>> supervisor brown . >> okay. good morning and welcome to the government audit and oversight committee on december 5, 2018. this is the final meeting for the committee of the year. i'm joined by aaron peskin and vallie brown. mr. clerk, are there any announcements?

>> clerk: yes. [agenda item read] >> supervisor kim: thank you so much, and i also want to recognize the staff at sfgovtv for ensuring that your meetings are available to the public and on-line. mr. clerk, can we please call the first item? >> clerk: item one is authorizing the budget and legislative analyst -- including the role currently performed by the mayor's office of community and housing development and related oversight. >> if ythank you so much. this item was called by supervisor peskin, and do you have any comments before we go into it? >> supervisor peskin: no. it was heard before the board of supervisors. i know severin campbell is here

from the budget and legislative analyst's office to answer any questions, but with your approval, i would like to send this with a positive recommendation to the full board. >> okay. thank you. we'll open it up to public comment on this item. seeing none, public comment is now closed. [ gavel ]. >> colleagues, can we move this item to the full board? >> supervisor peskin: so moved. >> and we'll do that without objection. [ gavel ]. >> mr. clerk, can you call the next item. [agenda item read]

>> thank y . >> supervisor kim: thank you so much, mr. clerk. we have chris corgis to present before us. i just want to recognize the members of the steering committee for their tenacity and active involvement in working towards reaching the 30% threshold in order to move forward with the special election. in particular, i want to recognize our cheer, james spinell -- chair, james spinello for doing significant outreach. i want to recognize the other members, as well as other parties that were involved.

this community benefit district really is based on years of work that our office has done initially first to bring together all the myriad of very small neighborhood organizations that makeup the western south of market including our different alleyways and trying to convene a larger neighborhood association. over time, it's just really clear that this neighborhood needs additional support, and this benefits district can enhance the services whether it's security or street cleaning, particularly for our neighbors and residents that unfortunately live on our streets, as well. we are surrounded by several c.b.d.s including tenderloin and yerba buena c.b.d., but i want to hand it over to chris corgis. >> today, i'm presenting the

resolution of intention sponsored by supervisor kim to establish the property based community benefit district to establish what is known as the soma west community benefit district. we've been conducting out reach to determine if there was interesting among property owners, residents and business owners to establish a district, what services needed to be provide, how should service methodology be structured, and how should the benefits district be in structure? the proposed fiscal year 2019-20 budget for the district will be $3.9 million, of which 3.8 million will come from community funds. excuse me. i have a frog in my throat this morning.

the service areas are clean, safe, and beautiful, which will be approximately 80% of the budget. marketing and advocacy, approximately 7.56 of the budget, and the administration of the basic approximately 9% of the budget. the petition was mailed to over 2700 different property owners, 589 individuals representing 30.28% voted in favor of moving forward with the c.b.d. which represents $1.1 million of assessments. 274 of the respondents responded no, which represented about 13% of the district. out of the 2700 that were sent out, 863 total petitions were returned. with me today is aaron alunta who was the planning and engineering consultant for this c.b.d. to present a little more about the district.

>> thank you, chris. good morning, supervisors. my name is aaron lunta. it's a pleasure to be here today and to have this group and the steering committee here, reaching the point that they have. it's very exciting. as has been discussed, there was extensive community out reach and education to the public, to the property owners, the residences, business owners. the stakeholder group has been working since 2016 on this outreach process, so there's multiple surveys sent, feasibility studies, several info workshops to the public. they have a robust website t t that's up that has all the information on the site. they have a steering committee that's since led the process that's conducted approximately 35 meetings, as well. they've been at the soma sunday

streets event, outreaching to the public. filipino night market in soma. they've also secured several grants that have helped fund this process. in front of you is just a -- an outreach poster that went up in all the businesses in the neighborhood. it was on their website. it's a really good overview what the c.b.d. is about and what the group of the mission is. this is the boundaries of the district. as chris mentioned, it's rather large, about 2700 parcels. about 80% of the project is going to be on clean, safe, and beautiful. includes foot, bicycle, vehicle patrol, pedestrian bike safety program, a sidewalk clean team with pressure washing, graffiti removal, trash removal, public

