have c.b.o. attorneys at the shelter and navigation centers. they're focusing on transition-aged youth. they are often not people that want to come into our offices. and so it's a specific focus on this, it's important to us. and then cases that we talked about earlier, the dual diagnosis cases to apply and to receive s.s.i., you have to kind of disentangle the substance abuse disorder from the mental health disorder because if it is only substance abuse they're not eligible for s.s.i. and you need to isolate the factors to be able to make that case. so the legal approach can help with that and the attorneys are sort of experts in that. and then we also have focused on clients, caap clients, who we have assessed and we've said through our assessments we think they could do a light work assignment but not a full work assignment. so for those clients if you notice that they're struggling and they don't seem to be showing off or having trouble

with what we call light duty work assignments the tipping point workers can say this is really an s.s.i. case and reassess. so there we have about a 350-person target over the three-year contracts. if successful, then we can scale it. so i know that it's been a long hearing but i just want to conclude and we obviously know that there are gaps in our systems. i think that we're working -- each of the departments is working really hard and more closely, honestly, than we ever have to address the crisis on our streets. and there are areas that we just need more resources and we hope to try to identify those, to highlight those and we look forward to continuing to partner with the board and with our colleagues in the other departments to work on these issues together and to work on the crisis. happy to answer any questions and if you have any follow-up questions for any of my colleagues or jill nielson from daas, happy to answer. >> there's going to be an

opportunity for public comment, but for now i will see if my colleagues have any comments or questions? yes? supervisor walton. >> supervisor walton: thank you, chair mandelman. so right now i just have one question and maybe h.h.s. could answer this, where would you say that the gaps in services are? >> i guess i'm up. um, so, i mean, i think that there are gaps throughout this system. i mean, we're talking -- i think that there's absolutely, you know, gaps in community-based residential care programs and whether they're board and care facilities or transitional housing and treatment programs or skilled nursing facilities. there's definitely gap there is so that when people are leaving

p.e.s., whether or not there's housing available for them, if they still need care, -- sorry -- if they still need care and we don't either have permanent supportive housing or they still have medical issues that make it difficult for them to get into p.h.s., we really need more of those beds. but also as we're adding more community-based care we have to understand that those folks need to go somewhere. so, you know, for every transitional program that we set up we need to be planning for where those exits are going to be and whether they are to permanent supportive housing or whether -- which i think that we have a fair amount in the pipeline, or whether they're going to small co-op programs that i think that are more suitable for folks. we need more of those, but i will say that there has been a fairly robust development of permanent supportive housing over the past -- you know, 15 years in this city. but there's not been the same level of growth. in fact, i believe that there's actually been a shrinking of the community-based residential type

programs. >> and i would say from the d.p.h. perspective, the gaps are really in low barrier access programs, like the respite at hummingbird. because not everyone is ready to really be able to go into a full service residential treatment program. they're not always able to meet all of the entry requirements. but having that low barrier access where they're off the streets, they're not either in a hospital bed or in p.e.s., but are in a shelter place where therthey are constantly engagedo say, when you're ready -- are you ready today? no. well, i'll talk to you again tomorrow and maybe you'll be ready. that's one. and, also just the whole spectrum of what we call the lower level of care. someone not in an acute psychiatric bed. that could be residential care

facility for adults. but, again, it's the -- our goal is to meet people where they are and to provide the lowest level of care that gives them the most freedom and access but the help that they need. >> what's the budget for h.h.s. and the department of public health? >> the d.p.h. budget in total is i think about their 2.1 billion or $2.2 billion. >> and h.h.s. is $260 million. and if i could add one more thing that i think that we did not address around the gaps in the system and i think that this is a really critical point is that prevention needs to be added to the equation. we -- i don't think that we're investing enough money around mental health or around homeless services in the areas of prevention because no matter, you know, how much we add add, e

