health and physical health are equally as important. allowing for anonymous assistance would also be effective because it is evident that most teens do not want to ask for help publicly. lastly, professionals working with teenagers should be more open and equipped to talk about mental health struggles by being provided with the correct necessities to help teens work through their problems. as a high school senior i have grown to see that the process of moving from adolescence to adulthood is tricky enough with college essays, picking a major and knowing that i'll leave my childhood behind. so providing teens with accessible professionals to speak with will only benefit our communities. everyone needs to be aware of their mental health because it's not selective or to be stigmatized or to be put aside because it's too hard to understand. working through these issues will nopt only give opportunities for teens to grow and flourish into dulls but also to allow our communities to be stronger as they improve the way of life one kid at a time

health of the fetus. of course, they should be able to talk to a physician and a mental health provider. are -- so left may be linked to a variety of birth defects. women must be able to have important conversations about these medications and risks to their pregnancies. the medication must often prescribed for epilepsy has a 10% risk of causing birth defects. women with seizures have potentially lethal seizures without this medication -- causing lifelong harm to the fetus. i can't believe my colleagues want to get between a woman and her physician. i can go on, there are several examples of mental health and physical situations where it is essential that women, that our government not get between a woman and a physician in veteran -- a veteran who is fighting for the freedom of all of us is not able to get even life saving health saving counseling. this is absurd. doctor hayes, you have served veterans tirelessly for decades. one of the things you have had to do that we've only recently learned about is

health care. that they have earned through their service, to our nation. and va he is determined to stand by that commitment. mister chairman, this concludes my remarks, my colleagues and i are prepared to answer any question that you and your colleagues may have. >> thank you, doctor elnahal. it is a pleasure to have you before our committee. i now recognize myself, for five minutes of questions. i will begin with you, dr. elnahal. your most recent employer was a non va community hospital. and based on experience, and knowledge about the state of reproductive health care access in this country, post pandemic and post op, can you tell me a little bit about the capacity of community providers to care for pregnant veterans and to provide abortions, and how that influenced the aids decision to issue last friday's interim final rule? last friday>> thank you, miste. i indeed let a hospital in newark, new jersey. that is a state that does afford these services, for these women across the state. and so t

health problems?: i do, david. i think it is gotten better certainly than it was, 20, 40 years ago. i see that stigma all the time. one of the conversations i have with people -- especially, it is a stronger stigma in my generation and older generations. younger generations are less affected by it, but there i still see a reluctance to talk about needing help and being bullied or being the victim of abuse. which contributes to mental health struggles. the other piece that is important is it is not just in our words and actions but i see that stigma. i see structurally as well, look at how we reimburse for mental health care in our country. and despite passing into thousand eight the mental health parity law, that has been unevenly enforced and needs to be stronger. it is harder for people to get mental health care in our system that it is for them to get care for his goal health issues. we have a long way to go to close the gap. david: are there mental health problems of people at work? in other words

health program. san francisco tb prevention program and the sf health network are collaborate to welcome and support ukrainian in san pran when fled due to the war. many are joining sponsors to say in the u.s. temporarily under the program enentitles them to employment and medical conferage after leaving their home. since the u noticed for ukraine program start in the april. the team supported ukrainians from ages 4 months to 86 years of age. they are a collective effort and shout out to the staff for welcome and patient centered care y. there are additional announcements training opportunity in the director's report and i will go on to the am covid update with if they could come up on the screen. commissioners you see here that in terms of our cases per 100,000 in san francisco this is the larger it graph on the slide. we continue to plateau in terms of cases very much reflecting the u.s. trendses shown in the insert. >> next slide. and in terms of hospitalizations our hospitalizations have been sta

goal health issues. a long way to go to close the gap. david: are there mental health problems of people at work? in other words, if you are working remotely are you going to be more lonely and will that cause a bigger problem? do you think it is better for mental health for people to be coming back to the office and so forth? dr. murthy: this is such a good question and i do think our workplace has had a really powerful effect on our mental health and well-being. it's one of the reasons i just issued a surgeon general's framework on workplace mental health and well-being. almost 80% of people are saying there's some aspect of the workplace that is contribute negatively to mental health and well-being. but 81 percent of people want to find a workplace that supports mental health. so this is our chance to really figure out how to make workplaces engines for mental health and well-being. i laid out a strategy for how to do that, but when it comes to working from home, this is an important consideration. th