space activation. $300,000 of the budget, about 70% of that is going to advertising. besides that, there's also money for administration, $350,000, and then, a contingency and reserve line item for those that might not pay the assessment. so it comes out to a total budget of almost $4 million. the assessed methodology is based on two variables, parsing or building land square footage -- parcel or building land square footage thank you. >> are there any questions for urban or community based consulting on this project? >> supervisor kim: i don't see

any questions from community members. thank you so much. thank you so much so urban place consulting to working with our broad stakeholders group, and i do want to thank our previous executive director for the tenderloin community benefit district, city of gibson, if he's -- steve gibson, if he's here, and aaron and katey. so at this time, i'm going to open up for public comment on this item, please come up to the mic. mr. spinello. and we'll give you extra time as the chair. >> so i had a diagram. >> supervisor kim: sfgovtv, if you could -- >> i thank you very much, jane kim, for this process. i've lived in the neighborhood since 2002, and i noticed for a long time that there was needs and changes that continually needs to be addressed.

while i was doing this, a neighbor of mine started a neighborhood watch group, and i saw a lot of success with that. and once that success, i actually started a neighborhood watch group. but as i started doing this, i realized there were a lot of people just like myself who were voice are their concerns and -- voicing their concerns and opinions, but they were small voices. but the more i started doing this, the more i realized that all of these voice dos were yelling and screaming. people didn't know how to address that. they didn't know what to do. but the reality is all of those voices started -- they all had the same goal, including you. we all had the goal of trying to make a clean, safer, more vibrant neighborhood. since i've been in the neighborhood, i've noticed more

people moving in, i've noticed more businesses coming in. we've had a lot of new development coming in, and there is projects continually building. we have the great one, we have l7, and we have 855 brannan, large complexes. while i was working with this and started to understand what really community benefit district was, that kind of understood what we needed to do, and we all started to come together. it was amazing because i saw these groups that were starting to set themselves up. there was better soma, western soma voice. we all had the same ideas, and i noticed that they all started to come together. and under your leadership, it really made a difference. >> supervisor kim: if we could allow the chair to continue. >> what i noticed is we were able to come together, and i was amazed how everyone really had that same goal, and it was

a volunteer steering committee that really made a difference that allowed, you know, what i was trying to do actually happen. it wasn't just me, it was a culmination of everyone, and it was everyone that was involved with not just the steering committee, but the people that we reached out to. we reached out to, you know, businesses and communities, and organizations as well as property owners small and large. so here today, i also have our steering committee that would like to say a few words, and i do have some organizations, as well, and i really appreciate everything that this has been up to this point, and i look forward to moving forward. thank you very much. >> supervisor kim: thank you so much, mr. spinello. miss benedict? >> hi, deborah benedict, 75 door. as you know, steering committee and really just a citizen and participant as you and everyone

is in this project. we've been working quite diligently and regularly to bring together an improvement in our neighborhood that we all recognize needed to be happening. and quite frankly, i was part of the small groups that were being meeting and also with the supervisor -- or not the supervisor, the police chief and also the person in charge of the southern station, captain fong, about the issues and problems. and i was going to different -- bounding from meeting to meeting, as many people were. so in meeting different people, i came across james, and we shared a vision that we could improve as regular people that live there, walk there, shop there, we could improve the neighborhood, and we're very grateful for your help in providing us the opportunity

and the direction through chris to create something with the help of the voters and business people in our neighborhood to be able to increase the quality of life for everyone transiting through as well as for the people who like myself who live there every day. so i want to thank everyone who participated in the steering committee with me and shows up week after week, night after night to work on the details of bringing this project forward, and i can't tell you, i'm so grateful to look at the end of the long slog and the actual progression of this project so that we begin to come to conclusion and begin to have services. thank you. >> supervisor kim: thank you so much. >> thank you, supervisors.