many more units of housing that we add we're helping about 50 people a week to exit homelessness. but we're seeing an inflow of about 150 newly homeless people per week. so until we can address prevention issues around homelessness and i think also around people who are experiencing mental health or other challenges that may put them at risk of losing their housing, i think that is going to be an important equation to longer term success. as well as continuing to make the investments in our systems and how they work. and investing time and money in improving collaboration, whether it's face-to-face collaboration or through our data systems. so systems improvements as well as prevention i would add to that list where we have gaps. >> what is the mission of the department of public health? >> to protect and promote the health of all san franciscoians. >> so would you say we're in a

homeless and affordability crisis in the city? >> a homeless affordability crisis? >> in san francisco? >> oh, absolutely. we see it every day. in fact, i learned from dr. barry zevin is the simple way -- wee hav we have this mucs and this much housing. and so we are definitely in a crisis. >> by the look at the slide and you look at the behavioral health spectrum of care and i listened to the mission of the department of public health and i see the difference between h.s.h.s budget and the department of public health's budget. i know that there are a variety of services that you provide and a plethora of uses for the resources of the budget. why does d.p.h. not provide any housing as a department under this spectrum of care?

>> d.p.h. -- so d.p.h. previously provided housing? >> correct. >> and we transferred all of those services to h.h.s. when it was formed. >> when you transferred all of the services did you also transfer all of the resources? >> i believe so, yes. >> all of them? >> yes. >> okay. so what you're saying is that as we focus on addressing the housing crisis and the homeless crisis, that the department of public health doesn't have any resources to provide for actual housing? >> i believe that's correct. >> yeah and i will -- i will just add, i mean, this was an intentional decision that was made. there were approximately 800 units that were in what was then called the direct housing portfolio run by the department of public health. and that was their access to housing. those probably turned over at a rate of about 80 units a year.

when the portfolio was combine bod a single supportive housing portfolio, bringing in units from multiple departments, we now have 7,700 units available to the clients who are at the highest needs clients in the city. and we see a turnover of about 800 units in that portfolio. so under the current scenario it is actually -- we are doing a much better job at serving higher needs individuals in terms of the volume of people that we're able to rehouse, because now those 800 units are really going to the highest needs individuals. and not necessarily based on the d.p.h. list as carey pointed out earlier. what we have found is that there's sometimes a difference between the highest needs individuals and the highest users of our medical system. so i think that we are truly getting to a place where we're focusing on individuals and what their needs and are getting them prioritized into housing. so having, you know, a bifir

indicated system of housing or the way that things used to be actually meant that d.p.h. only had 80 units of housing per year, whereas now i would gather that, you know, 90% of our clients are also d.p.h. clients and they're having access to 800 units of turnover units per year. >> thank you. >> supervisor mandelman. >> did i hear it correctly? >> that was exiting in-patient psychiatry. >> okay. so what are we doing or what can we do to increase that number? >> it's one that i can answer. thanks. one answer to that is that street medicine met with in-patient psychiatry yesterday and talked about having a backup

plan for those patients who don't connect. and they'll be back on the street. and if street medicine is aware of those folks, we have got a lot better chance that we could connect to them as the backup for, hey, they didn't connect to the initial plan. it's a small piece. but i think that those kind of connections that we didn't have before can amount to some really positive connection. if not immediately, down the road, because these folks are going to continue to have conditions that need our help. >> i think that is all i have for now. >> can i follow-up -- so what was the statistics? >> 52% of people leaving in-patient psychiatry continue to receive care within a week after discharge.

is that what that was? sorry. >> it's 52% we're seeing in the follow-up appointment within seven days. >> it seems very low. i mean, that's not the -- that's not the 51/50, right? that's someone who is actually been admitted for an acute psychiatristic hospitalization? and they've spent some serious time at s.f. general and they have some serious needs. >> i'll let dr. o'leary address it. >> so the question is regarding how people receive follow-up after they leave the in-patient units. so everyone who leaves the in-patient unit is given a specific appointment for follow-up at -- with their out-patient provider whether it's a new one or an ongoing

provider they have already had a relationship with. and there's a range of whether people will follow-up with those appointments or not. so what we're hearing is that 52% of people actually within seven days came into their appointment and were seen. given our -- i wish that number were higher, but given our patient population, that's actually -- i think that it's fairly reasonable. because there are a number of patients that even though we make appointments for them they tell us very directly that i'm going to see that person, i don't need that, i don't want it. so i think that the 52% -- again, we're working to try to make it higher. i think that one of the levels of care that would be helpful to have greater access to is in intensive case management where we could do outreach to try to increase the likelihood that person is going to connect with

