for psychiatric emergency services. and i'm here and dr. mark leery to help answer questions, with relation to p.e.s. can you please repeat the question at the time and i want to make sure that i answer that. >> so tracking of placements, outcomes, -- and brought to p.e.s. is there some sort of central tracking database for those folks. and what happens to them, who is serving them, what outcomes are for them. and then by extension, do we have that for our system as a whole? so for that subset, which is a significant one, my concern is there is -- and this is i think part of your mandate here, is that we have a lot of different folks who are delivers services, a lot of contracting out at various levels. and the concern is, as you know very well, people really, you

know, falling through the cracks, because we're not able to track where they are. and whether they walk out, you know, referred somewhere and they walk out the door one day and then we lose track of them and we don't see them again until they're 5150 again years from now. how are we addressing that sort of broader systemic tracking and case management? >> thank you. this is such a really important question to ask. i'm certainly very concerned about people simply falling through the cracks and we're not able to meet them. what happens in most systems and our system also has its own constraints around our data processes. however, a common process for that data to be integrated in the ccms. and that data feeds from p.e.s. medical record, electronic medical record into ccms. some data fields that are coded properly, there's some data fields that we have learned

recently, based on the previous hearings, that are improperly coded. i want to be clear that when an individual is in psychiatric emergency services, every individual is assessed for their needs and assessed for their after-care needs. the process for connecting them to those services has been less than ideal. i appreciate earlier that one of the b.l.a. analysts reported also around there's certain individuals coming to p.e.s. who may be privately insured. another factor is we have to respect the patient's choice, an individual may choose to decline those referrals at any given point in time. in terms of what we need to do around our data collection process, we're certainly excited to be going -- that the hospital system is transitioning to epic, which allows us to communicate more efficiently and directly with our outpatient health

services. it is a major goal for ours to make sure no one falls through the cracks, because we're unable to communicate in realtime. >> so my understanding is that it doesn't exist right now, to the extent that it exists it's not entirely reliable, some folks may be in it, some folks not. some folks might not be totally updated for. and that we don't have single way to keep track of the folks serving, many of them touched by multiple service providers and referred in various ways or comfort from multiple visits for a variety of reasons. >> every person who receives services is enter into the the common medical record for the hospital system, which needs over into the ccms system. the challenges in terms of which data fields and information is being pulled across the systems is one factor. the other side of this is the

outpatient behavioral health system record, which is avatar. all of our p.e.s. records, received services in p.e.s., whether they're connected to an outpatient behavioral -- and so the information is collected, it is in a -- it does come together at some point. however, we want to certainly be able to really consolidate that as much as possible. >> great. okay. thank you. thank you for that. i have another came of general question along the bottlenecks are. maybe a little more general. we obviously -- anyone who lives in the city and certainly number my district, there's just a tremendous need around mental health and substance abuse-related treatment and services. and understanding where the -- where the capacity needs are and how we can more aggressively

address those. i think is something that i'm trying to get out of this hearing. i'm not seeing the level of planning and strategy around meeting the capacity. and really understanding where that need is. so, you know, there was supervisor ronen quoted an article that said, you know, there are a few places to discharge mentally ill outpatients, few facilities where they can't do harm to themselves or others. and, as a result, we're releasing folks back out on to the street or very little connection to services. where would you say the greatest need is in terms of expanding

capacity, where -- when you were at p.e.s., do you think you would have liked to have a lot of people sent to or have access to, that you weren't able to because of capacity? when i look at a number like near 3,000 that have been 5150 or 5250 and a few beds, it looks like what may be happening then is that we're finding ways to quickly determine that people have been stabilized, and sending them on their way, because we don't have the ability to send them to escalated levels of care. because of capacity issues. so wouldn't necessarily be reflected in a wait list. it would be the way we have to do things, because of the triage that's taking place. can you speak to or somebody around the capacity that is really needed. for people who look at what's happening out in our city and our streets, and even what's

coming into the hospital. it doesn't look like the beds are near the level they need to be to serve all of those folks effectively. >> this is where we went into our policy recommendations and that was the last page of our slide. because we agree that bed capacity could be increased, right. which is why -- the idea of increasing the psyche respite beds or the behavioral health respite beds. we can start pulling people in. those are the folks that aren't really wanting direct service care, but it's a place where we can engage them and start the process. and certainly co-occurring treatment beds. the outreach services -- i mean, a lot of this is what dr. bland was talking about, unless they're in involuntary status,