my name is alex ludlum. i'm a member of the community and volunteer neighborhood resident. i just wanted to expand on one thing that james said about the public input and the community outreach. i've never been involved in any organization that was so exhaustive in its efforts. frankly if i had known how exhaustive, i might not have been so keen. but we had three separate surveys that we modified each time to try to increase the response rate both by mail that was delivered to everyone in the district and on-line. we had constant weekly public meetings. all our steering committee meetings were open to the public, and we eagerly invited people, both in person and on our fliers. speaking of fliers, i've never been a part of an organization

that updated its merchant posters in the windows every time the dates passed to include the upcoming meetings, so it's really been a long road, and i'm very pleased that the diverse groups who have participated on the committee, who have give us their opinion, we truly have been adaptive to people's inputs as it comes in both from the surveys, and e-mails. thanks very much. >> supervisor kim: thank you. and by the way, the first bell is just the 30-second reminder, but thank you for being brief. >> my name's tim figueres. unlike the others, i don't live in soma, i no longer work in soma, but i love it so much, but i feel that something like the community benefits district

would really benefit the neighborhood. i was really fortunate to be able to work with all of them as well as noticed all that you've done, supervisor kim, to help this c.b.d. come along. so i'm just here to thank you and thank all of the steering committee with the hope that it definitely will make the soma communitiy and the community neighborhood better. >> supervisor kim: thank you. so many that we were able to name the batting cages after you and your 30 years of service to the south of market community. >> supervisors, my name is harold hugasian. i operate a flower shop for the last 19 years in the south of market. i own a building there, and i'm also the president of somba, south of market business association, which has been associated with this project

due to james's regular updating of posters, but i got one of the first ones, and it was easy because i could help people look at the door, there it is. that's when the next meeting is. i'm going to tell you, james has told me, this project is going to cost me in terms of $4,400 a year. that's on top of the $22,000 taxes that i pay on that building. i'm so happy to be able to do it because i know we're going to get a return on that far beyond the 22 k i pay. no offense, but the further you throw it away, the less of it comes back. i've got a neighbor that she's opposed to it, and i'm working to get her on the committee even if it passes because our friendship was solidified when she saw me painting graffiti off of my building 15 years ago.

thank you so much. >> supervisor kim: thank you so much, mr. hugasian, and that's absolutely the way to get people on board who are not on board. >> hi. my wife and i were fortunate enough to purchase one unit there last year. we own one building, two unit. my wife and i are probably going to have kids in a few years, and i don't have to want to make a decision. we spent frankly way too much on it because we want to stay there. i'm in support of this, so thank you for the consideration, it's obviously a great idea. >> supervisor kim: thank you. >> hello, and thank you,

supervisors, kim, peskin and brown. my name is aaron thompson, i serve on airbnb's public community team in san francisco. i'd like to star by thanking supervisor kim for your ongoing support of c.b.d.'s formation. as the largest employer in the proposed district, we believe the c.b.d. will ensure the vie theity, safety and cleanliness of our community for years to come. we are proud to stand with residents today and business owners small and large to form the business district that will thoughtfully address some of the most pressing issues of our government. we politely ask the government and audit oversight committee to support the soma c.b.d. >> supervisor kim: thank you so much for being here. >> hi. my name is brendon tobin, and

i'm on the soma steering committee c.b.d. i live on the border of yerba buena, but just on the other side. i saw how the side of the street in the yerba buena community benefit district was cleaner than my side of the street. and i initially wondered why that was, and i found out about the yerba buena community benefit district, and i found out about the efforts to form a community benefit district in my neighborhood in the western half of soma. so i've been very involved with helping communication and curating the monthly e-mail and all the other monthly communications going out to members. and being part of the community benefit district has also helped me learn more about the unique character of this neighbor. i'm constantly impressed by meeting people like tim who have such an impact in the neighborhood and a legacy. i'm confident the community benefit district will help introduce people to the benefit of the district and

