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tv   Government Access Programming  SFGTV  April 12, 2019 2:00pm-3:01pm PDT

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i foresee that continuing to grow. this next slide talks about our access to treatment. we have a reentry team that works as part of our buy hear yoral health team. we're all working from the same patient information. if my jail bay -- i'm speaking talking about the weight on the d.p.h. side. from the moment the referrals is done or the authorization
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request for placement is done to the moment the linkage occurs. so for case management, the linkage could occur while the person is in custody. but for the other things i have listed here, those obviously indicate a release from jail and placement in the community. one of the things i mention briefly and katie miller will talk about in more depth is our mccarther foundation safety and challenge grant. what is so important and unique about that is it looks at the weights in jail from start to finish. it's not just looking at weight on the treatment side but also in the case processing and resolution side and i think that sort of more holistic and collaborative approach allowing everyone to come to the table and sort of air where we're not working well in a more open way and then really all commit to addressing where we can shorten the over all time rather than just focusing on one piece of
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what the time is from a rest too release. the wait for case -- so, when you say out patient treatment, what are we talking about? >> that would be an out patient mental health clinic. it's a lower level of care. it might be out patient substance abuse day treatment. it's sort of the entry level of care offer by community behavioral healing. so you still need medical necessity but it's kind of for the highest-functioning folks. >> if you need medication for your mental health diagnosis and you need out patient treatment for a substance use disorder, you can pretty much get those things for, just as involved population, pretty much immediately? >> yes. >> are these consistent with
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sort of folks who are not just d.p.h.'s weight times for people in the community who need to access treatment for schizophrenia or a meth addiction? >> so there's a great deal of consistency. actually i looked at that in preparation for today. the place where we see the biggest discrepancy is in the referral to residential mental health and duel-diagnosis treatment. and that is -- >> which you are about to get to. as you can it's a long way, 84 days. and investigating what that is about, i think there are several factors and one of which the patient on inpatient psychologist or and the other piece is. >> exactly. >> the other piece is
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challenging for treatment programs getting into the jail to assess the patients and that's not because of any barriers being put in place by the sheriff's department, it's frankly because it's sort of out of a lot of the programs scope in terms of what they regularly do. i think some folks don't particularly like coming to the jail. it can be difficult to get an interview room at times. >> you are having trouble finding community partners for residential treatment? >> we have the partnerships. i think that getting into the jail to actually see the patient is a challenge. >> say that again? >> health rate 360 created a position specifically to work with the forensic population and do in-custody assessments of patients referred to their programs. that worked incredibly well. we had someone who have clearance and they knew the jail and they knew my staff and they
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knew how to get into the jail. they knew what times to come and where the interview rooms would be full of attorneys or the jail might be on lockdown for count time. and we're definitely worked close with our partners to develop that same level of skill. it takes time. lastly, our locked facility waits, i just want to say with bringing the behavioral center online, those 40 beds, that's made a huge dent in our wait times. we've placed some people as quickly as two weeks. >> soon i think. >> that's on my last slide. you stole my thunder. [laughter] it's been a really important intervention that has allowed, particularly our misdemeanor and incompetent to stand trial population. there's case law around that and
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the lynn of time in which those folks need to be placed. it's 60 days. we've been able to meet that goal. some of the longer waits are the most severely impaired patients that get served and have to go to the state hospital because they're too high-needs for our local lot facilities. again, you know, obviously we work closely with the defense attorneys because -- a treatment plan like this, if the person's legal situation would allow them out in days. and the other thing i want to say about sort of mental health needs and working with the legal teams, you know, the population we focus on is largely driven by who comes into behavioral health court and who comes no drug court. that's largely driven by what
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their legal situation is. is it appropriate for the courts. is it the length of time they would serve in going the traditional criminal court about the same they're do on v.h.c.? we don't look at the population as a whole and a o. who are our highest need and highest risk patients and let's put all our resources there. a lot of that is because those folks often come in and out really quickly or they aren't appropriate for a collaborative court so we might not know what is going on with the legal case. the courts drive a lot of their work and so what the judge was saying about that comprehensive needs assessment i would encourage it looks not just at the collaborative court population but the population as a whole and really saying who are our highest risk, highest-need people and i think the ma caughter safety and justice grant will allow us to get some of that.
