all right. well, thank you all so much for being here. i'm san francisco mayor, london breed. and today i'm joined by trent rohrer, who is the executive director of human service agency. matt dorsey, a supervisor from district six. and cedric akbar, the co-founder of positive directions, along with a number of other members from project positive direction. positive direction is one of our really amazing programs. it focuses on abstinence based, provide housing and wraparound support for people who have suffered from substance use disorder. they've been very effective in helping people get their lives on the right path. and that's why we're here today . we are here to focus on getting people's lives on the right path. san francisco is a

known, compassionate city, and when you think about the amount of service and resources that we offer to the public, we lead with our hearts or we lead with a desire to help people. for so many folks who have family members who suffer from addiction, this sometimes can be really personal. wanting to see the city do more to help people get into treatment. it should not be any more convenient to get access to drugs than it is to get access to treatment. and what we are trying to do with a number of our changes and initiatives that i realize are a bit controversial. we're trying to get people into treatment. this is where we are. we see something a lot different with what the drugs are doing to people today than ever before. we see so many more people dying young, dying, not just are going through a situation and getting better, dying on our streets of san francisco, we're seeing more lives lost to this than covid.

and with covid, we shut the whole world down. and with these drugs and how potent potent they are, this is poison. this is killing people. and we're on track in this city this year to exceed had the highest number of overdose deaths than we have since this thing has really taken over, dominated, destroyed and taken away lives. and we need to do something about it. and we need to get uncomfortable with being uncomfortable. we need to get comfortable with being uncomfortable. al and so why are we here today? we're here because we need to make a significant change. and one of those changes is to require treatment for those suffering with substance use disorder when they are seeking to get support from the city and county of san francisco. general assistance. ga. it has a lot of different

names, but no more. anything goes without accountability, no more handouts without accountability. so in order to get resources from our city, you will need to be in a substance use disorder program and consistently seeking treatment. int and that is really why we're here today to make that move, to get people into treatment and get them the support that they need. our city workers, our street medicine teams, our street crisis response team, our overdose response team. we have a number of people who are working every day out on our streets to provide to support, to provide programs to lead with compassion. and last week alone , 80 people were contacted and touched out on the streets, asked if they wanted services, provided treatment on demand, and only one agreed. and as you can see with some of the arrests

that we're making for public intoxication, when people are not accepting help. and so now it's time to make sure that we are cutting off resources that continue to allow this behavior for to occur without the accountability, without someone involved in a treatment program that could lead to a better life . it's time for us to get serious with treatment and with support for those suffering from addiction in in light of what has happened with the number of people who are dying, we're seeing the headlines. we're talking about it. everyone's talking about it now it's time to do something different about it. this legislation will have to go through the board of supervisors, and i am grateful to have supervisor matt dorsey here in support. and i'm looking forward to seeing other members of the board board support this very impactful legislation. and to be clear, this will be a fight. this will not be easy,

but it is necessary. and ultimately i understand and very challenging and difficult of a decision. it is to make. i am more concerned about the lives that we will save and the people that we will get help in order to deliver this effectively for the public. we want change. mothers want their children to be healthy and safe. families want their brothers and sisters back in their homes. and people want to see the folks that are suffering from addiction get clean and sober and get on the right path with like so many people, all that positive direction has helped directly with not only wraparound services, but with housing, with food, with support, with love, with compassion. but not in anything goes approach. and that's why we're here today, because it's important that this program is implemented as aggressively as possible. we can't say we want to see change and not be willing to make the

hard decisions to get there. and today it's a hard decision. it helps with the other work that we're doing where we are making arrests and we're trying to get people into treatment court and the folks who are refusing, well, this is an incentive to get them into treatment program , into a program that will help save their life and that's what this is about. so i am looking forward to sending this legislation to the board of supervisors. and my hope and my prayer is that as a result, we will then begin to see more people in treatment. and that is the goal of what we're trying to accomplish here today to explain a lot more about the program and to go into more depth will be the director of the human service agency for the city and county of san francisco, trent rohrer. thank you, mayor breed good morning, everyone. as the mayor said, i'm trent rohrer. i'm the executive director of the human services agency in san francisco. we're the agency that

administers dozens of public benefit programs to benefit over 250,000 san franciscans every year. it's important to note that this change only applies to one of those programs and the program that that it applies to is called the county adult assistance program. in other counties, it's referred to as general assistance or ga. this is a program that is mandated by the state of california in all 58 counties to provide cash, aid and other supports to single adults who have no children under the age of 18. so we're not talking about families with kids. we're not talking about seniors who are receiving in-home care. we're talking about single adults between the ages of 18 and 65 who have no dependents. right now in san francisco, there are about 5200 people in this program. this is the program that provides cash assistance to homeless individuals. it provides cash assistance to many formerly homeless individuals who are living in our supportive housing , along with other other