neighborhood, as well. finally, i want to thank the supervisors and everyone else who's put in so much work to make this happen. thank you. >> supervisor kim: thank you so much. >> hi there. hello, supervisors. i'm rye ran jackson. i'm a west soma resident. i'm also a steering committee member for the soma west c.b.d. i'm enthusiastic here today in support of forming this c.b.d. because it will make our neighborhood clean, safe, and bue beautiful, and i thank you for your vote. >> supervisor kim: thank you so much. >> hi. my name's derek lopez. i've been a resident of soma since 1995. i've seen our neighborhood change in the 20-plus years i've been in this area. i'm a part of the steering committee, and i have the same issues as james that came about the formation.

a lot of the issues that we had were very similar in our neighborhood that's on the edge of our area. i do support this. we want to reclaim our neighborhood for all the different aspects of it to make it cleaner, beautiful, and safer, so please support this endeavor for us to form this community benefit district. thank you. >> supervisor kim: thank you. >> hello. thank you, supervisors. my name is misha olivas. i'm with united playas, and i don't need to go over the challenges and ills of walking through the streets of soma. i'm not on here as a member of united playas but as a resident. i think it's super unique to see a neighborhood in san francisco where new residents, future residents, current residents, everyone is working

together to make the neighborhood better. so i cannot state my support strong enough of this process, and we're super excited for the improvements that it will bring. thank you so much. >> supervisor kim: thank you. >> hi. i'm chris foley, and i want to be misha because she's awesome. i've been involved in soma about 30 years now. i've helped them at various times, but i believe the western soma community benefits district is really important. i'm i'm a member of another community benefits district, and we're really instrumental at hiring homeless people which gives them a job and gets them

off the street. >> supervisor kim: thank you mr. foley. >> i do know there were a lot of people who came here who didn't want to speak, so if everyone could stand who at least supports the soma c.b.d., that would be awesome. >> supervisor kim: thank you, mr. spinello, so seeing no further public comment, public comment is closed. i wanted to thank everyone who was here today. this is really a project that i feel has taken about six years, really, to come to full fruition. i have to say one thing i'm really proud of is how diverse this committee is.

everyone works together to make the neighborhood safer and cleaner and healthier for all of us, and i'm really excited about what this community benefit district will do. i'm right on the edge, so one side of my alleyway is one part of central market, and one part will be part of the hopefully new west soma c.b.d. so hopefully i'll be able to join as a community member, and serve with matt haney. it's really been amazing to see what the east cut and yerba buena community benefit district has done. i know that west soma has felt like an ignored part of soma. it's a residential neighborhood with a lot of diversity and a lot of need, and so i think that the c.b.d.'s really going

to support our neighborhood, and i think it's great that it's being directed by the residents and small business owners that live there. so colleagues, seeing no further comments or questions at this time, i'm hoping that we can make a motion to move these items with recommendation to the full board, and we can do that without objection. [ gavel ]. >> supervisor kim: thank you to everyone who came here today on behalf of this item. mr. clerk, did we call items two and three together? >> clerk: we didn't. i'm sorry. >> supervisor kim: i'm sorry. i meant to do that. can you please call item number three. [agenda item read]

>> supervisor kim: mr. corgis? >> thank you, supervisors. today i'm here authorizing the mayor to cast a ballot in the affirmative. as the owner of 18 parcels of real property which the board of supervisors has jurisdiction over that would be subject to an assessment in the proposed property and business improvement district to be named the soma west community benefit district. on december 21, 2018, the department of elections will mail out ballots to all property owners in the proposed district with 18 ballots being sent to the city and county of san francisco. a list of the parcels is part of the resolution. there are 18 parcels with a total assessment of approximately $176,000 which represents 4.64% of the total weighted vote. i'm here to answer any questions if you have any. >> supervisor kim: thank you so much, mr. corgis.

