I would like to thank our colleagues from sfgov tv for broadcasting this. Clerk any documents to be included as part of the file should be submitted. Would you call item number one. Clerk 1. Resolution authorizing the Mayors Office of housing and Community Development to accept and expend a grant in the amount of 300,000 from the California Department of housing and Community Development to provide funding the west side of San Francisco districts 1, 4, and 7 for i am the sponsor of this particular item. And i just want to also really thank member ting to have worked closely with us to secure these funds in support of our neighborhood in the west side of San Francisco growing our capacity to get rental buildings. In my district over the last ten years, ive last 400 units of Affordable Housing. On the east side of San Francisco, there are several amazing nonprofit organizations that help stabilize these buildings through acquisition and property management. On the west side, we simply do not have the organizational capacity to meet this need. This funding will help us change that and im so appreciative of phil ting to his commitment of preservation of Affordable Housing on the west side. Good morning, chair fewer, supervisor stefani and mandelman. Supervisor fewer provided the context for this grant, so i wanted to talk a little bit about the timeline for implementation and awarding the grant. So the Mayors Office of housing and Community Development released a notice of Funding Availability for small sites on september 13, and as part of that we included a portion of funding for capacitybuilding grants. The west side Planning Grant was included as part of that nofa. So applications for the capacitybuilding grants were due on november 1st. We conducted our Proposal Review Panel for reviewing the application. We expect to notify grantees of their award by the week of december 16. From there, well enter into a Grant Agreement for the west side Planning Grant. And the Work Associated with this grant would start in january 2020 and the grant term would be one year. Thats the timeline for implementation. Were really excited about this opportunity. This is the first time weve had capacitybuilding as part of small sites, and were excited to support our sponsors and growing their capacity to engage in this program. Im happy to answer any questio questio questions. Thank you very much. I am thrilled also. Lets open this up for Public Comment. Any members of the public like to comment on item 1, seeing none, this is closed. I would like to make a recommendation to move that to the board with a positive recommendation. Clerk would you like to send this to the full board with Committee Report . Yes, please. Madam clerk, can you please call item number 2. Clerk 2. Resolution declaring the intent of the city and county of San Francisco city to reimburse certain expenditures from proceeds of future bonded indebtedness; authorizing the director of the Mayors Office of housing and Community Development director to submit an application and related documents to the california debt to permit the issuance of Residential MortgageRevenue Bonds in an aggregate Principal Amount not to exceed 38,700,000 for 53 colton street; thank you very much. I believe we have joyce flen he here. Good morning, supervisors. My name is joyce flen. Im here to present on item 2. This item relates to the resolution for proposed bond issuances for 53 colton. The purpose of the resolution before you is to approve the hearing the city conducted to comply with the federal tax equity and financial responsibility act, or tefra, and enable the project to apply for bond financing. The proposed bond issuance will be conduit financing and will not require the city to pledge any of its funds to the repayment of the bonds. This is a 96unit affordable new construction project located on colton street between goff and 12th street. Approximately 35 units will rehouse permanent tenant leases from the neighboring civic center hotel, which is a singleroom occupancy building. All units will serve formerly homeless adults. This will be subsidized with the citys current funding program. It is currently a parking lot. We anticipate the project will Close Construction financing and Start Construction as early as september 2020. Here with me today is serena calloway a representative from the Community Partnership and katie strather. We would like to thank you for your consideration today and look forward to your support for this project. Thank you very much. There is no bla report on this. Lets open this up for Public Comment. Any members of the public like to comment on item number 2 . David elliot louis. Im a resident and a board member. I get to observe the organization from the bottom up and the top down. This is an organization ive been involved with for over a decade. Its really well run. They do remarkable work. This particular project will provide almost 100 units of permanent Supportive Housing in the high 90s. For hitting a population thats less than a quarter of ami and a population thats unhoused. They will be again saving lives. People will be placed through coordinated entry, the department of homes, Supportive Housing. Its a really good project. This agency has a good track record of success. Theyre well respected in the field of permanent Supportive Housing. Theyre fiscally sound. I hope you will support this ask. Thank you. Thank you very much. Any other Public Comment . Seeing none, Public Comment is now closed. There is no bla