or so to meet with people, now of course, it's virtual to prepare drafts and adequately review and get around it signing them with our notary and witnesses. some of them you can do on your own. with a lawyer it's going to take two to three weeks. >> : just for folks to know she is a non-profit providing these services. we want to let people know they have help out there especially from our non-profit partners. i'm go to go turn it over to you. >> : we have so many questions coming in. we have a question from cony. two single person bought a house with 45% and 55% separately. after being married for two years they did not change the

title. now the husband wants to change his 45% to his wife. will that change the property tax? >> : sharing of ownership information between married couple r. in that situation we wouldn't expect a reassessment. >> : they can own their property together as community property within that marital trust, there are some benefits to married couples in owning property as community property in a marital trust. essentially if they own property as community property and one of them passes away. if they property is sold even though both of them haven't passed, that surviving spouse will dpet the full basis. that's a unique thing for people

who own properties as community property. >> : that's something that is-i'm glad you brought that up. i think if you're like me, when you first bought a home you were not paying attention to all of these legal documents, nor did you know what they really were. one thing i suggest you take a look at for properties because it's a big part of what we own. take a look at your deed and how it is that you have recorded holding title. you're going to see on that line there's actually very specific legal language that speaks to how people are owning things. what is the reeght o right of survivorship afterwards. we own the property as community property. kind of speaking to what she is saying rk th, the designation oe deed is how we own the property.

if i purchase the property with my partner, wasn't my husband yet. we own the property together. we may have opened it as tenants in common. we each have a real proportionate share and may have no rights to survivorship. that may say i own my 50% share and he opens his 50% share. unless i designated it somehow with a tod or if i had put up a trust or will or something that strig nateed it wouldesignated . who is in the chain of inheritance for me. i'm designated in my deed that we're owning separate portions of it. he doesn't have a right to receive my portion if i pass away. i recommend because i think especially when we first buy property it's such a blur you

don't pay attention to the language in your deed. you may want to pull that document up and see what it says. it speaks to not only how you are owning it but what happens in terms of survivorship and where that property passes passs afterwards. >> : i would say that's for people who purchase property prior to about 2000 or so a lot of people were taking title as joint tenants with their spouse. without the writership and being community property, i believe that if one of them passed and then it was thereafter sold, they would only get the basis on that 50% rarymg than the 100%. it's very important to pull out those old deeds. i see deeds indicating all kiefneds okinds.

that's a great tip. >> : right. >> : we have one last question. we'll get back to the rest of you after the webinar. the last question is-there's so many to choose from. should we put a trust name or actual beneficiary, for example, a child on the beneficiary form. >> : on a retirement account or life insurance? >> : it's not specified. >> : okay. can you read that again? >> : should we put a trust name or actual beneficiary for example children on a beneficiary form? >> : you can put someone down as a primary beneficiary. if the child is a responsible

adult you could put that child down as a beneficiary. i don't know how old this person's child is. if the child is younger, you have to think about if you just put someone's name down on a beneficiary form that person would attain that asset at age 18. you can think about being 18 and you came into a large sum of money that may not be a good thing for us. if you have younger children and they aren't financially responsible yet, you can put a trust down and certain restrictions. for instance, that money would only be for health, education, support, or maintenance until that person is thirty years old or 25 years old. that person would have living expenses and attend school but would not receive the check book

until age 25 or 30. you want those assets to be controlled. >> : i think that's a great point to wrap up with which is again, i think each one of the different tools that we've talked about today whether it's a will, trust, descrig natein da beneficiary. what are your wishes? how things are? the intended beneficialary is five years old, you may want to think about how you want to set that up. there's more flexibility in terms of designating condition nz which that person is cared for until they are of the age that you think they should inhaisht or receivinherit.

i hope you begin thinking about these questions. i'm sure there's resources to help you get through some of those questions and pros he is s we move forward. >> : in discussing children because i didn't have time to get into that. people with young children, children under the age of 18, they should probably prepare at least a will if they own a home, they can prepare a trust as well. in those documents, you would typically designate who you want to be the guardian of your children should you pass away. this avoids chaos between well intentioned family members. it's be best to make that very clear because the court gives

deaf randeference to that choic. >> : it drives home the point when we talk aboutest at about e planning, it's about love. how do i take care of the people who survive me and make sure they are set up in a good way, they don't assume burdens or things without clear understanding with about where you want things to go. especially for young children as well making sure that, you know, who you think are the best guardians and folks who take care of them are actually going to be the ones who can. i think that's really important. thank you for spending time with us and all the panelists who joined us. our translator for making sure that everything is accessible to our participants. we hope that you learned a lot. thank you so much for joining us.

>> : thank you, everyone. >> : thank you, so much. i just want to remind folks we're going to put up the poll one more time to you can give us feedback for our first dij cal famildigitalforum. we hope that you stay well and enjoy the rest of your weekend. bye bye. >> : bye.>> : this meeting willo

order. welcome to the july 23, 2020 meeting of the public safety and neighborhood services committee. ear clerk is john carol. i want to thank folks at sfgtv and it for all of their support as well. mr. clerk do you have any announcements. >> : success. during the covid 19 health emergency the committee room is closed. this precaution is taken pursuant to all federal and state orders and directives. public comment will be available for each item on this a agenda. san francisco cable channel 26 are streaming a call in number

across your screen. to provide public it is available by call in. once connected and prompted into the meeting i.d. after you've dialed in press pound followed by pound a second time to be connected to the meeting. when connected you'll hear the meeting discussions but be muted and in listening mode only. when your item of interest comes up dial star followed by three to be added to the speaker line. please wait until you've been unmuted to make your comments. best practices are to make your call from a quiet location. turn down your television or radio. time delays we may experience in

coverage in streaming. you may submit your public comment in either of the following ways. you may e-mail me, john period c arroll dot gov dot org. your written comments may be sent by u.s. postal service. the a address is one dr. c arlton at goodlet place. items will appear on the board of supervisors special agenda of august 112020 unless otherwise stated. >> : thank you, mr. clerk. please call our first item. >> : the hearing to consider the issuance of the type 57 beer

wines liquor license to do business as the four seasons on the private floor of the mission. members of the public who wish to provide public comment on the item should call in. inner the meeting id. press the pound symbol twice and press the star key followed by the no. 3 to enter the queue to speak. the system will prompt that you have raised your hand. >> : great. this first item, i believe we heard before on march 12th. we heard from the alu and applicant at that time. we continued it to allow the

applicant the opportunity through the district six office the opportunity-i understand that has happened. unless colleagues have any comments or questions and unless the applicant has anything further they'd like to say or the alu has anything further they'd like to say, i will open this up to public comment. all right. not seeing anyone has anything to add to our 12th hearing on this, let's open the public comment. >> : thank you, mr. chair. operations is checking to see if any callers are in the queue. for those who have already connected to our meeting. please press star followed by three to be added to the queue. for those already on hold, please wait until prompted to begin. for those watching our meeting

on cable channel 26 if you wish to speak on this item please call in by following the instructions on your screen. have any speakers raised their hands? >> : yes. i currently have two caller nz the queue. >> : can we take the first caller. >> : i can say a few things about the public comment before we do. speakers will have two minutes. we ask that you state your first and last name clearly. if you've prepared a written statement, we ask you leave that with the clerk.

due to time we ask that you not repeat any comment. do we have another caller? >> : good morning. i'm waiting for item three. i have pressed star three. i'd like to speak at that time. >> : thank you for calling to participate in our meeting. what we request that you do is wait until agenda item no. 3 is called. at that time press star three to be entered into the queue to speak for that agenda item. in the meantime we'll move to the next caller if there is

another caller. >> : mr. chair, that completes the queue. >> : great. public comment is now closed. colleagues, would you-no further requests that i'm seeing. support issuance of this license. i think we can collect our clerk to prepare a resolution determining the issuance of this license will serve public convenience and necessity. i recommend we move that with positive recommendation. >> : on the offer motioned that a resolution be forwarded for this service premise. (roll call) mr. chair, there are

three ayes. >> : great. motion passes. >> : agenda item number two is a resolution declaring anti black racism as a crisis in san francisco. city and county departments and agencies promote racial equity and local state policies advance efforts to dismantle systemic racism. if you wish to make public comment please call the number and enter the meeting i.d. press the pound symbol twice and star three to wish you indicate to speak. please wait until the sit em sym

indicates you have been unmuted and may begin to speak. >> : thank you, so much. thank you supervisor stephanie. i just want to appreciate all of my cosponsors for this resolution. supervisors ronan-we all know anti black racism is and has been a public health crisis. if we look at the negative outcomes for black people as a result looking at depression and ways it's spread in different areas in life. it's important to call it out. this resolution which has also been presented at the human rights commission provides a pass to address anti plaque blak

racism. you'll see a series of laws and passages. i want to thank everyone for stepping up. today we have a few presenters. we're going to start with brittany. now we are going to bring up the human rights commission. >> : thank you, supervisor. good morning supervisors. thank you so much for that introduction and thank you all for your cosponsorship of this very important resolution. i serve as the acting chief of shaf bustaff i'm also a proud mf mega black ssf. we're a group of proud black

