. >> good morning, everyone. the meeting will come to order. this is the december 6, 2019, special meeting of the budget and finance committee. i am chair fewer.

i am joined by supervisors stefani and mandelman. i would like to thank our colleagues from sfgov tv for broadcasting this. >> clerk: any documents to be included as part of the file should be submitted. >> would you call item number one. >> clerk: 1. resolution authorizing the mayor's office of housing and community development to accept and expend a grant in the amount of $300,000 from the california department of housing and community development to provide funding the west side of san francisco (districts 1, 4, and 7) for >> i am the sponsor of this particular item. and i just want to also really

thank member ting to have worked closely with us to secure these funds in support of our neighborhood in the west side of san francisco growing our capacity to get rental buildings. in my district over the last ten years, i've last 400 units of affordable housing. on the east side of san francisco, there are several amazing non-profit organizations that help stabilize these buildings through acquisition and property management. on the west side, we simply do not have the organizational capacity to meet this need. this funding will help us change that and i'm so appreciative of phil ting to his commitment of preservation of affordable housing on the west side. >> good morning, chair fewer, supervisor stefani and mandelman. supervisor fewer provided the context for this grant, so i wanted to talk a little bit

about the timeline for implementation and awarding the grant. so the mayor's office of housing and community development released a notice of funding availability for small sites on september 13, and as part of that we included a portion of funding for capacity-building grants. the west side planning grant was included as part of that nofa. so applications for the capacity-building grants were due on november 1st. we conducted our proposal review panel for reviewing the application. we expect to notify grantees of their award by the week of december 16. from there, we'll enter into a grant agreement for the west side planning grant. and the work associated with this grant would start in january 2020 and the grant term would be one year. that's the timeline for implementation. we're really excited about this opportunity. this is the first time we've had

capacity-building as part of small sites, and we're excited to support our sponsors and growing their capacity to engage in this program. i'm happy to answer any questio questio questions. >> thank you very much. i am thrilled also. let's open this up for public comment. any members of the public like to comment on item 1, seeing none, this is closed. i would like to make a recommendation to move that to the board with a positive recommendation. >> clerk: would you like to send this to the full board with committee report? >> yes, please. madam clerk, can you please call item number 2. >> clerk: 2. resolution declaring the intent of the city and county of san francisco ("city") to reimburse certain expenditures from proceeds of future bonded indebtedness; authorizing the director of the mayor's office of housing and community development ("director") to submit an application and related documents to the california debt to permit the issuance of residential mortgage revenue bonds in an aggregate principal amount not to exceed $38,700,000 for 53 colton street;

>> thank you very much. i believe we have joyce flen he here. >> good morning, supervisors. my name is joyce flen. i'm here to present on item 2. this item relates to the resolution for proposed bond issuances for 53 colton. the purpose of the resolution before you is to approve the hearing the city conducted to comply with the federal tax equity and financial responsibility act, or tefra, and enable the project to apply for bond financing. the proposed bond issuance will be conduit financing and will not require the city to pledge any of its funds to the repayment of the bonds. this is a 96-unit affordable new construction project located on colton street between goff and 12th street. approximately 35 units will

rehouse permanent tenant leases from the neighboring civic center hotel, which is a single-room occupancy building. all units will serve formerly homeless adults. this will be subsidized with the city's current funding program. it is currently a parking lot. we anticipate the project will close construction financing and start construction as early as september 2020. here with me today is serena calloway a representative from the community partnership and katie strather. we would like to thank you for your consideration today and look forward to your support for this project. >> thank you very much. there is no bla report on this.

let's open this up for public comment. any members of the public like to comment on item number 2? >> david elliot louis. i'm a resident and a board member. i get to observe the organization from the bottom up and the top down. this is an organization i've been involved with for over a decade. it's really well run. they do remarkable work. this particular project will provide almost 100 units of permanent supportive housing in the high 90s. for hitting a population that's less than a quarter of ami and a population that's unhoused. they will be again saving lives. people will be placed through coordinated entry, the department of homes, supportive housing. it's a really good project. this agency has a good track record of success. they're well respected in the field of permanent supportive housing.