report. Any questions or comments from my colleagues . Lets move this to the board with a positive recommendation. We can take that without objection. Madam clerk, can you please call item 3. Clerk 3. Resolution fixing prevailing wage rates for 1 workers performing work under city contracts for public works and thank you very much. I believe we have pat mulligan with us. Good to see you. Good morning, supervisors. This is the annual submission before the board for San Franciscos prevailing wage standards. It includes the ten classifications Service Sector under 21 c as well as the 60plus with hundreds of subclassifications that are recognized by the California Department of industrial relations. Its frequently a consent item. Just so everyones aware, there is some controversy over 21 c 3 as related to the car rental facility at the San Francisco international airport. There is some pending litigation related to that. That should have no impact on the submittal before you today. Its worth noting that 21 c 3 has not changed from the previous years. It reflects no change in that item. Could we have the bla report, please. Good morning, chair and members of the committee. This is just the annual approval by the board of supervisors of the prevailing wages for 2020 for covered classifications. We talk about page 3 of our report shows the various categories of workers that would be covered, and attachment 1 gives more detail on some of the classifications to be covered by this. Catchment 2 summarizes some of the changes for each of the categories of workers that would be covered. In terms of the impact so the proposed prevailing wages based on collective bargaining agreements and was approved by the Civil Service submission. The potential impact to the city is unknown. It would really depend on how much of this is passed through in contracts to the city, but because the board has discretion over how they choose the wages and doesnt have to take these recommendations, we consider this a policy matter for the board of supervisors. Thank you very much. Any members of the public like to comment on item 3 . Seeing none, Public Comment is closed. Any comments or questions from my colleagues . Seeing none, that is closed. I would like to say prevailing wage is important for our workers in San Francisco. It is as bla said, it is negotiated agreements about how much people should and need to be paid actually for fair wages for the work performed. It ensures equity and sets a standard for what workers should be paid in the private sector. While i did work on the school board, i ensured that our workers were being paid at prevailing wage. Having said that, id like to make a positive motion to pass this to the full Board Committee report. I can take that without objection. Thank you very much. Please call the next item. Clerk scloipt 4. Ordinance amending the administrative code to establish Mental Health sf, a Mental HealthProgram Designed to provide access to Mental Health services, Substance Use treatment, and psychiatric medications to all adult residents of San Francisco with Mental Illness and or Substance Use disorders who are homeless, uninsured, or enrolled in medical or healthy San Francisco. Thank you very much. And i believe we have supervisor ronen here to join us. Good morning, everybody. Im sorry for being late. And im so incredibly excited to be here. After two years of studying and planning how to fix the growing Mental Health crisis in San Francisco, supervisor haney and i reached an agreement last month with mayor breed to implement Mental Health sf in collaboration with her and the department of public health. Just on behalf of supervisors haneys behalf, he is out of town and couldnt be here today and sends his regrets, but would pretty much not want to miss this for the world but happened to be out of town. Im absolutely thrilled to be moving Mental Health s. F. Forward today. The legislation before you reflects our joint commitment to solving our Mental Health crisis on the streets, with particular attention paid to the intersections between homelessness, Mental Illness, and Substance Abuse. San franciscans will soon have access to a comprehensive Mental Health care program. We designed the system to provide access to Mental Health services, Substance Use treatment, and psychiatric medications to vulnerable residents, specifically those who are homeless, uninsured, or enrolled in medcal with severe Mental Illness. This includes a number of components. A 24 7 Mental Health service center, a 24 7 street Crisis Response team, a drug Sobering Center, an office of coordinated care, increased beds at every level of the system, as well as case managers for everyone who needs them. An office of private Health Insurance accountability for those residents who do have private insurance but are unable to access timely care. I want to thank you to the hundreds, the literally hundreds of frontline workers, labor unions, and advocates, including nurses, Mental Health care workers, social workers, family members, consumers of Mental Health services, and Community Agency leaders for believing that we can do better. A very special thank you again to my colleague supervisor haney for fighting alongside of me every step of the way and to our incredible Mental Health s. F. Committee who worked so hard on every detail of this legislation, many of who i see here in the audience today. I also want to thank the other supervisors who worked on this. Finally i want to thank mayor breed and her staff