struggle with these particular challenges, 41% are in crisis, which is demonstrated by their high use of the emergency psychiatric services and 95% suffer from alcohol use disorder and the sad reality is what we're seeing is there is a real issue of equity because 35% are african american, despite the fact that we have a population of not even 6% of african americans here in san francisco overall. this is just the beginning. the first step of this initiative that we are proposing today is understanding the data, analyzing the data, and also making direct impacts on the particular population and

really digging deep into those particular issues with those particular individuals. and now as a result, what we plan to do about it, this is just the beginning of several initiatives that we planned to announce to ream get deep into the weeds of addressing mental health in san francisco. i want to be clear. there is not one thing that we will be able to do to address this issue. there are a number of things that we will put forward over the coming weeks to help the public better understand the issue, to help the public better understand and appreciate the people who are working in this industry, the ones who are helping us deal with these issues every single day. to help people better understand that there are folks that we've been able to help and to support and that many of the programs that we have in place do work. but there is a need for reform. there is a need to increase capacity and to better examine, you know, new ways to address this issue.

the first step in the initiative that we're proposing today is to expand individual care coordination for those we have identified. so of the 4,000 -- and doctor bland will go into a little bit more detail, but to just really center in on those who are most in need and that population and to really target them with individualized coordination. we also will definitely need to get them stabilize and stream the housing and health care process. because we have to have a safe place for them to be, to recover, to go through whatever process they need to go through to get back on their feet. and we also need to understand that this challenge is not a 9:00 to 5:00 issue. we're going to expand the hours of our behavioral health access center so people can access these services on nights and

weekends. let me be clear that the three elements of the initiative are just the beginning. and so we know we have more work to do to improve transparency and the efficiency of our system and to enhance our services and improve what we need to do for the most vulnerable of our city. we are committed and we are ready to roll up our sleeves and to do the work. because this is not a political issue. this is about people's lives. and this is about understanding this population so we can get to the root causes and to help people. it comes with a number of various layers of things that we have to do. and i know some of you are familiar with what's happening with our conservatorship legislation and how it's gone through the board and how that is going to hopefully help individuals who are refusing treatment, but in desperate need of services. that is one approach.

this is another approach. we've already opened a new -- 100 mental health stabilization beds and our goal is to open 100 more by the end of this year and focusing on specific things to target this population in a way that's going

going to help turn around what we know we see on our streets every day is something that is so important. i'm sure you have this same example. you may see this same person on the corner every day, screaming and yelling. and i have a particular individual who removes his clothing and when i see him, i can't help but think this could be my father. this could be my grandfather. this could be my uncle. this could be my family member. and i want to help him. i want to make sure he gets the support he needs. it is not humane to continue to allow this to occur on our streets and that is why we have to move forward with a number of initiatives to help address this. now what we're proposing will not n many ways, be able to solve the issues that we know everyone is facing. we're not going to be able to force everyone into treatment. we know that locally the laws make it difficult to do something of that nature. but we do need to try. we do need to kaord nate our services and we do need to make sure that we are better prepared to meet people where they are. we can't assume that when they walk into the doors of a place like this that they know what to do. we need people who are going to be able to help them understand -- people who are going to understand what the challenge is and be able to address the challenge and that doesn't include, here, fill out this paperwork and take care of this

and bring your i.d.. that is not the way we are approaching this particular issue. it's about getting the kind of results where you can see and feel a difference on our streets every single day. so we have work to do in here to talk a little bit more about what we're proposing and what he's discovered since he's taken on this role as of march of this year is dr. nagusa-bland. [applause] >> thank you, mayor breed, for your support as we embark on this multiyear effort to transform mental health and substance use care for people experiencing homelessness in san francisco. thank you, dr. colfax, for embracing the scale of the change we need in order to make a difference for this population and for the entire city. thank you also jessica for your