and global health. in my clinical career, i focused on providing abstract trick care. for women with limited access to care in such places like rural south carolina, native american reservations, as well as other countries. i would like to discuss -- abortion harms. the dobbs decision which returns the decision-making back to the states provides the opportunity to limit the harm to unborn human beings, but abortion not only poses risks to the mother. it is always lethal to the unborn child. it is my opinion that abortion is not health care. abortion is intended to terminate unexpected pregnancy and does not result in a live birth. the goal of abortion is to kill the embryo, which is a human being. there are different types of health care and abortion either prevents or treats any disease that has instead its goal of the death of a human being. it is not health care for the mother or her fetus. the majority of ob/gyn's do not do abortions. in a 2018 survey, only a 7% of practice ob/gyn's performed aborti

more mental health programs. the solution lies in integrating mental health within the overall health care system and workspaces, and as africans, as individuals, out like us to see mental health move from just being a conversation to action, where we can start doing things and embracing our wellness and fighting the stigma that surrounds mental health. so right, there's a man talking about the stigma and talking about his own mental health journey. what do you think about that and africa? man, i know that he's very impressive. very, very impressive. i call an old man, especially those in 9 area. when you have issues, you know what happens back home. when most men have mental health issues be the result of drinking. they become a colleague that the way they take out their mental health issues. they just drink the tuple and come back home and sleep all come back home. you know, in both get involved in what devices of domestic violence and things like that. that is what they do. so if and africa man can talk about

mental health? how do we take care about mental health? it's like brushing your teeth every day. do something every day that contributes toward the positive mental, well be most key pick up on that. i'm yes, i'll just quickly go back to what ruth shared about, you know, addressing men's mental health. so what we've noticed, what we've observed over the years, is generally in the health care system. women have better health seeking behavior and men. so even if it was something like a cold or during coldly, that woman is more likely to seek out. i treatment and health health care. yeah, treatment of some kind am, which isn't the same for men. however, addressing mental health, mental health challenges amongst men, what we've discovered, what we've seen locally is it's important for us to consider rich reaching men where they are. yes, they have, they, they suffer more from, you know, they suffer more from depression. suicide rates are high among men, so they are the most ball. there are bull when it c

health. i'm here with dr. murthy, the surgeon general of the united states. thank you for giving us this time. dr. murthy: i'm glad we are having this conversation. david: i'm sorry we cannot do this in person but i did come down with covid. i managed to dodge it for two years. i don't know what happened but i guess my luck ran out. is covid still a major problem in the united states? people like me are still getting it. dr. murthy: first off, sorry you have covid. from personal experience, i know it is a serious thing and even though you are vaccinated, you and everything, you can have breakthrough infections and have mild symptoms. i wish you the best in your recovery. as a country, here is where we are. we have come a long way in the last couple of years. i remember very clearly in march of 2020, when more and more people were getting sick, when hospitals were starting to fill up. we were seeing terrible scenes in new york city in the months that followed and we did not know a lot about th

public health commission core. this is one of eight uniform services in the united states government consisting of 6000 officers dedicated to improving public health each and every day in their day jobs. but we also deploy them during times of emergency. we send them when there are hurricanes or tornadoes that hit towns. we will send officers to help provide basic care. routinely drink covid-19, we deployed thousands of officers to help with everything from vaccinations to supporting health care systems. so that is one of the jobs of the surgeon general. the other job is to inform the public about vertical public health issues that arise, and this could be informing -- informing them about how to prevent yourself from getting sick, how to manage illness when it arises. with covid, that has been an important part of my work. increasingly, my focus has been on the wider inset -- well-being which were a real struggle for the country even before then. david: you were the surgeon general under president obama and you se

to deliver quality health care. they receive medical, dental and mental health intake screenings within 24 hours upon arrival. they receive a comprehensive health assessment including physical examination and mental health screen by a qualified health care professional within 14 days. detained noncitizen identified as high risk are taken in for higher level care immediately. i.c. has health care delivery and undergoes extraordinary scrutiny. it oughts regular reviews and when needed, implements corrective implementation plans and subject to levels of independent oversight inspections by the d.h.s. office of the inspector general, the i.c.e. oversight office and d.h.s. ombudsman. i.c.e. learned of forced medical procedures provided by a provider serving the irwin county detention center through a whistle ploar complaint. we take these allegations and all allegations of medical mistreatment seriously. in october of 2022, following a whistle ploar complaint, i.c.e. discontinued sending to this offsite provider and to p