my apologies for not calling this at the same time as item 2. we'll take public comment on item three. seeing none, public comment is closed. [ gavel ]. >> supervisor kim: can we take a motion on item number three? >> supervisor peskin: so moved. >> supervisor kim: and we'll do that without gavel. [ gavel ]. >> supervisor kim: so our next item is on behavioral and health services. i do believe when i spoke with supervisor safai yesterday, that you wouhe would be here - he's here? great. >> clerk: would you like me to call the item? >> supervisor kim: yes. [agenda item read]

>> supervisor kim: thank you so much, mr. clerk, and we do have the sponsor of the budget here today, supervisor safai. >> supervisor safai: thank you, chair kim, colleagues. want to thank, also, the budget and legislative analyst's office -- oh, i see severin. there you are. want to thank the department of public health. actually, this was the first thing i did when i came into office the very first day at the board meeting, i asked for an audit of mental health services in the city and county of san francisco. i want to thank former director

barbara garcia for immediately engaging her staff and asking them to dig deep on this. this was something that had never been done to my knowledge at this period of time. this was an analysis of those that might be incarcerated, those that might be in the community receiving medical care, doing out patient services. and it was very important to me because as we talk about the issue of homelessness and those receiving emergency care and the way in which we're reacting to this issue at the ground level, i wanted to understand the breadth and depth and the available and the functionality and the efficiency of those services that we're providing. so understanding how the two

issues intersect, both homelessness and mental health services, and understanding that there's a significant overlap between that as well as drug addiction, so we were definitely shocked to learn in many ways that patients with mental health and mental illness and substance abuse were very often homeless, but more often than not was cycling in and out of emergency care, and often its costs associated with that. we have worked over the last 1.5 years, and i want to thank the budget and legislative analyst's office, because this was a pretty significant undertaking to dive into the significance how deep an audit and how deep a look that they were going to take. we had about eight findings and 15 recommendations, but before i get into talking about the specific of that, maybe i have the opportunity for severin to

come up and say a few words about the report. and then, there was an additional report that was done and released more recently, so i'll give severin the opportunity to say a few words. maybe we can then get into questions, and there's individuals in the community that would like to speak, we can do that, as well. so through the chair, can we bring her up? >> supervisor kim: absolutely. severin? >> thank you, supervisor kim, supervisor safai, severin campbell from the budget and legislative analyst's office. we have a brief presentation on the report we released yesterday on the behavioral health in the jails. >> supervisor safai: great. and i also wanted to thank latoya on this. before you speak, i also wanted

to thank the new director -- i think right when this custodity came up, we had a new behavioral health director come in for the city and county of san francisco. thank you. please proceed. >> good morning, thank you, supervisor safai, and chair kim, and the committee. i thought i might start by defining what is behavioral health, so when we talk about behavioral health, we're referring to mental health and substance abuse services, including residential treatment, residential detox services, opioid treatment as well as the other services listed on the slide. so far the past five fiscal

years from fiscal year 2010-11 is to fiscal year 2016-17, b.h.s. served from 20,000 to a little over 25,000 clients each year, and providing those services cost the city about $300 million each year. on the substance use side, we served over 7,000 clients each year during those fiscal years, and again, mostly adults age 18 to 59. so because we saw this huge proportion of clients being in the adult group, we decided to focus our audit on adults. so substance use actual use were between 60,000,070 million each year, the main difference is that substance use has been

primarily funded by county fund dollars. so in terms of key findings, our first finding was that civil service clinics fall short of performance goals. every behavioral health service provider scores it as a performance scale, from one, which is unacceptable, to 4, which is commendable. performance objectives, like making sure each client has a treatment plan, and satisfaction. we looked at a sample of 20 community-based programs, and all by two received a score of more than three, so at least satisfactory and towards commendable or exceeds expectations. on the civil service side, we had four sample service clinics, which is all of the adult clinics, and only

three -- excuse me. so all obtained a score of three or less. so at most, their score was satisfactory. so we thought that indicated that there might be a performance problem on the civil service side. a part of the reason for that could be that there isn't an adequate corrective action plan, so if a civil service plan is underperforming, there's no procedures to say these are the steps you need to take to rectify that problem. on the community-based organization side, there is far more strict rules, so if you don't deliver the far more contracted levels of service, if you don't meet that standard, you might not get paid, so there is a very strong incentive to form on the c.b.o. side. so our recommendations were on the behavioral health side, that's b.h.s., to ensure that c.b.o.'s meet their goals and

