What you can to see if there is any support that can be provided to bring him and if it is possible to authorize a statement of support on behalf of the San Francisco resident and his family, who has dedicated themselves to San Francisco. The second would be with regard to the cease and desist order to the massage therapists, im just wondering if there is administrative relief that we can do, even though there is an ordinance that is in the hands of the board of supervisors. The department here has a role in providing some directionality , particularly given the testimony here, and i guess they report back to us in terms of what can be provided. Thank you. Thank you, commissioners. Item nine is reported back from the august 27th, 2019 meeting. Im bringing you my last announcement that you can read off of. Thank you. [indiscernible] could you craft up the document about the [indiscernible] yes, thank you. I will remind you what happened in this. This is just august 27th, i should remember. We didnt did discuss the regulatory c. E. O. Report and the Human Resources report and we also heard an update on the expensive and very successful go live implementation. The enthusiasm that people had around it, i may note it is one of the first times i have seen an d. H. R. Rollout in a hospital where people werent enthused. During the medical staff report, the Committee Approved the following, a new Psychiatric Department chief, and standard procedures for genetic counsellors. R. N. Medicine refill, ob gyn in pediatric village list, and it was in closed session where we then discussed the reports. Thank you. Any questions from commissioners the next item, please. I believe there was something brief to say. Dr. Colfax . I just wanted to also acknowledge the commission because of the leadership role that dr. Alice chen, who knows the chief medical officer of the department. We werent able to share this in writing for various reasons, but she is moving on from the department to be Deputy Director of Health Policy and chief medical officer at state and it is an amazing opportunity for her, at a huge honor for us to have her go work at the state level. I just want to acknowledge dr. Chens leadership and her many contributions to the health department. She has mentored many people in the department, and we will miss her very much, would just to really congratulate her. If i may be so bold, absolutely if the commission would be willing to determine her on her. Thank you. We would do that and say yes to this secretary that we create a document that honours her as she leaves the department. I would foot i will forward you the email where the full title of her new position is explained. The next item is consideration for closed session i would like to move for a closed session. Second. All those in favor signified by saying aye. Aye. Thank you, everyone who is not involved in the closed session. Have a lov move to go back into open session. Second. All in favor . I aye. Motion to disclose or not disclose . Second. All those in favor . Aye. Motion to adjourn in honor of alice chen. Motion to adjourn in honor of alice chens service to the department of Public Health and the city of San Francisco. Second. All those in favor say aye. Aye. Thank you. We are adjourned. San francisco and oakland are challenging each other in a battle for the bay. Two cities. One bay. San francisco versus oakland. Are you ready to get in on the action . Im london breed. And i am oakland mayor libby schaff. Who will have the cleanest city . We will protect our bay by making our neighborhoods shine. Join us on september 21st as a battle for the bay. Which city has more volunteer spirit . Which city can clean more neighborhoods . The city with the most volunteers wins. Signup to be a bay protector and a neighborhood cleaner. Go to battle fo they are joining us today because we know this work is not easy. Im joined here today by the director of Mental Health reform, grant colfax who is our director of the department of Public Health as well as yolanda who has been a client here for some time and she will be speaking to you later today. Thank you for being here and all the folks who are doing the hard work. We know that Mental Health there is a Mental Health crisis here in San Francisco and i know that we often times hear that were being thrown around loosely. But the fact is that as someone who grew up in San Francisco and know that we have had challenges in this city, including issues around homelessness, what i see is something that ive never seen in my lifetime of growing up in the city and that is people who are in serious, serious crisis. Serious need. And the fact is, in San Francisco, the frustration is that we have a lot of resources. We have a lot we have a lot of dedicated revenues to help spousht support people, but we have discovered that the coordination has to be better and more efficient to really help people that we know are struggling. So we have people who have, as we unfortunately know, theyre homeless. They have challenges with addiction. They have a number of other ailments, including Mental Illness, and unfortunately have nowhere to go but the streets. We need to make sure were prepared to meet people where they are. We know that people are cycling in and out of our Emergency Rooms and only to be released, to be back right on the streets where they came from. Our jails and theyre having trouble staying stable in our Shelter Systems and trouble maintaining housing. When i was on the board of supervisors, i had a number of clients that i was specifically dedicated to, to have a better understanding of how the system was working and whether or not it could help to reach them and, sadly, those three clients who im still connected with, are still struggle on our streets. We have to end the cycle. We have to do more and we have to be prepared to make the hardest decisions that weve ever made before. Residents like yolanda are amazing Success Stories and she has been a client here since 2009 and has really turned her life around and im really happy to have her here today. The good news is that, you know, when the city focuses and works together to address these issues, we can actually accomplish great things. Back in march, i announced that we were hiring a director of Mental Health reform because that is exactly what we need to do with this system. Dr. Anton will be speaking a little bit later about what hes been doing suns he has taken over this role