for her willingness to work with us to find unity and to dr. Colfax and his staff for their collaboration. Now that we have developed this program, i want to thank all of my colleagues for their cosponsorship. We hope to move forward with the appointment of all members of the Mental Health s. F. Implementation working group as soon as possible early next year once this legislation becomes law. The mayor has then committed to hiring the director of Mental Health s. F. By next summer and to expediting major renovations to the citys current Behavioral HealthAccess Center so that it can be transformed into the new 24 7 Mental Health service center. Most other aspects of Mental Health s. F. , however, cannot move forward until we have identified a longterm Funding Source for the measure. I am thrilled to have a strong commitment from mayor breed to work with us to identify at least 100 million per year in new funding to fully realize Mental Health s. F. In efforts to reform the business tax or through other reform measures. I will not rest and i know supervisor haney will not rest until we have the funding that we need to fully realize Mental Health s. F. We will continue to explore every possible option for funding, including the idea of an excessive c. E. O. Salary tax, if necessary. Needless to say, we have a lot of work ahead of us, but today i cant be more thrilled to officially launch us on our first step of that work by introducing a few amendments on the current draft of the legislation that im asking my colleagues to send and asking to be sent to the full board with positive recommendations. I wanted to go over the few small amendments. I believe we passed this out ahead of time, but if you need more copies i will be send those down. The first thing that we have done is made two small edits to the definition of harm reduction. On page 8 replacing the term self harming twice, the first with the word harmful and subsequently with the term specific. Second, we have added two seats to the Implementation Working Group. It now has 13 seats instead of 11, six appointed by the board of supervisors, six appointed by the mayor, and one will be appointed by the city attorney. As it states on page 20, line 20, the additional mayoral seat will be held by a Substance Abuse treatment provider. As it states on page 21, seat 13 will be held by a person with expertise in the field of health law appointed by the city attorney. Finally on page 23 we state that the Implementation Working Group will work with both the controller and the department of Human Resources to conduct a staffing analysis, not just the controller as previously stated. I see that dr. Colfax is mentioned and i want to thank you for your collaboration and work on this. I see behind you dr. Nigusse bland who has put time into this and will be very much a part of implementing Mental Health s. F. I wanted to acknowledge you. There are several other members of the incredible Behavioral Health staff. I want to say this has never been about the work of the frontline individuals in the Behavioral Health department. You are all the most Extraordinary People that i have ever had the pleasure of needing and your work on a daily basis is the most difficult work that requires fortitude and love and commitment and hard, hard work. This is about creating a system for you so that your work can be easier, more sustainable, more longlasting, and ultimately more effective. I also wanted to acknowledge the Labor Council and several unions. Ken from the sheriffs association. Your commitment to this legislation is honestly such a major part of how we got here. I see steve fields, the executive director of the progress foundation, whos part of the committee and is much of the brain behind this legislation. So i want to acknowledge you. I also see jackie preger who was part of the Mental Health s. F. Campaign team when this was a campaign out in the field and not a piece of legislation in city hall. I just want to acknowledge you. With that, i will turn it over to my colleagues and ask for a motion to approve the amendments after Public Comment. Do you want to do a presentation first . Im so sorry. I didnt ask cph to prepare a presentation, but is a presentation not necessary . Good morning, supervisors. Grant colfax. We were not asked to make a presentation, but were here to answer questions. I would like to make a few comments about how delighted we are with this potentially transformative piece of legislation and with mayor breeds support and the support of the board. This really is an opportunity for us to modernize our Behavioral Health system. As we know, the issues around Behavioral Health, particularly around the intersection of Behavioral Health, homelessness, psychosis, Substance Use, that this is a key issue at multiple levels. I see that we can use this opportunity to have this be the next big thing that our community and our government comes together to solve. Within the department of public health, weve done big things with community, with science, with our providers, and obviously with the policymakers. I think what we did to transform the h. I. V. System of care and we were ground zero of the epidemic of h. I. V. Were now talking to getting to zero new h. I. V. Infections. We were the first local jurisdiction to provide universal Care Coverage for people through healthy San Francisco. So i just see this as an exciting opportunity to use data to support the workforce, Bring Community wisdom forward, and focus on in a detailed way how