partnership in this important work as we endeavor to trace safety and civility for our neighbors. i also want to acknowledge the community-based providers and philanthropists, clinicians and researchers, advocates and clients who dead indicate themselves to improving and saving lives in san francisco. we will need everyone working together if we're going to make the kind of impact that this population in san francisco needs. here's what we found out about our population. we looked very closely at who used san francisco's health care and social services in the most recent fiscal year. and as the mayor pointed out, out of nearly 18,000 people experiencing homelessness, we found that close to 4,000 of them also have both a history of serious mental illness and of substance abuse disorder. we found racial inequity in the population. 35% are black or african

american. when just 5% of san francisco's population is. 41% of these individuals are high users of urgent and emergent psychiatric services and 95% suffer with an alcohol use problem. now we have seen other large cities analyzed our high use of emergency services usually from a cost perspective. but as far as we know, san francisco is the first to [inaudible] health diagnoses of people experiencing homelessness to identifying a population and tailing solutions to that population's needs. this is how we solve problems in medicine. when a patient comes to us with a complex set of issues, we are not haphazard in our approach. we test. we collect information from collateral sources. we diagnose and we treat. we use data to precisely target

our problems. we inknow vaitz and, most important of all, we persist. we are here to solve problems for the entire population and confront a crisis for our city. these are the people who need help the most. helping them will make the biggest difference for them, for our health system, and for the entire community. when we talk about behavioral health, we mean mental health and substance use. we know that when someone is suffering from a mental illness or addiction, it is a lot like a chronic health condition such as diabetes or even hypertension. when people are in treatment, they do better. when they have a setback, we don't give up. and when 4,000 san franciscans find themselves in the intersection of mental illness and substance use disorder, business as usual does not work for them. we have to find ways to use the

system to bend in their direction. i'm happy to say that this work has begun. as we rolled out the first in what will be a series of recommendations we can say we are entering a new era of collaboration with the department of homelessness and supportive housing. jointly identifying the people in greatest need and relentless about getting them on a path to civility and wellness. with other city partners, we will be able to keep track of these individuals and wherever they touch our system a care coordinator will respond. when we say we're increasing access to behavioral health care and we can promise, we promise that we're going to focus on these 200 most vulnerable people in this group right now. and work together to get them connected to housing, treatment and care. we will be meeting weekly to discuss each of these individuals and tracking their progress. we will outreach to them wherever they are.

we will problem solve and remove barriers to accessing care and the lessons that we learn will ultimately help us improve the system of care for more people. going forward, the recommendations i will continue to deliver to mayor breed will be driven by clinical expertise, by data, by evidence and by the most innovative and best practices we can find or imagine. they will promote equity and transparency in our system of care, that -- they will advance harm reduction and lower barriers. they will build on the legacy of addressing problems that might seem intractable and of making stability, wellness and recovery possible. the clients and staff here at the south of the health clinic show us that perseverance every day. with that, i'd like to introduce yolanda morris et. [applause]

>> about 15 years ago, i came to san francisco because i was being abused and i fled that relationship. i didn't know anyone in san francisco, i left my clothes and i didn't look back. i was also an au addict and i was an alcoholic and i was homeless. i came here and slept in the alley. i've been every street out here that you can name and through the years i did want to get help. i didn't know how. and so after more abusive relationships, i finally got a good guy and it was his choice for us to get clean. he said we gotta get clean in order to make it here in san francisco. i'm going to stop doing what i can do so that you can get your act together.

and so i decided -- because i've been in all the shelters out here. i know how the shelters work. i decided to stay next door. i stayed there for a year. and i behaved. from there, i went into an s.r.o. they placed me in a single-room occupancy is what it is called. a room with a bathroom and i stayed there for five years and prior to me -- when i first moved into the s.r.o., my mother was dying of cancer and she didn't tell me because she knew it would take me out. i had a year of clean on me and i didn't look back and thought that's not what my mother would want. i'm going to stay clean and i'm going to fight. soy went out and found everything that i could find. this is one of first places that i came to because i had a lot of stuff going on mentally and physically. they were able to help me get on medication. they were able to help me get therapy, to get to the root of the problem, what was going on because i had a lot of stuff going on and after doing that, i had a lot of anger issues,