a mental health professional. >> how many people are being discharged from acute psych each week? >> i'm sorry. >> how many people are being discharged from acute psych on a weekly basis? >> on a weekly basis, 15 to 20. from san francisco general in-patient psychiatry. there are other patients discharged -- >> and supervisor stefani asked, how many of those folks do you think that are homeless when discharged? >> from in-patient psychiatry, i don't have an exact number. i would -- it's a minority of the people that we discharge. but i don't want to hazard a guess because i really don't know the exact number. >> it would seem like -- i mean, the 51/50 revolving door is a very hard thing to figure out how we're going to actually -- i mean, given current resources --

what we could even do about. but it does seem like we ought not to be discharging people from an in-patient acute psych hospitalization unless there's a real strong plan including a placement for them to be in following an in-patient hospitalization. i don't know, that's something that i'm interested -- and we're not going to figure it out here but i'm interested in knowing what kind of resources would be needed. >> to echo the comment that was made earlier. we need additional resources at all of the lower levels of care. and an important part of that is residential treatment. jeff mentioned the stabilization beds. that's very helpful resource for our in-patients to have access to. again, they can be found by their intensive case managers when we know where they're going to be staying.

but, you know, we simply don't have the resources in our system right now to be able to provide a bed in a setting above the level of a shelter for everyone who is leaving both p.e.s. and in-patient psychiatry. >> do those people at least get guaranteed a hummingbird kind of placement if they're leaving? >> no. as has been mentioned, hummingbird is always full. we certainly make use of it whenever there's a bed available, but they're not -- there's not always a bed available for everyone who is leaving in-patient unit. >> it seems like something that we should fix. >> we need more beds. >> yeah, no, i get it. all right, thank you. >> supervisor ronen. >> supervisor ronen: yes, thank you. i just wanted to shift just briefly to costs. so one thing that supervisor mandelman has brought up several times is that we know that

people are staying in-patient psych sometimes, especially the locked ward, because there isn't a step down. and when they're in a higher level of care that their conditions don't warrant that, we're not reimbursed by medi-cal. what is that costing the city in general fund every year? >> i don't have that number off the top of my head, but basically it costs the actual costs of care for an in-patient psych day, which may be a couple thousand dollars a day. >> supervisor ronen: i thought that it was $7,000 a day? >> no, the actual cost in terms of -- >> the reimbursement that you would get if you were making that available to someone else who is probably waiting for that bed -- jackso absolutely.

>> the city would be drawing down $7,000 of dollars. >> supervisor ronen: can you get that number and send that number to me? >> yes, we will. >> supervisor ronen: and you're going to also send to me the average waiting time for a residential treatment bed. >> yes. >> supervisor ronen: i just want to make sure that i get those numbers and follow-up. i want to echo that is not just supervisor ronen but all of us on the committee. thank you. >> supervisor ronen: sorry, last question -- is there any other place where we are unable to draw down, due to the federal dollars, to help to pay for these services because we don't have sufficient availability of the proper level of treatment in the system? other than the one that we just mentioned?

>> yeah, we have issues with not enough lower level of care within our entire system. not only with the mental health and substance abuse but medical and surgical and skilled nursing. so any given day at san francisco general there are probably 20 patients who need some -- 20 to 30 patients who need some form of lower level of care, predominantly on the skilled nursing, but also rcfe, board and care. but on the psych side, it's really what i talked about in terms of lset, the locked sub-acute and more of a hummingbird and also some rcfe that is psych oriented. >> supervisor ronen: so on the psych side then, the only place where we're perhaps unnecessarily relying on our general fund, where we could be drawing down state or federal levels is in this area? there's no other area that you