were making progress so that we see that our work is valuable and really making a difference in peoples lives. So i think the data piece cannot be underemphasized here. I also want to say with a few of my colleagues i spent some time at the state meeting with key policymakers. Im excited that so much of where the state is headed with some of the medcal changes aligns with this work. From the focus on more flexibility around Behavioral Health services, more in lieu of services, which means more wranedaround services, its key. I think its important to emphasize that this problempar. I think its important to emphasize that this problem didnt happen overnight and it wont be solved overnight. We often overestimate what can be done in two years, but underestimate what can be done in ten years. So i think thats a key piece to keep in mind as we make progression here. We are progressing positively in some ways. This is a continuum. Its not as though something and i appreciate supervisor ronen for recognizing the work done in Behavioral Health. The Street Medicine Team working navigations on the street in navigations and shelters on the street to start people on treatment in real time. I was at Division Circle clinic, where im seeing patients half a day a week, alternating with our aids clinic. Its remarkable whats happening in that work. Were expanding that Street Medicine Team because of the investment that you and mayor breed all approved in february. Were collaborating with the department of homelessness and Supportive Housing better than ever and really having shared priority clients to make sure that we take a whatever it takes approach and marching down on a datafocused way how were making progress. And understanding in real time on a casebycase basis how the system needs to change to meet the needs of the people were serving. As you know, were planning to expand the Behavioral Health center. Obviously Mental Health s. F. The goal is for it to provide more opportunities to spant expand it further, but were on that journey. Supervisor mandelman cochaired the Methamphetamine Task force. I just think that across the spectrum of care were making great changes. Bringing in the leadership, the talent, working with our academic partners, our community partners, we are going to be in a very different place over time with the work in support of you as policymakers, with the support of the community and the scientists, and i think most importantly with the voice of the people who have Behavioral Health diagnoses, having their voice at the table is key. Very excited about this hearing and moving forward together. Thank you very much. Could we have a blv report, please. Yes, the proposed ordinances before you today would approve the Mental Health amend the administrative code to approve Mental Health s. F. The Mental Health code changes sets out the basic Service Requirements and the process to develop an Implementation Plan. We give some very preliminary numbers in table 1 on page 13 of our report one time and potentially low and highscenario costs. However, the actual costs would depend on what the Implementation Plan would show for the budgets. We consider the approval of the proposed ordinance to be a policy matter for the board. Thank you very much. Supervisor mandelman. Thank you, chair. I think one of the things that may have been obscured a little bit in the more contentious moments around the discussions around Mental Health s. F. Is how much agreement there is i think in city hall, in all places in city hall, in the department of public health, and in the Provider Community and in the Client Community and Patient Community about whats broken, what needs to change, and where we want to be. I want to congratulate the authors and the department for having forged a document and a piece of legislation that i think reflects consensus around where we need to move and what we need to do. So im i dont know if im the last cosponsor, but i think im one of the last and im happy to be able to join. I do if my colleagues will indulge me for a few minutes want to check in on some of the elements that are reflected in this legislation that are priorities for me. I dont want to prejudge the work that the working group will do, but i also dont want to wait for a couple of years and i dont think we will be waiting for a couple of in moving forward on some of these things. I know im going to ask questions that the department doesnt have definitive answers for, at least some of them, but i would like to check in on some of the departments thinking on some of these issues. So starting with the office of coordinated care, one of the things that struck me in our budget process and every single meeting that ive had out in the community is how uncoordinated it feels like our care for these often very sick people is. And actually, the lack of coordination reflects itself in two ways. One is a lack of coordination for an individual who is cycling through services but never the cold handoffs keep happening, the person comes to the same person and goes through the same cycle, the same person never actually gets that coordination. I think that was reflected in some of the work that dr. Bland has already done in identifying that, wow, even as we look at the highest users of these systems, many of these people do not have currently assigned case managers. I know there is a commitment in the department to fix that. I am assuming that is part of what the office of coordinated care is doing. A lot of it is getting