available for further conversation about this. i must sign off now, but i'm very happy to return to you and add more after her response. thank you so much. >> supervisor mandelman: thank you. dr. hammer? >> so we started to, in work with our finance steteam, i th you know, before covid, started to develop a business plan for the expansion of our street outreach teams and the office of care coordination. everything has expanded with covid-19, so some of what you're asking is part of the cost analysis with the covid-19

activation? it's part of expanding our staff in the hotels, expanding our street presence, working with c.b.o.s to see if we can do contract modification so that we have more workforce to draw on so that we can get the successful programs that predated covid-19. i don't have a cost on it right now. as i try to articulate, a lot of what we have quickly put into place, more quickly than anybody expected, during phase one of the activation, i think it's given us sort of a foothold, a building and expanding into those areas that i talked about. >> supervisor mandelman: although that doesn't -- i hear that you're doing the work on the -- on the street response,

but i guess i'm still missing the where folks in crisis would be taken, you know, over the next year if we don't have adequate capacity in p.e.s. >> right. we -- we -- i mean, i think what we need to really focus on is with some slight reduction in capacity at urgent care. we've been able to maintain most of our capacity in our diversion units and a.d.u.s, but yes, that's our biggest concern is if we expand our street outreach work, and it's 24-7, and it really moves us toward of vision of mental health s.f., which is more behavioral health teams on the

street interacting with people and trying to engage them and bringing them into care, the big question that comes up is where do we take them? where do we take them that's not p.e.s.? and we have very few options right now. we are optimistic about the expansion of hummingbird, that hummingbird will be another option, but as you know, beyond p.e.s., we have urgent care

options. >> supervisor mandelman: over on the -- you know, in the sort of homelessness side, we've spent -- you know, we have significantly increased over time, although maybe not enough, the number of outreach workers, but the thing is they don't always have places to offer people. we could easily replicate that conundrum by having really fantastic crisis intervention teams that could go out and have a conversation with people on the streets but have no place that they could take that person. well, it strikes me as where we are now, and strikes me as completely unacceptable, and i

would move to hear -- you know, it doesn't have to be right now, but i would love to hear the best thing from the department of public health on how to manage people in crisis, in psychosis. they might need to be in a licensed psych health facility like door. but i just think my hunch, based on the world that i live in and see, is we don't have places for people in crisis right now, and we need places for people in crisis. the immediate response, before someone ever gets referred for a conservatorship or a voluntary bed, that we need to have better placement.

this came out of the report from the task force about the sobering centers, as well. and this is not the budget committee. this is the public safety and neighborhood services, but last year, in budget, we said, tell us what you need and how much you need to do it. what we got back was thank you so much for the question. we're not quite ready to tell you that, but we will be in the future. well, a year has gone by -- you can't diminish the impact of a

global pandemic or people that are in psychosis or serious intoxication indication that are out on the streets. >> i think that's the crux -- to me, that's the at the heard of where we know we have to do better. if we have unused beds, if we have unused treatment facilities, we have to ask ourselves that if we build it, will they come question? i think that's why so many of us were so excited about the drug sobering center model that we were looking forward on piloting is it seemed like we were based on what we were hearing from people -- people who would be using it as well as the harm reduction community is this is what people needed. again, it was a pilot, and it was a suboptimal not permanent

place, but it was good ideas about what people want and what they will engage with. i'm the first to say that we have a problem that we have some services for those people who have the most severe, most complicated needs, that they don't want -- you know, as many people as we put on the streets say that's not how people want to engage, and that's what i hope we get to moving forward on in these main areas around that mental health s.f. legislation. >> supervisor mandelman: but i would just point out -- and i think i have a couple more questions, and i'll feed to the other members of the committee. you know, the meth sobering center was -- i mean, what is it -- many different people on the meth task force had many different ideas what the

sobering center would be and what services it would have, from a place to get out the streets to more of an altern e alternative to p.e.s. from what i've heard on the streets, there was a real need to reduce pressure on p.e.s. and how a sobering center does that -- i can see stories how it does a little bit on the margins, but unless it has more, unless it is built to deal with people in acute crisis, it may not achieve that, and i know there have been conversations over time about potentially an alternative acute crisis facility in addition to p.e.s. seems like neitheither -- my s is that we need that. if we don't, i'm happy to have that explained to me, but i do

