while we rethink and reform how we deliver behavioral healthcare in the city, we will provide wrap-aroundrtive services, the office of coordinated care, a revamped and refocused on our access center and a significant expansion of the services for behavioral healthcare treatment beds, navigation centers to help those who need help the most. it's a plan to support our most vulnerable individuals including those who refuse service or are unable to accept help. we will not get there overnight and we cannot get it done without working together. this initiative is ambitious, thorough and let's be clear, it will be expensive. mental health sf will be a priority in any budget this upcoming budget year and i hope it will be a priority in yours. that being said, we need a lot of additional revenue and i am asked our capitol planning committee to prioritize a bond, to pay for capital improvements on the november 2020 ballot so we can do things like build more mental health beds, acquire and expand board and healthcare facilities and enhance the facilities we already have to provide services. i reall

up the things we are doing well, change the things we are not doing well, and modernize our behavioral healthcareystem to catch up with behavioral health, so that san franciscans can be confident we are providing the best solutions possible. mental health will allow us to invest in the workforce, both in civil service and community organizations, so that those dedicated to serving others can afford to work here and do the things they do so well. this is a visionary framework, and i'm optimistic that resources will follow. this will enable the department and the community partners to carry out the plans in a way that is evidence-based, that advances equity, and reduces harm. we know that wellness and recovery are possible for everyone. this agreement and the unity we are showing here today are part of san francisco's legacy. we come together to do great things. we've done it with h.i.v. and with healthy san francisco. now is the time to transform behavioral healthcare. together we can make a difference and save lives. thank you. >> thank you, dr. colfax. now we are going to hear from two members o

amateur behavioral healthcare, ptsd, traumatic brain injury rehabilitation prosthetics and orthotics,ental exposure to toxic agents when you get in combat. these are the things that, frankly, the va does extraordinarily well. but the va can't do everything well. so if you are a veteran and you need specialized care or something is not available in your community, you should be able to get that in the private sector. i envision a hybrid system with a strong modern va focused on centers of excellence and things that are important to veterans and the ability to seek the private sector when those are not available. >> "after words" airs saturdays at 10:00 p.m. and sundays at 9:00 p.m. eastern and pacific. on book tv on c-span2. all previous "after words" are available as podcast at the watch online at book tv.org. [inaudible background conversations] i know you have great energy we saw you coming in this looks like a very excited and high energy group let's try it one more time, good evening. that's the energy we know you

for example behavioral healthcare is as extensive and as large as behavioral is struggling and trying to get access to put 5 million veterans and just dump them into the system we just know the veterans would not come out on the right side of that. i became a very strong advocate to make sure this is a system that works well but is sustainable. >> owner make sure we come back to privatization for quite don't want you to think i'm skipping that. be will get to that but what you mentioned was common within the veteran community if you've been to one you've been to all especially in the beginning doing a lot of programs. why do you think that is even though we talk about an agency that has oversight you get so many different stories? so what you hear is our membership often tells us they would like to have access faster why is there such a variety of levels quick. >> it is under public scrutiny that no other hospital system in the country has they can tell you those little things that happen in the v.a. that never come to the attention of private sector are now the subject of congression

i mentioned behavioral healthcare, ptsd, traumatic brain injury, rehabilitation, prosthetics, orthotics, the environmental exposure to toxic agents when you get in combat. these are things that frankly the va does extraordinarily well. the va can't do everything well and so if you are a veteran and you need specialized care or something isn't available in your community you should be able to get that of the private sector so i envision a hybrid system with a strong modern va focused on centers of excellence and things important to veterans and the ability to see the private sector windows are not available, and i publish about as they model of care in the new england journal of medicine so everybody could see the plans that i had for the va and one that i think frankly just makes sense for veterans. >> host: going on with privatization, this term comes up for debate when we talk about the recently passed mission act before that the term was choice, things like that. can you talk about what that bill did, but it does, what it will do, it was passed a year ago, implemented in june of this

healthcare system does in all cases.ed for example, our behavioral healthcare system, it is expensive, it is a large. wheree the private sector beaver healthcare system is really struggling and trying to get access, if we were to put these 9 million veterans, just dump them into the private sector system on a system that is already struggling to meet its needs, we just know that the veterans would not come out on the right side of that. i became a very strong advocate for making sure this was a system that works well, that we need to modernize, but that it will be a sustainable system. >> host: and you touched on a couple things i want to make sure we come back to, privatization and things like that are very important topics, a large part of your book, we will get to that in in a little time but i want to continue with the scene setting because what you mentioned reminded me of a common saying that certainly within the veterans community even within the v.a. if you've n to one v.a., you had been to oe v.a. pic you mention how in the beginning you did a lot of going around to visit dif

private sector doesn't do the things that the va healthcare system does .for example, our behavioral healthcare system, it is extensive, it is large. the private sector is really really and trying to get access. if we were to put these 9 million veterans and dumped them into the private sector system that is already struggling. we know the veterans would not come out on the right side of doctor soy became a strong advocate for making sure this was a system that works well. that we need to modernize and improve that it will be a sustainable system. >> you touched on things that i want to make sure we come back to privatization are important topics. a large part of your book.we will get to that. but i want to continue with this setting because you mentioned reminded me of a comment saying within the veteran community, if you've been to one being, you've been to one va. you mentioned how in the beginning you did a lot of going around to visit different va's. why do you think that is that even though we are talking about an agency that has oversight of all of these areas, you get so many different