populations means what we're proposing to do is to require every one who is receiving cash assistance through this program. so 5200 people to first go through an assessment and screening to determine if they suffer from substance use disorder subsequent to the screening for those who who we have confirmed, they have a substance use disorder, they will be required to enter into substance abuse treatment and successfully participate in that treatment, which we will be monitoring in order to receive that cash assistance. those who choose not to be assessed or screened, those who choose not to enter into treatment, should they should they're screened, be positive. will no longer receive cash assistance. and how much are we talking about? the majority of the individuals who are receiving assistance receive $697 a month. if you are homeless because of care, not cash, you receive $105 a month and a guaranteed shelter bed.

individuals again who did not seek treatment when treatment is called for based on the assessment will lose that cash. important to note that if someone is in homeless shelter or someone is in support of housing, a large majority of individuals in this program were formerly homeless. they have been housed successfully through care, not cash and through other interventions by the department of homelessness. they will not lose their housing, but they will lose their $697 a month. why are we doing this? we've been looking at this data along with with mayor staff and others for really for a number of years. but but there are three data points that really i think, calls for this pretty significant change. one one is about 20% of individuals who receive county assistance have self declared that they have a substance use disorder. now, this is a self declaration and those in the field will agree with me that generally a self declaration is an undercount or underrepresentation of those who

actually suffer from substance use disorder or addiction. the second data point the department of homelessness and supportive housing did a survey in in 2020 to along with their homeless count, where 52% of homeless individuals surveyed self disclosed that they had a substance use disorder, that they considered a disabling condition. the third data point , the chief medical examiner's office, did a report from 2020 to 2022 that showed that 25% of overdose deaths during that period were people who had no fixed address. in other words, they were homeless. the data is clear. this is a population that disproportionately suffers from substance use disorder. it's a population that is not available, availing themselves of treatment. we have the treatment resources, the human services agency will ensure that we fund the additional slots needed to provide them to individuals who want to seek treatment. and again, if they don't seek that treatment, they will no longer be receiving cash aid. we anticipate the process

going through the board should it be successful, we will take some months to put the program in place to secure the contracts with providers in order to do both the screening and assessment as well as the treatment, and are really looking forward to making positive change for a population that is too long suffered from addiction in and specifically from opioid addiction. and fentanyl use. so now i'll turn it back, i think either to the mayor or to supervisor dorsey, to say a few words. thank you so much. my name is matt dorsey. i am the supervisor for district six in san francisco. and it was the conversion of a public health crisis in drug overdose deaths. and my own journey in recovery from addiction. that moved me to ask mayor london breed and then voters to consider me for a job on the board of supervisors that quite candidly, i never thought i would want, let alone have. but this issue is why i asked for

this job and this approach, this initiative is why i am so grateful for the leadership of mayor london breed. i am proud to be here and to support this initiative. i believe it will better incentivize treatment and recovery for a population that is at wildly disproportionate risk for drug addiction and drug overdose fatalities. i don't need to remind everybody that we are facing an unprecedented loss of life in san francisco. san francisco is not alone in that. but we know that we have got it worse here. we also know that coercive interventions can work. this approach reflects a key principle in the national institute on drug abuse that treatment doesn't need to be voluntary to work. and i just want to repeat that. please get this guide. this is the national institute on drug abuse treat coercive interventions can work. coercive interventions can save lives. sanctions and incentives

like those mayor breed is proposing today are evidence based. and according to nida, can significantly increase treatment entry retention rates and the ultimate success of drug treatment interventions. one additional point i want to make is that i think too much and for too long in the crisis that we have seen in our city, we have been leaving the strongest ally in this crisis on the sidelines. and that ally is represented very well here today. and that is the recovery community itself. as a member of the recovery community, i will tell you, the people who are going to save my life when i need it, when i'm at the end of my rope, it's going to be my brothers and sisters and non-binary siblings and the recovery community. and san francisco can oftentimes be a bad influence. but i will tell you, the flip side of that is that we have a recovery community that is phenomenal and we need them in the game. this this program will do that. this is going to be something that i

think will not only save lives, but give people a chance at a better life. there is a better life on the other side of addiction. and that is true if you are an individual struggling with substance use disorder or a city struggling with a crisis. and one representative who i think is just extraordinary at that is the person who's going to speak next. and that's cedric akbar. all right, good morning, everyone, and welcome. um, you have some people that are here and some people that are doers and mayor breed right now is being a doer and making the changes in san francisco of accountability. we look at her and we as a city have to hold her accountable. and when we hold her accountable, well, what does she have to do with us? hold us accountable so when i look at this situation of how how this is going to happen and transfer her and as she said, we're still doing this with love

and kindness, but it's at some point that the people on the streets, the people in san francisco, we all have to take accountability for our actions and for our consequences. and once we accept those, we can move forward. i'm a true believer of everybody staying in their own lane and do what they do best and work for a better san francisco. so we, the recovery community city positive directions equals change and truly support. mayor london breed on this particular issue and we will support her all the way to the end of this to see it through. so i ask and encourage the citizens of san francisco, the voters of san francisco, the people of san francisco. so whether you land on the ground or you at the top of the pop to be able to support this together and together we can make the change. thank you. thank you, cedric, and thank you again for being here and just for some perspective, san francisco.