can think of? >> i think that the other areas we are -- i think that we're maximizing our ability to draw down dollars through our out-patient system but it's really the in-patient system where we've got the biggest clog. so that's -- i think that's the right answer. >> supervisor ronen: okay, thank you. >> all right, well, then now is the opportunity for members of the public to speak. speakers will have two minutes. we ask that you state your first and last name clearly and speak directly into the microphone. those who have prepared written statements are encouraged to leave a copy with the committee clerk for inclusion into the official file. no applause and booing is permitted and in the interest of time speakers are encouraged to not have reputation of previous statements. if you would like to speak

during public comment we ask that you line up on the right side of the chamber. okay. good. i do not know. go ahead. >> (indiscernible). >> ace, your time is beginning. >> i mean, let me say one thing for the public here. it is ridiculous for us to be up here and sit here silently while your department is up here talking about most of them shake the egg, yeah, yeah, yeah. i can shake my head and say, no, no, no. so what are we going to do -- my name is ace on the case, by the way -- we'll have to put together what they call community reform. you know, reform everything else. how to use the toilet. how to piss and everything. we're going to have community reform. so we can have accountability outside of this city hall frame here. because it's not working for people. let me give you a good example. i am a homeless person. i went to surgery and had surgery on my head. i went to all of them programs.

what they're talking about, yeah, it's a no -- no to every one of them. i'm right now living over here on eddie street at a place there -- what is it called -- some hotel, whatever it is, under the care of these doctors. i have care of doctors and psychiatrists and now they want me to take psych medicine. i'll be damned if i take some psych medicine. i'm already crazy. let me say just one thing here. i'm standing here as a black man talking about black issues. this homeless problem is that you go back to the origin and the city and county got rich getting money from the state, from the federal and then you tell all of the homeless come here! as soon as they land they go down there and get welfare and everything taken from us. taken from the black folks. let me just say one thing -- y'all let that director here like he got it that way. he need to sit here and to be accountable to some questions that i'd like to ask him. now i ain't going to be able to say what i want to say in 20 seconds here and i'm pissed off now and my high blood pressure is going up. but there needs to be

accountability on every department here that is getting millions -- hundreds of millions of dollars. i remember back when ali alto was the first czar of the homeless program. she had them right want and now you have people making millions of dollars... (indiscernible) don't have time to let me say... >> clerk: next speaker, please. >> thank you, ace, thank you. >> (indiscernible) i'm going to talk to london. i'm going to talk to her. all of the programs. >> thank you. next speaker. >> get that and a bag of chips. >> clerk: next speaker, please. >> we can't question it. the department of homeless -- all of that money go to him. he's top heavy. >> okay, we've got to keep going. >> if you don't want me to act crazy you better do the right thing for the community. and the black folks.

>> please begin. >> do i get my time. i'm dr. alan cooper. for a long time i worked at stanford with patients with liver disease and i have a lot of experience with people with drug use problems at stanford and at the v.a. in the last five years i have done safety net medicine here in the city. first at the arbbury clinic and now working for bury i think at the 5th street clinic as a volunteer in the shelter. and i want to tell you about a case that we had -- and i think that barry and his team do an amazing job. incredible, given their resources. and the problems of getting outreach and i have a potential solution if i have enough time. so i saw a man a few weeks ago who had just been discharged from one of the local hospitals in the central line after a suicide attempt. he was sci schizophrenic. he had been a drug user, heroin user and didn't use anymore but used heroin to try to kyle

himself. after three days in the hospital he was discharged to the m.s.c. clinic where one of barry's nurses saw him. a guy who i really love because he does a great job. and he said, wow, he has a bad celluliteis on his leg and he had been given some information but he couldn't walk around very well because of his leg. he had three appointments the next day. one of which was critical because he had to get up to see his doctor at the tenderloin because he was having bad side effects from the psych medicine. he was coherent, he was interactive and wanted help. okay? there was no way that he was going to be able to keep three appointments the next morning. one at 8:00 and one at 9 one at 1:00, and barry's nurse said that he has to be evaluated for a respite bed and he can't just sit on the street and walk around from place to place.