the Case Management to these people who need it. But i just wanted to offer the opportunity an opportunity to talk a little bit about what you were thinking about in terms of the office of coordinated care and how the creation of an additional bureaucratic element will enable a focus on the coordination that we need. Good morning, supervisors. My name is hally hammer. Im director of ambulatory care. Ambulatory care includes primary care, Behavioral Health, maternal child and adolescent health. Ill speak to the office of coordinated care. In ambulatory care, really, one of our major goals and its exciting to speak to this piece of legislation and the opportunities it gives us to do more coordination of care and more integration of care between our different ambulatory services as well as the rest of the network. So when we read the legislation and really imagine how the office of coordinated care would be set up, we model we did the cost estimate based on what is articulated in the legislation, but really will be honed down and defined by the Implementation Working Group. So three levels of care coordination, which is fairly aligned with how we do care coordination now, but really expands our ability to coordinate care, especially for those who need the highest level of care coordination and Case Management. So ratios we use ratios from 1 to 10 for the highest level of care management. Based on our evidence for what works, which is sort of a social worker, Behavioral Health clinician peer team who have ratios very low patienttoclinician ratios, 1 10. The next level would be similar to our intensive Case Management, the ratio is 1 17. And then for people who need less intensive Case Management, a 1 50 ratio. We also want to just acknowledge that the people we serve move through Different Levels of need and Different Levels of complexity. So will move between those Different Levels of care. The office of coordinated care will also encompass, so the costs also include some of the work to be done in coordinating for people leaving jails and psych emergency. It also includes what is really key in all of this, which is data and analytics, which is having some realtime inventory that we are working on, but we dont have the easy access to right now, what our capacity is at any given point in time. So that office of coordinated care really incorporates a lot. Increased Case Management services at all levels of care as well as the data and analytics to support approximate this happen again as dr. Colfax articulated, that we need to look at evidencebased practices to look at new models of care so we better align our services with what people will engage in and with what people really need. Excellent. Through the chair, i just wanted to supplement the answer before you. If you have other questions . I do. Do you mind if i supplement this question . Through the chair. Thank you, chair. So a couple things. I just wanted to say that the office of coordinated care is way more than a new bureaucratic element. I would not describe it that way at pull. There are new types of interventions, activity, and coordination that is not happening in any way, shape, or form right now. So let me talk about those aspects. If you start with the im going to go through each part of this. The realtime inventory. Not happening. We were in many hearings ourselves. When we asked for it, it wasnt happening. Thats going to happen and be coordinated and then that information used across providers to inform not only providers of getting people through to the appropriate level of care, but this board of supervisors and the mayor about where we should be investing resources. Thats something thats not happening right now that will be run by this office. Case management. It is true that we have case managers and intensive case managers right now. We do not have critical case managers, which is the third type of Case Management, but is created by Mental Health s. F. What those case managers will do is proactively go out and engage people who are refusing treatment to over time develop relationships and trust and a rapport to try to coax those people into treatment without the use of coercive tactics. That is not something thats happening at all right now. Its something that we know works when an individual has enough time and energy and resources to do that work. We just dont have a system in place right now that does that. Secondly, the office of or thirdly, the office of coordinated care is going to provide a case manager to every individual that needs one. In fact, we think that the major cost of Mental Health, one of the major costs, is in this aspect. The biggest workforce expansion that will happen under Mental Health s. F. Is case managers, hands down, completely. So right now we cannot say that everyone in our Behavioral Health system has a treatment plan or a case manager. Thats not happening. Thats one of the biggest problems of why were not coordinating that care across service, why we have whether you call it the merrymaker merrygoround or the hamster wheel. We need to make sure that everyone is exiting has a treatment plan and a case manager that will make sure that they dont just end up back on the street and back in jail or p. S. A week or a month later. Not happening at all. That will all be coordinated through the office of Case Management. Finally were going to have an office that not only has Realtime Data of the availability of beds, but thats going to be collecting data and informative of how we can continue