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>> it does seem broken, the people who are cycling don't get caught on the outside and don't get caught on the inside. >> the cycling once are difficult. those in and out quickly. it's really challenging. i still work one day a week at county jail 1 because i want to see who are patients are and what they look like and what's going on. that's why when i was working with the d.a.'s office, tara anderson from the d.a.'s office i asked for a position focused on the short-stay repeat users. because that's a real challenge for us. and i'm excited. >> we have the funding but we haven't hired it yet and if we can start to really link some of those people and identify quick connections in the community to get them to the level of care
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they need. the next slide is talking about cross initiative and the health commission resolution. i think just last week i was in rockville maryland for the policy academy and it just struck me what an important resolution it is because it talks about how public-health is an intervention for reducing and preventing criminal justice involvement and in every way and i think that is a profound move that was made, again, the multi police inary jail treatment teams, which i didn't mention those were weekly meetings with those between the sheriff's department and my staff to really talk about patients that are in maybe at high-risk or doing really well and could transition to a lower level of care.
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we've been very successful of getting people off of administrative segregation and into a housing unit where they can program and that has been a huge accomplishment. and then sb-145 which you are very familiar with and also very exciting about 80-1557 english panning ou1557 expandingmedicate jail. san francisco has been doing medicated assistance in the jail for decades. this is really an exciting opportunity to expand that service by having the funding to provide medication that is less
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easily diverted and expand to some other medication types and then lastly -- >> i want to step that down a little more english? [laughter] so,. >> this was introduced by assembly chu. we've provided people who come in and are in opioid withdrawal a human wayne and people who are methadone. we continue that, we don't cut them off. which you might be surprised to learn is which is the wait most entities do it.
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but, what we don't do is continue those people who have not been on throughout their incarceration and leave them when they leave. we're getting money to buy -- >> to start people -- >> to start them and continue it using a preparation that doesn't allow people to divert it and it's the film and the film adhere to your cheek so no one can sa trade them later. they're safer for the patients in the jail. at the time of discharge so it's a great opportunity that has been provided previously. there are two injectable forms.
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one shot every 30 days. which may be ground-breaking for our patients and then another shot liveatrol and it's. >> t-rex: trexone. one shot every 30 days. they're very, very expensive. it will be great if we can get some money from the state for it. >> the safety and challenge grant will talk about a little bit more but this is an opportunity that i have to say has really motivated and excited me is an approach to this population that i haven't seen and i'm really looking forward to see what the results will be. i'm confident that they will be excellent. and then my last slide is just a
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little look at them. i think you've seen this slide before. >> it looks at d.p.h. over the last few years and the appealing center is on there and the new addition tractor-trailer beds and also the 72 transitional step-down beds on treasure island for people stepping down from substance use resistance and humming bird place and intervention offers the years. it's important to note that all d.p.h. services serve the justice-involved population. some just do it more knowingly than others. and i think the direction that we at d.p.h. are moving in is really identifying criminal -- being aware of criminal involvement. being aware of criminal risk factors which often are exactly
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the same as health risk factors. recognizing that there's a profound difference we can make in someone's risk for criminal justice involvement and also in addressing the effects of incarceration. >> my questions, colleagues? >> i'm glad you didn't stop talk talking. thank you. we enjoyed that much more than your daughter. all right, so next up, we'll hear from kathleen conlee lacy. the program director for city wide case management forensic program. >> good afternoon, supervisors and thank you for calling this hearing. so my name is kathleen lacy and i'm the director of the city wide case management forensic program. which is under the ucsf program of psychiatry. our target population is individuals with severe mental disorders, most who have co