(please stand by)

>> he was in a drop-in bed. he had been discharged from the hospital to a drop-in bed. he was told he was going to get a permanent bed. he didn't want to go anywhere because he was afraid he was going to lose his permanent bed. he was afraid if he got readmitted, he was going to lose his bed at the s.c. shelter. >> supervisor stefani: okay. i'm going to give you my card. i'd like to contact you. >> okay. >> chair mandelman: okay. next speaker. >> my name is c.j. and i'm here to speak as someone who has

mental health challenges as well as physical health challenges and has basically come here to share a little bit of what i call relay services. i come what they call the relay services era, and what i mean by relay services, i was able to get help from every step of the way, and i see that's missing now. so basically, i dropped into a 24-hour helshelter, i was feel suicidal. they took me to a place called wes westside crisis. the case manager stayed with me until i seen someone. once i seen someone, they gave medication for me, had a van pick me up to take me to the psychiatric unit because i was

feeling suicidal and having some thoughts of killing myself. that person was able to talk to the psychiatric unit. the unit had what they call a discharge plan. after three days of finally getting some rest and some of the medication that i needed, then we talked about a discharge plan. so someone was able to sit with me and make sure that i had stable housing, make sure i had a stable way to get services, a self-help mental health drop-in center. so then, i was able to get help. able to get permanent housing, a permanent shelter bed. so what i see missing, there doesn't seem to be that hands-on approach -- [inaudible] >> chair mandelman: thank you. thank you.

next speaker. >> my name is diane chee, and i'm a medical student at ucsf? and prior to thaso first off, d to thank everyone for having this discussion this morning. i think everyone can acknowledge we have a very fragmented and hard-to-understand caring for individuals experiencing homelessness. i'm here to talk about 5150s as a coordination of medical services for individuals who are housing unstable and living with substance use disorder? and i would also like to express deep concern about bills such as sb 1045 to expand the use of 5150's. 5150s are currently used in the medical system, and they are ultimately a medical decision?

5150s are currently done after significant deliberation with doctors, nurses, social workers and other multidisciplinary social workers on part of the care team and are done as part of a long-term multidisciplinary plan. we know that they can often be a traumatizing process that often involves law enforcement and handcuffs. trauma can be extremely disruptive to the patient-provider relationship, and we know that a trusting patient-provider relationship is the foundation that brings people in to access services. we also know that evidence shows that trauma is tightly linked to substance use and mental health. in medicine, we recognize the importance of trauma informed care which is care that acknowledges the trauma or patients experience and -- our patients experience and continue to experience in the community and the medical system? one of the primary out comes is

to preserve patient autonomy and patient decision over -- >> chair mandelman: thank you. next speaker. come on up. >> hello. my name is ronnie, and i'm a medical student at ucsf, and i work with patients who experience homelessness and have mental health and substance use disorders regularly at the clinic at mcf south? i just wanted to address that there's, like, we're talking about different strategies to address these issues, especially people who are experiencing homelessness with mental illness and substance abuse disorder. one thing that comes up, people supporting involuntary treatment for people? and there's a thought that some people need to be, for example, conserved in order to recover and for their own well-being?

i want to say that our medical training contradicts this logic. the evidence-based approaches that inform medical management have shown that long-term recovery is most successful when there's internal motivation from the patient, trust in the provider-patient relationship and approaches to meet people where they're at. they have been more successful in the long-term effective recoveries? and a bill such as being proposed, sb 1045 to expand conservatorship and involuntary treatment, there's some studies on a similar program in massachusetts, and there's evaluation from overdose data there that found that people were involuntarily committed were two times more likely to fatally overdose than those who

voluntarily went into treatment. you must be including the people who have lived experience of homelessness and daling with these diseases. i would like you to address the prejudice you might be holding inside when you ask people to comment longer and those you don't. >> chair mandelman: thank you. next speaker. >> my name's teresa palmer. i'm an m.d.-geriatrician, and i work with senior and disability action. i am against 1045, but i understand the stuff that 1045 is trying to address. someone today did say there's

enough stablization beds. that was confusing to me because i know there's not enough. there is some model of -- this model of assertive case management where you go out to the person. it's my understanding that for case management, people are waiting, and even funds like the dignity fund, there's a waiting list for case management and home delivered meals. so these programs are not effective at meeting the need at this point. could we develop a division of assertive housing case management with supporting services for these high-need people? could someone explain how that could be done and how the