depression, suicidal thoughts. i had to do anger management here twice and i finally got it right and i started doing other programs. glide was out there. sage was out there. it is not out there anymore. i went to the women's re-entry center. i didn't feel comfortable at first because they walk you over there. i've also been incars rated out here in san francisco for drug possession and other things of that nature due to my drug use. and so i just slowly said i'm going to build myself up and started doing things for women against rape and violence. i got an award from the d.a. i like the write. i started writing here. i found out that i'm a pretty good poet and i do -- i do poems here every year for the black history month. they embrace me here. i've been coming here since 2012 getting support and getting help.

and i graduated from a lot of programs out there and i started doing peer mentorship through san francisco state. i've graduated from ram, i've graduated from nami. i expunged my record. i got my driver's license back. five years into my s.r.o. there was a program called brilliant corners. they came and gave out vouchers to people who are willing and ready to move out of the tenderloin and i had two weeks left and i fought hard and found me a one-bedroom and i got out of the tenderloin. but i still come to the tenderloin because this is an ish yaoufm i know a lot of people here. i always want to do anything that i can to disclose support and help the people in the community. so i continued. i'm still with my guy. we're getting married this year. and -- [applause] thank you. and also i want to say that i was able to get a really good

job through help rights 360th called maps and it's mentor and peer support. they give you a job and they give you schooling for that. so i was able to do that. and now i teach groups in jail. i teach groups to the men in san bruno on domestic violence. i teach groups to the deputies about crisis intervention training. i go out and volunteer. i do anything and everything that i can to support anyone. we work in all the collaborative court. now i was an addict nine years ago and this is what i'm doing now. through all the help that started here at south end market. you know? they really helped me out an awful lot. they were very patient. i went through several therapists and psychologists. but finally got it right and i'll be flying away and graduating from here soon because i am moving on to other things. i have a nice full-time job now.

so, yeah. that's about it. [laughter] [applause] >> well, thank you, yolanda, for sharing your story. it's amazing. it is an inspiration to us all. and we wish you the very best as you get your certification in drug and alcohol counseling. amazing work. also, by the way, we're hiring. [laughter] just putting that out there. we're looking for right people. i'm the director of health for the city and county of san francisco. i would like to thank the mayor and thank you, dr. bland, and thank you to our host today, natalie henry berry and the hard-working staff here. this is one of the places in the city's system of care where

people can get their medical care, dental and behavioral health care needs met under one roof. i've seen what the staff here, with persistent compassion have been able to do by partnering with their clients on journey to stability and wellness. they are psychiatrists, pharmacists, behavioral health clinicians, nurses and support workers who go out into the community and meet people where they are. many clients are experiencing homelessness when they enroll in services here and most are diagnosed with both mental illness and substance abuse disorders. but the work makes a difference. and on my last visit here, i went out with the team. and this is a client, who's now housed, but was ton street for many years. wheelchair-bound, had chronic controlism, refused treatment

for many years. but the team continued to engage him, continued to bailed relationship. helped him when he was ready to get healthy. helped him when he was ready to get treatment for his alcoholism. and this client, living in the tenderloin, is a valuable member of the community. is actually continuing to move that forward just like yolanda. he's now volunteering at the san francisco aids clinic providing harm reduction materials for people who need them. he is moving the work forward and this is the kind of model of peers helping peers in a system that meets people where they are and does whatever it takes to help get them off the street w. this new data and focus on the 200, we can make a difference. i think when people are ready for treatment and volunteer for treatment, that is key. i also think we need to recognize that one of our challenges on the streets that

some people will refuse treatment. some people in the most dire needs of treatment will refuse treatment. so we need to be there when people are ready to go into the services and meet them. when they're ready. but we also need laws like the conservatorship law to provide people with the support for short-time conservatorship to help them save their lives. these are life-saving interventions. and that persistent compassion is what we have seen here and what we've come to expect from our director of mental health reform in. a few short months, he's transformed the way many of us think about caring for people experiencing the intersection of homelessness, serious mental illness and substance abuse disorders. this is a population, as you've heard of 4,000 people who require specialized solutions. kit take a while. it can take time for them to achieve their goals. but we know that wellness and recovery is possible, as you've