why. so the second key finding is the need for additional case managers. it enables them to swiftly act on the needs of their most vulnerable clients, so they speak with them and supply support on all aspects of their life. make sure if they have housing, if they need help with finding a job, it's really just looking at the whole person. what we found for every adult discharged from intensive indicate management, more than two adults were referred to services. so you're looking at a 232 percent different sit being referred to case management that aren't being referred to the program. there were around 48% of the case management load, which are around 1,000 people each year were in the program for five or more years. that's pointing to a question, did everybody need to be in the

program that long? did some people need to be discharged a bit sooner, so one of our recommendations is getting a client on a readiness tool. the other is that staffing has been flat during this time. in terms of our recommendations to rectify that, we suggested that b.h.s. improve protocols to better transition long-term case management clients to better improve the wait times and care. and then increase the number of intensive case management staff accordingly. the third finding was that there are poor transitions to lower level of care. so we just kind of talked about the levels available to intensive case management. a lot of people aren't being discharged, but for those who are, we found that 38% don't access outpatient services at all. so what that means is after

moving from having someone checking on you every time, now you should go to seeing your therapist or psychiatrist once a week, and that's not happening. these are the most vulnerable clients who might be cycling through p.e.s., and they're not continuing to engage. there's only 16% of clients who engage in services after four months of -- four months after discharge. one of the reasons for that is there's a huge drop in support, so if you move from not having someone checking in with you every day to just having your weekly or monthly appointments, that might not be enough. we do commend b.h.s. where they've implemented a program where they'll have peers and workers make contact with the clients so they don't become out of services as well. we found that 32% of discharges

from psychiatric emergency services during fiscal year 16-17 ended without a patient referral or service link jake. again, this is a high level of care, so this is patients who are having an acute decompensation or just having a vulnerable point. there are many reasons why this could happen. one, there's clients who simply could refuse to be linked to other services or receive an outpatient referral and there's not b.h.s. can do in those services. but for those who are willing, we do have some recommendations on how b.h.s. can address that. and the other thing we also wanted to point out, which is why fixing this sort of system issue is really important, is that 65.5% of p.e.s. clients during that year were struggling with a mental health diagnosis and substance abuse diagnosis and they have a

higher recidivism rate. one of the things was to update the 2016 protocols that were already developed, so they recognized this was a problem. and we recommend some additional improvements to ensure that referrals are given to everyone who's discharged, and make sure that there are notifications to the b.h.s., like, county providers in advance of client discharges so they can make sure that transition takes place. and then, the second piece was making sure that intensive case management staffing is at a level that is adequate to transition these clients. the fourth finding which i think the city is well aware of is there's a cohort of adults that are not stablized, and i'm referring to the top 5% of individuals using the city's emergent services, and they account for 58% of the total costs. that's -- 52% of the total costs.

that's 5% of the patients accounting for 52% of the total costs. it just reinforces the point that behavioral health is a high point. we did want to highlight that for those who did not voluntarily seek services, b.h.s. has voluntary services. if you look at the table to the right, 56.2% of p.e.s. visits were on a 5150, involuntary hold, so that means a person was brought in against their will. we're just highlighting a point that it's a policy decision for the board to consider how can we help those who might be voluntarily seek the services that they need? the d.p.s. whole person care team pilot program is tailored for the high user group, and they're working towards better meeting the needs for this

group, but we do think there's a discussion about the need for the behavioral piece, so we think that b.h.s. should appoint a liaison to the d.p.s. whole person care team. and of course that the director of d.p.h. should continue to work with h.s.h. to increase the availability of medically intensive supportive housing since we know that most of these clients are homeless. so the report that we released yesterday addressed the behavioral piece in the jails? and what we've found was that most jail booking events involve people with a history of substance use. i think there's -- we thought there was a perception that most people in jails actually have a severe mental illness, but it's only 1.1% of booking individuals with a severe mental illness only, while it