barriers to getting case management could belowered? >> chair mandelman: thank you. next speaker. >> good afternoon. jordan davis speaking for myself. happy pie day, everyone. we should grow the pie for more housing and voluntary services. however, we should also throw the pie at coercesive treatment and skefconservatorships. now i tell my story a lot. i'm formerly homeless. i was one of the people that the neighbors often talk about, but i was able to get better and i was able to get housing and get a lot of things done. but there's a lot of people that just, like, the system is failing them, and i recognize that. for example, a lot of the housing systems or s.r.o.s, they're bad for our mental health, and i say this as someone who represents tenants on a city board about this. these are not built for mental

health. and also, like, the sword of damocles hanging over us on master leasing, because it may not be permanent. we don't have any rights. a big component of mental health for the homeless is meeting people where they're at. it's least restrictive treatment available. it's resembles what a middle-class person would live in. that's why we've got to do more subsidized housing, to make sure people who need it get that housing. i've gotten, like, stablized, but who knows how long that's going to last with the living situation that i and many other people had. thank you. >> chair mandelman: thank you. next speaker. >> good afternoon. my name is maria guillen, and

i'm a member of the voluntary services first coalition, representing senior action network -- i'm regressing, sorry. senior and disability action as one of their board members. so what today's hearing says to me is that this type of hearing, the asking of thoughtful and probing questions, and the opportunity for public comment and for them to -- for us to share our concerns should have preceded the drafting of legislation like sb-1045. 1045 is not the answer to our crisis in san francisco, and that crisis is a lack of services for those in need. it's been shared. there are substance abuse needs. there are housing needs.

there are substance abuse needs. this afternoon -- this morning, i -- the moment -- the powerful moment today was when our supervisors had the opportunity to ask what would it take to do better? what kind of resources are required to have a different system? how do we fix the system? and to me, when this happened, it's okay, we're taking responsibility. we're taking some accountability for the problems and not blaming those that are affected. please, let's not propose something overreacting, over arching, and denying, like forest conservatorship. i implore on all of humanity, fix the system, feed the

system, before we are the failures of a failed system. >> chair mandelman: thank you. next system. >> hello. good morning, and thank you for your time. i've worked with some of the people in the room. i am a city of san francisco registered nurse. my name is jennifer steen, and i think it's really disrespectful that jeff kozinski left. i think it's really disrespectful. i think we knew what we were doing in writing the code, and i think it was incredibly important in writing that. the homeless budget is 2 0 --

200 million. as everyone here said, i agree quite strongly that levels of care are lacking in all levels, and that people need to be able to be supported so that they can exit. i think supervisor ronen, you've asked many good questions about exiting, exiting, exiting. right now, i work in exiting, transitions. exiting is a problem. we don't have enough beds. there was a study with multiple recommendations about where beds are needed and can be provided with a cost breakdown. this work group put together this draft. someone sent it to me anonymously. i don't know who did it, but i

think this is the kind of information that needs to be disseminated between staff as well as the people to serve. >> supervisor ronen: chair mandelman, could i have a question? >> chair mandelman: sure. >> supervisor ronen: so working in railroad amends, where do you think we should be focused -- so working in -- where do you think we should be focused? >> dual diagnosis, the 90 days, a.d.u.s. board and care and adult living centers. the log jams that exist both at laguna honda and san francisco general are the result of not

having places for people to go. they can continue having need, but we opened up the healing center to create capacity. we've opened up hummingbird to create capacity, but all those folks are still stuck in those new beds. so we've opened new beds, but they're ready to graduate and have no place to go. so the ask is all the levels. we need support service, hotels. i think jeff kozinski made a great numerical statement that hundreds of beds are opening every year, but they were planned before this year. i think it was also stated that the departments aren't communicating to figure out who was in need. so we can look at length of homelessness, but if we're not fully coordinating the overlapping needs of mental health care, medical health care, dimension diagnosis,