they're fiscally sound. i hope you will support this ask. thank you. >> thank you very much. any other public comment? seeing none, public comment is now closed. there is no bla report. any questions or comments from my colleagues? let's move this to the board with a positive recommendation. we can take that without objection. madam clerk, can you please call item 3. >> clerk: 3. resolution fixing prevailing wage rates for 1) workers performing work under city contracts for public works and >> thank you very much. i believe we have pat mulligan with us. good to see you. >> good morning, supervisors. this is the annual submission before the board for san francisco's prevailing wage standards. it includes the ten classifications service sector under 21(c) as well as the

60-plus with hundreds of subclassifications that are recognized by the california department of industrial relations. it's frequently a consent item. just so everyone's aware, there is some controversy over 21(c)(3) as related to the car rental facility at the san francisco international airport. there is some pending litigation related to that. that should have no impact on the submittal before you today. it's worth noting that 21(c)(3) has not changed from the previous years. it reflects no change in that item. >> could we have the bla report, please. >> good morning, chair and members of the committee. this is just the annual approval by the board of supervisors of the prevailing wages for 2020 for covered classifications. we talk about -- page 3 of our report shows the various categories of workers that would

be covered, and attachment 1 gives more detail on some of the classifications to be covered by this. catchment 2 summarizes some of the changes for each of the categories of workers that would be covered. in terms of the impact -- so the proposed prevailing wages based on collective bargaining agreements and was approved by the civil service submission. the potential impact to the city is unknown. it would really depend on how much of this is passed through in contracts to the city, but because the board has discretion over how they choose the wages and doesn't have to take these recommendations, we consider this a policy matter for the board of supervisors. >> thank you very much. any members of the public like to comment on item 3? seeing none, public comment is closed. any comments or questions from my colleagues? seeing none, that is closed.

i would like to say prevailing wage is important for our workers in san francisco. it is as bla said, it is negotiated agreements about how much people should and need to be paid actually for fair wages for the work performed. it ensures equity and sets a standard for what workers should be paid in the private sector. while i did work on the school board, i ensured that our workers were being paid at prevailing wage. having said that, i'd like to make a positive motion to pass this to the full board -- committee report. i can take that without objection. thank you very much. please call the next item. >> clerk: scloipt 4. ordinance amending the administrative code to establish mental health sf, a mental health program designed to provide access to mental health services, substance use treatment, and psychiatric medications to all adult residents of san francisco with mental illness and/or substance

use disorders who are homeless, uninsured, or enrolled in medi-cal or healthy san francisco. >> thank you very much. and i believe we have supervisor ronen here to join us. >> good morning, everybody. i'm sorry for being late. and i'm so incredibly excited to be here. after two years of studying and planning how to fix the growing mental health crisis in san francisco, supervisor haney and i reached an agreement last month with mayor breed to implement mental health sf in collaboration with her and the department of public health. just on behalf of supervisor's haney's behalf, he is out of town and couldn't be here today and sends his regrets, but would

pretty much not want to miss this for the world but happened to be out of town. i'm absolutely thrilled to be moving mental health s.f. forward today. the legislation before you reflects our joint commitment to solving our mental health crisis on the streets, with particular attention paid to the intersections between homelessness, mental illness, and substance abuse. san franciscans will soon have access to a comprehensive mental health care program. we designed the system to provide access to mental health services, substance use treatment, and psychiatric medications to vulnerable residents, specifically those who are homeless, uninsured, or enrolled in med-cal with severe mental illness. this includes a number of components. a 24/7 mental health service

center, a 24/7 street crisis response team, a drug sobering center, an office of coordinated care, increased beds at every level of the system, as well as case managers for everyone who needs them. an office of private health insurance accountability for those residents who do have private insurance but are unable to access timely care. i want to thank you to the hundreds, the literally hundreds of front-line workers, labor unions, and advocates, including nurses, mental health care workers, social workers, family members, consumers of mental health services, and community agency leaders for believing that we can do better. a very special thank you again to my colleague supervisor haney for fighting alongside of me every step of the way and to our incredible mental health s.f. committee who worked so hard on every detail of this legislation, many of who i see

here in the audience today. i also want to thank the other supervisors who worked on this. finally i want to thank mayor breed and her staff for her willingness to work with us to find unity and to dr. colfax and his staff for their collaboration. now that we have developed this program, i want to thank all of my colleagues for their co-sponsorship. we hope to move forward with the appointment of all members of the mental health s.f. implementation working group as soon as possible early next year once this legislation becomes law. the mayor has then committed to hiring the director of mental health s.f. by next summer and to expediting major renovations to the city's current behavioral health access center so that it can be transformed into the new