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occurrence substance use disorders and who are justice involved. our model is to provide intensive clinical wrap around services by a multi disciplinary team of psychiatrists, nurses, m.s.w. nba left case managers, peer specialists and employment specialists. we typically start working with our clients in custody. most of our referrals come from jail behavioral health services and the probation department. we collaborate with the courts and develop discharge plans and pick up our clients when they're released from jail and take them to their residential program and we follow them continuously for several years providing individual therapy, medication management, crisis interventions, group therapy, advocacy, with the criminal-justice system and linkage to everything from
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entitlements, d.m.v., primary care, employment services, housing and anything else needed to assist in their recovery. we currently serve 62% of the individuals in behavioral health court, which includes b.h.c. and our newer misdemeanor, behavioral healing court. d.p.a. contracts with us to have case management to 175 justice-involved clients. the probation department contracts with us to direct the clinical services at the community assessment service center and this consists of 220 intensive case management slots and we serve an additional 300 clients through groups and classes or drop-in support. the sheriff's department provides behavioral support to 40 clients and their no-violence
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case management program and to provide the assessments and treatments for individuals and behavioral health court. also, the sheriff's department, through recently through a bgaa grant has funded a city-wide clinician to be located at pretrial services to assist in addressing the significant need for behavioral health expertise at the early stages of the criminal-justice system. i wanted to highlight how critical they have been in providing behavioral health services to the justice-involved population in addition to d.p.h. probation has allocated nearly $15 million in ab-$109 to community based organizations to fund residential beds, detox
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beds, transitional housing and sro beds to help meet the demand for this population. while some more expensive services are reserved for individuals on probation, the creation of the one-stop cast reentry center provides a space for anyone to drop in and receive varying degrees of support and services. they were instrumental in getting state funds to help provide clinical services so we can expand b.h.c. to address the misdemeanor population and we showed remarkable outcomes for this and the majority of whom were homeless and 78% of them were receiving psychiatric emergency services in average of 3.8 times in the 12 months prior to entry and nbhc and upon
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graduation, all have stable housing, were engage in on going treatment and were linked to disability benefits and 12% were rearrested with misdemeanor arrests after the study period. the sheriff's advocated when the grand ended to include the funding to include this program in her budget which we are very thankful for because this was a very large gap that was addressed through her efforts. it's important for all of us here to understand who these clients are that we're talking about today. the people we're treating have severe psychotic mental disorders like schizophrenia and by polar and substance disorders, methamphetamine is the primary drug of choice for this population. most have experienced years of
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homelessness and homeless when they enter our programs. a frightening distinct wishing characteristic of the justice-involved population is the nearly, across the board experience of trauma at a very young age and continuous experience of trauma up to present day. it's also important to note that our clients are firmly entrenched in the criminal-justice system. these are not just one-time arrests. we focus our limited case management class on those who have been cycling through the jails and emergency services for many years. our clients are very high-risk in that they have committed serious felonies such as assault, robbery, arson. this specialized role as forensic case managers is crucial in effectively searching this population. we consider ourselves boundary spanners as we have to negotiate
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two very large symptoms. we are the bridge between the mental healing system and the criminal judge system because our clients are firmly entrenched in both which compounds the complexity of working with population. while we are lucky in san francisco that we have great collabbations between the courts, the d.a.s office, the p.d.s office, the sheriff's department and d.p.h., the two systems are not set up to work seem lesley on behalf of the population. this has an extra layer of public safety concerns that are not typically present in the general mental health population. and it rice clinicians to work closely with the criminal-justice system to ensure access to the behavioral healing services that they need. research is showing that just providing mental healing services to the justice-involved population, does not translate
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to reduce resida vism. we have to have risk factors and needs that they share with the over all criminal justice population. mental healing clinicians are not typically trained to do this which is why we need specialized services at every level of care. we need to recognize that this offer representation of justice-involved individuals with severe behavioral healing needs is a public healing crisis and we need to treat it as such. currently, we access the same behavioral services available to the general population, as tanya laid out for you. the problem is that our clients face that added barrier of cycle north and out of jail, which is increasing the likelihood of losing housing entitlements