to innovative to have the best Behavioral Health system in the country. Not happening right now at all. Finally through this office were going to have a marketing and an outreach campaign. Nobody knows who to call right now if they see someone screaming and going into traffic. The person they call if they call anyone at all, but now san franciscans are so used to see that, that we just walk by and feel guilty and call the police. Not anymore. Under Mental Health s. F. , there will be a 24 7 mobile outreach team. People are going to know the number and a team of skilled physicians are going to come out and engage with that individual. So there is a lot that this office of coordinated care is going to do. We provided a roadmap for that in Mental Health s. F. , but of course the specifics have to be developed by the department and by the Implementation Working Group because theres so many details to making that overall vision that i just described actually happen. We didnt want to be so prescriptive that the department and the Implementation Working Group cant innovate, which is going to be necessary. We cant presuppose every little detail of how this needs to be done, but we can provide an overall vision for a level of coordination and a level of intervention that is we know can be effective if its appropriately staffed and appropriately discharged and appropriately coordinated. That is what Mental Health s. F. Does and that is a heck of a lot more than just a new bureaucratic element. Go ahead. And i think we all wholeheartedly subscribe to that vision. I do think that there is a risk that if we are not diligent and attentive and come forward with budgets and hold folks accountable over time that that will be just another office, and thats not what you or i want. And definitely not what dr. Colfax wants. To that point, that is why we are clear. Mental health s. F. Will not happen unless we have at least 100 million a year more of investment in this program. Weve never tried to hide that fact. This wont work, and i promised dr. Colfax, who is ready, willing, and excited to implement this system, but he cannot do it unless we get this money. Thats why not only are we going to be i, ill speak for myself, im going to be diligent and vigilant every single day that this gets implemented how its supposed to get implemented. I and we have work on our plans to figure out how were going to generate 100 million more in revenue a year, otherwise this wont happen. Thats where our continued engagement and not only preferable, its essential. Oh, im sorry, go ahead. Im reclaiming my time. So given that this is a bold vision of Something Like a universal right not a a right for each indigent san franciscan or homeless san franciscan to access the right and appropriate Case Management, are we talking is this budget at the scale we will be able to deliver that . Do we think that 22 million a year, and thats currently on the upper limit, is about what it will cost to ensure that we dont have cold handoffs, that we have case managers for everyone in the system, that we have a higher level of Case Management for those in need, and that we have and i think there is some work actually. I see it happening in my district, that there is work to people that are not currently, you know, saying yes to care, but theyre getting visited by selton all the time. But thats not what i think supervisor ronen is describing in terms of basically everybody who needs someone looking after them has someone looking after them. Because if its 22 million, we shouldnt wait. We should move more quickly and we should get as close to it i mean, either way we should try and expand this in the next years budget. Im curious, is that the final target or is it something more . If its something more, thats fine. I want to manage expectations. Is 22 million a year what it would cost to provide adequate Case Management for everyone who needs it . I appreciate the question, supervisor. One of the things thats challenging as this is developed, we need to test some of these hypotheses and adjust accordingly. So i think the question is important, and i also want us to not be in a place where without more Data Information that were that we are somehow answering yes or no to that very specific number because there are lots of things that we need to figure out. I will give you just in terms of workforce, for instance, we know and i think the Community Providers in the room how hard it is to train, recruit, and retain people. So when we think about the expansion of the workforce and those costs, when you look at some of the numbers that have been estimated with our office, the Mayors Office, the bla, there are ranges in there. I would ask for your forbearance and patience in terms of being able to answer absolutely yes or no. I think what we have here is a vision, a commitment to value, and a commitment to evidence and partnership to answer some of these questions with the working group. We do have our budget analyst here. And obviously dr. Hammer can answer some more granular questions. I just wanted to point out that we are in a stage where were under development and a lot of these very specific questions that do need to be answered, were just not prepared to be able to hammer down, okay, yes, it will be 22 million or 23 million. I understand that may not be the gist of your question. More like maybe 50 million or 100 million. And i dont know, but we can give you the ranges based on some of the assumptions we made, but again, as we learn