24/7 mental health service center. most other aspects of mental health s.f., however, cannot move forward until we have identified a long-term funding source for the measure. i am thrilled to have a strong commitment from mayor breed to work with us to identify at least $100 million per year in new funding to fully realize mental health s.f. in efforts to reform the business tax or through other reform measures. i will not rest and i know supervisor haney will not rest until we have the funding that we need to fully realize mental health s.f. we will continue to explore every possible option for funding, including the idea of an excessive c.e.o. salary tax, if necessary. needless to say, we have a lot of work ahead of us, but today i can't be more thrilled to

officially launch us on our first step of that work by introducing a few amendments on the current draft of the legislation that i'm asking my colleagues to send and asking to be sent to the full board with positive recommendations. i wanted to go over the few small amendments. i believe we passed this out ahead of time, but if you need more copies i will be send those down. the first thing that we have done is made two small edits to the definition of harm reduction. on page 8 replacing the term "self harming" twice, the first with the word "harmful" and subsequently with the term "specific." second, we have added two seats to the implementation working group.

it now has 13 seats instead of 11, six appointed by the board of supervisors, six appointed by the mayor, and one will be appointed by the city attorney. as it states on page 20, line 20, the additional mayoral seat will be held by a substance abuse treatment provider. as it states on page 21, seat 13 will be held by a person with expertise in the field of health law appointed by the city attorney. finally on page 23 we state that the implementation working group will work with both the controller and the department of human resources to conduct a staffing analysis, not just the controller as previously stated. i see that dr. colfax is mentioned and i want to thank you for your collaboration and work on this. i see behind you dr. nigusse

bland who has put time into this and will be very much a part of implementing mental health s.f. i wanted to acknowledge you. there are several other members of the incredible behavioral health staff. i want to say this has never been about the work of the front-line individuals in the behavioral health department. you are all the most extraordinary people that i have ever had the pleasure of needing and your work on a daily basis is the most difficult work that requires fortitude and love and commitment and hard, hard work. this is about creating a system for you so that your work can be easier, more sustainable, more long-lasting, and ultimately more effective. i also wanted to acknowledge the

labor council and several unions. ken from the sheriffs association. your commitment to this legislation is honestly such a major part of how we got here. i see steve fields, the executive director of the progress foundation, who's part of the committee and is much of the brain behind this legislation. so i want to acknowledge you. i also see jackie preger who was part of the mental health s.f. campaign team when this was a campaign out in the field and not a piece of legislation in city hall. i just want to acknowledge you. with that, i will turn it over to my colleagues and ask for a motion to approve the amendments after public comment. >> do you want to do a

presentation first? >> i'm so sorry. i didn't ask cph to prepare a presentation, but -- >> is a presentation not necessary? >> good morning, supervisors. grant colfax. we were not asked to make a presentation, but we're here to answer questions. i would like to make a few comments about how delighted we are with this potentially transformative piece of legislation and with mayor breed's support and the support of the board. this really is an opportunity for us to modernize our behavioral health system. as we know, the issues around behavioral health, particularly around the intersection of behavioral health, homelessness, psychosis, substance use, that this is a key issue at multiple levels.

i see that we can use this opportunity to have this be the next big thing that our community and our government comes together to solve. within the department of public health, we've done big things with community, with science, with our providers, and obviously with the policy-makers. i think what we did to transform the h.i.v. system of care -- and we were ground zero of the epidemic of h.i.v. we're now talking to getting to zero new h.i.v. infections. we were the first local jurisdiction to provide universal care coverage for people through healthy san francisco. so i just see this as an exciting opportunity to use data to support the workforce, bring community wisdom forward, and focus on in a detailed way how we're making progress so that we see that our work is valuable and really making a difference in people's lives.

so i think the data piece cannot be underemphasized here. i also want to say with a few of my colleagues i spent some time at the state meeting with key policy-makers. i'm excited that so much of where the state is headed with some of the med-cal changes aligns with this work. from the focus on more flexibility around behavioral health services, more in lieu of services, which means more wraned-around services, it's key. i think it's important to emphasize that this problemp-ar. i think it's important to emphasize that this problem didn't happen overnight and it won't be solved overnight. we often overestimate what can be done in two years, but underestimate what can be done in ten years. so i think that's a key piece to keep in mind as we make progression here. we are progressing positively in some ways. this is a continuum.