individuals. we're fighting for sovereignty and justice for black individuals. black people comprise only about 5% of the city but are 10% of all covid 19 related deaths. this item hasn't gotten the air time it deserves. housing, economic, power, police accountability, and public health. the resolution before you is an extensive but not exhaustive list of the many structural barriers that many san franciscans face. we want to call out anti black racism in particular because that is the hostility towards prejudice of black people and culture manifested towards

institutional or systemic interactions, processes and outcomes. i'm proud to be here with my coauthors. we really want to highlight the truth that racism, not one's race is the greatest determinant to the atrocious outcomes listed here. many they are attributed to individual behavior, these indicators are informed by structural and institutional decisions. this provides a bit of- >> : sorry for the interruption. >> : as supervisor walton mentioned there's a list of steps the board of supervisors

can take to really address the indicators that we listed here. we hope to continue working with you and others on everything to improving the mental health outcome and tangible recommendations for reparations and continue a conversation on police accountability. i'll pass it over to my colleague, thank you. >> : good morning. thank you supervisor walton and supervisors. i lead our quality improvement-quality improvements-my branch programs for community equity and promotion grants. i led-this resolution was born

out of the group mega black sf is made up of a lot of different subcommittees of which the public health subcommittee is one. i colead that subcommittee. what happens is we put forth policy recommendations that we'd like the city and county department to put-to work onto unlift. it was important for us to act on this right of way because of the climate right now with the pandemic and police brutality of which effect black people gravely. we're dying at disproportionate rates of both. as was stated, this resolution pertains a lot of data pertaining to the social determinants of health.

we know racism is a driving force behind the health determinants of force. we don't want this resolution to be just rhetoric. we'd like this resolution to stand as a way to hold our city and county departments accountable. to do better by the residents and the city and county of san francisco and be intentional around opportunities, around funding, and around housing care, and treat the black people of the city of san francisco. now i'll turn it over to lydia. >> : thank you so much. i come to you as a black resident of san francisco. a former dph employee and a u c

sf medical student. offering this resolution was not only disheartening but incredibly infuriating. as somebody who worked for the city i know we funnel millions of tax dollars into policies that are systemically contributing to these outcomes. they are intentionally producing these outcomes. in the same way these outcomes are systemically produced, they are not going to simply disappear. it's unacceptable for the patients to have to bear the brunt of the failures. i'd dedicated my career to bettering the outcomes of black

lives. we need to stop failing our black residents today sm thank thank you. >> : thank you ladies so much. supervisor at this time i would appreciate if we can go to public comment unless of course you and supervisor stephanie have some comments. >> : i do not have comments. thank you for this resolution and giving us the opportunity to consider it and vote on it. i will open this item to public comment. >> : thank you, mr. chair. operations is checking to see if there's any callers in the queue. for those who have already connected to our meeting via phone, please press star three if you wish to speak to this item. for those already on hold, please wait until you are

prompted to begin. you will be prompted that your line is unmuted. for those watching on cable channel if you wish to speak on this item, please call in by following the instructions on your screen. do we have any callers that wish to speak on agend speak on a gem number two? >> : there are no callers in the queue. >> : great. i will close public comment. i will move that we forward this resolution to the full board for recommendation. we have an amendment. >> : we do have a proposed

amendment that you all have. i'm just going to read them out on page three, line six replace health with heart disease. add 5% of the city's covid 19 cases and 10% of covid 19 deaths on page four, line five leading san francisco public health and replacing it with san francisco public health commission. page six, line six, including within the city and county of san francisco sif em. system. page seven lines six through eight adding a new clause whereas on july 212020 san

francisco health commission unanimously passes racism as a human rights stif rights system. i do know they are pretty substantial. we can come back on this next week. >> : okay. i will move- >> : yes city attorney. >> : i just wanted to say that i did hear the amendments that you read into the record. i don't believe they are substantive for purposes of the brown act. i don't believe you require a continuance. >> : thank you. i should have asked council to weigh in. my apologies. >> : thank you.

i will move the amendments that sawp visor walton just read into the record. please call the roll. >> : (roll call). >> : motion passes. i move that we move the motion to the full board. >> : i just want to thank supervisor walton for his leadership and passion and commitment on this issue. i'm sorry happy to be able to support it. >> : thank you. >> : mr. supervisor.

i will move and amend that we forward the amended resolution to the board of recommendation. >> : recommended as amended. (roll call). mr. chair, three ayes. >> : great. motion passes. thank you. >> : if i can thank you so much. i just wanted to thank many members and particularly want to thank mr. c lauda under wood as taking the initiative on plaquek racism. the outcomes that have led-this is our continued to hold everyone accountable and come up with tangible policies that

effect black people here in san francisco. i'm glad we know what we need to do here in san francisco. thank you ladies for presenting this morning and bringing this resolution to us. thank you. >> : thank you. mr. clerk. can you please call the next item. >> : i can. agenda item no. 3 is to discuss the housing preliminary evaluation report. members of the public who wish to provide public comment should call. enter the meeting id press the pound symbol twice to scect to o the meeting. the system will indicate that

you wish to speak. >> : thank you, mr. clerk. this hearing is-we started with conversations back in june on the 25th. it's been just over a year since the board has opted in so the sb1545 the conservatorship program, to just quickly go over some ground we covered then. some moderate expansion. not clearly the solution for all folks who have mental illnesses on the street. but the solution perhaps for some who are repeatedly over the course of the year interacting and being involuntarily detained

at least eight times over the course of the year. cycling in and out and never getting longer term stabilized in a longer term way. there's not a ton of these folks out there. we heard as there may be as many as fifty that meet that threshold criteria. not all of those fifty would qualify but i do think this is a small program that is given the amount of attention that it has received that we really do have to try it to make work. i know there are folks try to go ding todo that. when we left off last month, we asked to come back today a month later and update us op how we are doing. today we have the director of

forensic behavioral health at dph. i think we're going to hear from director almeda? >> : correct. >> : okay. >> : good morning. >> : take it away. >> : again, good morning to the supervisors and the members of the public. i appreciate being back here today to give an update on this important issue. as we discussed at the last hearing, we have-at that time we've been able to start moving forward to serve individuals as we discussed some of the amendments in senate bill 40 that they are on the potential pathway to a conservatorship with the goal of helping to intervene and engage them in other voluntary services. we have begun that process to

serve individuals. with the limitation that covid 19 provides for us which highlights the collaboration and preparation that we had before we were able to move forward with this. we have not yet submitted paperwork to move forward with housing conservatorship. we have a couple of individuals on the pres cusp. we want conservatorship to be the last report for an individual and if there's other ways we can engage them, we want to do that. mental illness is siclicle there are times where there are intense pers of crisi periods od

less periods of crisis. we anticipate we'll be moving forward with paperwork depending on the individual and likely in the next week we'll be moving forward. >> : okay. how many-do you know how many folks have received notification that they are hit their fifth. >> : that's a good question. i believe there are five individuals that we are working on serving. i don't know if all of them have received a notice. but i know that there are a couple of individuals who have had more than five. we talked about those individuals and around care coordination in much more intense and collaborative ways. >> : at this point what do you see are the primary obstacles if you do identify, once you serve them on the fifth and they've still gotten to eight.

previous interventions have not engaged them and kept them from coming back from the city eases voluntary detention. what do you see are the primary challenges to moving these initial few people towards conservatorship. >> : at this point we're not anticipating any obstacles. there were certainly challenges and frustrations for the amount of time it took us to move forward. we've used that time to engage with our partners. we have a really good collaboration to be able to move forward. i don't anticipate any challenges. we really don't know how the court will proceed with these cases. i think that's more of the own known at this time. we will need to see what happens when we move forward with our first case. i think moving forward what that will help us identify some of

the challenges and what the barriers are supporting this program to be able to pivot and adapt as needed. >> : okay. do you feel like you may be within weeks of moving forward with a petition. >> : yes. unfortunately as hard as we are to try to avoid that for individuals, i think we may be moving forward in the next couple of weeks. >> : supervisor walton. >> : thank you, chair. just a couple of questions. how do we notify individuals that have more than five? >> : that's a great question, supervisor. there's documentation that has been created by the city attorney's office and public defenders office. individuals get a notice of what 5150 they are on. if you have three more

conservatorship is a potential pathway for you. at six those numbers will change. there's very detailed information on what fiv five 51y are on. other services and access to services and how we can support them in accessing those services. >> : what is the individual breakdown? >> : i can get you more information. most of the individuals on the immediate more potential pathway are caucasian. i can get you more detailed information of what that looks like for the totallality of the population. >> : i would definitely be interested in that. >> : it's something we would want to be more mindful of.