we have need the opportunities to meet them where they are, to engage them in services. that's why i feel like our -- one of our greatest opportunities lies. do you have something to say? >> i would agree with that. we want them to know where to go. and many of those people are coming to psychiatric emergency services, which i think accounts for some of the return rates that we're seeing. we're as more and more

individuals come to p.e.s., we certainly want to maintain access for an individuals and so we had to do some efficiency projects. and looking at where's the most appropriate place for an individual who is no longer in the crisis state, to continue their care and continue their ongoing stability. and that was the impetuous for the pilot program. it's moving people from the most acute setting, which has the own risks to a more appropriate setting where they can continue on the care continuum. now the great thing about the project, it clearly increased the volume of activity that occurred at the urgent care clinic, significantly i would say. they can speak to that, steve shared the data with you. the challenge is how do you

again develop an efficient process to move people through from the urgent care clinic into the acute diversion unit. that's something i'm very much interested in partnering of steve.

he says that has never happened. i wonder how this outreach, and i appreciate the expansion of the outreach in general, and

again, i live in the tenderloin. i haven't myself seen direct outreach in that way. can you talk about how the outreach actually operated in practice? are folks going out one-on-one to try to connect people pro actively with services. one of my concerns, yes, there is a population that is going to ps in various ways, in terms of population in need and in the city with an on demand policy, how are we serving that population pro actively because it is the only way he will get connected is 51/50 or going to jail, that is a broken system.

>> we can speak to lead. we are talk about outreach in lead. >> he is not charged with any crime that i'm aware of. >> please excuse me. i just literally walked in the door, i heard the gist of the question. i can address the lead program we take referrals from law enforcement so they are out in if tenderloin and can do referrals to our program. it doesn't have to be arrest situation they can do referrals to lead for individuals they know are at risk out there. the lead case managers and outreach workers are in the tenderloin each day. even those not referred by law

enforcement. the case managers are engaging with people that are not referred. >> i am familiar with lead. there are a lot of people out from actively using drugs or having dual diagnosis or experiencing homelessness that, yes, and how we are doing outreach to them to get them support or get them connected in a proactive way i want to better understand in nighttime and 24 hours, you know, it seems to be a huge need. i don't know. i understand what lead does and who is responsible for that? >> who is responsible for reaching out to people? >> is that happening? how many people are being connected? it seems that it is a huge area

of need. >> okay. >> i think our most under served -- most underserved time is evening to overnight. during the day they have fest the engagement specialist team in partnership with department of homelessness who felt some of the clients had more distinct behavioral health needs and a team to go do assessments and engagements. the normal protocol is by calling comprehensive crisis, which is a partnership with the assess team embedded within the team. they can also call 311 and homeless outreach will dispatch through to us if they feel it is something we would be better

equipped to manage. >> it says two hours during the day. if somebody is on the streets, in crisis, in need and you want to call to get that person some support and some help, i am worried that we don't have. this is not a situation that is medical 911. let's get this person into the system to try to get some escalated level of care which they nay accept voluntarily. i am not clear how that is happening. >> response times aren't as ideal as they can be. part of the purpose of assessing out is they are in the tenderloin and mission walking the district specifically. hopefully they will be more responsive than coming through. >> thank you. supervisor walton. i want to shift a little bit.

i know a system of care is difficult. if we look at slide 11 and talk about the work force vacancies, i want to know what plan is in place for recruitment of the staff level needed. by this date and time we want this percentage of vacancies filled. what is the recruitment plan and the strategies and goal to get fully staffed up to adequately address the needs here in the city? >> are you talking about recruitment across the board or specifically psychiatry? >> i am talking about slide 11 what you need to get the job done. >> right. well, i know there are union negotiations to assist us -- i am looking at it. >> let me ask a different question. negotiations probably has nothing to do with what i am trying to get. what is the recruitment plan for

filling vacancies next year, next three years and then how much percentage of the budget is dedicated to that recruitment to have the staff we need to be successful in san francisco. >> thank you. we have a two-pronged approach working with our hr. as you remember several months as mickey callahan announced the recruiters at the hr. we have also hired recruiters one priority is filling mental health vacancies, psychiatrists, social workers and therapists. our plan is to really utilize those new resources. up until six months ago we didn't have them and hopefully put a dent in the 20% vacancy rate reported there. >> i had to deal with the school