heard today. and with our partners at the department of homeless systems and supportive housing, thank you, jeff, for being here today and the human services agency. we have agreed for the first tomb on ways to identify, treat and house the most vulnerable population in our city. and mayor london breed to spark the champion of harm reduction, someone who understands the inequities that lead to core health outcomes and that we must continually push harder to overcome. under her leadership, san francisco continues to invest in health care and housing that our city needs. thank you, mayor breed. and thank you all for being here today. thank you to the team and let's move forward together. [applause] >> thank you. again, thank you so much, yolanda, for sharing your story. and stories like yolanda's is why we do the work. it is what we care about the most because the fact is, you

know, people go through challenges. people go through struggles. and nine years being clean and sober takes a lot of work. it takes a lot of courage and to get up here and tell your story will have such a tremendous impact on so many other people's lives and hopefully encourage them to get the help and the support that they need. and i think that is important to remember in having the conversation about the struggles and the success stories. because we are not going to give up. and i know that people in san francisco are frustrated by what they see on our streets. i'm frustrated. but i'm not going to give up. i think it is important that we have ways to help people. that with our additional $53 million in investment and behavioral health program that our additional $100 million in investment, the homeless supportive services indicates that we're willing to make investments. now it is time to put those

investments to good use. and to understand that every dollar we spend on this issue is a dollar that can change someone's life. and so we have to be deliberate in our approach to really focus on this and make sure it is not a political issue. this is a long-term plan of action that will deliver the kind of results that will help people, like yolanda, get really a second chance at living a healthy, productive and thriving life. so thank you for all of you for being here today. and again, i want to express my appreciation to the team and the folks who are working with so many of the clients that i know things can be challenging, but the fact that you're here, i know that you've not given up. this work is rewarding,

especially when you're able to get the kinds of results that show that supporting people like yolanda do yield and so it really means a lot to have so many incredible, dedicated people doing this work every single day because it is not easy. and i'll tell you that, you know, because you all know that i spend a lot of time walking the streets and having the conversations and going out there with some of our teams and having the conversation. within two hours of walking just four blocks, i was mentally exhausted with the conversations that i had and also trying to get people the help and the support that they needed and just work that -- the energy and the emotion that goes into trying to help people every single day is something that's admirable and i want us to really appreciate the folks who are part of, you know, our mental teams and our nonprofit

organizations and our homeless out reach workers and even law enforcement and the work that we're out there doing to help change and save people's lives. this is the first of many steps that we plan to take and, again, this is, i know, a very complex issue. it's not wraped in the usual political package that the press, i know, wants to see it wrapped in. but this is actually what we need to do. get into the nuts and bolts, make the right decisions and get out there and make the changes that will help impact the people that we are here to serve. so thank you all so much for being here today. and dr. colfax and dr.s blanlz -- dr. bland will be here to answer any further questions that you might have. thank you. [applause]

[♪] >> i am the supervisor of district one. i am sandra lee fewer. [♪] >> i moved to the richmond district in 1950 mine. i was two years old. i moved from chinatown and we

were one of the first asian families to move out here. [♪] >> when my mother decided to buy that house, nobody knew where it was. it seems so far away. for a long time, we were the only chinese family there but we started to see the areas of growth to serve a larger chinese population. the stress was storage of the birthplace of that. my father would have to go to chinatown for dim sum and i remember one day he came home and said, there is one here now. it just started to grow very organically. it is the same thing with the russian population, which is another very large ethnic group in the richmond district. as russia started to move in, we saw more russian stores. so parts of the richmond is very concentrated with the russian community and immigrant russian community, and also a chinese immigrant community.