think it's -- you know, that's key to getting someone -- someone who's psychotic on the street is not going to go to a sober -- like, the sobering center is not an option. they need to be taken somewhere else, i think, a. and i guess my last question is, i've heard from multiple people -- supervisor ronen, but also people within d.p.h., that this care coordination is among the most -- and i think this is right -- is among the most important functions that we should be trying to build out over the last year. we had that extended conversation about case management, but really keeping track of who needs our services, and what those services are and getting those services aligned into what makes sense is really critical, and mental health s.f. envisions that as an office of

care coordination. i don't know if that is to happen in the next year, but what is your thinking if you had some resources, how you would begin to build out care coordination in a way that we would feel? like, we would see in the data, we would experience in the city? not the full gold plated version of this because, obviously, we're not going to do that right now, but what's the obvious sort of beachhead plan that, okay, we're doing this? >> so with your permission, i'm going to ask our acting director, marlo simmons, to answer your question. she's been looking carefully at the office of care coordination

idea and how we move forward on care coordination, building that structure, even before it's fully funded, so i'm going to ask marlo to start. >> supervisor mandelman: great. >> good afternoon, everybody. marlo simmons, acting director of behavioral health within d.p.h. the legislation and how mental health s.f. talks about the needs, i think, is really right on and reflected a lot of the problems that we have in our system. one of the first things that we'd like to do is really build out a linkage function and what that looks like, for example, in the s.i.p. hotels, to supervisor ronen's example that she shares, is that the staff and hotel would have a place to call when they see a concern

about a client, and that that call -- there is someone who immediately answers the phone, talks with them about what they're seeing, what's the best response. and in that case, it sounds like someone should have come out and helped that client get access to medication or whatever services are needed. we've started that with the shelter in place hotels. it's very new, and obviously, to get people to use that kind of service, they need to know about it, so that's where you get the marketing campaign that's involved in the office of care coordination. you need to train the staff in what to expect when they get calls or what will happen when they call the line, and then, you need quality insurance when the staff calls the line, they get a person on the line, so they understand the response, there's follow up. so there's a lot of details at every stage. i think we also need to really

expand the street-based outreach that we're doing. some of us talk about it as relentless street-based outreach, and that is what it is with people. there's a lot we have to show that it works. with the care coordination, if you identify someone who's willing to engage, how do you get them in the front door? that's what we hear from people involved in the system, in the jail system, in the prison system, in the foster care world. it's helping people understand what's available, what's the best match for the client, and helping them actually get there, and that takes a lot of time and engagement and real conscious work and being aware that the services have high quality or meeting the needs of

the compliantlients. and looking at the data, the outcome, what we're trying to achieve. a lot of information around accessing where we are. so people like the folks at p.e.s. are able to say oh, here's the outpatient provider, so it's kind of a lot of glue in between of all the silos of services that you have. >> supervisor mandelman: so that takes resources? >> for sure. >> supervisor mandelman: dollars, and although it is a high priority for the department, i am -- my understanding is, you know, that it is not dp-- the best

priority may not be included in your budget. so if the two stated things end up -- and a place for people to land -- if the outreach happens, and they are brought in somewhere -- like, those things would all need to get added either in the next month by the mayor, finding money from somewhere else or, less likely, from the board of supervisors trying to find money to shake out of the mayor's office to pay for those things. i mean, i think what would be

really useful for this supervisor -- i don't know about for others -- is for the department of behavioral health services -- similarly along the lines of what the doctor has done with the beds, but to think a little bit along the lines of some way of measuring a meaningful move in these areas, and then a cost associated with it, and i would love to see what it is. i know that supervisor ronen -- may already have asked the controller for this, or at least in some ways, i'll ask the department to look for those. all right. i'll cede the floor. supervisor ronen, you have