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cycling in and out of the emergency rooms and ultimately our clients have higher mortality rates. we also know that individuals with behavioral health needs end up spending more time in custody than the average person. which compounds the exposure to trauma and exacerbates their symptoms. if we truly want to address this public healing and public safety issue, we need a comprehensive strategy that will allow a seamless continuity of care for this population. right now, we have amazing programs run by a many city departments. however, there's no over all plan or coordinating entity to make sure that the clients are smoothly transitioning through these systems. because of this, clients are sickelling between the streets, jails, emergency services and falling through the cracks. if we truly want to address the fact that our jails have become the de facto mental health hospitals of yesteryear, we need
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targeted services for this population. we never change the current state without coordinating the city department that's touched these lives. we know resources are limited and the result of that, instead of making clinical decisions on what would be the best option for a person, we're forced to make financial decisions that are not necessarily in the best interest of our clients. we strongly believe we need dedicated resources at every point of the mental health system and at every intercept where someone can come into contact with a criminal-justice system. so pre arrest to right before prison. so this includes additional capacity for jail behavioral healing services to plan discharges for all that need it, not just the d.h.c. clients.
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we need additional residential beds that allow for seamless discharges from the jails where we don't have to put these people at the bottom of the wait list. we need additional intensive case management that works closely with the criminal-justice system and it follows clients as they go in and out of jail and not because they get row arrested. we need anna ray and supportive housing both and traditional and permanent housing that addresses the intense barrier criminal justice involvement and access to housing which s. i know, housing is always an issue in san francisco. the criminal history and background can add additional barriers to obtaining housing. i want to end by saying treatment is not layered and i just want to emphasize it's a
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process and in b.h.c., i was one of the founding members of b.h.c. many years ago. we give people a lot of chances. we don't want them to fail. even if a person isn't successful the first time around, we will try it again and we will keep trying. some of the barriers that we have are that residential treatment is now funded through drug medi-cal mostly, which puts a limit of two treatment episodes in a year and that can be getting out of jail, going to the program, they decide that they can't handle it and they leave the next day, that's one episode. so, we need diversified treatment for people when they need it regardless of what drug medi-cal will pay for. tanya mentioned getting access in custody for community providers. this is crucial.
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my case manager spends a good portion of their week going into jail and talking to people and supporting them and trying to work with the defense attorneys to get them out and make sure they have the resources ready when they get out. we need to have a whole variety of housing types for this population. some people aren't ready to stop using but it doesn't mean we stop working with them. we need low-barrier s.r.o.s where they can live where we can find them. if we can't find someone, we can't treat them. we need to get the board and cares back that have all disappeared. we needn't of county board and d cares. we need communal living situations. where we have staff that can support the communal living
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process and help them be successful. so i'm going to end with that. there are models out there, we have talked about kind of getting more of a strategic plan for the city. i put something in your packet. it's the sequential intersect model. i can put it on the overhead. so this is a model that is used throughout communities throughout the u.s. policy research associates comes out and does a mapping with a community with all the people that are involved and looks at every intercept. we did a little bit of this in the jail reenvisioning workgroup. i think we need a more extensive look at our system and the numbers of people that are
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showing up in each of these intercepts and what services we have available in order to assess what the true need is. >> thank you. >> i have a couple follow-ups. two things i did not follow. so one thing that you said, which i didn't love, was that there's no evidence that mental healing services being provided to people in jail makes any difference at all. that's what i thought i heard. >> that's what you heard and that's how i heard it the first time as well. the research is showing that just providing mental health services does not reduce resid a vism.