which is almost impossible to place, and if you're incontent, you can't even go into a residential program if you might need it if you can't climb stairs. in san francisco, most people live on hills, and so they can't get access to programs. i think we need different differentiations, obvious to people who are doing the work and utilizing the services. if you have an issue -- if you just walk with a cane, you can't go into a program. p.e.s. used to be able to refer directly to progress a.d.u. beds and cannot do that any longer. so we're seeing that a lot of clients -- if you go into inpisht, you can be referred, but only for the first seven days of your stay. so people actually are not able to even make that simple exit. a.d.u.s are called acute

diverse units, and they were designed and created as an outlet for p.e.s. now they're not being used that way, and that's problematic. >> supervisor ronen: good point. good point. >> chair mandelman: i think supervisor stefani -- >> supervisor stefani: no, i would like to give you my card because i would like to follow up with you and see that report. >> chair mandelman: we probably would call like to see that report. okay. next speaker. >> good afternoon. my name is gloria hernandez. i'm so glad to be here. originally from illinois, came here, started working with homeless, some of them are still homeless. i believe that people are doing

the best they can. i believe that with my mind, heart, and spirit, but i have serious concerns that everybody needs to work together. usually, what i've seen from living here for 24 hours that the homeless, the first people they encounter is the outreach people and the police department. i would like to know exactly what training they have to exist because this is did definitely a mental health issue. if you don't know how to assist a person, that person will remember that and not go further into what they need help with. so please, if you could investigate and find out -- because -- in other words, i was just told by the director of the homeless that there's 40 policemen that are trained in this area -- oh, that sounds

great to me. but those 40 policemen are not all over. in other words, at any given day, there will be different police that apparently are not trained. why is it that not all of them are trained to assist the homeless because this is definitely a big issue, and how that is taken care of is how they're going to feel about the next steps. thank you. >> chair mandelman: thank you. next speaker. >> hi. my name is robert marquez. i want to thank the supervisors for going in and asking this. part of the problem that you're having -- i appreciate your approach, is that these rights

establish living in self-determinance. it created the 5150 as a public safety hold, krisk hold with a professional recommendation from psychiatrists. so what you're looking at, when somebody gets released, they get eight different states of competence, opposed to 5951. when you start adding it up, it's the standard. it's competency. so when you start putting this together and saying this happened this many times, what's the basis? what's the basis for holding them. and then why? why -- the questions you had with why the merry-go-round? to address your concerns, effective january 21, senate bill 1152 will require hospitals to modify their

current discharge policies by including a homeless discharge policy planning and procedure. -- [inaudible] >> -- prior to discharging homeless patients, hospitals are required to document and perform a check list of events such as offering patients a medical screening for infectious diseases and transportation up to 30 miles. basically, effective july 1, 2019, hospitals must have a written -- >> chair mandelman: thank you. next speaker. >> hello. i'm sandra larson. i'm a former mental patient, and i've had e.c.t., and it was in the residential system here in the city and county, and i

think they're great. they create community. and the statement i want to make is based on the consumer movement. people need to be able to own their success. it should not be what someone else has given them as it is in the current mental health system. the effort needs to be client driven and that's in the mental health services act. it takes investment, time, and effort. people need to be invested owning their success. some could be peer workers and helping promote their community, healthy community as we've been promoting with mental health services recently. i believe in the long run that is what will help all of us, otherwise, we're going to continue rescuing people who can't survive because they're without family and support. for a little while, they'll be

assisted and then have no support to continue. the other part here is that we do not have enough adequate beds or services currently to house and treat people for extended period of times for 30 days, three months, six months to a year but then release them to a community that has no place for them because they are former addicts and qucan i se schizophreniaics. you have to have people working for the community. >> chair mandelman: thank you. >> hi name is sam lu, and i work in the coordinated health system. one thing that is really clear from this presentation is

there's so many gaps in the system and it's inadequately serving the homeless population. homeless people really haven't had the chance to receive services voluntarily. the city needs more intensive case management that meets people once a day wherever they are living and builds relationships on trust in order to get people into housing and services. we need to invest in community mental health. it's also clear there needs to be a needs assessment. what are the gaps in the system and how can we fill those gaps? coalition on homelessness proposes that the departments work to identify where those needs are, especially before we try to implement something like