>> : my last question from the cases of individuals with more than five 5150, what is the particular illness that's been identified? do we have that information? >> : yes, i can also get you more detailed information. looking at that data myself, most have a substance abuse diagnosis. meth amphetamine use. most have a history of psychosis or current diagnosis of schizophrenia. >> : thank you. i just want to go back over something you said about being the last resort. i wondered-what do you mean by that? are there situations where last

resort might actually harm the individual you are trying to help and who is deciding last resort? if conservatorship is the thing that's going to help the individual the most maybe for idlogical purposes some people think that's not the case. what's the medical determination, i just want to make sure people get the help they need to lead productive lives. if you're saying it's a last resort. who is it a last resort for. is it for people who think it shouldn't happen in the first place or the individual who really needs the help? >> : i can steal that one. the law requires both under existing lps statute as well as under the new housing conservatorship law we have to

demonstrate to the court that every other possible interventions has been exhausted before we move to conservatorship. because we are removing the civil rights. >> : i appreciate you asking for the clarification. one of the possibilities for individuals and particularly with housing conservatorship. we have to consider out patient treatment as a less restrictive option. balancing as she was saying. this is-we have to ensure the people are in the least restrictive setting and at the same time to ensure the wellness

and recovery of conservatorship. >> : thank you again for that. i definitely believe in aot treatment which started as laura's law. everyone said it wouldn't work. we were able to pass aot and laura's law, low and behold, it has shown that it does work. i really appreciate the confirmation around that. >> : out of curiosity, have there been folks who have since started giving these notifications around the fiv 510 following around that. >> : there are individuals we have identified through this process who are eligible and worked for all parties to make those referrals. to answer your question, yes.

not immediately in the recent weeks of referring individuals into aot. we have proactively identifies those individuals. we've been more proactive in that. >> : has aot been impacted by covid 19? are you having challenges in linking with the people you are supposed to be serving? >> : there are absolutely some challenges related to that. certainly there are more prot kols in terms of being able to access people at the hospital for individuals being referring to us at that point. all of our partners have worked really closely with us to do zoom whenever possible to connect with individuals. as people are sheltering in place which they should be doing, it has been more difficult to fine individuals that were precovid 19 maybe easier to find in the community. we have also been working

closely with our port ners to identify if individuals are at a shelter in place site to make those connections and locate individuals whether it be in a crisis situation which is hopefully not the case. if we can connect with them in other lobings in the community. i think our team has done an amazing job adapting with that and to move forward an adapt with individuals as much as they can. >> : thank you. i think we can open this up for public comment. mr. clerk, can you get us started. >> : thank you mr. chair. operations is letting us know if any callers are in the queue.

do we have any callers who have raised their hand to speak on agenda item no. 3. >> : yes. there are currently eleven callers in the queue. >> : great i'm going to say a few things about public comment. speakers will have two minutes. we ask that you state your first and last name clearly and speak directly into the phone. if you prepared a written statement you're encouraged to send a copy to city clerk for inclusion into the file.

we ask that speakers avoid repetition of previous comments. let's have our first caller. >> : my name is paulina. i hold the board of supervisors accountable for not addressing the issue of homelessness. i was a harassed by a homeless man in san francisco. they let me know that they dealt with the man earlier in the day. he was 5150. i expect more meaningful action. current conservatorship

implementation. public legislation, robust mandatory local triage and advocacy for shorter and longer term inpatient facilities. the detail of my vision are a loss of decorum in the interest of time. i don't claim that i have it all figured out. i don't want to come off as not being open to pragmatic enterprise. thank you for your time. >> : thank you. next speaker. >> : this is michael. i'm calling for senior disability action. this program of extended conservatorship needs to be done

as quickly as possible. the entry point are inherently racist. nearly a third of people with fifty one fifty holds are african american. this needs to be resolved before conservatorship proceeds. it is permanent support of housing. if this program cannot cover permanent supportive housing, it's usit's useless. this does not for housing mental health substance abuse and cannot access them. if the city can't house homeless people with the extreme risk of covid 19 in hotel rooms how can

we trust them to do anything about conservatorship. 70% of san francisco's homeless used to rent. out of control real estate market. i believe this conservatorship program is juf trying to sweep that problem under the rug. thank you. >> : thank you. next caller. >> : i want to second everything the first caller just said. we need more action on conservatorship. we are terrorized daily by people suffering with mental illness. i was chased by someone with a

metal pole. all throughout the day different individuals with different mental health problems. people are afraid to leave their house. i have three people selling their homes because they don't feel safe in their neighborhoods. this is something the city needs to be addressed right of way. that's my perspective. thanks. >> : thank you. let's have our next caller. thank you. my name is michael good win. i'm speaking because of how we address our citizens with mental illness is not working. recently a man wildly swinging

an axe at trees. i was with my infant and fourary old. four year old. it happens again and again. we're put in danger just for walking around the neighborhood. that's why i'm here today. calling 911 to address these issues. the most vulnerable incapable of making decisions to connect them with services they need to recover. public opinion polls show that san franciscans support conservatorships for homeless on the streets with mental health

services. [indiscernible]. please listen to the majority of your constituents. please support funding street crisis response teams for individuals. if it's life and death, we can and must do this for san francisco. thank you. >> : thank you. let's hear our next caller. >> : hello. my name is lisa. i'm calling regarding the agenda item that for some reason the agenda item didn't become available as we were waiting. i wanted to say since there's already anti discrimination policies- >> : mr. chair i have to pause the speaker's time for just a

moment. we missed getting public comment item for agenda item number two. we're hearing public comment specifically on agenda item no. 3. >> : how should we do this? this is the second time this has happened. the same thing happened with minimum staffing item for the police department. how do we make sure to get back on after this item. >> : agenda item two is not going to have another public comment. i would love to receive your comments if you could send me an e-mail i'll add them to the file. all eleven of the members of the board of supervisors will receive your comments when they consider the item on august 11th. >> : okay. another change. okay. thank you. >> : thank you very much.

can we get the next speaker, please. >> : hello. i'm an organizer at senior and disability action. i'm just calling to express some concerns about this expansion of conservatorship and the preliminary data that we have so far about it. recognizing that no one has been served under this program as of yet. it does not show that people with multiple 5150 holds has been offered housing. what the offer is like. that is something that needs to be worked on before this moves forward. in response to supervisor walto's question about race of

people, i noticed that she mentioned that most were caucasian. that's very misleading that thirty percent of people are black. black people represent 5% of the people of san francisco. black people are disproportionately arrested, convicted like this conservatorship could lead to. do we want to incarcerate more black people in facilities raight now where contacting covid 19 is dangerous and it seems like a poor idea to be putting people in these institutions at this moment.

>> : thank you. next caller. >> : you may think something smght you alread.you already hak account. you have access to stuff you don't understand. >> : we are connected to agenda item no. 3, if you'd like to speak. >> : you know i'm not checking. >> : you are in public comment. >> : what i'm doing is i'm prioritizing. >> : can we go to the next speaker and come back in a moment. >> : linda chap man. i'm speaking as a social security claims representative.

operations analyst. just a really critical thing that fell apart in the way the city is administering matters for people who are homeless. the responsible representative payees-[indiscernible]. you couldn't just take a medical diagnosis. many people with mental illness are very capable of renting a place. there are other people without needing to be institutionalized are not able to hanle the moneyy

in that way. otherwise we have to get either community public guardian which is usually the case to handle their money and see they got a hotel room or a certain allowance. it's much like-under the social security machines and how does it-them as well. the va representatives-social security representatives knew that that needed to be done. in finding out who was paid, certainly involved in the social

security administration. >> : thank you for your comments. your two minutes have elapsed. >> : can we have our next caller. >> : what's going on with san francisco-anything i can do to help you. >> : i'm okay. i work with- >> : our next caller. >> : thank you. i'm certain that san francisco isn't sufficiently addressing the conditions of homelessness. our already stressed businesses and parents with children. speaking rationally and open drug use and blocking passage. these have ruin evenly become a

normal part of life. on may 26 stated data of department of health, the number of people who have died is twice compared to the same time period last year. drug overdecembers complicating that issue. all the profits to provide services to close the gap including additional housing options. thank you. >> : thank you. next caller. >> : i'm cocaptain of the thirty

nine hundred block neighborhood watch. thank you for this opportunity to speak to you. my neighbors and i are distraught about the mentally ill and homeless people on the streets of our city. specifically in my neighborhood. it's an arty for people to room day and night. one individual consistently shows up between 2:00 a.m., 4:0p of his lungs for the voices in his head to go away. the fifteen children on our block ages nine months to 17 years are wondering why adults are not helping this particular person. treat mental illness is harming

all of us. my neighbors and i want you to take compassionate action. we're ready for these individuals on streets to receive the help they need. please fund and support seshing those who qualify and please support funning crisis response teams. they so desperately need behavioral health services and intervention. i'm confident you'll do the right action for the benefit of all of us. thank you for listening to me today. >> : thank you. let's hear from our next caller. >> : good morning chair and supervisors. i'm a leader of rescue sf. a city wide grass roots coalition seeking action to

address homelessness in our city. i'm speaking to you now because i see people throughout our city in danger. i'm speaking also for those neighbors unable to be here. those juggling child care, jobs, or struggling to work during covid 19. the vast majority of san franciscans support these common sense programs sm programs. a january 2020 poll, the problem is not lack of support. the problem that we neighbors and your constituents safe is one of accountability on the part of our mayor and

supervisors. we need you, our colleagues, and mayor to act with more urgency to fund programs. now is the time. we just need the will. we need our sawp visors an mayor to sponsor this. we support you. we have your backs on this. we need to start conserving the most vulnerable who suffer again and again. drug and treatment facilities dawring this pandemic, then when in time is now. we support you. you are accountable. thank you very much for all you do. >> : thank you. let's hear from our next caller.