spends $650 million dollars for behavior health programs that help at least 4000 people with a number of services and programs , whether it's behavioral health, substance use disorder. we've recently added another 350 behavior health beds. and our goal, as i said, is consistently to get people into treatment and support that they need. so the public is wondering if we're spending all this money, this is just for behavioral health. this is not even included in homeless shelter and all the other amounts of money, the millions. and in a two year period, over $1 billion for various homeless shelter beds and other resources to try and help folks. we have seen in the amount of money increased significantly. but what we have not seen is changes to what is happening on the streets. and in fact, you can attribute the based on the number of deaths that we've that we've seen that why is it

getting absolutely worse? s why are we losing more people to drug overdose just in august alone, 84. and as i said, on track to surpass any of the numbers that we've had in the past post and during covid, we shut the whole world down. we have to attack this program, gram. and the work that's necessary to turn people's lives around in a way that is going to truly lead to positive change, truly lead to people's lives being saved. so that's why we are here today. that's why we're grateful. i want to also say that even though we can't compel anyone into treatment, i'm really grateful for the work that's being done at the state level that is going to add some additional resources for behavioral health conservatorship and other things that we can use to help get people into treatment. i am grateful for the clarification from the city attorney around and the work we're doing to clear encampments in san

francisco and just for clarity on that. but again, leading with service or leading with offers of help, leading with support, but there can no longer be a climate of anything goes. there has to be an accountability piece attached to that. and that's what this piece of legislation, ann, will bring to the work that we are doing on the streets and with that, i think i will take a few questions from the press. a city or a state that has implemented similar screening requirements that you would point to as a model or example of this. i don't know if i would point to them as a model of or being effective, but i know there are other places that do this, and so we can get you that information at another time. there were public health leaders consulted on this policy shift at all, and they think it'll be effective. yes what do you say to them? what do you say to voters and people in san francisco who are being frustrated by the seemingly intractable problem? i think that it still ranks as homelessness street issues still

rank as one of the most frustrating issues for people in san. well what i'll say is and i think, christian, you might have did this story last week about the financial incentives that were given to people to stay clean and how that program was working and seemed to be effective. we need to make sure that we're doing everything we can and let's just put this into perspective, because i know people are really frustrated, but we've done some great work since i've been mayor. we've helped almost 10,000 people exit homeless since these would be people that would otherwise be on our streets and the numbers in san francisco between 2019 and 2022, we saw the only county in the bay area saw 15% reduction in unsheltered, unsheltered homelessness and on top of that, you know, folks keep talking about the numbers. there's 7000 people on the street at any given day. that's not entirely accurate. and the point is, you know, we got a lot of work to do, but we know before the pandemic, during the pandemic, things were way more

problems stick in terms of the number of people who are homeless in encampments on the streets. the difference now that we're seeing is the overdose deaths are of significant proportions. you know, people are dying at large. alarming rates. and what i say is, you know, because when i made the decision to make arrest of people for public intoxication and there was, well, we want you to arrest the drug dealers and not the drug users, it's like we can't have it both ways. we got to put everything at this problem in order to deal with it. and it requires, as i said, time and time again, tough love . you know, we don't want to see people on the streets. our heart , you know, i know my heart when i see this. i think of these people as my people. i know people that are out there living and using drugs in those tents who i grew up with, who had never used drugs in their lives . and they're out there on the streets in these tents. and the possibility of death is just a serious possibility. so i would say that we have to make it we

have to get as i said earlier, comfortable with being uncomfortable and making really hard decisions, scenes like this one, in order to get our city into a better place and in order to prevent people from dying from drug overdoses on our streets. well, what happens? what happens with those people? many are like, i don't want to get off drugs. and, you know, they might say, i just rather not get the money from the city. that welfare that i'm getting and still be in the streets. and they have other means to get money, either stealing or asking or whatever. so what happens with those and i don't want. well all we're not suggesting that everyone is going to accept treatment. that's just not realistic. for those of you who have either suffered from addiction or know people who suffer from addiction, people do it when they're ready. and this is a way for us to provide an incentive and to continue to implement the various programs and resources that we are providing. we're not going to give up on sending our wellness teams out on the streets and continue to offer help. but my