district. every year we have about 500 vacancies. they have no plan to recruit teachers. the data showed every year. when can i see a plan what dph is doing to fill the vacancies to address the mental health needs we need in san francisco? >> we can get a plan within a week. >> madam chair i have a question about san francisco general no longer referring patients to residential treatment. that is not true they never stopped and they continue to refer them. >> supervisor ronan is going to continue her questioning. i want the public to know this question is going longer than we anticipated. i have released the police

department and also the sheriff. i want to thank the sheriff for coming. thank you for her press here. we will have them report when we have a hearing on the cost of incarceration. the sheriff will be happy to present her findings at that time. we will continue with the questioning of the department of public health, and i just also want to thank you, the community folks presenters for patients and to let folks know the police department and sheriff's department will not present today. with that i think we have supervisor mandelman on the roster. >> i will be brief. i want to underscore the point i think my colleagues have made the need for better data out of dph. i think this is an issue the budget and legislative analyst

have been trying to work with the department on public management is a challenge. this is a vast bureaucracy, but it is clear that we need better data, and i think that doctor colfax, i think, understands that, and is going to be working. i imagine we will not see an overnight change. this will take months or years to get the data. it is difficult and frustrating to make budget decisions when we don't have the information and the mayor doesn't have the information that is helpful to o allocate scary sources. that is a view i share. i also just, you know, the other thing i am reminded here. supervisor ronan and i over the

last two years and me over the last year within the public health bureaucracy and our partner organizations. one of the things that has been challenging for me is how the perspectives are from different -- depending where people fit. one of the acciden the the excif having the doctor sorting through the perspectives and data and figure out the data we need to get more truth. people say all sorts of things and have all sorts of understandings why the world is as it is or what is decided by sf general or the basis for decision about where people are routed. i think, you know, one of the things i am greening it is hard to figure out the actual truth.

i wish you luck, doctor bland. the last point i guess i would make about the data. the wait times, figuring out the right wait times is useful. there are two things left out. one, i i think earlier we said forcing people to treatment doesn't work. sometimes people are involuntarily treated. people in psychosis are not in a situation to engage in a conversation about their treatment. the need for step down locked facilities, which was a bit of a fight, actually, the addition of 14 healing center beds was not something everyone was excited about doing. iit is clear to me those step down locked facilities are important and we probably don't

have enough as it is. they are expensive. it is hard to treat and meet needs of our sickest, most vulnerable without spending a fair amount of resources. we spend them on them whether we care for them or not in a systematic way. we do need to find the place meant for them which in some cases are going to be locked. i think it is important to understand that and not shy away from it. there is sometimes a role for treating people who do not know that they need treatment. that does not mean we do not need to dramatically expand access to voluntary services. it is incorrect to allow ourselves to believe that if we fixed all the wait times and allowed everyone trying to voluntarily access services to get in we would not still need to provide services for people

not voluntarily trying to access those services. what is left out of the charts is who is not going on the charts because they are not saying sign me up, the folks one of the things that has come up in the meth task force is how challenging to impossible it is to have a meaningful conversation about treatment opportunities with someone who has recently been psychotic, who is on the merry go round or hamster wheel. that is the hard population to get into treatment, and may need, i would submit, some time-out that may not be on a voluntary basis where we can get the drugs out of their system and maybe be able to have a few months down the road a conversation about whether treatment, you know, may be appropriate or something they

want to pursue. those are just kind of my thoughts at this moment. i do want to thank the folks in dph. it is hard you haven't had a leader for some time. there are clearly weighs in which dph has not been functioning optimally around this question. there are a lot of great people doing a lot of extraordinary work in a system that hasn't quite made sense or sometimes worse than that. thank you. >> i also want to ask our public speakers for patience. if you can't stay, i apologize. i have so many cards. if you like to submit comments in writing we would be more than happy to accept those. supervisor ronan. >> thank you. i wanted to follow up because i have been texting back and forth

with steve fields, who said that they stopped referring to the transitional programs in april after 40 years every ferring stabilized acute clients to the transitional programs. i don't know if kelly can come back to the mic. he said it is her understanding d ph stopped referring clients. i want to understand the truth what is going on and why. >> there is a drop. it isn't they stopped completely. iit is a stop because of the 30-day wait. you can't do that on the in patient unit. if there is not a bed immediately available they skip over it. they look for alternative destinations. if it is in the window of three to seven days, we are willing to do an except to 10 days stay on