>> : hello. calling from the neighbor's association an the van necessary council. i just want to comment in the last few years we've seen an increasing number of homeless individuals in the van necessary and hope street corridors many in the severe danger of walking into moving traffic. this is 'major certain along the marina sm hundred. hundreds of residentses are concerned about helping the most needy of compassion neat care. we strongly support conservatorship as a tool to help these individuals move forward in their life. san francisco can also look to

best practices or better practices around the country where these types of programs are helping people get better. i urge you to join with people all over the country and state move forward to help these deserving individuals. thank you very much. >> : thank you. let's hear from our next caller. >> : hi this is ben blind. today i'm calling on behalf of the discover poll community which i'm an executive director. i just want to be clear here at least what we believe this about is a small amount of individuals who cause an overwhelming amount of disturbance and difficult for neighbors in the district. discover poll doesn't have the

same issues but almost everybody who lives in the neighborhood knows there's a single individual who causes a huge amount of disturbance an problems. stands on the corner of california and polk. he swears at everybody and gets vialenlygetsviolent. we are very much in support of that to help people feel safe. that individual kicked a brand new pizza out of somebody's hand and stomped on it. we can walk and chew gum at the same time. this program needs to be funded. i'm hoping that supervisor

walton's idea to reallocate police defunding resources can be used to help these individuals that are causing an overwhelming disturbance in the neighborhood. thank you very much. >> : thank you. next caller. >> : my name is jennifer. i've lived in different city neighborhoods. now i live in the northern part of the city. i strongly support conservatorship. thank you for working on this initiative sm that's great because there's so many people moving nem san francisco. it's a threat to city rez dens sm i want to sup or the outdoo .

i'm calling in support of conservatorships. i'm happy to hear about organizations-we are not happy about it. we think our fellow citizens need treatment and conservatorship should be strongly supported. thank you. >> : thank you. next speaker. >> : part of it we've been

studying this an looking at the data-howsessing is beinhousing d for folks who are causing disruption. we know for a fact they are long wait lists for housing. treatment beds. there's difficult access into treatment. there's a lack of social workers. there's a lack of people out there trying to promote positive ways to get into treatment. we don't really have enough voluntary treatment for the folks who are actually seeking treatment. i think it's incorrect to assume that people who are out there suffering are necessarily refusing service. the problem is we don't have

enough services period. we need to expand and one great way to move forward with this is to fully fund this year so we can grow our community of coordinated system and actually provide people better access to services and treatment into housing and follow their progress through the system. part of the problem with conservatorship is we know this 5150 massively effects the black community. it's another form of incarceration. >> : thank you. let's hear our next speaker. >> : good morning. my name is c heryl.

i support the initial trust of this law. there's no enforcement. i'm distraught by the homelessness we need to get the most vulnerable care victims off the street. the mentally ill person who kills his-[indiscernible]. the mentally ill person who tried to kidnap two kids out of the car in c astro. everybody says housing is not the answer because you have some guy in the mark ho hopkins hote,

there needs to be a coordinated treatment effort. we hold the mayor and supervisor accountable for the actions and need to get it going because it's not working for us. thank you very much. bye. >> : thank you. let's hear our next caller. >> : hi. my name is gabby and i'm the policy and planning manager. we're part of the treatment. i'm hear to express my concerns regarding the implementation of this program. an intersection of behavioral health and all systems that ha

have-we must fully recognize that the conditions we're seeing today is a byproduct that was never designed to serve people of color an the poorer class. when we speak to the issue of homelessness, drug use, and mental health our system pe perpetuated these outcomes. we blame the individual veering us farther away from action. the potential consequences from policies that converts the problem before it's initiated. we strongly believe that voluntarily services are more effective. the discussion of lack of

voluntary services available. long waiting lists of housing, lack of coordination. we need more beds, more out reach, housing. all things that should be easy to access. we do not need to expand conservatorship. we need to expand equity and affordable housing. i really hope and encourage that we look at this through a housing and racial equity first lens. we tackle homelessness while tackling mental health thank you. >> : thank you. >> : my name is fra fransis. i would lake to commend you for providing a reasonable solution.

the conservatorship program should be expanded and actively sur suedactivelyexpanded. i know we should try to provide the housing for those people into the system on the way to conservatorship. i believe the mentally ill who are in this condition will not be able to be in support of housing until they are part of a prodpram that takeprogram. that takes care of the fact that they are in crisis. the people of rescue sf who may not be able to participate today. i would like to command the supervisors particularly my district sawp visor catherine stephanie through all the years she has been involved has been

actively pursuing this issue. we are constantly seeing people who are walking out into the middle of franklin street and screaming at the sky. i also would like to say i had my car stolen the other day an on way to pick it up, i talked to the police officers. they say there has to be a coordinated effort who are mentally ill and may also have a weapon. whether there is a weapon involved so you have both the mentally ill coordinator as well as the police involved for that particular person. thank you very much. >> : thank you. hear our next caller.

>> : hi. i'm somebody who suffers from deep depression. i'm formerly homeless. i'm a seven year organizer with community homelessness. i thank you guys for having this hearing. i respect everybody's person pel connections and issues. a lot of the connection has been on individual instances. i think it's important to lend out and look at the background impacts of the issue. the current pandemic impacks mental health needs to be taken into consideration. we have inadequate resources exacerbating mental health issues all around. housing people first that

haven't been taken into consideration. i think the racial impacts for the state enforcing discrimination is an important component to consider. in the future are we going to be looked back on whether we did everything first before we chose mental health incarceration. i don't think that we've tried that enough. thank you. >> : thank you. next caller. >> : good morning. my name is george. i live in district seven. i'm in favor of increasing the funding for conservatorship. the reality is sad. repeating a cycle who are in and

out of jail and hospitals in the same areas they once were with no help and no plan in sight. it's not humane to just say somebody has the right to be on the streets dealing with the same challenges over and over again. i've had my own problems. i'm in a wheelchair. it's hard to get around with people lying in the street. i tried to help someone who was homeless incoherent. he got picked up. four days later, same place, they are lying there incoherent. i don't know how to solve this problem. folks do not know they need help. the residents have to be on highest priority. please increase the funding of

conservatorship. thank you. >> : thank you. hear our next caller. >> : hi. my name is lauren. i'm a fifth generation san fran sis can living in district three. i'm calling to join others in stating my concerns for conservatorship. i don't think that expanding conservatorship is the answer sm i do believe that providing voluntary services are more effective. i'm not seeing evidence that those are actually being provided. housing is an important step to providing stability. that's in the entire answer but that does need to be provided

and it's absolutely not being provide sm i don't think it makes sense to expand conservatorship when we haven't tried the basics of taking care of people. i agree with the concerns about the racial inequity. how the demographics of people who have the 5150 hold are predom-proportionately compared to the population are disproportionate of african americans. i encourage you to continue to provide more volunteer services and not implement sb125. thank you. >> : thank you very much. let's hear from our next caller.

>> : hello. i'm the founder for civil rights nationalist incarceration in medicine. at this time we ask for civil civil-[indiscernible]. >> : are you still there? i've paused your time because we've lost our connection to your phone line. are you still there? can you hear us? could we come back around once to mr. di de la rows la rosa.

>> : does the same day and time work for her. >> : you should probably mute the line while he is making this appointment. >> : mr. chair, this completes the queue. >> : i have gte gotten another t message of someone who wanted to speak but couldn't get through. >> : would you like to open public comment once again. we would have to start over and ask people to inner the line at additional time for that agenda item. >> : is there any way to take

public comment after the item has passed? we have the board of supervisors vote as well. >> : the queue has been cleared. we could ask all of the 16 listeners raight now ilistenersm to raise their hand. >> : is there a way for us-could you give the instructions. >> : i can do that. should we rescind the vote that ultimately sent the item back to the board of supervisors. >> : why don't we just ask first. >> : at this time we're reopening- >> : we're not reopening. if you reopen then we have to rescind the vote. >> : thank you for the clarification. >> : operations will check to see if we have any callers in

the queue. please let us know if we have callers that are ready. please press star followed by three if you wish to speak to agenda item number two. you will hear a prompt informing that your line has been unmuted. for those watching on cable and wish to speak on agenda item number two, please call in by following the instructions on your screen. to enter the queue it to speak for agenda item number two. gentleman may i suggest that because of the time lapse between our meeting and the

broad cast that we just give the users a few minutes so they can hear the message and allow to dial. >> : we do have some people that expressed interest in speaking on agenda item number two. >> : yes. there are three people now. >> : is it all right with you if we rescind the vote? >> : yes. >> : i'm going to move that we rescind the vote. do we need to take a vote on that? >> : no, sir. >> : great. we will-that vote is rescinded. i will reopen public comment on item number two. >> : you do need to take a vote, you can state it without objection. >> : on the vote to rescind the vote. (roll call) the vote to

recommend the amended rez lawtioresolutionto the board ofs been rescinded. >> : let's reopen the public comment on item number two. let's hear from callers that want to address us on item number two. >> : ante black racism is an absolute crisis. i'm very proud of the board of veusupervisors for stepping up.

i would like to say that mental health issues disproportionately effect people who are of color. black people because of the nature of stress in a racist society. as we try to figure out how to care for people conservatorship is not the answer but it's continued support. especially out patient mental health services is the answer. a few days ago the mayor released a statement saying there would be a new investment in housing. i think that is wonderful. especially when you consider it's supportive housing sm the part that worries me is i didn't see in her announcement what that support is going to look like. if we're relying on the current existing structure of support for the housing that will

increase without any true increase in the support that is provided, we'll see the same results sm in the same press statement is said we'll see people going in and out of this housing. will we expect people to stay out every single year. why are we creating something that is designed to fail. we should expect to see these people remain in place because of the supports provided. how do we maintain people in a dignified state. how do we keep people supported so they do not need to be involuntarily locked up. >> : thank you. two minutes have concluded. >> : thank you. let's hear our next caller.