with a clear voice, they wanted to reject some of the inappropriate behavior coming out of washington. they want to preserve healthcare and a strong economy. i remember when i ran for governor, 18 years ago, virginia was 2-1 republican, we did not have a single statewide elected officials. eight out of our congressional representatives were republicans. we have flipped that. we reflect our values and last night was when we finally came in full circle and took the house back. >> not far from where we saw a mass shooting last year and a pro-gun republican won. >> if you look at those races, those state senators got reelected, won by 10 or 15 points of margins. they escaped with a one or two-point margin. >> let's talk about senator richard burr. someone you have worked with on a bipartisan basis for years, is calling for the whistleblower's identity to reveal. do you agree with him? why are they asking for this? >> i strongly disagree on chairman burr on this. some of the strongest advocates, whistleblowers, senator chuck grassley and susan collins who understand when we want people in government if they see something w

behavioral health needs. for our clients we want a system of care that offers access to high-quality healthcare to meet their needs. for the system of care to make sure we develop a system that is grounded in evidence-based practices to reduce harm, increase recovery and suited to deliver the services to those experiencing homelessness. to that end, we developed key roles. first is being able to communicate the vision to the homelessness from the perspective of health department, issues around equity and strategies to address those issues, identifying opportunities for innovation and further investment on the part of the healthcare system. many of th of the programs neede scaled. lastly, making sure we are grounded in evidence-based and evidence-informed uses that do e decisions anal locations going forward. i would like to emphasize that this is a population-held approach. we haveitedded a february h specific segment for whom we want to improve the delivery of our services. this depicteds, one, there are approximately 18,000 individuals in san francisco experience goes homelessness at this time. this is rec

healthcare. rural elders have chronic disease and visibility on lower prevalence of behaviors and rising rates of suicide. access to healthcare is a genuine issue in an initiation to a pronounced shortage of care personnel we have a doubling in rural hospital in 2013, 2017 compared to five years ago. for solutions let's continue to expand telehealth by closing the digital divide and dedicated funds for the opioid crisis must go to rural and before a role hospital closes to declare a public health emergency and may be averted and expand the provider grant program. also today more than 1.1 million older adults or lgbtq and many have endured years of determination and plumbing and housing and inserted in silence. now as they age they encounter determination and long-term care facilities which led to the long-term care quality index to promote care and facilities including having trained to staff. more facilities should adopt this. we also need to designate lgbtq as an underserved to get data. moving to food insecurity whether people can obtain food to lead a healthy life. $5.59 for feud and security

environment for your constituents, more affordable healthcare, more rational immigration system and the like. but we have had to confront the behaviorf this president and now we're forced with the opengation ope obligation to assess whether his conduct threatens the constitutional order. that's what we have to determine. >> so the determination will happen in a process. the intelligence committee, as you know, will be leading it for now in these public hearings that are set to start at some point. then your committee may end up charged with drafting these articles of impeachment. can you talk about -- has that process begun? have you, you as the committee and staffers started to put together anything related to these articles? where are you on that? >> well, you can't do it yet. if there was -- >> can you start thinking about it? >> well, of course you think about the evidence that has been developed some in public from the president's own lips and from his chief of staff. but in the end, if there are articles, and that has not been decided, they would be based on the facts that are still being pursued. so when you think about the n

healthcare now mental health. san francisco. >> hi, my name is veronica forbes. i've been a social worker for nine years. i am a community behavioral health specialist homelessness expert and the original program manager of the navigation center. in san francisco, my clients waited one to throw months in jail or decompensating in the streets or shelter from mental health and drug abuse services. when someone seeks help and is put on a wait list, there's a very narrow window of time to make a difference and when missed, it takes months to years until the they're ready or able to seek help again. all the while, they're spiraling downward in their ability to function yet san francisco makes cuts to the mental health rehab center, residential care facility and acute diversion units and i'm here to tell you all to support mental health sf because living people with mental illness and drug addictions in the streets or criminal enforcement system is ineffective and it's dangerous and it's wrong. >> hi, my name is wind could haveman and i'm vice president of aft2121 at the city college of san francisco. and we are grateful you have crafted

behavior information and informational poverty in immigration status, all of those data sets help us understand the community level, why the hesitation or the limitations to vaccination or access to healthcare or maybe language barriers. when we are able to use all the data that google has at their hands that we don't. i think were better able to target where efforts should go, as an example during the opioid crisis we andhe other states funded by cdc have been looking at vulnerability assessments. so were looking where are deaths happening, where are babies being born with neonatal syndrome, where our hepatitis c and hiv increasing, where does the overlay with poverty and other statistics. that is use of big data to look at vulnerability and target where we should be working. we could do that with many more things if we have the technology and interconnection. >> thank you doctor, i go back. >> we will recognize doctor murphy. >> thank you, mr. chairman. thank you for coming this afternoon and i appreciate your expertise. a question i will have for doctor watkins, i was looking through the copies that you have a medical records and having experienced the explosion of the electronic medical