it's not as though something -- and i appreciate supervisor ronen for recognizing the work done in behavioral health. the street medicine team working navigations on the street -- in navigations and shelters on the street to start people on treatment in real time. i was at division circle clinic, where i'm seeing patients half a day a week, alternating with our aids clinic. it's remarkable what's happening in that work. we're expanding that street medicine team because of the investment that you and mayor breed all approved in february. we're collaborating with the department of homelessness and supportive housing better than ever and really having shared priority clients to make sure that we take a whatever it takes approach and marching down on a data-focused way how we're making progress. and understanding in real time on a case-by-case basis how the system needs to change to meet the needs of the people we're

serving. as you know, we're planning to expand the behavioral health center. obviously mental health s.f. -- the goal is for it to provide more opportunities to spant expand it further, but we're on that journey. supervisor mandelman co-chaired the methamphetamine task force. i just think that across the spectrum of care we're making great changes. bringing in the leadership, the talent, working with our academic partners, our community partners, we are going to be in a very different place over time with the work in support of you as policy-makers, with the

support of the community and the scientists, and i think most importantly with the voice of the people who have behavioral health diagnoses, having their voice at the table is key. very excited about this hearing and moving forward together. >> thank you very much. could we have a blv report, please. >> yes, the proposed ordinances before you today would approve the mental health -- amend the administrative code to approve mental health s.f. the mental health code changes sets out the basic service requirements and the process to develop an implementation plan. we give some very preliminary numbers in table 1 on page 13 of our report one time and potentially low and high-scenario costs. however, the actual costs would depend on what the implementation plan would show

for the budgets. we consider the approval of the proposed ordinance to be a policy matter for the board. >> thank you very much. supervisor mandelman. >> thank you, chair. i think one of the things that may have been obscured a little bit in the more contentious moments around the discussions around mental health s.f. is how much agreement there is i think in city hall, in all places in city hall, in the department of public health, and in the provider community and in the client community and patient community about what's broken, what needs to change, and where we want to be. i want to congratulate the authors and the department for having forged a document and a piece of legislation that i think reflects consensus around

where we need to move and what we need to do. so i'm -- i don't know if i'm the last co-sponsor, but i think i'm one of the last and i'm happy to be able to join. i do -- if my colleagues will indulge me for a few minutes -- want to check in on some of the elements that are reflected in this legislation that are priorities for me. i don't want to pre-judge the work that the working group will do, but i also don't want to wait for a couple of years and i don't think we will be waiting for a couple of in moving forward on some of these things. i know i'm going to ask questions that the department doesn't have definitive answers for, at least some of them, but i would like to check in on some of the department's thinking on some of these issues. so starting with the office of coordinated care, one of the things that struck me in our budget process and every single

meeting that i've had out in the community is how uncoordinated it feels like our care for these often very sick people is. and actually, the lack of coordination reflects itself in two ways. one is a lack of coordination for an individual who is cycling through services but never -- the cold hand-offs keep happening, the person comes to the same person and goes through the same cycle, the same person never actually gets that coordination. i think that was reflected in some of the work that dr. bland has already done in identifying that, wow, even as we look at the highest users of these systems, many of these people do not have currently assigned case managers. i know there is a commitment in the department to fix that. i am assuming that is part of what the office of coordinated care is doing. a lot of it is getting the case management to these people who need it.

but i just wanted to offer the opportunity an opportunity to talk a little bit about what you were thinking about in terms of the office of coordinated care and how the creation of an additional bureaucratic element will enable a focus on the coordination that we need. >> good morning, supervisors. my name is hally hammer. i'm director of ambulatory care. ambulatory care includes primary care, behavioral health, maternal child and adolescent health. i'll speak to the office of coordinated care. in ambulatory care, really, one of our major goals and it's exciting to speak to this piece of legislation and the opportunities it gives us to do

more coordination of care and more integration of care between our different ambulatory services as well as the rest of the network. so when we read the legislation and really imagine how the office of coordinated care would be set up, we model -- we did the cost estimate based on what is articulated in the legislation, but really will be honed down and defined by the implementation working group. so three levels of care coordination, which is fairly aligned with how we do care coordination now, but really expands our ability to coordinate care, especially for those who need the highest level of care coordination and case management. so ratios -- we use ratios from 1 to 10 for the highest level of care management.