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>> some phd tried to do something -- they are isolated and if you are providing other services, what does that statistic mean? >> so it doesn't mean that it's not important. >> it sounds like it. >> it does sound like that. it doesn't reduce recidivism necessarily. it does increase and reduce people's symptoms. it does increases people's quality of life. when they look at recidivism, all things equal, there's a risk needs responsive model whereon the risk factors which are no different between the mental health population and the non mental health population in criminal justice settings.
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so, if we really want to reduce recidivism, not only do we need to reduce symptoms, we those to address those risk factors, which are attitudes, beliefs, poor family supports, it's basically poverty. similar characteristics in the over all criminal justice population. >> it seems like it would be hard to address those without addressing -- >> i'm not saying that it's not important to provide this mental health services. that's not what it's saying. i am a mental health provider. >> are you just saying that now because -- are we reacting against this because we're dogmatic liberals or -- law no, we're going to reject your data or? >> it's not saying that we don't
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provide mental health services, we absolutely need mental health services so people with function. it's saying we need to address those risk factors that are bringing these people back to custody. which are is substance use, it's employment, it's your peers that you hangout with, it's environment. >> it's interesting it doesn't like, that treating or not treating the mental health issues that someone experiences wouldn't show up as making it easier or harder to address it. there wouldn't be a clear relationship? >> there is in a sense that interventions that they're talking about to address these criminaattitudes is cognitive behavioural therapy. the research that's currently being done actually we are involved in a research study with jennifer scheme to test out
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this intervention, which is a pretty intensive c.b.t. group program that addresses thoughts and beliefs which lead to behaviors. in order to participate in that treatment, someone needs to be fairly stable. they need to be on their medication, housed. they need not to hearing voices constantly in the moment in order to be able to engage in that intervention. >> thank you for that extremely confusing statement. >> you asserted something controversial. something was not always popular. >> right. >> can you restate what that was and explain it? >> sorry if i was not clear. having dedicated beds for this population. >> dedicated beds for just
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people coming out of jail? >> for the justice-involved population that has behavioral health issues, i'm saying if we truly want to reduce the people that are sitting in custody by 300 beds, we need targeted services for this population. we have to get away from just giving them -- having them fight for what is already out there for everybody. we have to be real. >> you are not saying because the services need to be different or you need to have particular residential treatment facilities that are specifically for forensically-involved. you are not saying that? you are saying it because you have to commit to having those spaces. it could be in the same
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treatment facility and you have to make sure -- >> i also, like tanya was saying, your traditional mental health programs who are not working everyday with the criminal-justice system, it's a complicated system. so if you are not set up to be working with them everyday, its reinventing the wheel and a waste of resources, to be honest. if you have programs that are dedicated to this population, all the collaborations are there and a lot of things can get involved for the benefit of the client that otherwise it becomes time-intensive and it's like reinventing the wheel with every single new client. >> thank you. >> wher you are welcome. >> vice-chair stefani has a question. >> thank you. it goes back to the recidivism
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but we didn't like what you said. [laughter] >> it's not my research. >> i know. >> i didn't like it when i heard. i tried to get jenn scheme here to talk to you about this because it is the most recent accepted research in this field. >> i just want to -- when judge dorfman was here he handed out this and basically talking about rearresting in san francisco. maybe it's two different things. obviously, a analytically whater information being looked at is probably being looked at differently. he said 78% avoided arrest within one year of graduation and 66% within two years of graduation which leads me to believe that behavioral health court is doing what it is set out to do. and i'm not saying what you provided is saying otherwise.
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for me it's just incongruent and i'm a -- if you can explain what you first said about what i just raised. >> yes, absolutely. they are very successful programs. it is a model that works. let's just say that. the reason it works is because we are addressing those risk factors in addition to providing them no mental healing services. >> perfect. thank you. >> i know. [laughter] >> we're here to provide more provocative in sight. katie miller with the district attorney's office. >> i'm not going to go down that rabbit's hole. other than, i think your last question and what kathleen is answered is exactly the point, right.
