond since 2010. so, all of this is really adding very dramatically to the really severe housing crises that we're facing in san francisco. i want to spend a little bit of time around challenges. we still continue to have a challenge around discharge. discharge from private hospitals and public hospitals. we're still having people ending up in our streets and shelters that are in no position to be there. of course it's very expensive to keep people in the hospitals. so, this is an ongoing challenge. one of our biggest challenges

from the perspective of coalition on homelessness is the very deliberate and continuous demonization of homeless people themselves. and this has kind of ranged from this sort of intense mythology around homelessness. you know we talked today a little bit, i think the gentleman from applied research did a good job of showing [speaker not understood] is not real, but that has really entered into i think a lot of our policy. a lot of our policy has been making it as comfortable as possible for people to simply disappear, that people are choosing to be homeless and that's why they're out on the streets. this sort of -- it's gotten to the point where it's such a creation of what feels like almost a permanent under class in our dialogue. it's almost as if it's a separate population that came from another planet the way we talk about it. i mean, really.

you hear it all the time. i was walking my dog in the park, a man in the park said, i didn't know homeless people jogged. a really negative thing. homeless people are no different from impoverished people. the only difference is if you have a housing subsidy or not. i tried to cut this, you know, this idea of people coming from other places in a bunch of different ways. one of the things i looked at, it's a number of bus tickets given out of town versus the number of people based on the raw numbers from the homeless count who came here for services. and san francisco has given -- for every 22 homeless people, a bus ticket out of town, one person has come here for services. so, you know, that's one way to look at it, but there's a lot of different ways. and i think what this sort of mythology has done and certainly the hatred lead to violence against homeless

people in the streets. the mythology has made it very difficult to develop the popular support that we need to create solutions to homelessness and has, you know, kind of furthered the acceptable use of homeless people as a scapegoat in various political races. and when we talk about homelessness and we read about it in the media, if you take out the word homeless and you put any other word in there, it wouldn't be acceptable, yet the homeless population is over represented by members of the lgbt community, by african americans, by women who are victims of domestic violence, disabled people, all people who experience severe oppression in our society are over represented in the homeless population, yet we continue to feel like it's okay to talk about human beings in such a hateful and dehumanizing way. i wanted to talk about that because i feel like that is a major challenge we're facing as we move forward that needs to be addressed.

continued criminalization of homeless people, of course homeless people get between 11,000 and 18,000 citations a year for being too poor to afford a place to live. this massive competition for affordable housing, disparity between income and rent continues to get broader and broader. so, moving on to the policy ideas. i talked a little bit about prevention, but we really need to close off the entry into homelessness and i think we can do it. we've been doing it in really smart ways. when, you know, mission neighborhood resource center did it one time, just look at their clients. not so long ago, 40% of their clients were homeless for the very first time. so, we have a large number of newly homeless people also. i know this is about chronic homelessness, you know, but we kind of prefer to look at it as a holistic issue. so, one of the things we want to do and we made some leeway, we need to go farther.

we need to halt all preventable [speaker not understood] in san francisco. legislation and budget action. there is a lot of stuff that's being discussed here. we'll be coming forward with budget proposals around this, but we shouldn't have anybody else lose their rent control apartment in san francisco unnecessarily. we need to develop eviction standard in nonprofit housing and public housing. we talk a lot about eviction in the private market. we need to really kind of set the standard in our nonprofit and public housing and have a mediation before it goes to eviction. since 2009 the eviction collaborative said there's been [speaker not understood] human agency funding alone. since those folks are coming out of homelessness, presumably we can say a good proportion of those rushed to homelessness after eviction. it is so much harder to get back in housing. that is something legislatively we can do, get creative and avoid it.

we also need to look at our shallow rent subsidy program. you know, we've had a lot of success with it with like i said, about 300 families. how about using that in a creative way to keep low-income household in the rent control apartments for folks that are paying more than 07% of their income on rent that are at risk of losing that housing and having the subsidy ~ so that the housing is unaffordable for them becomes affordable. ~ 70% we can also look at having a deeper shallow subsidy program and supervisor avalos alluded to this in talking about section 8, that many -- the shallow subsidy program in san francisco is having an increasingly difficult time placing families inside san francisco. so, what we're doing is paying for a subsidy and we're placing san francisco families outside of san francisco. so, we need to look at that a little differently, have a deeper subsidy and be able to keep our folks in san francisco which is i think what all of

us, you know, you know, we have a lot of agreement on that. this also can be, you know, part of a budget proposal this year that we can do. we need to create more exits out of homelessness. i talked about creating a deep permanent subsidy. we can also fully fund the san francisco housing authority to meet their infrastructure needs without using the housing trust fund. so, we got the housing trust fund. that was amazing. san francisco housing authority was hit where we have these infrastructure needs. so, the housing trust money, you know, is being diverted over to keeping our public housing which is incredibly important, but we need to do both. so, let's get the money into public housing from general fund and let's have the housing trust fund create new units of affordable housing for folks to create those exits out of homelessness. bevan dufty had talked about this as well and i couldn't

agree more. opening up the housing authority wait list, prioritizing homeless san franciscans and fill the vacancy as quickly as possible. we've gotten better at the housing authority, but you can drive up to potrero hill and count for yourself, how many boarded units there are. makes you want to pull your hair out. why is that unit sitting there? so, keep moving on that stuff. we have some stock there as the housing authority moves are happening. eliminate unnecessary barriers to housing. you know, this was talked about a bit. you know, we talk about credit ratings as a barrier. we also have the criminalization piece. people get tickets, they can't pay them, they go to warrant, they get kicked off the housing wait list, they can't get into our other housing. when they have active warrants they can't differentiate what it is. when you get a ticket and they won't give you housing because you couldn't pay the ticket and so you're duck on the streets. and, so, really trying to get rid of those barriers.

we have tried the criminalization, it hasn't led to people getting off the streets. it actually as praythtion it. ~ exasperates it. we need to look at the master lease. 28 units were master lease units. it's often talked about as supportive housing. supportive housing from the federal definition means it's affordable, that it's permanent and that it's supportive. most of our master lease housing is not affordable. people are paying more than 80% of their income for rent. it's obviously not permanent. it's a lease that has a time limit on the end. we're mutting money into private landlords, there's equity in it. we get people off the streets quickly, we are able to improve the conditions, we're able to stop the practice of moving people from room to room every 25 days so they don't get tenant rights. there are a lot of positives, but there are some serious draw

backs. we're doing the crises, 10 years into it, okay, 14 million a year, we're not getting equity. maybe we can take a look at that and try to figure out, addressing the affordability issue, for example. the mental health treatment system, i talked a little bit about this. you know, if you talked about kind of the old coolers like the joe ruffin who worked in department of public health 30 years, mental health, some other folks who had been around a long time. they talk about san francisco, the flourishing mental health system we had in the 1970s, and then the loss of our board and care, and all this stuff happened. but we continued to seriously deconstruct our mental health treatment system. we lost a lot of really solid program. we had amazing peer run programs that were incredibly effective that we lost. we can do creative things. we can have ati