sb 1045 which will take away the civil liberties of homeless people. there are a multitude ofries as to why people may not -- off reasons as to why -- of reasons as to why people may not want to receive services. healthright 360, it's a 90-day program. one of the reasons that we've heard that people don't want to go into treatment, it's such a taxing process to become sober, only to know that you are going to be exiting back out onto the street, right? and until we have that housing, people aren't going to be -- >> chair mandelman: thank you. next speaker. >> hi. thank you. my name is spencer hudson, and

i wasn't going to say anything at this hearing because i am so far from being an expert in mental health issues and hen mal health treatment that i am just out of my depth, and all of the other speakers have spoken so eloquently and knowledgeable about the situation. however, i can tell you this, i can tell you that sb 1045 that was passed last year is a bad piece of legislation. and how do i know this? i know this because three counties: san francisco, san diego, and l.a., were given the opportunity to implement sb 1045, and san diego and l.a. have said oh, no thank you, not interested. only san francisco is implementing it. how do i know it's a bad piece of legislation? it's because many speakers from the departments here and every single speaker here who knows more about this than i do have

said we need more, more, more. more funding, more beds, more resources. sb 1045 doesn't provide one single dime of additional funding for services. how do i know it's a bad piece of legislation? because everyone i've spoken to who knows more about this than i do said we need to concentrate beefing up mandatory services before we beef up incarceration. the authors got it so wrong that the number of estimated people that's going to be served has dropped to 300 to five, and they have to go back and fix it this year with 1040. sb 1045 is a bad piece of legislation and we should not be implementing it. >> good afternoon, supervisors.

i am jessica layman, the executive director of senior and disability action. i want to thank you for having this hearing and taking the time to look at these issues. we all agree their issues around mental health and housing and services in our city right now. i know you've heard from other people that sb 1045 is the wrong approach. people overwhelmingly oppose the approach taken on sb 1045. at the same time, when we talked about our priorities for the year, mental health services, the need for expanding mental health services for seniors and people with disabilities was at the top of the list. so people know that we need services, and people are saying i'm having trouble accessing services. we have start there to make sure any time somebody needs services that they can get it,

that there's follow up, intensive case services to make sure that people aren't falling through the cracks that we know they are. today, we're talking about income, and it's almost impossible to find housing in our city for that amount of money. we have a lot of knowledge in the city, right, between city staff, between the supervisors, and perhaps most importantly, people who have lived here, people who have been traumatized by 5150, people who have needed mental health services, people who have had substance use. we've got to bring those folks to the table, and i feel confident with all of us, if we back up and really look at what do we need to do, we can come up with some good solutions that work for everyone.

thank you. >> hi. good afternoon. jennifer friedebach, coalition on homelessness. thank you for having this hearing. it is an incredibly important issue. we have so many people out on the streets suffering from mental illness that we all see all the time. i think what we all do as a city and policy makers is oftentimes we look at the person and not ask what happened to them. maybe think what's wrong with them, but most often blame them for being out there, and very rarely do we say our system is failing, and the reason that they're out there is our system failed them. we have -- i know we have proposals in front of us, and people are talking about 1045, the coalition on homelessness

is opposing that. we do not think that's going to solve the issue that we're looking at. we think it's coming from a political perspective. we do not think it's centered around people with experiences, with psychiatric crises, and that's what we have to do. we have to bring them back in, figure out exactly what's going to work for them, instead of putting them in a system that's incredibly expensive and in the end doesn't add any capacity to our system, doesn't get us any further than where we are now. conservatorships, there's an organization across the state that have weighed in and said listen, the reason we're not bringing people in in a

conservatorship process doesn't change anything. i urge you to continue this conversation to really bring -- >> chair mandelman: thank you. next speaker. >> good afternoon. i am peter, and i am here speaking truth and power, free of all fear. so i got to wonder, what's the thinking here today? the homeless man on the street that talks to god, that talks to the creator, he's the one that's a 5150? or is it those in the system that are trying to work something out that never seems to happen, the same system that did the very same thing from the native americans from that time to this moment? a system that's run