>> : hello. i'm representing tax payers for public safety. we strongly recommend the human right of puc public crisis. covid 19 offers us the opportunity to rectify past and harmful mistakes with respect to racism. covid 19 is telling us to add equity to our framework of medical conditions and age. we need to elevate the age criteria and underlying medical

conditions sm that's how we're conditions. that's how we're going to flatten the curve. we'll be able to address voluntary housing arrangements. on policy level we support mental health sf and supervisors walton on reparations. we really think this is the opportunity. please reframe and add equity to our considerations. thank you.

like legitimatizing campgrounds in our city like camp dwellers on a sliding scale. i'm sorry i had difficulty saying that. the city has a need to -- has a precedence -- the city has a precedence for campgrounds, and you know what that is. and utilizing the ancillary property in san francisco for campgrounds for some of the homeless people, you're giving them a place that they can

identify with where they live, they can probably and shouldn't pay a sliding scale fee to be on a safe fenced area inside the city. and them the more difficult population, which is the one addressed in the conservatorship group, how many of them are actually in that group because of the trauma that they're experiencing on the streets? it's connected. it's not random. homelessness gets such mental insanity. so, thank you for your time. >> thank you. do we have anymore callers? >> thank you. since there are already anti-discrimination policies at the local, state and federal level, this resolution should say rather than prioritize, it should say ensure or reflect equity in all programs. not prioritize racial equity and all programs.

ensure or reflect, not prioritize, racial equity over all the other types of discrimination. it's still relative and important. but doesn't prioritize it over other situations. thank you. >> thank you. do we have another caller? >> mr. chair, that completes the queue. >> great. public comment on item 2 is now closed. i will -- all right. do we have to revote on the amendments -- or do we need to revote on everything? >> so, the motion to amend still stands. we rescinded the vote to recommend the amended resolution to the board of supervisors. but the full resolution is still here if you wanted to make any other actions. >> so i'm going to move that we forward the amended resolution to the full board with a positive recommendation. >> on the motion offered by

chair mandelman that the resolution be recommended as amended to the board of supervisors -- [roll call] >> mr. chair, there are three ayes. >> great. the motions pas, again. and the resolution, again, we'll go to the full board with positive recommendations. all right. so, now we're back to item number 3. and i think that i closed public comment. but if i did not remember to close public comment, i am now closing public comment on item 3. and if any of my colleagues have any comments. or i will make do with my own and we can move on to the next item. ok. oh, it look like supervisor walton does. >> thank you so much, chair mandelman. i did just want to state that i have always had an issue with

conservatorship as -- >> ok. thank you so much. >> as an opportunity for negative interaction. >> ok. >> and people of color. and that's always a problem. i know who's most likely to be conserved here in san francisco, especially disproportionately. so, as we work to eliminate negative contact with law enforcement and provide better outcomes for black people and people of color, i believe this is not the answer. having said that, this is why mental health s.f. is so important and a different response to addressing mental health issues on our streets is very important. thank you, chair mandelman. >> thank you, supervisor walton. i want to thank all of the folks who called in today for a very small program that continues to inspire a great deal of passion. i do think, you know, that there is an argument that's

made against conservatorship that i whole heartedly reject, that until we are able to offer voluntary services and housing to every single person who needs it, that we should not prioritize the sickest, most vulnerable and most expensive to the system. and i think that is completely and absolutely wrong and whether it is by conservatorship or some other means, i think we need to move first to try to get the folks that have the greatest need the care that they need for their own sake and for the sake of their communities. again, i think we're going to talk more in the next hearing about, you know, the investments which need to happen to support not only conservatorship but also ah lot of -- a much broader set of interventions to try and get help to folks with serious behavioral health challenges on the streets. but, again, i want to thank those who called in. to hold us accountable to

protect people's civil liberties and people who should not be on the streets and off the streets and into care. so for our city staff, i want to thank you for the work that you continue to do. director alameda and deputy director nielsen, i look forward to further updates on this. i don't want to close this hearing. i want to continue it and get another update. august, i suspect that we're all going to be pretty preoccupied with budget. and so i think that it makes accepts -- sense to have this in our first meeting in september. >> on the 10th of september should be a regular meeting date for the public safety and neighborhood services committee. >> i move that we continue this item to that september 10 meeting. when we will receive next

update and by which time it sound like there may, in fact, have been a petition filed at least some additional folks may have gotten help through a.o.t. or other means. so please call the roll on any motion. >> on the motion to continue this hearing to the regular public safety and neighborhood services committee meeting date of september 10, 2020 -- [roll call] mr. chair, there are three ayes. >> thank you, mr. burke. the motion passes. please call our fourth item. >> agenda item number 4 is a hearing to discuss and analyze covid-19 on the city's responses to behavioral health needs to san franciscans. member of public which wish to provide public comment on this

hearing, should call 415-655-0001. enter the meeting i.d. of 1468128928. press the pound twice to connect to the meeting and press the star key followed by the number 3 to enter the queue to speak. a system prompt will indicate that you have raised your hand. please wait until until the system indicates that you have been unmuted and at that time you can begin your comments on agenda item number 4. mr. chair? >> thank you, mr. clerk. this is also a continuation of a hearing that we had back on june 25 where we received an update on -- or a presentation on how the covid-19 pandemic has impacted the city's ability to provide interventions and outreach to folks who are on the street experiencing mental health crises and our efforts to get health care to folks who need it. during that report, we heard -- or during that presentation, we

heard a report from dr. anton sebland on the results of the behavioral health optimizization study that he and his folks had conducted, showing a -- demonstrating that with a sizable but not insurmountable investment. a little over $10 million. that model could reduce the wait time for various beds within our system down to zero. and then also hearing some initial thinking from the department about implementation of some of the elements of mental health at best. that the hearing, it was fairly preliminary, the thinking was fairly preliminary. but other than the bed study, they were not able to provide us with sort of budgetary

estimates of what it might cost and so i invited them to think a little bit more about it and bring us back some figures, in particular i was interested in what it would take to build out these crisis intervention teams that we talked about as a more appropriate response to people in crisis on the street. i would say just this morning, as i was getting my bagel coming in to city hall, i saw happening exactly what i think we would like to not see happening, which was an older -- probably north of 50 african american woman possibly unhoused, likely with mental health issues who apparently had had the police called on her. while i was there, three police cars came up. a very large white police officer began to engage with her. very deftly and speedily removed a large knife from her bag.

but, you know, that is probably not the way any of us would want that interaction to be going down and i think we would all like to see a way of engaging with folks who have behavioral health issues on the street as a first response. that is something that we talked about in many contexts as part of mental health s.f. and part of the meth task force and we asked them to give us some more good thinking about what it might take to roll that out in the coming year, begin to roll that out, what the costs would look like, what would be needed. we talked a lot also about the need for additional care coordination, which is a concept in mental health s.f. around an office of coordinated care. and we asked the department to do some more thinking about that. and then we -- supervisor ronen had asked for more detail on behavioral health access center and i had asked for more information about whether the

behavioral health access center or some other access point, as we do have these crisis teams, given that e.d.s. is overcapacity and no everybody who is in crisis necessarily need to be detained. but what kind of place and spaces we would have for people to be taken to by these crisis teams if they have a successful engagement. so, we invieted them to do some more thinking about that. they have -- supervisor ronen and i have been briefed since then. we've done more thinking on that. and so i wanted to invite them back. i understand that we're going to be hearing from dr. howie hammer, director of ambulatory care first, followed by marlo simmons, the interim director of behavioral health services and the director of mental health reform and greg wagner, our chief financial officer,

available for questions. dr. hammer. >> good morning, supervisors. can you hear me? >> yes. >> good morning. and thank you very much for inviting us back. i'm hallie hammer, as supervisor mandelman said. i'm director of ambulatory care for the san francisco health network, department of public health. ambulatory care includes behavioral health services, primary care, jail health services, maternal-child adolescent health and whole person integrated care. before i get started, and i'll give a brief presentation and joined by my colleagues to. -- joined by my colleague for the discussion and answers. before i started i can't help but look back to june 25, which as supervisor mandelman mentioned is when we last met with this committee. i just want to reflect briefly on our covid-19 situation today and where we were on june 25 when we last met. on june 25, we were all in