goal is to make it more uncomfortable and more inconvenient for them to be out on the streets, especially when we offer them help to the point where they will hopefully accept what we're offering and know that it's easy to access. as mayor, how will you judge success of this program? we've seen, as some of these law enforcement initiatives have rolled out, overdoses have been , you know, at very staggering rate. i'm wondering how are you gauging the success of this program and those previous law enforcement initiatives? what we keep track of the data. the data means nothing. if you still see the conditions and you still see people dying. i think the big indicator of this is, you know, making sure that we're able to get people into treatment and looking at the data there, i think part of the solution also is, of course, seeing fewer people die from drug overdoses. so all the data that we keep track of the goal is get people into treatment, save lives and our hope is that we will see this begin to reverse this

mayor, these sorts of proposals or earlier versions of them decades ago actually attracted a ton of criticism on civil libertarian grounds. and that the cost of drug testing, for example, far outweighed the benefits given. and i'm wondering if you could just respond to the criticism. this is sure to attract from harm reduction expert well, i appreciate you bringing this up because i don't know if you all heard about the program where they received a state grant to provide, you know, for those who are clean, they're giving gift cards as incentives to stay clean. and they have to get tested. and so it's happening and it can happen. i think the goal is to get people into treatment to potential early look at diverting resources to make sure we have what's necessary in order to provide testing and other things that we need to do to make sure our that our organizations have the capacity to administer the program. but everyone's going to

have an excuse for why we shouldn't do this. and at the end of the day, at this point, as far as i'm concerned, we're going to do everything we can to move forward and to get people into treatment. controversial or not. but, you know, what's their solution other than we should not you know, i'm tired of people telling me no and saying what we can't do and pushing back on things yet they want to complain about the number of people who are dying on our streets and want to see us do something. well, this is something and this is better than nothing at all. and once the sort of universe of the money for the benefits that would potentially be impacted or it's $100 a user who is unhoused. so we are looking at the i'm sorry, i think your information might not be entirely accurate. can you repeat the question differently ? you know, how many you have, what, about 5000 people receiving 5000. 200? yeah and so it's certain number of those receive the 697. and then the unhoused people getting that

money get about $105. and so i'm just wondering, how much do you think how much money in total is this potentially at stake here? if you were to remove those benefits? well, to be clear, as trent rhorer just stated, you know, many of these people who we provide general assistance to , you may not even fit in this category, but we are still requiring treatment for those who have substance use disorder and we don't know what those numbers are. and what he said is that self-reporting about 20, i think it was like 20, 25. and those are usually under reported numbers. so we don't have a specific number at this time. the goal is really not to take anything away. the goal is to require something. and in addition to receiving the money that they're they're getting. and so i think we won't have a number until we go through the process of analyzing each

particular individual case because ultimately the goal is treatment. how do you know who has i mean, you can see who's hiring up, but how would you know who's receiving the money that has a substance abuse just because of the behavior? and they need, you know, trent, do you want to talk about this? okay. thanks, mayor. thank you, mayor. um, so the program will be initiated by by requiring everyone who's receiving county assistance to go through a screening and an assessment for substance use disorder. so we'll be consulting with experts in the field to figure out what are the best assessment and screening tools include, including potentially testing to reveal who has a substance use disorder and who does not. and that will be able to bifurcate the caseload that way, offer the treatment to those who are positive and showing signs that they have substance use disorder . and just want to go back to your question when you're talking about numbers. so we have a about 20% of those 5200

at any given time are homeless and receiving 105. about 1700 of individuals on cap are formerly homeless who are in our supportive housing sites receiving the $697. and we know that they're given the data that we're looking at where we see 52% of homeless have self disclosed, that they have a substance use disorder that they consider disabling. 1700 people were formerly homeless. we can assume they were in that category. they are now receiving $700. we also know from our data that people are who are being arrested and offered treatment on the street. many of them are housed in those buildings that we are funding to the homeless department. so there is a very a significant number of individuals receiving that $700 who have a substance use disorder. have one more question. all right, phil, do you have the votes for this? i hope i do. that's where the public comes in, putting political pressure on their

board of supervisor members to support. this is definitely going to be a fight. it won't be easy, but ultimately, my hope is that the board sees this for what it is, and this is a part of the solution to help us get to a better place with the number of people who are dying from drug overdose in our city. thank you. all right. thanks, everybody. all right. okay. thank you for is. thank

you so much to everyone for joining and we are now going to call this meeting to order for the our city our home oversight committee. it is september 28th, 2023. and we will start with roll call. laura, if you would, please. i've apologies. okay member catalano, absent member cunningham denning present. uh, member vice chair d'antonio. yes. present member. friedenbach present member. preston present member. walton absent. chair. williams present. all right. so we do have quorum and we're