based on our evidence for what works, which is sort of a social worker, behavioral health clinician peer team who have ratios very low patient-to-clinician ratios, 1:10. the next level would be similar to our intensive case management, the ratio is 1:17. and then for people who need less intensive case management, a 1:50 ratio. we also want to just acknowledge that the people we serve move through different levels of need and different levels of complexity. so will move between those different levels of care. the office of coordinated care will also encompass, so the costs also include some of the work to be done in coordinating for people leaving jails and psych emergency.

it also includes what is really key in all of this, which is data and analytics, which is having some real-time inventory that we are working on, but we don't have the easy access to right now, what our capacity is at any given point in time. so that office of coordinated care really incorporates a lot. increased case management services at all levels of care as well as the data and analytics to support approximate this happen again as dr. colfax articulated, that we need to look at evidence-based practices to look at new models of care so we better align our services with what people will engage in and with what people really need. >> excellent. >> through the chair, i just wanted to supplement the answer before you.

if you have other questions? >> i do. >> do you mind if i supplement this question? >> through the chair. >> thank you, chair. so a couple things. i just wanted to say that the office of coordinated care is way more than a new bureaucratic element. i would not describe it that way at pull. there are new types of interventions, activity, and coordination that is not happening in any way, shape, or form right now. so let me talk about those aspects. if you start with the -- i'm going to go through each part of this. the real-time inventory. not happening. we were in many hearings ourselves. when we asked for it, it wasn't happening. that's going to happen and be coordinated and then that information used across providers to inform not only providers of getting people through to the appropriate level of care, but this board of

supervisors and the mayor about where we should be investing resources. that's something that's not happening right now that will be run by this office. case management. it is true that we have case managers and intensive case managers right now. we do not have critical case managers, which is the third type of case management, but is created by mental health s.f. what those case managers will do is pro-actively go out and engage people who are refusing treatment to over time develop relationships and trust and a rapport to try to coax those people into treatment without the use of coercive tactics. that is not something that's happening at all right now. it's something that we know works when an individual has enough time and energy and resources to do that work. we just don't have a system in place right now that does that.

secondly, the office of -- or thirdly, the office of coordinated care is going to provide a case manager to every individual that needs one. in fact, we think that the major cost of mental health, one of the major costs, is in this aspect. the biggest workforce expansion that will happen under mental health s.f. is case managers, hands down, completely. so right now we cannot say that everyone in our behavioral health system has a treatment plan or a case manager. that's not happening. that's one of the biggest problems of why we're not coordinating that care across service, why we have -- whether you call it the merrymaker -- merry-go-round or the hamster wheel. we need to make sure that

everyone is exiting has a treatment plan and a case manager that will make sure that they don't just end up back on the street and back in jail or p.s. a week or a month later. not happening at all. that will all be coordinated through the office of case management. finally we're going to have an office that not only has real-time data of the availability of beds, but that's going to be collecting data and informative of how we can continue to innovative to have the best behavioral health system in the country. not happening right now at all. finally through this office we're going to have a marketing and an outreach campaign. nobody knows who to call right now if they see someone screaming and going into traffic. the person they call if they call anyone at all, but now san franciscans are so used to see that, that we just walk by and

feel guilty and call the police. not anymore. under mental health s.f., there will be a 24/7 mobile outreach team. people are going to know the number and a team of skilled physicians are going to come out and engage with that individual. so there is a lot that this office of coordinated care is going to do. we provided a roadmap for that in mental health s.f., but of course the specifics have to be developed by the department and by the implementation working group because there's so many details to making that overall vision that i just described actually happen. we didn't want to be so prescriptive that the department and the implementation working group can't innovate, which is going to be necessary. we can't pre-suppose every little detail of how this needs to be done, but we can provide an overall vision for a level of coordination and a level of intervention that is -- we know can be effective if it's

appropriately staffed and appropriately discharged and appropriately coordinated. that is what mental health s.f. does and that is a heck of a lot more than just a new bureaucratic element. >> go ahead. >> and i think we all whole-heartedly subscribe to that vision. i do think that there is a risk that if we are not diligent and attentive and come forward with budgets and hold folks accountable over time that that will be just another office, and that's not what you or i want. >> and definitely not what dr. colfax wants. to that point, that is why we are clear. mental health s.f. will not happen unless we have at least