health care. when medically necessary veal offer abortion counseling and provide abortions when the life or health of the veteran would be endangered and if the pregnancy were carried to term or their pregnancy would be the result of rape or incest. self reporting for pregnant veterans constitutes sufficient evidence of a act of rape or -- incest. it's a safety decision first and foremost to ensure enroll veterans in va veterans can access life saving services at va no matter where they live. protecting the health and lives of pregnant veterans is a primary concern of you. it's important to emphasize that va is taking steps with the primary mission in mind to preserve the lives and health of veterans. there's nothing more important than that. this emergency authority allows us to save lives as we progress toward implementation. as this will be a new service, we recognize that significant steps will be need to be taken across the system to implement it. and while a formal implementation is under de

so, we need to take time and talk about health disparities, which is in my field of behavioral health and substance use disorder is talking about institutional stigma and bias and i think sometimes pull the punches by using language like disparities, stigma when really what we are talking about is discrimination and racism occurred at a institutional and cyst systematic level. lack of cultural understanding by health care providers contribute to under diagnosis or misdiagnosis of mental illness in people from racial and ethnically diverse. black patients are 77 percent less likely to receive medication assisted treatments or opiate disorder or (inaudible) lead to greater criminalation resulting in greater reluctance of individuals to seek help. there are entire factors of the national substance use or drug court treatment systems that have significant problems with blocking access to diverse populations as bonifyed diversion programs. next slide. there are populations we know to be more at risk. people with existing mental health or substance use conditions may experience and did duri

mental health and substance health services include outpatient treatment, in patient treatment, services and a larger way of specialized services. services are available to residents of san francisco who receive medical benefits, san francisco healthcare plan benefits and also residents of san francisco. so one of the caveats that we wanted mention, is mhsa, they do not allow for our funds to be use for substance use disorder. so only if a person has that as their larger mental headlight license are we allowed to use any services for substance use disorder. next slide please. so just to talk a little bit about the annual update. so each year, required by the state to present our annual update to local legislative bodies. the 22-23 annual update is a report that includes community program input and highlights from 21-22 as well as a little snap shop of our plans for 22-23. it's important to note, again that the state determines the funding categories that administers the funds to all california counties including san francisco. and counties are required to have a plan and we need to submi

population health. this is the first report the population health clinics gave pulled from epic dast at categories are hard to read and hard to understand. those top. the top 2 embarrass represent city clinic basically. both general city clinic and the blue bar is their hiv proirm care clinic a special clinic offered through city clinic. third is tb clinic and the last the fourth is the adult immunization travel clinic. that last ma gent line represents a comparison this is everybody else that was pulled from at this time to show how than i were doing compared to other sessions based on the epic definition. next shows that the dast that i referred to compared to the other sections we saw, reftive low number of people. reporting a sexual orientation other than straight. and we are not sure of the reasons for that but -- can sort of guess this it has to do with the stigma or people fear being admitted to the hospital. okay. and then -- next slide. more of the data this is gender identity. and then the per

reproductive health care. with more bands taking effect almost every single week, just last friday, a judge reinstated an abortion ban in arizona that was originally passed in 1901. let that sink in. a law banning abortion for more than a century ago, before women won the right to vote is now back in effect. republicans are turning back the clock on women's rights, back to a time where women were not viewed as equal citizens, and the way they had no control of their own bodies. more than 33 million women with -- live in states hostile to abortion. most of these states, abortions are now severely restricted, and are outright bans. this means that roughly half of the women in america live in states that rob them of their fundamental freedom to make decisions about their bodies. this stands in stark contrast to other countries of the world community like ireland, argentina, new zealand, and mexico. all of which are expanding women's rights to an abortion. today, we will hear directly from a patient and doctors wh

so you have these growing in health and employment at older ages. you asked about inequalities in health and other measures other than just the number of years you're going to live. and that's hugely important because, you know, we really reduce health to difference between being alive and dead and i think one of the most consistent in all of the social sciences is that people who are more advantaged tend to have better health by almost every measure of health that we can come up with in almost every time in place that can look, then people who are less advantaged. that's really true. the board and in the us over the past 3 to 4 decades, we've seen some really worrying changes as you. in the bottom half of the income distribution and in terms of health, in terms of well-being, we're talking about things like chronic conditions. we're talking about things like, you know, just, you know, disabilities affect your daily lives, the ability to kind of take care of yourself on a daily basis. those all those, you know, forms of ill health are all much more