hfp-many of us mentioned that we were beginning to be aware that the surge in cases and hospitalizations that we were anticipating maybe in august of september, the planning for was upon us. during that week of june 25, our hospitalizations jumped from 39 at the beginning of the week to 64 later in the week. it's 65% increase in hospitalizations that week. and a lot of it happened over this last really intense and very difficult month. but i just wanted to start by sharing that i'm happy to say that finally our hospitalizations look like they've plateaued. the public health indicator related to hospitalizations for the first time today since that last week of june is out of the red zone. and looks like we're not seeing that major surge in hospitalizations that we had seen before that was so concerning. so, for covid-19, we -- i'm

happy to say that we're in a better place than we were a month ago. turning back to mental health s.f. and behavioral health reform, this morning police presented an overview of our wok on mental health s.f. implementation during this fiscal year and in the context of our current covid-19 city-wide response work with the resulting financial constraints we're facing across city departments. you'll hear more about program priorities and budget recommendations, which we've discussed and i think we all agree will provide the resources needed for d.p.h. to build a foundation and begin to implement mental health s.f. i'm joined today as supervisor mandelman mentioned by greg wagner, our incoming chief operating officer of d.p.h. and rcfo, director of mental health director and actor of behavioral health marlo simmon and as i mentioned those

joining the discussion and answer questions after a brief presentation. next slide. >> as the mayor and board acknowledged by unanimouslies paing mental health s.f., our behavioral health system is flawed, has many gaps and we have many opportunities for improvement. mental health s.f. provides the framework for that improvement. calls to reform our system have been growing for years. not only at the local level, but also at the state and federal level. the affordable care act, the 2016 medicaid final rule and the state's proposals of 2019 all seek to reform how our services are delivered, funded and regulated. these efforts are closely aligned not only with mental health san francisco, but also with other calls for reform, including recommendations from

the meth task force, the 2018 behavioral health services audit by the budget legislative analyst, and the mental health reform work. with so many invested in improving our system, it's encouraging that these efforts are focused on a shared vision and overlapping goals. these goals include, number one ensuring people have access to the right type of care at the right time. in number two, more effective care, eliminating disparities in care, care experience in outcomes, operating our services more efficiently. along with more effectively. ensuring network adequacy. and also showing data that services are effective and that outcomes are clearly understood. next slide.

with the current budget outlook, there are limits to what we can implement in mental health s.f. this year. and we have to say that at the outset. d.p.h. iss ing that we begin mental health s.f. implementation by focusing on a few key priorities. we believe these strategies will allow for measurable and appreciable, visible progress in achieving the goals outlined in mental health s.f. moreover, as we discussed at last month's subcommittee hearing, we have an opportunity with our covid-19 response to propel some of these new tissue tiffs forward because they are rooted in the care models we quickly built to resfonld the challenges of preventing covid-19 and mitigating spread for unsheltered people living on the streets and in the new isolation and quarantine and shelter in place hotels. the key mental health s.f.

initiatives that we hope to launch this year, number one, building an office of coordinated care. number two, making data informed investments to increase the number of behavioral health residential treatment beds in our system. number three, piloting expanded street crisis response and outreach services. and based on subsequent discussions with the supervisors and looking more closely at what is possible, given the current bleak budget picture, beginning planning for a newly expanded mental health services center. next slide. many of you have seen this diagram before. as you know, behavioral health services provides services along a broad continuum of care represented by the different layer of this pyramid. clients enter our system through many different access points and frequently utilize

many levels of care in their path to wellness and recovery. we know that too many clients face barriers to, a saysing care, even when first trying to access care during the mental health crisis and too many people fall through the cracks when transitioning between levels of care. in fiscal year 20-21, our overriding vision is to build the foundational infrastructure needed to improve access and flow through our system. we should consider this work the essential building blocks, the foundation of mental health san francisco. let's start by focusing on the office of care which will help address critical gaps in our infrastructure and support our goal that clients can access the right level of care at the right time and that we'll effectively coordinate care as clients move through the system. next slide.

you'll see on these next few slides some detail about each of the four areas we're focusing on. and for each, some detail about the budget modeling and i just want to note before i go on that most of what we're sharing is unit costs. so, should be looked at by that lens and that understanding. so, it is not additive. it's unit costs either by team or by number of specific number of clients served. the office of coordinated care has a very broad mandate that includes making sure that people throughout the community, including consumers of care and providers know about our services. it also is mandated to make our services more accessible, efficient and effective, to build an accountability, improving data collection or reporting and, most importantly, build a behavioral health workforce that will provide different levels of care coordination and

management. in many ways, the office of coordinated care will serve as the engine of mental health s.f. implementation. we need staff to lead and manage the work. in the current fiscal year, we see making progress at various levels. first, we'll promote awareness about our services beginning with critical communication tools like developing a website, upgrading the phone system used by our 24/7 access line and developing outreach materials promoting key access points including the phone number that the public will be able to call to report a behavioral health crisis on the street. sick, we need to train staff on the frontlines of homeless response and criminal justice system to understand behavioral health and we need to support those they serve with behavioral health issues and learn how to help clients access services when they need them. most people are known to

frontline providers from across our civil service and city funded social service programs. third, these providers have regular contact with individuals that need behavioral health services but sometimes don't know how to help them access those services. behavioral health provider consistently report that services are confusing to navigate and difficult for clients to access. residential treatment may be available. we know we have open beds at almost any given time. but we have created a system that is exceedingly hard to access. especially for those suffering from serious behavioral health issues and disorganization. not to mention often co-existing homelessness, substance use disorder and trauma. care coordinators are the experts in both navigating a complex system and engaging, connecting with people who often live with a whole constellation of impediment to successfully accessing and

engaging meaningful care. in many cases, clients need extra support to benefit from our services. mental health s.f. envisions an expansion of our current systems of care to provide case management at various levels of intensity and that is what you see in the bottom rows of the grid. throughout this, is the need for better data collecting or reporting including a bed tracking system to better understand wait times for different programs and outcome measures which are the foundation of system-wide and provider-level accountability. next slide. second is behavioral health bed capacity and flow. in addition to improving access and flow, we've discussed service areas where we know we just don't have enough capacity. residential treatment beds is one such area. thank for the great work of my

colleagues, we have a data-driven plan to make key investments in beds that we predict will significantly decrease wait times, help clients move out of inappropriate levels of care and improve overall flow through the system. in february, we were on track to pilot a drug sobering center, but covid delayed the implementation of this program. so, that is also listed in the cost estimates. one of our greatest challenges in opening new beds, as i think you all know, is the real estate procurement process and that right now is the main impediment to our moving forward with our drug sobering center plans. please note that these investments will be supported by the work of the b.h.s. bed availability and optimizization project team, which, when it exists, will sit in the office of coordinated care and whose goal is to more effectively utilize and manage behavioral

health residential treatment resource as an integrated delivery system. next i'll talk about street crisis response and outreach. crisis response is a critical part of comprehensive behavioral health system and we heard some about this challenge today. in times of crisis, we need a rapid, coordinated and trauma-informed response. we're working with ems-6 and others throughout the city to develop a model for street crisis response based tonka hoots model which was developed in eugene, oregon and has been implemented by many other cities. what we see -- we see as the essential components of a well-functioning crisis system, number one, someone to call, which is well publicized, easy-to-use responses. number two, someone to response. well-trained, trauma-informed and culturally competent mental

health staff to reduce the need for police response. number three, a place to go. and we have some limited examples of places that we can take people 24 hours a day, like our alcohol sobering center. but the drug sobering center is a key idea, key solution to right now a real impediment which is that we don't have the right resources for our crisis response workers to take people 24/7. and number four is linkage to ongoing care. we need to interrupt cycling through crisis services and so our critical -- what you saw in the previous slide, the critical care case managers would focus on this work, on linking people who have been initially engaged when they were in crisis, linking them to ongoing care.

this work will synergize with the task force that the mayor is convening with our behavioral health crisis planning and our existing programs. like the comprehensive crisis program. and let's see. next slide. the mental health services center. mental health service calls for a mental health services center to provide 24/7 access to assessment, urgent care and medications in one or more buildings. our behavioral health access center currently provides those services at 1380 howard from 8:30 to 4:30 monday through friday. new funding for the mental health service center would allow behavioral health to expand hour into the eveningings and weekends. for this plan to have the desired outcome, behavioral health services will need to work with residential and other

treatment programs to expand the hours they do intake. this is a big, big problem we have now, which is even when we can expand hours, we don't have residential programs which are open for intake into the evening, at night and on weekends. we need to build a coordinated system between, one, the street crisis and outreach response staff. number two, the mental health service center. and, three, residential program intakes without synergy between those three arms of the triangle, we -- we won't effectively be able to connect with people and bring them into care whenever they need it. [please stand by]