this. >> supervisor ronen: yes. thank you. dr. bland kept referring to a team. who's on the team? >> yes. so i'm having problems. after this, i'm going to switch to a different network. if i lose you, i'll be back in. so lauren bruner, who you've heard from, is an analyst working with dr. bland, and there are executive leaders from the behavioral -- from the d.p.h., myself included, who sort of morphed from our early work prior to mental health

s.f., from mental health reform weekly meetings to the mental health s.f. legislation and the projects that we had already started working on with mental health reform and the new projects, so, yeah, but it's led by dr. bland and dr. bruner. and i'll be back. >> supervisor ronen: i can talk to dr. simmons in the meantime. so a lot of what you're

describing in the dialogue with supervisor mandelman, it sounds like you're putting the cart before the horse. i don't know if any of you can answer these questions because it's sort of dr. bland's main thing, but i do have a lot of questions about the bed study? to me -- and i think i'm agreeing with supervisor mandelman, at least as i understood his comments -- that how do you even do that study if you don't have a system in place? i agree with that, that the office of care and accountability -- the office of care coordination, that that's

a different office that we're going to put off till later. the office of care coordination is the most important part of mental health s.f. because if you don't have an office where care is coordinated, and you don't have a structured team of management, etc., where people check in, you can't have that, and we've never had that before. i just don't understand without that, what's in place? who's the management? what's the different level of case management? who are the contracts with case management? who's quality control? who makes sure the same set of standards are being placed up? what's the tracking system tracking which patient is assigned to which care manager? if someone falls out, how do they get back in?

i've heard none of this system building in your talk or the way that you refer to mental health s.f., and it's really worry some to me, when i saw d.p.h.s budget that was presented to the mayor, too, i have to say, i was actually shocked that there was nothing in there, with the exception of a vague reference to hiring more people in the h.r. department at d.p.h. -- very important -- in order to even begin implementing mental health s.f. because you recognize you need to hire different staff to make it happen, or at least repurpose. so this is, again, why i get so frustrated. it has nothing to do with dr. bland, who's incredibly talented psychiatrist and physician. if the fact that you're focusing again on these one-offs, you know, this bed analysis that doesn't fit into a system -- so it's kind of vague and random.

maybe you can explain to me the methodology around it, and i'm wrong about it. but the rising prices on our street, you know, from a gut level, it just makes no sense. and so, you know, it -- it -- it's extremely worrying to me nowhere in your presentation, nowhere in your budget submissions to the mayor, and nowhere in talking about your work in the middle of a global kri s crisis is there talk about mental health s.f. it's just extremely problematic to me. i'm really glad we have a meeting set up in a few days. i think it's next week, even, but i'm really shocked that

there hasn't been more thought into what would the first phase look like? you've told us that street medicine goes out with a hot team. and supervisor mandelman asks, well, where do you take them? where do they go? well, we don't know. it sounds like a year ago, when we had to take the reins ourselves to create mental health s.f. and not to say that you guys haven't worked really hard, because i know that you do every single day. as supervisor mandelman said, no one can underestimate the impact of covid, but i at least hope going forward that we're thinking about it in the same way, and from the presentation

and all the discussion and the drafts of mental health s.f. and all of that, that we're still in a place where it's hard to get answers to question. >> supervisor mandelman: before you answer, i would just say that this presentation definitely reflected conversations that i and my office have had with d.p.h. >> supervisor ronen: okay. >> supervisor mandelman: i did not ask for a report on mental health s.f. implementation. i asked for what's going on on

the streets, and it was the thoughts that were in my head about beds and other things, which has overlap with mental health s.f. >> supervisor ronen: sure, and i guess that, and i guess that that wasn't the topic of today's presentation, but the reason that it's triggering to me is because in the way that you're answering questions that supervisor mandelman is bringing up, the framework hasn't shifts in terms of how d.p.h. is thinking about solving these intractable problems that we haven't gotten a handle over in years, and so that's what's worrying me. i hear you, supervisor mandelman. it's the way that things are being discussed that makes me feel that we're not moving in the direction that i thought we unanimously passed legislation,