mental health and substance health services include outpatient treatment, in patient treatment, services and a larger way of specialized services. services are available to residents of san francisco who receive medical benefits, san francisco healthcare plan benefits and also residents of san francisco. so one of the caveats that we wanted mention, is mhsa, they do not allow for our funds to be use for substance use disorder. so only if a person has that as their larger mental headlight license are we allowed to use any services for substance use disorder. next slide please. so just to talk a little bit about the annual update. so each year, required by the state to present our annual update to local legislative bodies. the 22-23 annual update is a report that includes community program input and highlights from 21-22 as well as a little snap shop of our plans for 22-23. it's important to note, again that the state determines the funding categories that administers the funds to all california counties including san francisco. and counties are required to have a plan and we need to submi

health care capacity for pediatric mental health act access, to increase mental health access outside of hospitals so children can stay at home and don't miss school. the rise act, a child would get an iep in high school say for example, for dyslexia and the guy will get redone when they go to college. the underlying problem leading to the iep has not changed. so why are we putting this as a transition from high school to college, you've got to go through it again? that the condition is not probably, that can be indicated but usually with dyslexia the condition is permanent. and so widely put obstacles for people to receive the interventions they need as they are on the pathway to be filling his halls to be our future leaders? now, it is so wonderful, you see young people stepping forward. ms. williams, thank you for your example that we will hear of of how you use grief in your life in order to lead people your age to mental health wholeness. an example for allstate, attempted suicide but after coming out of that has user experience in the kind of the process of events that led her t

we need health -- we need a health care system with the right facilities in the right places to provide the right care for vets in every part of the community. every part of the country. the bottom line with access is the same as ever. vets who get their care at v.a. do better. our v.a. clinicians know vets and in many cases, those clinicians are vets, and there is nobody better at caring for vets than them. that is one reason why vets who come to v.a. emergency rooms by ambulance are 20% more likely to survive in the following days than those who are transported to private hospitals. so, if anybody's asking where vets should get their care, please send vets to us. we are going to get them the world-class care they have earned. next, we are fighting like hell to end veteran homelessness, a phrase that should not exist in our language. our focus is on two simple goals, getting vets into homes and preventing them from falling into homeless in the first place. we are making real progress. last year, i told you about two ambitious goals for last year, to address veteran homelessness in v.a.

and sf behavioral health commission. this letter is signed by over 50 adjacent neighbors from the one block. we ask for your help. thank you. >> thank you for your comments thissant mr. lamb do we have any other callers in the queue please? >> madam clerk we have no more callers in the queue. >> thank you very much. mr. president. >> thank you madam clerk. seeing no more speakers public comment is now closed. [gavel] >> madam clerk we have representatives from the department of public health that are now on team so we'll go back to item 27. >> yes just for the record for the public who entered later item 27 was called. it is before the board. it's the rate ret contract for the substance use disorder services. i believe mr. rocha is online with us. >> supervisor mandelman you had questions? . >> well, i guess i. do i mean we have -- we have this item that has come to us which is now -- which i guess is being justified in part with an expenditure to an entity that we're not sure is going to be around for a program we're no

with health resume those talks with health unions.llege of nursing general secretary cullen wrote to the health secretary telling him it negotiations or nothing. well, we now speak fingers crossed to . health and fingers crossed to. health and social editor at the social affairs editor at the sunday johnson . lucy. yes, sunday lucy johnson. lucy. yes, you are here now , i believe. you are here now, i believe. fantastic. okay. right. first and foremost, are we going to bnng and foremost, are we going to bring the army in? is this a thing or is it just the thing that people say when they're in crisis? it tescos. bring crisis? oh call it tescos. bring the i think there the army in. well i think there are contingency plans not formalised yet but we have done that before during covid. we brought the army in to deliver ppe and also to do testing at mobile covid testing units. so it has happened before . the army it has happened before. the army obviously is trained in in certain emergency is, but they're not going to have the range of skill

of course, it's about mental health.course it's about gun policy, of course it's about anti-lgbtq rhetoric. it's about all these things. we need to do as leaders, we need to walk and chew gum statement. we need to try to make decision that lead to a safer country. >> one of the responses you did after -- i want to get my events right, i believe it was after the boulder shooting, that's when the state of colorado implemented a red-flag law. i think you believe here if there was a better understanding of how the red flag law worked, perhaps this shooter is prevented from having a gun at the time he wants to do his massacre, is that your sense? >> this looks like this would have been a good instance for the use of colorado's new red flag law, which has been used several hundred times, but could have been used even more. what this is, chuck, and a number of states have it, it's a legal way to temporarily remove access to someone's guns while they're experiencing a mental health crisis. that could be reported by a parent, a l