the in patient unit the flow has to flow. >> where does the person go. >> alternate destination. hummingbird to shelter to hotel. >> do you know how many people are released to the street? >> i had them pull that recently from the in-patient treatment. i have it from the treatment program. >> i don't have in patient. >> from the treatment program what do you mean? >> completion of the treatment program how many discharged to shelter or street. about 44%. >> wow. >> that speaks to the need for housing. >> right. it is a particular type of housing that has a health connection. why isn't that something dph is asking for. >> because housing isn't under dph any more. >> it is not divorced from it either. if we stabilize someone and

release them to the streets, how often are they going to come back on the hamster wheel back into the treatment programs? we don't, i guess, keep that data. that is an extra figure, extraordinary figure again. >> for a while dph doesn't have the housing component any more. we work with hsh and let them know our needs in terms of housing. we shared that with them. they are good partners and are listening and are hearing our concerns and trying to meet them as best they can. >> it is someone who had a psychotic break, was found not to be, you know, not a danger to themselves or others, sent to acute unit, given treatment for

ho knows how long and returned to the street where it is impossible for someone to get well. it is extraordinary to me there is no one looking at that whole. this is not new information. is there anyone, you know, trying to come up with a vision of how we serve these clients better and really meet this goal of ours that we truly believe in? i share this, we truly believe and have seen with proper care and treatment people can get well and can become productive members of society. we see it all of the time in some of the community-based programs and co-op housing programs through progress, through positive resource centers, and yet in the budget ask, it is extraordinary to me nobody is asking for more of

those services. we know they work. we could stop this cycle. you know, i know everyone is well-intentioned and working hard, but i am just shocked by the lack of vision and truth telling around what we truly need to stop seeing people walking around this acute crisis in our streets that is the number one thing that those in san francisco say is a problem in our city, that is morally wrong, it is dangerous, and that we have known about for a very, very long time. yet i have not heard once today anybody talk about this figure that 44 people are returned back to the streets. it is disappointing. the last thing. i know people in the public with a ton of experience in this

issue want to talk and tell you what they are telling me. the data we are getting is not true. i want to hear from them directly. they can tell you this data is off. before i do that, i just wanted to ask the da's office who i think is here. is there anyone still here? hi, katie, i didn't know it was you. good morning. i was pretty shocked to see the numbers in the bla report around the low numbers of graduation rates from the behavioral health justice court and drug court. can you speak to why you think that is? >> i do want to give what i think is a clarification about it, and acknowledge i think the way the graduation rated was calculated for behavioral health court is based on the number of

people who had an appearance in the court. that is not the way the process works. somebody may come to the court to be assessed to see if they are suitable and the legal back and forth whether we can reach a disposition we all agree on. i think if you look at the actual enrollment numbers and compare that's to folks who complete it is different. i think there is a methodology question. >> what about your experience in accessing different levels of care? >> sure. i would say this. i don't have firm numbers and kind of weight times with me today. i do know when we were here speaking about behavioral health court a couple ways ago they did a great job pulling together data around wait times specifically for folks in the jail. what i would say is that, you know, what the data doesn't

acknowledge in the bla report the disparity in wait times for folks just involved and folks in the community and we definitely see differences, particularly in the time to get into residential treatment for mental illness or for the disorders. i believe for substance abuse it may be faster from the jail to get into treatment. for others it takes significantly longer. it is something we have been talking about a lot and acknowledging the need to move forward on. there is many things about the time they are in jail that we need to address. the treatment is a barrier. i would say the other thing that came up when we spoke about this most recently here i would highlight for the members of the board is that i think there are

constraints around the medical funding. if somebody has gone through residential drug treatment twice in 12 months they are not eligible for medi cal funding. we know what recovery and relapse can look like for people. we have experiences for folks complete or not completing but go through and leave the programs multiple times in a year. we have them in custody wai waig for the clock totic. we have used the general fund dollars when medical cannot get us where we need to be. >> that 85% of the people in jail with the mental health illness diagnosis. is that accurate? >> i think that is specified in

here. that is not a diagnosis they acknowledge a history or a need. overwhelming what we see the people coming through the justice system with huge amounts of struggle in their life. it shouldn't be sure pricing to us at the end of the day is jail is responsible for housing the people that need treatment. we are fortunate to have jail health there. for us to ensure people can take advantage of behavioral health court, drug court and a new law called mental health diversion which offers offer from traditional prosecution. we need to have enough services to do that. >> that wait times you talk about, what are you talking about? what is the extent?