deal brokered with the mayor, would be leading us. >> so supervisor ronen, i hear what you're saying, and i'm sorry that our presentation and the way that we're talking about our work over the last few months during the covid-19 activation wasn't based in the language that i think we all did -- the language, the vision, the tenets, the different projects are articulated in the mental health s.f. vision. before february -- remember, this was incredibly complicated transformational work. you were the author and visionary working with us. it's expensive and requires a lot of infusion of not just

staff and changing how people do their work, but also facilities improvements. when you talk about an office of care coordination, when you talk about 24-7 access, those are huge transformational changing. i'm glad that we started it. we talked about the expand of bhac, how we would expand access to 24-7. we had started work on the street crisis intervention response team and how that was articulated in mental health s.f. you know, the work that dr. bland discussed, so not just

the bed modelling, but how we use this. but because there was this, you know, wellspring of support for, like, i said, major transformational change, we put our effort toward it. and now, here we are. so as i said, you know, if we are able to flatten the curve, and if we can pool some of the

huge resources that we've invested in the covid response -- street outreach response is hugely resources intensive. you know, it will take a lot of staff. we will have to hire staff for that and not for, you know, the clinical support that's needed for people if you put them in hotels. so i just want to be realistic that we can only do so much. i do take responsibility and really hear you about -- that we not only need to talk about, but start thinking about that our transformational work -- our mental health reform work is mental health s.f. until we do something, it's what we all were very excited

about. the legislation -- we're moving toward something. early april, we had a meeting date for the working group. we never had the working group meet, but we're focusing our energy of hiring a new director of mental health san francisco. those things need to happen before you can see what you need to see and what's urgent. so i think what we're trying to convey in this presentation is we've already started working on basically what's sort of -- i don't want to say low hanging fruit, but it's things that are directly related to our covid response and what we have to do right now and what we see as the start of building the foundation for mental health s.f. i think they are, the work that we're doing in the s.i.p. and

the street work, that's the start of building that foundation, but we're not there yet, as you know. >> supervisor ronen: i really appreciate that. your response makes a lot of sense to me. i'm happy we're having this conversation, and i want to thank supervisor mandelman for calling this meeting and having this conversation because it's starting to sharpen what's needed moving forward, and i hear what you're saying. and again, we were moving sort of in the right direction before covid hit, and it's thrown everything haywire. so i'm looking forward to getting together and talking about this in a different way in the midst of covid -- we're both coughing now, but i really appreciated what you said, dr. hammer. thank you. i'm done. >> supervisor mandelman: okay. thank you, supervisor ronen.

vice chair stefani, if you don't have any questions or comments, let's go to public comment. >> clerk: for those who have already connected to our meeting via phone, please press star-three to be connected to this item. for those already in the queue, wait for the prompt. the prompt will be, "your line has been unmuted." for those on-line or on channel 1626 to 415-655-0001, and then enter 1458532772. press the pound symbol twice,

and then star-three to be entered to speak. do we have any callers? >> yes, we currently have three callers in the queue. i will queue the first caller. >> supervisor mandelman: and i will repeat our public comment rules. speakers will have two minutes. we ask that you state your first and last name and you speak directly into the phone. if you've prepared a written statement, you can send it to the city clerk for inclusion into the file, and in the interests of time, speakers are encouraged to avoid repeating statements. let's hear the first caller. >> hi, can you hear me? >> supervisor mandelman: yes, go ahead. >> hi. my name is javier. i'm a san francisco resident and community organizer. i also represent the treatment on demand coalition. the pandemic has us in an

unprecedented time in terms of health care, and as always, people that are suffering under the status quo are hit hardest by covid-19. the homeless population has now hit fr moved from precarious on the streets. our communities have been asking for accessible treatment options for decades, and we have the tools to address this. i'm glad that we're holding a separate hearing on the city's response to unhoused people because we passed mental health s.f. late last year. this bill was to make mental health treatment in s.f. actually accessible at a time when we're having a conversation about reducing the police in our every day, our

only conversation is finding out different ways to lock people up. it's embarrassing that our city orders its constituents to shelter in place to stay safe when they don't offer how and then continue to complain about unsightly homeless people who our communities are offering solutions that aren't at the center of our conversations. we must implement mental health s.f. now and house people that are on the streets. we are facing rough economic times, and our approach is always to cut or slow down crucial change like mental health s.f. when the dot-com bubble burst, we cut mental health services. in 2008, we put mental health on the back burner again, and look we ahere we are now. >> clerk: the speaker's time