$100 million a year more of investment in this program. we've never tried to hide that fact. this won't work, and i promised dr. colfax, who is ready, willing, and excited to implement this system, but he cannot do it unless we get this money. that's why not only are we going to be -- i, i'll speak for myself, i'm going to be diligent and vigilant every single day that this gets implemented how it's supposed to get implemented. i and we have work on our plans to figure out how we're going to generate $100 million more in revenue a year, otherwise this won't happen. that's where our continued engagement and not only preferable, it's essential. >> oh, i'm sorry, go ahead. >> i'm reclaiming my time.

>> so given that this is a bold vision of something like a universal right -- not a -- a right for each indigent san franciscan or homeless san franciscan to access the right and appropriate case management, are we talking -- is this budget at the scale we will be able to deliver that? do we think that $22 million a year, and that's currently on the upper limit, is about what it will cost to ensure that we don't have cold hand-offs, that we have case managers for everyone in the system, that we have a higher level of case management for those in need, and that we have -- and i think there is some work actually. i see it happening in my district, that there is work to people that are not currently, you know, saying yes to care,

but they're getting visited by selton all the time. but that's not what i think supervisor ronen is describing in terms of basically everybody who needs someone looking after them has someone looking after them. because if it's $22 million, we shouldn't wait. we should move more quickly and we should get as close to it -- i mean, either way we should try and expand this in the next year's budget. i'm curious, is that the final target or is it something more? if it's something more, that's fine. i want to manage expectations. is $22 million a year what it would cost to provide adequate case management for everyone who needs it? >> i appreciate the question, supervisor. one of the things that's challenging as this is developed, we need to test some of these hypotheses and adjust

accordingly. so i think the question is important, and i also want us to not be in a place where without more data information that we're -- that we are somehow answering yes or no to that very specific number because there are lots of things that we need to figure out. >> i will give you -- just in terms of workforce, for instance, we know and i think the community providers in the room how hard it is to train, recruit, and retain people. so when we think about the expansion of the workforce and those costs, when you look at some of the numbers that have been estimated with our office, the mayor's office, the bla, there are ranges in there. i would ask for your forbearance and patience in terms of being able to answer absolutely yes or no. i think what we have here is a vision, a commitment to value, and a commitment to evidence and partnership to answer some of these questions with the working

group. we do have our budget analyst here. and obviously dr. hammer can answer some more granular questions. i just wanted to point out that we are in a stage where we're under development and a lot of these very specific questions that do need to be answered, we're just not prepared to be able to hammer down, okay, yes, it will be $22 million or $23 million. i understand that may not be the gist of your question. >> more like maybe $50 million or $100 million. and i don't know, but -- >> we can give you the ranges based on some of the assumptions we made, but again, as we learn and try to execute this, we would have to -- and also i think there are amounts that we can give -- depending on what the policy-makers and the resources that are made available, there are things that

we can do with different amounts. to say this is the total package and how much it will cost this or next year, going back to my point, in two or 10 years, this is an iterative process that needs to go on here in regard to reaching the goals that we all share. >> whatever it is, it's a moral em -- imperative. >> i appreciate the chair letting me answer these questions. two things. one of the jobs of the implementation working group is to do a staffing analysis. our hypothesis about why it's so hard to retain and recruit case managers is the rates are low and the work satisfaction is

very low because we don't have a supportive system in place. so that a case manager works so hard to get someone off the street, into care, clean, stabilized, on medication. after they're in the residential program, they're placed right back onto the street, where it's almost impossible to stay clean. you're like, why did i put all that time and effort into this job, when the person is just going to end up back on the street. you can imagine how eventually you would want to switch jobs. that's not like you're contributing in a meaningful way. our hypothesis is if we raise wages, improve the system and have a system in place that gets people well, it will lead to a job satisfaction that is so much higher, that people will stay. again, as dr. colfax said, that's a working hypothesis. the second thing is i want to be clear while in total we're calling this a universal program