>> i am trying to remember. we were here a few weeks ago. i believe jail health can provide that to you. >> i think it is down to an average of six weeks wait. >> a year ago i visited behavioral health court. what i was told by the attorneys and i believe you were there. i can't remember. the reason that the program isn't successful as it could be the because you can't get the bed in the treatment facilities to make the programs work. if that is still the case, i think what i would say the way i would characterize it we have people who would be willing to go in the program in they weren't waiting as long as they are to get to the program. i have to give a hand to the folks across the aisle from us who are really trying to work with their clients to explain

the value of treatments. it is hard when they could enter a guilty plea to leave jail. we know having treatment in a timely way can promote as many people as possible to benefit in the programs going into them. the other thing to add together is when we spoke a few weeks ago. i think it is really important to make sure that our treatment providers have the training and the will to serve folks who are in the justice system. we come with a whole set of other kind of requirements and expectations that can be hard for folks to work with. we want to make sure we have the quantity of services to serve everybody but folks can serve the people we are frying to find help for. >> i want to end this before hearing from the public. i appreciate that doctors are in

these very new roles. this is not a new issue in san francisco. it has been one of the most important issues in our city for a very long time. a year ago we got an excellent report from the budget and legislative analyst that had very specific recommendations about immediate ways to improve our system of care, and a year later i don't see that much change. i see for the first time a request addressing for budget increasing addressing some of the needs like the need for intensive case management. when we dig into some of the other things like the peer support system at ps, we are only talking about, i guess, to get people to hummingbird which

is full all of the time and we don't have enough capacity. the budget request is for more capacity. without presenting a vision of a system of care that works where we can say to those in san francisco whoever ready see people wandering the street in crisis. this is what our system works. these are how people are talking to each other, this is how we get them in. if the answer is that these services aren't the ones they want we have the wrong services. it is upon us to create the right services. the stories i hear is people want the services or can't get them or can't get them in the moment of clarity when they want the services. we lose them and you know there are efforts to do the more involuntary treatment. until we get people, the

immediate access to services voluntarily, it doesn't make sense that we are going in that route. we don't have that system of care in san francisco. nothing i heard today gives me the confidence we have plans to create that system. that is something that is deeply concerning to me. i want to make clear that i understand sometimes there is a need for locked wards. that always must be part of the system. i am never in any way, shape or form saying we don't need that. i am saying we don't have enough of what we need in terms of step down. every time we asked for it we are not getting clearances from the department. it is something that i will continually be pushing on, but today i have to say unfortunately i walk out of this hearing feeling less confident

than when i walked in, and that is a shame. >> thank you very much, supervisor. this has gone on a long time. i am going to be very brief. we have one presenter and a lot of public comment. i want to go back to what my colleagues mentioned about the lack of data. specifically data on outcomes. what i see i would like to know what the average length of stay is for under these categories. we are seeing better results if people stay the maximum amount of time and then also i would like to know when we said that we have also surplus dead wednesdays. what is the number we actually have at our disposal. this is missing. you can take it with a grain of salt. what i think is misses is that over arching mission statement about what we believe and what

we think our responsibility is in our delivery. i feel like it is all over the place. i think a mission statement that would encompass what our belief system is but also about what we are responsible for delivering also, and would help guide us around priorities and what we need to meet that mission goal. thank you, dph. i believe that supervisor ronan has requested data points. if you would submit those i am happy to continue this to the call of the chair and call it back for data points. also supervisor walton's data point around recruitment. the next speaker the community presenters, bill hearse and cw johnson from the mental health

association. thank you for waiting and thank you for your patience. >> i am not steve fields. i have prepared comments from steve to share with the committee. i wish the community presentation was better put together today so i apologize for that. i know there are plenty of folks to speak. i am bill hursh. my professional experience including work at mon traditional health program and directing a legal service program and directing mental health association of san francisco where i advocated for additional support of housing and serving 20 years as executive director of the aids panel in san francisco. addressing the legal needs of those living with hiv who have

mental health issues as well. you will hear from speakers from a range of populations and service modalities. underlying all of the testimony is the simple message housing is healthcare. it is impossible to address the health needs of people with mental illness, substance use disorders and people living with h.i.v. if they do not have access to save, affordable housing. while most folks believe the people who are homeless living on the streets got there because of mental health and substance abuse. for many the trauma, violence and deprivation they face on the streets is the cause of mental health and substance use disorders. two weeks ago at the budget hearing on homelessness i cringed when i heard about the