is up. >> supervisor mandelman: thank you. next speaker. nrs . >> supervisors, and you so called experts from the san francisco department, i'd like to bring to your attention that there are $12.78 billion budget. i know the san francisco health department washas a budget tha over $2 billion, but what i -- i've seen for is that a few

supervisors have their heart in the right place because i've spoken to them, but when it comes to the san francisco health department, it's pathetic. the director, grant colfax, he's all over the place. this is what happens with newbies. when they come here, it takes them about 500 years to understand san francisco. it is disgraceful to see so many homeless, and people assaulting people in the bus all over our city, and here, we are talking in generalities. one of the supervisors was right. we should take it upon ourselves to understand a few of the aspects, but the so-called doctor who is an expert, he's got something to do. probably to go to the planet

juby-juby but not to attend the meeting, and that's not becoming of anybody who's professional. san franciscans are fed up. in the interim, you have a supervisor and the mayor who spent all day yesterday cutting ribbons and doling out commendations. that's pathetic. we need to address -- >> supervisor mandelman: thank you. next speaker. >> good afternoon. my name is mary kate buckelew. i appreciate today's focus on mental health s.f. and coordinated care for people in crisis, and i wanted to talk about covid-19 and the impact on them, where entire families are sharing cramped and

substandard rooms. they've lot significant percentages of income. i would estimate about a third across the board, and they're isolated from families, schools, and community as they're dealing with extra stressors, like threats from their landlords, particularly for undocumented families, and putting food on the table. our demand has sky rocketed. our systems are all manageable with immediate, accessible and informed connections, i these are the cities most vulnerable families. they're people of color, low-income families, undocumented families.

as we do our system planning and evaluation of the impacts of covid-19 on people in crisis, i urge you to consider these families who are not as visible as some of others in crisis but who are truly facing unprecedented barriers. thank you. >> supervisor mandelman: thank you. next speaker. >> clerk: caller, go ahead. >> good afternoon. my name is carolyn kennedy. i'm a resident and community leader in district 8. thank you, supervisors, and thank you, d.p.h., for speaking. it's estimated that nearly half on the street suffer from behavioral health and substance abuse issues. and as supervisor mandelman

says, this is a health crisis that's visible on the streets of our city. i thank you again. this hearing has provided much information about the problem and about d.p.h.s response to the problem. we still desperately need mental health services to address the tragedy we see every day on our streets. we need to maintain and add to the funding for these critical services. supervisors, please take away one message from today's hearing. your constituents are sad and frustrated by a city where people are on our streets in full blown psychosis, where mentally ill people are harming themselves and others, where residents are being attacked and dying by those who are mentally ill. please know that residents in your districts want these services included in the 2020-2021 budget, and the department of public health,

please provide us with clear budget figures regarding what's needed to fund enough beds to treat those in crisis so that we can lobby for them. i applaud the work you're doing, i applaud the work of mental health san francisco. please sure that we can get those on the streets suffering psychosis into the service that they so need. the ones who are so severely mentally ill, that this is the right option for them. thank you very much. >> supervisor mandelman: thank you. next speaker. [please stand by]

thank you. next speaker. >> mr. chair, that completes the queue. >> great. well, if my colleagues don't -- well, public comment now closed. i want to thank all the public commenters for sticking with us

through these four hours and calling in. and i see of my colleagues, so i will make some concluding remarks. mainly in thanks to our folks for doing the thinking that went -- that underlay their presentation today. i think there is broad agreement i think, across the board, supervisors, mayor's office, department of public health -- i think there is a lot of shared understanding about how we need to fix our -- certainly our overall broken mental health system or at least -- yeah, we can call it broken. and the need to not wait another year. and so i think i am grateful to