because of the office of private insurance accountability, the specific population that is entitled to a case manager under mental health s.f. are the uninsured, the homeless, healthy san francisco participants, those individuals on med-cal with a mental illness. that is controlled by those paramet parameters. >> thank you for that. i would love to hear from the d.p.h. budget folks how you came up with this figure and what you think we're getting in terms of case management for $22 million a year. >> the legislation has several components to it. there is a mental health services center, which is the range that we have noted is around $18 million to $22 million. this is an actual substantial of potential expansion of our

behavioral health center to 24/7. there are also estimates of 25 to 35 million. again, the actual costs would really depend on the actual program model, the levels of service, and our capacity. >> everybody gets it in the way described in the legislation. >> yes. >> i mean, i'm just curious -- i'm curious if that was -- what number of case managers, additional case managers get added at that $35 million level? >> i don't have the actual s.t.e. because we're considered a service of community-based providers, but what we have done is identified a group of 4,000 people we do believe need to be case managed today. we have 250 that are in the top priority. they would be case managed at a 1:10 ratio, social worker, and

peer, as well as additional wrap-around support. a lower tier would be a 1:17 ratio with wrap-around support. and recognizing the reality of not being able to engage everyone at that level and still maintain a continuum of care for them. we're assuming that we will still have a touch on everyone at a rate of 1:50. as the legislation notes and supervisor ronen has noted, the actual levels ratios will be reviewed by the working group and made as a recommendation to the department, but those are the assumptions behind those numbers. >> okay. and i apologize for looking at the wrong line, and it is $20 to $35 million. but that $20 to $35 million is based on providing case management at the levels described in the legislation for the 4,000? >> yes. >> okay. cool. thank you.

the other piece -- this isn't necessarily a budget question, so you're relieved. but that i -- that has been talked about is the department's need to sort of manage its -- measure things and analyze the measurement that it is doing and one of the tremendous frustrations for this budget committee has been the lack of kind of sort of -- the department's inability, at least last year, in the budget to sort of -- in the budget process to describe where its highest priorities were around behavioral health and what it would need to achieve specific goals. i think, you know, we've had repeated audits and analyzes that have said that there needs to be better data and data management. we've had conversations about -- dr. colfax that that would be

easily a $50 million investment in i.t. for behavioral health services. i do hope and trust that that investment in systems and data management and data analysis and probably an ongoing set of data analysts is going to be part of what comes out of the working group and ideally things that we start funding even before the working group has -- fund through next year's budget, without necessarily waiting for the final results of the working group process. okay. there are two elements of mental health s.f. that i feel particularly attached to because of -- because they did come up in the meth task force, and they're both complicated and i think are going to require

qualificati conversation and thought and analysis going forward. those are the sobering centers and the street crisis response teams. so in our discussions at the meth task force, there was -- sobering centers were the highest recommended item, but it is not clear to me and we did not get to a level of detail in those discussing that everyone was talking about the same sobering centres. i will say and i think this is a conversation that this board is going to be having, d.p.h. is going to be having, there is a pressing need to relieve pressure on psychiatric emergency services and emergency rooms around san francisco. it's going to be really hard and complicated to create the meth

sobering facilities that serve either as an alternative or another form of treatment or a place to describe what has been described as the 51/41.5 person. that's at least what i was talking about in the meth task force discussions. supervisor ronen is nodding, which makes me believe that that is her understanding of what a sobering center would be. although the meth task force also recommends a range of services for people using meth, drop-in centers, places for people to come down off a meth high that i think what we think is needed is a place or multiple places where people who would be going to d.p.s. are being

diversitied. if we believe this changes, we might need to explore that. if there are people -- we think we could fill sobering centers with people who don't need that treatment, but that raises the question of how they'll be held there until they come down. i really want d.p.h. to wrestle with the complexity of that question and come up with something that provides relief to d.p.s. i've expressed this to dr dr. colfax off line, but i just want to make sure that that's where we're headed with the sobering centers, not to the exclusion of other centers and facilities for people who use meth, but that we have a place that reduces the pressure.

>> yes, i wanted to very much agree with you on that point. but having the center open 24 hours, seven days a week and connected with this street outreach team and having a place that isn't the emergency room and isn't d.p.s. where that team and the police -- but hopefully, if it works the way we want it to, the street crisis team can bring people and that is aimed at addressing the overcrowding in the diversion. but i absolutely agree with you that there's another population of meth users and that we have not fully figured out what the right architecture is for a meth sobering center is. that work is yet to be done, and i think we all agree we don't have that model