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that we know that we need really good behavioral health services for the folks that are coming through the doors of our building. and we also know we need to be addressing their risk factors and that is why having behavioral healing clinicians and service providers who understand the expertise necessary to provided that added piece in the justice and important. >> congratulations on your award. >> thank you. >> it's funny because i feel like i'm maxed out on speaking well last night and it's not going to happen as much right now. i am here today in my capacity of chief of programs and initiatives and that includes overseeing the units that do both our collaborative courts and our mental health work. it's funny, every department is rolling deep here today and so
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from my department i have tara anderson who is managing the macarthur grant and ronnie singh who is a managing attorney of our mental health and collaborative courts units and susan christian who is in both misdemeanor behavioral healing courts and mental health diversion. we're all here if you have questions. really quickly, because you've heard a lot of information, my role is just to talk about two things. right now and then of course answer any questions you have. this is a subject of great importance to him. he really is wanting to be talking about solutions, new ways of doze things and very honored to work with kathleen, jenny johnson is it here today and some other great thinkers to propose the idea around behavioral health justice and how it looks in the city. we have opinion talking a lot about the fact it feels exciting
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right now to be talking about these issues collaboratively and anew. i have a few things to touch on. the first one is the mccarther safety and justice challenge grant that tanya mentioned. we wanted to give you information on it. it is a good thing to keep in mind right now when you are kind of muddling through these complicated issues. so the safety and challenge grant is active actually in 52 jurisdictions across the country and 32 states. san francisco is lucky to be one of those sites. and i have to give a shout out to tara anderson for writing the grant that brought it here. the point is to implement strat goes that address the main drivers of local jail populations. and so, our goal in getting that grant and bringing the resources to san francisco is to reduce our jail population successfully that we wouldn't need to build another jail. so for us right now it's a 17% population reduction.
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it includes our office, sheriff, court, public defender, public-health and california policy labs, which is a research institution, this is with u.c. berkeley and ucla, they've been a great partner to our departments in the city helping us all do some new, cool things with our data and our data together to really better understand kind of the challenges we're facing. and according to an analysis that's is driving the work of our safety and justice challenge, and the population fall into key cat gov he's, it's people in and out quickly. it's people who are in and out for relatively short periods but over and over and over and it's people who are there for a very long time and the second two bullets points are the people that come to mind for us. folks who are continually cycle north and out for low-level offenses and maybe not getting
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attached to the services they really need and the people who are in behavioral healing court waiting a long time for that bed. so the role of the project is to look at those three populations and figure out what we need to do differently as a jurisdiction. one of the key strategies that the group working on it that is collaboration of our departments has been focused on, is to address people specifically who need behavioral health services in san francisco's justice system and the team has started developing a strategic plan looking at that piece and some of the components of that plan include reducing time to treatment, reducing time to case resolution and identifying who the high users of multiple sims tom are. the people coming through all of our doors repeatedly. and i want to highlight something that tanya said earlier, i know the focus of today is really talking about kind of length of time getting someone into treatment. that is a really big issue that
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we're all really working on. you know, all of our department have a role to play making sure they're out to the help they need as quickly as possible. if you put the person at the center of the process it's not important how many days they're in jail. they're in jail. it's great about the orientation of the safety and justice challenges that makes us all come to the drawing board together and figure out how to make all those pieces work. that is why we need both enough services but also a systematic approach to what we do. so we can know as a jurisdiction that we have that end point of services for them in place. so it's a really great thing. the way it's brought our agencies together is incredibly positive. i feel like you've heard that now before from multiple people