housing ladder which exists only to help move folks from independence and housing. it is a terrible metaphor for the crisis in san francisco. a better image would be of a stuffed up sink. the system is clogged. there are not enough treatment beds, shelter bedding beds, fols are discharged from hospital to streets. that makes no sense. we may not be able to solve the entirety of the crisis we face in one budget cycle. surely we can address the needs of the much smaller number of folks coming out of hospitals, residential treatment programs and transitional housing so they don't become homeless immediately after getting health stabilized. there is no system of care in

san francisco. there needs to be leadership from the city and resources dedicated to addressing the needs you touch on today. i would welcome the opportunity for a more expensive dialogue with community stakeholders to address the service delivery system and what can be done to create a continuous care to provide real sustainable solutions to the mental health crisis. it was disheartening this afternoon to hear about the lack of funding initiatives from the department of public health. i think we can agree the crisis demands additional resources and hopefully you will hear more about some of those specific funding proposals from folks in the community i am happy to share the comments from steve and cw can come up now. thank you.

>> hello, supervisor. i am cw johnson with the mental health association to make a statement from the mha. i have to read it. i got this at the last minute. i will try to make it as quick as possible. i know people are waiting. thank you. i think i lost it. at the mental health association of san francisco. the motto is at our core. prioritizing early intervention based on the recovery from their own mental health challenges to support those needing help. far too often members of the community are only introduced when they are in a crisis or

treated in the er. they are incarcerated in the county jail. that cannot be. population health management to return to early intervention. we are pushing for integrated outpatient and community care to incorporate peer support. we would like to see partnership among the community organizations to test this model where we can create a continual care with at line of caring and supporting a particular population in our community. it is critical to show the value of volunteer community service to evidence-based research and programs, needed to create accounted ability which we now have none. to demonstrate the relative value of the services being

provided. the mental health association of san francisco is committed to being part of the solution to the critical challenges we face as a community. the community of wealth has grown. the valuable members of the community the homeless, those facing chronic housing and mental health challenges are growing steadily. we support permanent affordable housing access to intensive care to create the continuum of care that we need. we urge the board of supervisors to work with us and the community to make these much needed changes. i am cw. i live with mental health challenges. i am happy to work with bill since 1999. we are willing to work with you to make it better.

thank you. >> any questions for our community presenters? seeing none. let's open this for public comment now. i will call out some cards that i received here. mr. right, jenny, mare mary, tanya, amanda, cheryl, betty trainer, robin ross. please line up. thank you very much. thank you for your patience. >> the quick way to take care of this problem. this is the answer to all of your questions. you cannot provid provideser pre services with a mat.

it is permanent housing. all of you got millions of dollars in the budget. this is 144 unit president building come -- apartment building. it can be built for approximately $56 million with $500 million you can build nine of these type of apartment complexes. nine times three is 27. you can build a 27 story apartment complex to house the people you want to help. here is an additional building that is 68 unit with three stories selling for $57 million. you use the same math times three. you can build 27 story apartment building complex. with in this apartment building complex that is 192 1928 stuuni.

-- units. they can be for mental disabilities and drug rehab that you are trying to help. london breed permanent rehabilitation and drug rehab. the apartment complex in that section. about this behavior court that came up here and said that you have got a success rate of 58 or 70% of permanent housing and placement of people going through the program. that is junk science. you are putting people in the program and not putting the formula how the people are in the system because of their drug habits. you claim you use the capacity and their crime -. >> thank you.

next speaker please. >> i am robin roth, co-chair of the san francisco hepatitis-c task force. i am cured. i can attest how the damage is not only physical but mental. the epidemic is at the intersection of opioid a meth and homelessness epidemics. c is now curable we have the opportunity to tackle all epidemics with point of care cures which is the task force budget. by expanding the navigation teams with people who inject drugs can be treated where they are in the streets, in the shelters and encampments. we have help c navigation teams

like san francisco aids foundation successfully treating this difficult to reach population and with some better funding for treatment and innovative mobile settings we can turn the tide on these epidemics. every person cured of the c virus prevents an average of 13 others from being infected every year. it helps people feel better. aches and pains ease. people get into therapy and turn their lives around. they are inspiring stories to improve not only their lives but the public health and increases street safety and cleanliness. 17% of the thousands tested did have hepatitis c compared with 2% in the general population. they are reaching the people

suffering from c and spreading it. it shows a low rate of getting those people to clinics for treatment. >> thank you. next speaker please. >> good afternoon. thank you, members of the board of supervisors for this hearing today and for listening to my comments. i am here of the getting to zero san francisco speaking for amanda today. she had to leave. in 2017 the reengagement committee conducted a survey of a wide range of clients facing the service providers for people living risk