was a vast majority, 84.5% had a substance abuse issue, so where around 24% had both a severe substance abuse and mental illness challenge. >> supervisor safai: can you go back two slides, i just want to go back to one point, on the cohorts of adults not stablized. >> yeah, sure. >> supervisor safai: it's a little hard to read on the screen. i think we talk about this a lot, and i think a lot of this information people suspect and have talked about in the public before. i just want to make sure i understand. so 5% of the individuals using the city's urgent and emergency services account for 52% of the total costs, and 90% of these users had a behavioral health diagnosis. so high users, if you go to the

third column, we're talking about 237 people? >> 2,237 people. >> okay. how many of those with mental health diagnosis? >> it's a little less than 2,000 of those individuals have a behavioral health diagnosis. >> supervisor safai: but the 5% of the cost, that's the 2,000 -- >> the 2,239. >> so out of 44,000 people, it's 2,000 people that are costing -- >> more than half -- >> supervisor safai: more than half of the cost. >> okay. >> supervisor safai: i just wanted to over emphasize the point, because i think this is an important point to jump out. okay. please proceed. >> okay. so as we just summarized in the slide, that most people in the jail are using substances and we wanted to clarify this does not mean that they have a substance use diagnosis. that information is

unavailable. these are people in the jails who either have -- have been prescribed withdrawal medication, have been given high risk of withdrawal or have been reporting that they're using substances. then we also looked at the average days in custody by behavioral health status, and you'll see with those -- either they have a severe mental illness or if they use substances or they have both a severe mental illness and they use substances, they have a higher average stay in jail compared to those with none of those statuses. and then we looked at how does average day stay in jail change with the severity of the crime. so we looked at the most violent crimes, assault, homicide. we also looked at quality of life only, quality of life -- people are often booked on quality of life among other charges, not serious and violent, but other charges, and everything else in between, and the trend still continues. those with severe mental illness and/or history of substance use do tend to have a

longer average day in custody. and finally, on the rearrest rate, we're seeing the exact same trends. so our takeaway from this is that the individuals who are struggling with both a history of substance use and severe mental illness, they're certainly staying the longest, and they have the highest rearrest rates, so we would recommend more attention to that population and better research to understand better what's happening there. so our policy recommendations are that the working group to reenvision jail placement should consider the prevalence of substance use in county jails when identifying alternative programs and services. there is new funding coming from the medi-cal drug organized systems, and assembly bill 1810 effective as of june 18 will divert more individuals from jail to behavioral health treatment fee free for up to two years, so there does seem

to be a state policy directing more people from jail into mental health treatment, so we thought that should be a part of the conversation. that concludes our presentation. we did want to thank d.p.h., jail health services, lisa pratt for the tremendous amount of work that it took to complete this audit report, and the sheriff's team. that's really important. thank you so much. >> supervisor safai: thank you. and i will say the same thing. i failed to mention in my opening remarks that mental health and substance abuse disorder services provide services to over 30,000 san franciscans annually at an annual cost of just under $400 million. so this was not an easy task to undertake. i also want to thank the director of behavioral health services and the department of public health. i know with ye strongly worked conjunction with either team,

and lisa pratt from jail services for taking the time to do this, as miss mcdonald mentioned. i do want to come back to the amount -- the 2200 patients that are in the -- that are taking the emergency services and that -- that are in need of mental health and have severe diagnoses that are accounting for over 50% of the cost. i do want to come back to that conversation. i think the citizens of san francisco will, you know, out of our budget, almost $400 million being spent on behavioral health services, and are we getting the best bang for our buck? are we really using those dollars in an appropriate manner, particularly when 2200 individuals out of 44,000 are 50% of the cost for -- in our urgent and emergency services. so i want d.p.h. to speak and do their presentation, but i want to come back to that point. i also want to emphasize the

point on the slide that was presented about the jail bookings and those involved in -- in our jails and their history of mental health and substance abuse because again, in terms of the amount of costs associated with that, and the level of intensity of need that they provide, want to really hear what d.p.h. has to say about some solutions about that because i think much of the debate about incarceration and building a new jail and so on has also been -- there's also been a debate about mental health services, and i think this really underscores the need for a mental health and substance abuse services in the jail system. so mr. garembacetti, if you would proceed with your presentation, and then, we can proceed with those two points. >> okay. well, good morning, supervisors.