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talking today. it makes me really optimistic. it doesn't bring money for direct services. it's worth noting that. it does bring us some positions, including a position in the jail that is really going to be eyes on who is there and who has been there for a long time and what do we need to do about that person? it brings the division that tanya talked about on her staff to make more connections for people and services and the data analysis and supporting this population. it's relatively low in its personnel but it gives us access to some of the best thinking around the country on this right issue right now and experts and people that can bring us more ideas. hwe want to take advantage of that. one of the the things is this idea is getting and completing a needs assessment and gap analysis for where we are and where we want to be with these
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services. i know supervisor mandelman you asked the judge, how much do you need and we all tried really hard to condition ourselves to not come here and not shouting things out, 30 beds! it's really hard not to do that when we feel like there's a will to bring us the services we need. the reality is we don't know the scale and specifics of how short we are in terms of what kinds of services we need for the folks who need mental health and stance abuse treatment who come through the criminal-justice system and if we make the investments about what we need for people. an example of that is we know we need more residential beds so we know they carry a high cost. and sometimes there may be folks who we in the d.a.'s office, we as an agency and others may be pushing for a residential treatment for someone because we don't believe they can succeed in out patient treatment because
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they have no place to sleep at night. if we had the appropriate treatment for them, less expensive and a place for them to sleep at night, maybe they would be successful and we wouldn't need the number of residential beds we asked for. we want to spend time digging down and understanding what the real kinds of programs are that the people coming into the jail need and i think we're at a moment where we could make that investment and do that real analysis. >> i believe voice chair stefani has a comment or question? >> yes, so when you say you don't know the dal scale and specifics, i want to know how you think we get to that information? what is the best way? what can we do to -- i've heard comprehensive needs assessment three times now from three different speakers. that's what wore trying to do. i would love to know how do we get to know what the scale and specifics are? is that something for dr. bland to do as the new mental health directors? what is the mechanism to get that information so that we can
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then invest wisely? >> sure. so i think that what i would say the best answer is is to actually work with an outside independent researchers on this and the reason that we would put that forward as a model, there's two reasons. one is that what's come up in the past for us is concerns around the appropriateness of sharing data. so there's hipa concerns, sharing criminal justice data but we know the law allows us all to be sharing that data in an appropriate manner with an outside partner. i will say, as an example, california policy allows and has done a lot with san francisco agencies in the last few years so they've had health department data, they've had information from the sheriff's department and they've become a great example of an outside organization partnering with multiple department this is this
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city to bring data to them appropriately which they can do pursuant to federal and state law. they bring information back to us in ways that aren't tied to individuals. they can help paint pictures of the different kinds of needs and different traject tories of the people coming through our system. so i think we stand in a moment now we are we have partnerships in place and we can do that and there's a group of us working to schedule a meeting through that process to sit down and ask as group. what are all of those questions we want answered? and also, i think it will take a commitment from the city to actually pay for a contract to do that work. putting that out there. >> what do you think the cost of an analysis is? >> i put $500,000.
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i want to say about that is that is in the heart of the newed money we would need. we do have some ability through some existing partnership we have through some of the mack agentemackauthor work to bring t pricetag down and use services and and money and resource 0 other places. i don't know today, standing before you, what the ultimate kind of reduced cost would be that i would submit. we can work on that for you. that kind of evaluation does take money. it's a reality. it would get us to a more efficient set of answers to help us be smart about our comments. >> i guess the thing that's -- well, ok. so, how -- how long do you think it will take to figure out what the path forward looks like and then how long do you think that path is?