the doctor for the work he has done, and particularly for this bed study. i would like to encourage the department to do a little more thinking about these buckets that are still -- pockets that are still -- at least in this presentation, fairly generally described. particularly street crisis response, outreach and care coordination to improve outcomes. i would love it if the department could spend some time thinking about how to make some significant moves in those two areas over the next year. and to do that, i think you're going to need the money to do it and it would be great to have, you know, some dollar figures attached to the projects that you want -- that you could undertake to make significant progress in those two areas. the area that i don't think i

really saw reflected in the presentation today that i would also like to have additional thought on, is how we're going to -- where we're going to take folks over the next year when they are -- or the next couple of years, when they are in psychosis, intoxicated and cannot remain out on the sidewalk in the state that they're in. as we've talked about, we can have great crisis outreach teams. those teams are going to need places to take people. and again, i think the time to start working on that, we cannot wait. we cannot go for another year with conditions on the street deteriorating. people in distress, visibly in distress, extremely sick and more of these folks out there than ever and not be able to at

least tell san franciscans that we're engaged and moving as quickly as possible to a better status quo. so i actually want to continue this hearing to the call of the chair. but it's my intention to have d.p.h. back at one of our two july meetings, because i would like to have more of that detail and maybe some dollar figures attached. and i do have at least a couple of additional questions about the -- you know, the results of the bed study, for example, you know, how does that proposed increase in funding relate to the existing d.p.h. budget for beds? because my understanding is the existing budget for beds does not actually account for all of the beds we buy over the course of a year. so if we're adding $10 million to a budget that already doesn't

account for -- for the beds that we need to buy over the course of the year, i'm not sure that's guaranteed we'll be making progress toward the number of beds that we need. anyway, maybe somebody can explain to me that aspect of the budgeting and maybe we can have craig wagner talk to us about that. and i'm wondering how the bed study relates to the beds we don't use. we know we have beds in the health facility, s.f. general, a number of locked beds that aren't in the budget. i don't think we budget for them, i think. so there are questions i'd like a little bit more information about. seeing supervisor ronen? do you want to unmute yourself? >> supervisor ronen: yes, thank you. i really just don't think we have the opportunity to ask enough questions about that bed study, so i would recommend that

create a time where the doctor can be here with us so that we can really ask questions about it. >> yep. so i think we need to have d.p.h. back to this committee in july. i did not anticipate that my housing conservatorship hearing would last hour and a half. and then we certainly did pepper presenters with questions as well. so the whole hearing has taken longer than anyone anticipates, but i think that is part of what happened here. he was around for three hours, so -- all right, with that, i will move that we continue this hearing to the call of the chair. and mr. clerk? if you could call the roll? >> on the motion from chair mandelman that the hearing be continued to the call of the chair? ronen aye.

stefani aye. chair mandelman aye. mr. chair, there are three ayes. >> supervisor mandelman: great. then the motion passes. mr. clerk, do we have any further business? >> clerk: that concludes this committee's business for today. >> well, then we are adjourned. thanks, everyone. it.

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>> hi. i'm chris mathers with channel 19, and you're watching coping with covid-19. today, i'm going to be talking about exercising during the pandemic. first, i'm going to tell you what i've been doing, and then i'm going to be checking in with some friends and family. i've been riding my bike. all i take is a pair of gloves

and a mask if i come into contact with anyone. i try to ride my bike during the time i'm sheltering in place. i try to ride for at least 30 minutes. surfing is my other regular outdoor activity. california state guidelines recommend you don't drive more than ten minutes for a spot to exercise, and although i'm close to ocean beach, i'm a bit wary to go there, so i'm using the time to do some maintenance. filling in gouges and dings, and sanding it down. i'm also repairing holes in my

suit. fellow sfgovtv producer chris took his first yoga lesson a couple of years ago and used to go to a class regularly before the lockdown. he and his wife set up a space in their garage for exercising. this routine is from an on-line class by power yoga. deann and andy have been using the ping pong table that they bought off craigslist and set it up in their back yard. ellie has been using this home gym to stay fit. it has everything she needed. and lastly, if the weather is bad outside, you can exercise your mind by doing a puzzle, sudoku, or just by reading a good book.

here's a quick recap. since i started this episode, the guidelines have changed. for instance, jack may be able to go golfing with some restrictions. go to sf.gov to get the most up-to-date