>> : if we just need more safe places for clients to be. are there more cost effective

models beyond just a single centralized health services center. the services design work, this is a really key part of the program. in the meantime what we're doing is working to improve the services through integrating our programs and coordinating with our service providers to ensure they are more accessible to our clients with an urgent need. so in conclusion, we have a lot to do this year. and even since last month, we've seen some encouraging steps forward. we're committed to hiring a new director of behavioral health as soon as possible. that position is poafed and we'rposted andwe're hoping the s

will begin soon. this leader will help guide the implementation work group. uth leadership, the board of supervisors and the mayor's office. until that time we'll continue to develop the areas which we identified at last month's budget hearing where we see synergy with our covid 19 response. care coordination will really focused on clients who are currently being housed in our sick hotels. we have over 2100 people unhoused and the opportunity for us to koor nat coordinate care d in this linkage opportunity and real assess their needs while

moving them over to this new area of great need. that k concludes my presentatio. i'm very happy to invite my colleagues it to join me as we engage in this discussion with you and answer your questions. >> : thank you, doctor. i have some questions but i'll refer to my colleagues if they have other questions. >> : i do. i'm sorry supervisor, i missed the chat. >> : go ahead. >> : just a couple of questions. the first one is what are we doing to address the mental health needs of our homeless population. the crisis we see on the ship

yard as well as areas of pat roll hill. how are we addressing these newer encampments that are arising? >> : we have staff that are

engaged in out reach at the safe sleeping sites and encampments. we hope to do more out reach we are proposing in this budget. >> : i was going to ask how that is working out because the one thng i know is nothing i know tt happening when our office reached out and have conversation and make connection it folks. we're not getting feedback, what happens after your team goes out an has conversations with community. nobody calls us back and says we wen ouwent out to this encampmed went to this sheller or encampment. it would be great if we could start tbetting tha getting thisf

response after we reach out. my other question is in regards to mental health. how close are we to deploying these professionals out into community and increase number of mental health professionals. i know you are asking that as we continue into next fiscal year. do we have any capacity at this point to increase the level of professionals to get out into community? >> : kelly, do you want me to respond to that? >> : yes. >> : we-what little capacity we have is really focused now on the shelter in place hotels and helping to meet the needs of the

twenty one hundred people that were housed. we don't have the capacity to increase the bodies on the street. >> : when i'm speaking with residents now, my response should be that we are not going to do anything right now with these new encampments because we don't have the capacity? >> : i think we are doing something. we continue to do out reach again and partnership with hdo c, we are working in closer partnership with ems6 than we ever have. we definitely need more resources and are not able to do everything that need to be done at this moment. >> : i'm going to follow-up because those answers don't gel with me. we need to get a handle on the

community and understand how we're going to help our unhoused individuals that needs support that are out on the street. those two answers didn't gel with each other. i'll follow-up more with you and have a deeper level of conversation. >> : certainly. >> : supervisor walton, i do think some th is somethin this e should discuss. we still have some street crisis response capability but, for example, in the sick hotels where we've housed now as we mentioned 2100 sheltered people with medical vulnerabilities. we've had to shift priorities to

medical vulnerabilities due to covid 19. we've begun to provide behavioral health services and link- >> : there have been major increases in encampments and unhoused folks. the fact that these are growing larger, we have folks that really need support an need help. we have to figure outt out a wao

be more responsive and effective so they doan have to be on the street and can be connected to one of our hotels as we are ready to prepare for advanced planning and coming out due to the crisis and pandemic that we're in. these encampments are growing. you all know encampments are shifting from one neighborhood to another in the community. we have to come up with a response an a tangible response to what's happening in our streets. thank you. >> : thank you. >> : i echo that. that's one of the reasons why i believe and i think probably most if not all of the members of the board of supervisors-as

we stand up our-do what we have to do to stem the pandemic, we also have to deal with the reality that neighbors are getting confronted with a whole lot of people with a whole lot of need. it's unfair to ask those neighbors how to manage those needs. it's not every neighborhood in the siy but it' city but many. i'm wondering, director, what is d ph's action with h stock right now? >> : you may be better equipped to respond to that. we have many different ways. many have been centralized reseptemberly as the command

center. >> : we have behavioral health staff that are part of the h stock team. they can-as they interact with people, they can call our street medics in. our crisis response teams and bring in clinicians to kek withh people. >> : we have a full time senior lynclinician and that person hes to triage as needed. >> : as an encampment resolution is happening now or what cosine okind ofcontact-

>> : multiple ways. there are individuals that get known to h stock as part of street out reach activities, ordering encampment resolutions. when that person is having a behavioral health issue, there's a designated staff person that they can refer that individual too. they can identify the most appropriate way to resolve the issue. usually it's to our engagement specialist team, may involve crisis, case management programses, we are also active, for example, the tender loin response plan that has happened over the last few months of kefd. we were actively ep gauged in

that attending regular meetings, doing the roach an assess p. yeah, i'll stop there. >> : yeah. i mean, honestly for my district, whatever is going on feels completely and totally inadequately. i think supersizor walto probably feels the same. i think even probably supervisor stephanie feels the same. it's different for different parts of the city there's different needs. in each case, you know, we want the public-one of the reasons this topic is so important is we want robust public health response that seems intertell lecseems intellectualintellectun

the police response because police response doesn't seem to work overa long period of time. yet, however, the response doesn't seem to be adequate at this time. that's why it has to happen this year. we know people do better in support of housing whatever condition they are coming in typically. most people do better with a roof over their head than not. it also creates, as you're having to do in the sick hotels. you have a high concentration with behavioral health needs, it creates a lot of demands for people in the department.

is there thinking how they have said are going to impact capacity both in terms of-and the need of the department for ongoing case management and also when people are in crisis and they get addicted or on the verge of addiction. anand need to get stable. if either of you have thoughts on that. >> : developing the model of care that's going to inform us best is what the needs are once we bring into people into housing and obviously they are temporary housing. how we can use the opportunity to immediately assess their needs both medical and behavioral health needs.

and then, you know, link them to care as quickly as possible and we've really been looking at this linkage function because people often need to be stabilized. trust needs to be developed. a rapport before people will engage in out patient care. that's really what we're learning from the sif experience. if you told us six months ago that we would have 2100 and that number is growing sick and unsheltered people in hotels not only with the challenge to provide medical nursing and services to those people but also the opportunity to figure out what they need when we put them in housing we would have

thought that we were crazy to think that. we're learning from that but as we talked about and as we know, the need especially the need of people experiencing mental health crisis on the street way out shifts our ability to address enough to see any significant response when people ask us to respond. we do have the fes team, street medicine, we have other teams that are trying to address crisis that may arise on the street. we're behind-woor not at alwe'rn a place and don't have a good coordinated system that response work. once we respond bringing people into care and staying engaged

with them, coordinating until they successfully engage in care or residential treatment. >> : i would like to test in these four areas. i know you want to make progress in the next four years. my and my colleagues feel like we have to make progress in the next four years. dr. hammer was saying there's this fundamentally stronger coordination and making sure the diverse resources that we have are being put to use as effectively non duplicatively in all the good ways as possible. i want to thank you for all work

you've done on this slide to budgetary implications. most of this season part of your budget submission because you were under a mandate to eliminate 10% of your budget this year. given to the mayor is a menu of options for investments that, you know, if resources could be found whether through prop c or some other mechanism that we could make significant investments or things that would move the needle or whatever metaphor you wan t want to use. if you do the math on the case management and prior to covid 19 we thought we had 4000 unhoused folks with significant behavioral health or substance

abuse issues who needed intervention, i would submit that three or four months into the pandemic we have many more people than that. many more unhoused people with behavioral health needs. that number is probably a lot higher than that. if you do the math with that even if you wer were only to pre services to the 4000 you had before, that wouldn't include case management for anybody or critical care management for anybody. now an if you're going to do those things an put it all together like the case management services like the population on the street is probably about a billion dollars. it's north of five hundred

million. we aren't going to be able to did that sm the stuff above the line items that are buildup off of the case management care, allocate and see where we can get the most benefit from the investment and if it makes sense even though it means we're going to leave some people with no case management at all. some really expensive and needy folks. those cosines of decisions are important. it's important to have an institutional brain try to go do that. if you had just doing the math now probably a little over

$3 million for these items off of cor coordinated care. it's south of five million. if thez were resource those wers had you, do you think by the end of this year we could have the office of coordinated care stood up? >> : we would be well under way. again the proposal is that we have the foundational leadership and staffing structure we need to really manage and implement the new systems we're talking about sm th. the consultation and linkation, the hiring is really the barrier to this. we would definitely have something set up by the end of

the year. we have a will the of things that we're already working on. >> : calendar year. >> : no, fiscal year. >> : yes. we would definitely have something in place. the hiring is the barrier. we know what needs to happen. we have experience doing the different pieces. this would give us the resources to really make some progress. one thing i want to clarify around case management not everyone out of the four thousand need case management. multiple layers of need over time sm the create cal care amongment deaf anily one of the needs we have to get to the folks like the ones available for housing conservatorship.