and try to execute this, we would have to and also i think there are amounts that we can give depending on what the policymakers and the resources that are made available, there are things that we can do with different amounts. To say this is the total package and how much it will cost this or next year, going back to my point, in two or 10 years, this is an iterative process that needs to go on here in regard to reaching the goals that we all share. Whatever it is, its a moral em imperative. I appreciate the chair letting me answer these questions. Two things. One of the jobs of the Implementation Working Group is to do a staffing analysis. Our hypothesis about why its so hard to retain and recruit case managers is the rates are low and the Work Satisfaction is very low because we dont have a supportive system in place. So that a case manager works so hard to get someone off the street, into care, clean, stabilized, on medication. After theyre in the residential program, theyre placed right back onto the street, where its almost impossible to stay clean. Youre like, why did i put all that time and effort into this job, when the person is just going to end up back on the street. You can imagine how eventually you would want to switch jobs. Thats not like youre contributing in a meaningful way. Our hypothesis is if we raise wages, improve the system and have a system in place that gets people well, it will lead to a Job Satisfaction that is so much higher, that people will stay. Again, as dr. Colfax said, thats a working hypothesis. The second thing is i want to be clear while in total were calling this a universal program because of the office of private insurance accountability, the specific population that is entitled to a case manager under Mental Health s. F. Are the uninsured, the homeless, healthy San Francisco participants, those individuals on medcal with a Mental Illness. That is controlled by those paramet parameters. Thank you for that. I would love to hear from the d. P. H. Budget folks how you came up with this figure and what you think were getting in terms of Case Management for 22 million a year. The legislation has several components to it. There is a Mental Health services center, which is the range that we have noted is around 18 million to 22 million. This is an actual substantial of potential expansion of our Behavioral Health center to 24 7. There are also estimates of 25 to 35 million. Again, the actual costs would really depend on the Actual Program model, the levels of service, and our capacity. Everybody gets it in the way described in the legislation. Yes. I mean, im just curious im curious if that was what number of case managers, additional case managers get added at that 35 million level . I dont have the actual s. T. E. Because were considered a service of communitybased providers, but what we have done is identified a group of 4,000 people we do believe need to be case managed today. We have 250 that are in the top priority. They would be case managed at a 1 10 ratio, social worker, and peer, as well as additional wraparound support. A lower tier would be a 1 17 ratio with wraparound support. And recognizing the reality of not being able to engage everyone at that level and still maintain a continuum of care for them. Were assuming that we will still have a touch on everyone at a rate of 1 50. As the legislation notes and supervisor ronen has noted, the actual levels ratios will be reviewed by the working group and made as a recommendation to the department, but those are the assumptions behind those numbers. Okay. And i apologize for looking at the wrong line, and it is 20 to 35 million. But that 20 to 35 million is based on providing Case Management at the levels described in the legislation for the 4,000 . Yes. Okay. Cool. Thank you. The other piece this isnt necessarily a budget question, so youre relieved. But that i that has been talked about is the departments need to sort of manage its measure things and analyze the measurement that it is doing and one of the tremendous frustrations for this Budget Committee has been the lack of kind of sort of the departments inability, at least last year, in the budget to sort of in the budget process to describe where its highest priorities were around Behavioral Health and what it would need to achieve specific goals. I think, you know, weve had repeated audits and analyzes that have said that there needs to be better data and Data Management. Weve had conversations about dr. Colfax that that would be easily a 50 Million Investment in i. T. For Behavioral Health services. I do hope and trust that that investment in systems and Data Management and Data Analysis and probably an ongoing set of data analysts is going to be part of what comes out of the working group and ideally things that we start funding even before the working group has fund through next years budget, without necessarily waiting for the final results of the working group process. Okay. There are two elements of Mental Health s. F. That i feel particularly attached to because of because they did come up in the Meth Task Force, and theyre both complicated and i think are going to require qualificati conversation and thought and analysis going forward. Those are the Sobering Centers and the street Crisis Response teams. So in our discussions at the Meth Task Force, there was Sobering Centers were the highest recommended item, but it is not clear to me and we did not get to a level of detail in those discussing that everyone was talking about the same sobering centres. I will say and i think this is a conversation that this board is going to be having, d. P. H. Is going to be having, there is a pressing need to relieve pressure on Psychiatric Emergency Services and Emergency Rooms around San Francisco. Its going to be really hard and complicated to create the meth sobering facilities that serve either as an alternative or another form of treatment or a place to describe what has been described as the 51 41. 