[♪] >> i think as living here in the richmond, we really appreciate the fact that we are surrounded three natural barriers. they are beautiful barriers. the presidio which gives us so many trails to walk through, ocean beach, for families to just go to the beach and be in the pacific ocean. we also also have a national park service. we boarded the golden gate national recreation area so there is a lot of activity to do in the summer time you see people with bonfires. but really families enjoying the beach and the pacific ocean during the rest of the time of year. [♪] >> and golden gate park where we have so many of our treasures here. we have the tea garden, the museum and the academy of sciences. not to mention the wonderful playgrounds that we have here in

richmond. this is why i say the richmond is a great place for families. the theatre is a treasure in our neighborhood. it has been around for a very long time. is one of our two neighborhood theatres that we have here. i moved here when i was 1959 when i was two years old. we would always go here. i love these neighborhood theatres. it is one of the places that has not only a landmark in the richmond district, but also in san francisco. small theatres showing one or two films. a unique -- they are unique also to the neighborhood and san francisco. >> where we are today is the heart of the richmond district. with what is unique is that it is also small businesses. there is a different retail here it is mom and pop opening up businesses.

and providing for the neighborhood. this is what we love about the streets. the cora door starts on clement street and goes all the way down to the end of clement where you will see small businesses even towards 32nd. at the core of it is right here between here and 20 -- tenth avenue. when we see this variety of stores offered here, it is very unique then of the -- any other part of san francisco. there is traditional irish music which you don't get hardly anywhere in san francisco. some places have this long legacy of serving ice cream and being a hangout for families to have a sunday afternoon ice cream. and then also, we see grocery [♪] >> we are seeing restaurants

being switched over by hand, new owners, but what we are seeing is a vibrancy of clement street still being recaptured within new businesses that are coming in. that is a really great thing to see. i don't know when i started to shop here, but it was probably a very, very long time ago. i like to cook a lot but i like to cook chinese food. the market is the place i like to come to once a year. once i like about the market as it is very affordable. it has fresh produce and fresh meat. also, seafood. but they also offer a large selection of condiments and sauces and noodles. a variety of rice that they have is tremendous. i don't thank you can find a variety like that anywhere else. >> hi. i am kevin wong. i am the manager. in 1989 we move from chinatown to richmond district. we have opened for a bit, over

29 years. we carry products from thailand, japan, indonesia, vietnam, singapore and india. we try to keep everything fresh daily. so a customer can get the best out a bit. >> normally during crab season in november, this is the first place i hit. because they have really just really fresh crab. this is something my family really likes for me to make. also, from my traditional chinese food, i love to make a kale soup. they cut it to the size they really want. i am probably here once a week. i'm very familiar with the aisles and they know everyone who is a cashier -- cashier here i know when people come into a market such as this, it looks like an asian supermarkets, which it is and sometimes it can be intimidating. we don't speak the language and many of the labels are in

chinese, you may not know what to buy or if it is the proper ingredients for the recipe are trying to make. i do see a lot of people here with a recipe card or sometimes with a magazine and they are looking for specific items. the staff here is very helpful. i speak very little chinese here myself. thinks that i'm not sure about, i asked the clerk his and i say is this what i need? is this what i should be making? and they actually really helped me. they will bring me to the aisle and say this is battery. they are very knowledgeable. very friendly. i think they are here to serve not only the asian community but to serve all communities in the richmond district and in san francisco. [♪] >> what is wonderful about living here is that even though our july is a very foggy and overcast, best neighborhood, the sleepy part outside on the west side is so rich with history, but also with all the amenities that are offered.

[♪] >> this is one place you can always count on to give you what you had before and remind you of what your san francisco history used to be. >> we hear that all the time, people bring their kids here and their grandparents brought them here and down the line.