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>> so tara -- >> i'm going to have tara talk about that in the context of the grant because they fit together so well and she is better versed in it than me. i think those kinds of things take a couple of years. it's a reality. we may be able to have shorter term answers along the way but i want her to speak of it if that's ok. >> the challenging thing for us as policymakers, legislatures, is there's a critical crying need out in san francisco right now and there's also these gaps that we can see right now and we happen to have and be in a position where we have money that we may not have in three years. and there are also -- my concern is spending years studying a
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problem to address it later. we've been studying the jails now, the jail issue for three years, something like three years. it doesn't feel like we've gotten real close to a solution. i take your point that there's smarter ways to spend money and less smart ways to spend money. we don't want to spend money on the most expensive intervention because it's the most obvious to you because when the cheaper one will get you further. we need that analysis. i'm concerned about saying yep, we're going to deal with this in 2022. >> absolutely. i'm not saying we shouldn't be doing investments in the meantime but i'm saying i don't think that we can answer the question with accuracy when the question is like what do we need right now? i think it doesn't mean don't try. we know we need anna ray of rayf
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services and we need this so we're operating as smartly as possible in the future. at some point we want to make sure this happens. >> throwing away all of my fears. >> concrete time lines associated with the safety and other resources ta come to bear because we're an implementation site part of that initiative. we actually are in the final stages of our accept and expend. the second and final reading on that matter will take place next tuesday, 10 days from that we'll get the mayor's signature or sooner and the permission to do the hires discussed today. some are important in terms of fogginfog forking the analysis e third party researcher that's been suggested but also with the
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a decisional resources is there's a specific set of money that is a federal resource for us that partnered with mack author and we'll have that available on the ground technical assistance to take us through something like the intercept model but maybe targeted a so that is a research over the next five months. also the timeliness that katie spoke to in terms of having all of the data use agreements and willingness to share data that previously sat siloed is upon us. just last week, the department of public-health committed to giving data identified data to california policy lab to do this more comprehensive high-utilize erinal sis.er analysis. in the past they've said in the system of care, who is
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frequently in hospitalization, who is accessing what other aspects of this system of care costing the most to that system and then you've had the jail within their own data saying who comes to us the most often? [ please please stand by ]
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>> so that when they are ready to engage in treatment, we should make sure that treatment on demand is truly available. there are some things to me to your point in terms of there is more we need to know from more comprehensive investment, but there are little pieces that we know today to make the right sense and can be investment for today. >> do you need additional resources for this work that you want to do over the next six
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months, or you've got what you need? >> we will need more resources to do that. >> along the lines of $500,000. is that something that has gone as part of a request for them to fund? >> no. >> okay. thank you. did you have anything? >> we do have the sheriff here, and if you had anything to say, i wanted to invite you up. >> first of all, thank you, supervisor, and especially supervisor madeleine -- madeleine -- i'm hoping all the supervisors will watch this because i think there was a lot of information here today. i think calling other hearings to address additional items, i
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think one of the things we might have missed a little bit was the prejob releases and what that is contributing to what is happening in the behavioural health, and we have a lot of people who are now with the humphrey decision, i think the study that tara referenced a few years ago may have shifted a little bit, or there maybe more high returns to jail because of the humphrey issue. i think people are getting out faster and coming back faster through that. that is something to look at. and to look at people who are getting out on on case management and pretrial that have mental health needs and what is happening with them. i think that would be another part that you might be interested in. i want to say that i fully i'm glad to see that we have updated and we are working with the sequential intercept model. that is something that you and i talked about a while ago, i would also say in terms of the data issue, i would hope that the board here ends the whole
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board will really support the justice program reset for the data collection and the data working. i just don't want us to forget that. everyone always talks about that and we don't have data. we are not able to put things together, and that is an integral part of making sure as a city we can do that. i do have a concern that the county jail is still opened. it's a horrible facility and it needs to be closed, i am not seeing much help in getting to a place where we can have a decent facility for people who are going to be in our facility as part of a sequential intercept model. we need to make that the best possible place we can. and i will just -- i was happy to hear you mention it, and i would just say we would not to like to forget that this part of
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the model. today there is three people living there. it will be much better in meeting the needs of our population, and i would also comment that 50 3% of people who are just as involved in this are out of jail on pretrial release, and i just want to make that comment as well. of the entire group that would be in jail otherwise, at least 50 3% are out on pretrial release, and that's a system that has its own momentum that i imagine we will be wanting to look at at some point as well. thank you very much for having this hearing. i really appreciate it. >> thank you. and then we have a number of folks from the public defender's