5 person. Thats at least what i was talking about in the Meth Task Force discussions. Supervisor ronen is nodding, which makes me believe that that is her understanding of what a Sobering Center would be. Although the Meth Task Force also recommends a range of services for people using meth, dropin centers, places for people to come down off a meth high that i think what we think is needed is a place or multiple places where people who would be going to d. P. S. Are being diversitied. If we believe this changes, we might need to explore that. If there are people we think we could fill Sobering Centers with people who dont need that treatment, but that raises the question of how theyll be held there until they come down. I really want d. P. H. To wrestle with the complexity of that question and come up with something that provides relief to d. P. S. Ive expressed this to dr dr. Colfax off line, but i just want to make sure that thats where were headed with the Sobering Centers, not to the exclusion of other centers and facilities for people who use meth, but that we have a place that reduces the pressure. Yes, i wanted to very much agree with you on that point. But having the center open 24 hours, seven days a week and connected with this Street Outreach Team and having a place that isnt the emergency room and isnt d. P. S. Where that team and the police but hopefully, if it works the way we want it to, the street crisis team can bring people and that is aimed at addressing the overcrowding in the diversion. But i absolutely agree with you that theres another population of meth users and that we have not fully figured out what the right architecture is for a meth Sobering Center is. That work is yet to be done, and i think we all agree we dont have that model yet. I wanted to agree with you on that point. Good. Thank you. And then im curious on so we have a lot of outreach going on in the city. We have ems6 going out and d. P. H. And teams going out. For this 4 to 6 Million Investment that were anticipating now, and i think it could be well more than that, the thing i was bringing up in the Meth Task Force conversation and that i think is intended in the legislation is a real transformation in what both the people who are in distress on the streets and san franciscans who are confronting people in distress on the streets in our response. As supervisor ronen said, many of us have gotten to the point that we are so regularly encountering people who are meth inebriated or on the verge of psychosis or in psychosis, we walk around and avoid, but we dont imagine there is anything we can do to improve this persons life. I think San Francisco dials 911 on folks in need less than we should, but thats not really going to generate a change in both the experience of people who are in distress and the people who are confronting those in distress. And im curious if d. P. H. Has any preliminary thoughts on how these crisis intervention teams might be structured, whether there is or is not a role for Law Enforcement or for the fire department. And whether the budgetary question is 4 to 6 million enough to ensure that i can dial a number and get a prompt, appropriate response from a medically Competent Team that also has the ability to access Law Enforcement if necessary to get someone who is in distress and should not be on the streets off the streets to one of the many optional alternatives, whether it is the Behavioral HealthAccess Center or the lessoptional alternatives like p. E. S. , possibly a Sobering Center. I think thats a really good question. I think theres while we are very proud of our comprehensive Crisis Services and understand that with the mission of our current Crisis Services of responding to mostly violent event events, working with the police, with police negotiations and homicide services, that we dont have a that we dont have this service right now and that well need to build it. If we are successful, then it could become a much more costly and robust service. We just dont know. What we envision is again working across agencies with shifting to have be a Clinical Service 24 7 of a Behavioral Health social worker and working with a peer, with e. M. T. , to have a team who can respond to Mental Health and Substance Use crises on the street. If we obtain our vision, we will have a lot more middle classes than jail for people to be triaged and offered the care that they need. So with a 24 7 Mental Health service center, which again we dont have. So a lot of the crises that we know about that i think we dont appropriately respond to right now happen after our existing center is closed and when there arent many alternatives, there arent any, besides urgent care and d. P. S. If we achieve our vision which were so committed to, there will be lots more alternatives, a 24 7 Mental Health service center, more urgent options, more hummingbird options. So we really look forward to that time when we can send a Clinical Team out, when we can meet with people where they are. Most of this happens after the hours again of