>> even though people move away, whenever they come back to the city, they make it here. and they tell us that. >> you're going to get something made fresh, made by hand and made with quality products and something that's very, very good. ♪ >> the legacy bars and restaurants was something that was begun by san francisco simply to recognize and draw attention to the establishments. it really provides for san francisco's unique character. ♪ >> and that morphed into a request that we work with the city to develop a legacy business registration. >> i'm michael cirocco and the owner of an area bakery. ♪

the bakery started in 191. my grandfather came over from italy and opened it up then. it is a small operation. it's not big. so everything is kind of quality that way. so i see every piece and cut every piece that comes in and out of that oven. >> i'm leslie cirocco-mitchell, a fourth generation baker here with my family. ♪ so we get up pretty early in the morning. i usually start baking around 5:00. and then you just start doing rounds of dough. loaves. >> my mom and sister basically handle the front and then i have my nephew james helps and then my two daughters and my wife come in and we actually do the baking. after that, my mom and my sister stay and sell the product, retail it. ♪

you know, i don't really think about it. but then when i -- sometimes when i go places and i look and see places put up, oh this is our 50th anniversary and everything and we've been over 100 and that is when it kind of hits me. you know, that geez, we've been here a long time. [applause] ♪ >> a lot of people might ask why our legacy business is important. we all have our own stories to tell about our ancestry. our lineage and i'll use one example of tommy's joint. tommy's joint is a place that my husband went to as a child and he's a fourth generation san franciscan. it's a place we can still go to today with our children or grandchildren and share the stories of what was san francisco like back in the 1950s.

>> i'm the general manager at tommy's joint. people mostly recognize tommy's joint for its murals on the outside of the building. very bright blue. you drive down and see what it is. they know the building. tommy's is a san francisco hoffa, which is a german-style presenting food. we have five different carved meats and we carve it by hand at the station. you prefer it to be carved whether you like your brisket fatty or want it lean. you want your pastrami to be very lean. you can say i want that piece of corn beef and want it cut, you know, very thick and i want it with some sauerkraut. tell the guys how you want to prepare it and they will do it right in front of you.

>> vote whether to disclose any items held in closed session, action. >> move not to disclose. >> second. >> aye. >> everyone has moved and everyone has seconded. all in favour? >> i. >> line item 11, adjournment. >> all in favour? >> aye. >> thank you.

>> you know i've always wanted to do this job that drives my parents crazy we want to help people i wasn't i did not think twice about that. >> i currently work as cadet inform the san francisco sheriff's department i've been surprised 0 work within criminal justice system field i had an opportunity to grow within that career path. >> as i got into the department and through the years of problems and everything else that means a lot i can represent women and in order to make that change how people view us as a very important part of the vice president you have topanga you have to

the first foot chase through the fight are you cable of getting that person whether large or small into captivity that is the test at times. >> as an agent worked undercover and prevent external and internal loss to the company it was basically like detective work but through the company from that experience and the people that i worked around law enforcement that gave me an action when i came to be a cadet i saw i was exploded to more people and the security he was able to build on that. >> unfortunately, we have a lot of women retire to recruiting right now is critical for us we gotten too low faster the percentage of women in the department and us connecting with the community trying to get

people to realize this job is definitely for them our community relations group is out attempt all the time. >> in other words, to grow in the fields he capitalized any education and got my bachelors degree so i can current work at city hall i provide security for the front of the building and people are entering entering but within any security or control within the building and checking personal bags is having a awareness of the surrounded. >> there is so month people the brunet of breaking into this career that was every for easier for me had an on the with an before he cleared the path for laugh us. >> my people he actually looking at lucid up to poem like

he joe and kim and merit made they're on the streets working redondo hard their cable of doing this job and textbook took the time to bring us along. >> women have going after their goals and departments line the san francisco sheriff's department provide a lot of training tools and inspiring you to go into the department. >> they gave me any work ethics she spider me to do whatever he wanted to do and work hard at the intersection. >> if you're going to make change you have to be part of change and becoming law enforcement i wanted to show women could do this job it is hard not easy. >> finds something our compassion about and follow roll models and the gets the

necessary skeletals to get to that goal with education and sprirmz whatever gets you there. >> if this is what you want to do dream big and actually do what you desire to do and you can go vertebrae far it is a fast job i wouldn't do anything else. >> ♪ ♪ ♪

>> good morning, everyone. the meeting will come to order. this is september 11, 2019. i'm sandra lee, chair of the budget and finance committee and