i'm here to present some information about our system of care and also in response to the performance audit. before i start, i do want to thank the b.l.a.s and all the people who were involved for their professionalism, response and diligentness that they took this work on, and you know, it took a lot of, a lot of effort to pull together. so i thank them, and also my staff, and all the staff at the department of public health who were involved in the process. so very quickly, for behavioral health services, you know, we have basically something that kind of propels us to do the vision, an overarching and arching goal. our goal is to really help people recover and be in recovery, and we want people to be in their environment, the least restrictive environment possible so they can get the best support and best care in the environment that they

thrive in. as well as we want to make sure our services are welcoming, any door is the right door and also it's culturally responsive and linguistically competent and again, the goal for us is the wellness and recovery of the individuals we work with, and we believe that recovery does happen. and for every story that we see on the street that we are sort of impacted, we have hundreds of other stories and thousands of stories of people who are succeeding and doing well in our system of care. so when we look at our system, it's important to know how the system of care is provided. [please stand by]

>> let me mention the amount of funding that is put to behavioral health services and

when we think about the number, the numbers much higher because of the variety services we provide. >> the goal is for people to be able to transition within these levels of care. if they need something at a higher level or lower level they will be able to move across the system as needed. i wanted highlight one client story. what we to is all about people and the relationships we build. we know it takes time for lovery -- recovery and lovery is possible. we had one individual, michael, who's in his mid-40s. he is homeless and lives on the street and he has not been part our system. this is not someone who's been in our system of care.

he's not receiving services. we have received multiple numerous notifications from neighbors from local people from businesses about their concern about this one individual. we know this that this individual presence and his behavior have impacted that whole neighborhood. immediately, as that came to our attention, we immediately looked at the background and found out more information. we deployed our engagement special to go out and meet and connect with this individual, to really understand what's going on and get as much information. we engaged with this individual and tried to about understand what the issues are and look at all these notifications coming and understand the patterns.

through this process there was an event that occurred that this person was actually ended up being taken to psychiatric emergency services and was put on hold for 5151 psychiatric manufacture services. because this individual was identified in our high priority case review, which we have this robust process that we look at these priority cases, immediately we are notified. we got involved and looked at the care of this individual and we followed it as far as what we will do upon discharge. this person got hospitalized. we provided as much information as possible but also came up with immediate planning upon discharge. what's going to happen if this person was discharged. we decided to immediate case conference with the homeless department with our behavioral health services and intensive case management and hospital

staff. we brought in intensive case management staff to start this process while this person was in the hospital engage with this person while they were in the hospital and then work with the department to identify this person with go to on discharge. this was a coordinated effort that we did together. then we had this information available and worked it out. he found out it person had family. we alleghenye allegheny -- we eh the family. they had come out to visit this person and they couldn't get this person in care. when the person was cleared from being able to be discharged from the hospital, everything happened from there. we the hospital with the intensive case management and the place to stay and went over and made sure the person was stabilized and continuously works and connect the person

with the clinic. now this person i can tell you, there's been no notification after numerous daily notification we had no notification for several weeks and this person is still connected, still with the intensive case management and now is even working on some of the core issues that person had as well as working with the clinic to engage in some activities. this is an example what it takes that it works. now i wanted -- i will let go the section i have around the audit. >> just before you do that, one other point is, you said some the recommendations that you don't agree with. you should highlight that. >> the four areas that i wanted to highlight, which kind of mimics what la toy where a