we want to be engaging with those people before we get to that point. >> : right. i just want to under score that point that there's investment in the infrastructure. i strongly hope the mayor puts in her budget and doesn't wait until the proper funs to do. funds to do.i think that is just foundational. we talked about some of the hr challenges. there's significant vacancies throughout public health. you have proposed, this was in the budget you did submit, i believe because i asked you about it an you told me it was. pretty significant expansion in d ph's capability and asking to

mee your need. >> : that's correct. there's a proposal to add 20hr staff staff. >> : i think we've all been frustrated over the last year whether the situations seem to be at least in part a function of not having enough capacity in hr to get the department staff up and to area you need to be staffed at. it seems both of these things staffing of this behavioral health brain to coordinate services just seems absolutely if you're go to go solve supervisor walton's challenges and stephanie's challenges and my challenges, those

administrative infrastructure pieces may not on the surface seem immediately related to getting folks the case manager they need but are critical and foundational in those investments have to happen, shouldn't wait and shouldn't be high priority for the mayor and for board. it looks like vice chair stef nie mieg have comments? do you wap to wait untichairste. do you want to wait until i'm done or i can jump in now. >> : it's about behavioral health and capacity. >> : let's do it when i get to

behavioral health and capacity. >> : okay. that's what i wanted to say about office and coordinated care. behavioral health and capacity and flow. okay. supersizor stephanie, you had a question. >> : i'm wondering if there's any contemplation or has there been in the past that any of these facilities would be silver living facilities. given what i see on the sly and what i know we need to address substance abuse and that aspeck p paiferral helming care, we asinspect oaspect ofbehavioral .

is that something you would consider, won't consider, should consider. if europe to listening to people in recovery that have successfully been through sober living facilities and whether you think that would be an asset of what we have to offer here in san francisco and whether or not that is something we can look at. >> : we do have step downs from substance abuse residential programs. part of our utilization work which we started early in 2019 is to really look and see how to increase flow through our residential programs and included in that is support for

ongoing recovery in our residential treatment beds. that's not specific-the specifics isn't called out in the analysis but we do have existing residential step down beds and really want to understand how we can optimize use of the ones we already contract for and if more are needed but those would be included in that equation. some of our residential programs as you probably he know supervisor stephanie, do have an aabstainance model like the salvation army. we do need a mix. part of the on going analysis

and mop optimize ition is optims understanding what that mix is.

>> : i want to expand the conservatorship, it's not all but a tiny fraction of the folks

with serious behavioral health needs. if we have any ambition to expanding folks that need care and can otherwise not access the care, you are in a situation right now that precludes that. having people getting access into key psyche beds that we cannot get compensated for. having people in jail when they shouldn't be in jail but a public health environment. there's a whole huge impetus importance in funding the subacute psyche that was identified as a top need in that

modeling. another point that modeling shows is for the vast majority of people go into those lock beds, we don't want them in lock beds for any longer that needs to be. that means there needs to be beds that take people to the next step. group living situation, something that is more independent or fully independent. any way, although it mention mes the doctor's analysis, we have an analysis of what we need. it's not just cost for ten beds. there's at least a proposal for initial starting point for how many beds the modeling shows. that doesn't account for all the additional people who come into the city that may have

behavioral health needs. all of the people who may be leaving the city because they may have found a place to live in the city. as a starting point 11 million-dollar investment is important. it's very challenging though, i'm reasonably sure that if we allocate the $11 million in the budget for 2021 not all of that money will get spent because the department is not in the position to bring those beds on line. i see nodding. and we see that from last year because we did fund a very significant expansion at the time we thought it was really needed which was dual diagnosis

beds of people who suffer from both severe mental health disorder and substance abuse disorder. you need to have the capacity in d ph to stand those up. is that the main obstacle to making the doctor's plans real? >> : and overall the ability of real estate in san francisco is a challenge is a longer term

placement. a place for all those folks who see people in distress on the street and think why is that person out on the sidewalk, shouldn't that person be getting care? there should be places for those people to be. there's a million different varieties of places to take people. the mental health service center could be another. i do think, you know, independent of the bed study

there's a desperate crying need in the next year, not two or three years from now but now, right now for-if we had a crisis intervention team that showed up to the bagel place and encouraged the woman with the knife to give up the knife and encouraged her to come indoors. that's what should have happened, not three police cars. >> : you'll see on the crisis response line there's a location for people to bring people. what you are saying is absolutely true. >> : and that's the urgent care? >> : correct. >> : okay. that's behavioral health bed. and then we would then talk

crisis response an out reach which, you know, i think we have talked about a lot. it comes up in the conversation about reenvisioning policing. it comes up within mental health sf. there's been enough task force. i think, again, a critical need that's also an hr problem. we need the ability to staff up and hire folks or have a staff that can work out the contracts with the non-profits they are going to be working with. whether it is that urgent care line there, the humming bird line, the sobering center line. my strong hope is that we have the resources over the next year and we can make investments in one or more places for these interventions to be able to take people. we're not sum pli duplicate

inning the homelessness housing world where we have hot teams that have nothing to offer. at least we should be able to offer someone an afternoon if not indoors because of covid 19 but outdoors with something moderate. i won't belabor the mental health service center. whether it's multiple access points or a single access point, i think we do need something in the short term which is more than what we got in terms of places-i'll leave any other-i

think i'm-i'm probably done with mine. should we do some public comment? okay. let's open this up to public comment. >> : thank you mr. chair, operations is checking to see if there are any callers in the queue for agenda item number four.

could you connect us with our first caller please. >> : speakers have two minutes. state your first and last name. for the interest of time we ask that you avoid the repetition of prior staims. statements. let's hear from our first caller. >> : good morning. thank you for calling this hearing. the reason i'm calling is because what caught my attention was the public safety in light of the covid 19 crisis an the

safe sleeping sites that the board supervisor approved. what i noticed is particularly in district eight, i haven't seen safe sleeping site to the poant of housing thpoint that he gathered more and more on the street. i did pass by the new safe sleeping site that was put out on the old mcdonalds site. it was amazing to see there were so few homeless tents and homeless people that were rooming around. i do believe that safe sleeping site does make a difference. in light that schools will not

be open for the remainder of 2020 and probably not 2021 why are we not leveraging these school buildings. i would really appreciate it why is it that we have not leveraged that in more districts. if there are other sites that we could leverage to have one safe place for homeless and unhoused to set up their tents an be there and be monitored. their health and covid 19 tests so we'll be able to get over this crisis without-and have a better control on it. thank you. >> : thank you. next speaker.

>> : can you hear me. >> : we can hear you but there's a lot of background noise. >> : all right. next speaker. caller go ahead. >> : i'm sorry. i was having trouble with my

phone. i'm an organizer with community housing partnership and treatment on demand. emphasizing the importance of mental health right now. it's important during this time having a national conversation about racism and policing an incarceration that we understand that our calling for ante racism and defunding the police is a call for expanding health care to unhoused san franciscans especially since the black population represents such a disproportionate amount of the homeless population in san francisco. we need to fully implement mental health right now and, you necessity, we're in full support

of-we're fully against the cut to behavioral health or any other department that have to do with behavioral health or are conducive to having behavioral health treat being effective. fully implement mental health right now. an we fully care for the public during our pandemic. >> : thank you. next caller. >> : thank you. i'm a resident of the c astro. i fully support what they are try to go do. i really urge you to defund street crisis response. it makes a lot of sense to me. i have some questions about the

presentation that was made though. we talked about the tw thousandd some odd hotel rooms. that seems to cause a crisis in personnel. they didn't just appear. they were on the street. it should be-i don't really understand why this is a crisis of funding for person he will when the problem didn't change much really. obviously we've added more people and that's a different story. that was my first question about the presentation. the second thing that i'd like to do is talk about money that would move. i'm not a big supporter of don't finance the police but in this particular case and i think many

would agree, a hot team and h sock have been totally ineffective. we really need to have professional help in there. many people have said they are not doing their job. the woman who just commented on the safe sleeping sites is absolutely correct. we've gone out an looked around. the comparison is unbelievable. i really do support the supervisor and would like to see the middle school established as a safe sleeping site. thank you very much. >> : thank you. next caller. >> : i would like to report

doing everything we possibly can to fun the mental health sf as soon as possible. it seems to me that it took a lawsuit against the city's forces to help the tender loin get the tents off the street. it seems that the lawsuit was welcome by the city because the workers wanted to do this but did not have the support. i believe that our agencies have all the right pieces in place. i think we really need to elevate this as high as we can in terms of an emergency so that we can go ahead an implement the plan. i was amazingly disturbed to

hear all the plans and to hear the time line. i agree with the callers that we need to move some funding. i'm not in favor of cutting the police department budget but i'm in favor of taking funds that the police department prefers not to handle a lot of the mental health issues unless it involves a firearm or weapon. in short, i'm just of the voice that we elevate this as high as possible in terms of the priority for funding the mental health services that have been described today. thank you very much. >> : thank you. next speaker. >> : hi. i'm a supporter of a city wide

grass roots coalition seeking action. housing is not the immediate response for people on the street who are in crisis. people in crisis need respite care. enforcement is the key. [indiscernible]. they reached 31 tents and that's it. folks that are addicted or mentally