back in march to get us on track. Today, we are launching an initiative to help those who are the most in need. At those Cross Sections of homelessness, Mental Illness and Substance Use disorder. And our plan is to better coordinate the care. Now i know youve all heard about the numbers. But the fact is the data with the numbers and the information wasnt necessarily clear. And that is a big part of what we want to talk about today. What is actually we see it. We know it is happening. We heard that there was data, but the fact is there wasnt really data in really clear, coordinated efforts. And so the ability to address this issue comes with understanding what is going on with the people and that includes the data. And analyzing the folks who are in and out of our system, understanding if they were offered services or why they refused services and where theyre located after their refused services. Through this analysis done by the health department, through dr. S nagusaplan and the department of Public Health, we have been able to identify 4,000 people with the characteristics of the population who are really in need through these various diagnosis. And of the 4,000 individuals that weve identified who struggle with these particular challenges, 41 are in crisis, which is demonstrated by their high use of the Emergency Psychiatric Services and 95 suffer from alcohol use disorder and the sad reality is what were seeing is there is a real issue of equity because 35 are african american, despite the fact that we have a population of not even 6 of African Americans here in San Francisco overall. This is just the beginning. The first step of this initiative that we are proposing today is understanding the data, analyzing the data, and also making direct impacts on the particular population and really digging deep into those particular issues with those particular individuals. And now as a result, what we plan to do about it, this is just the beginning of several initiatives that we planned to announce to ream get deep into the weeds of addressing Mental Health in San Francisco. I want to be clear. There is not one thing that we will be able to do to address this issue. There are a number of things that we will put forward over the coming weeks to help the public better understand the issue, to help the public better understand and appreciate the people who are working in this industry, the ones who are helping us deal with these issues every single day. To help People Better understand that there are folks that weve been able to help and to support and that many of the programs that we have in place do work. But there is a need for reform. There is a need to increase capacity and to better examine, you know, new ways to address this issue. The first step in the initiative that were proposing today is to expand individual care coordination for those we have identified. So of the 4,000 and doctor bland will go into a little bit more detail, but to just really center in on those who are most in need and that population and to really target them with individualized coordination. We also will definitely need to get them stabilize and stream the housing and health care process. Because we have to have a safe place for them to be, to recover, to go through whatever process they need to go through to get back on their feet. And we also need to understand that this challenge is not a 9 00 to 5 00 issue. Were going to expand the hours of our Behavioral HealthAccess Center so people can access these services on nights and weekends. Let me be clear that the three elements of the initiative are just the beginning. And so we know we have more work to do to improve transparency and the efficiency of our system and to enhance our services and improve what we need to do for the most vulnerable of our city. We are committed and we are ready to roll up our sleeves and to do the work. Because this is not a political issue. This is about peoples lives. And this is about understanding this population so we can get to the root causes and to help people. It comes with a number of various layers of things that we have to do. And i know some of you are familiar with whats happening with our conservatorship legislation and how its gone through the board and how that is going to hopefully help individuals who are refusing treatment, but in desperate need of services. That is one approach. This is another approach. Weve already opened a new 100 Mental Health stabilization beds and our goal is to open 100 more by the end of this year and focusing on specific things to target this population in a way thats going going to help turn around what we know we see on our streets every day is something that is so important. Im sure you have this same example. You may see this same person on the corner every day, screaming and yelling. And i have a particular individual who removes his clothing and when i see him, i cant help but think this could be my father. This could be my grandfather. This could be my uncle. This could be my family member. And i want to help him. I want to make sure he gets the support he needs. It is not humane to continue to allow this to occur on our streets and that is why we have to move forward with a number of initiatives to help address this. Now what were proposing will not n many ways, be able to solve the issues that we know everyone is facing. Were not going to be able to force everyone into treatment. We know that locally the laws make it difficult to do something of that nature. But we do need to try. We do need to kaord nate our services and we do need to make sure that we are better prepared to meet people where they are. We cant assume that when they walk into the doors of a place like this that they know what to do. We need people who are going to be able to help them understand people who are going to understand what the challenge is and be able to address the challenge and that doesnt include, here, fill out this paperwork and take care of this and bring your i. D. That is not the way we are approaching this particular issue. Its about getting the kind of results where you can see and feel a difference on our streets every single day. So we have work to do in here to talk a little bit more about what were proposing and what hes discovered since hes taken on this role as of march of this year is dr. Nagusabland. [applause] thank you, mayor breed, for your support as we embark on this multiyear effort to transform Mental Health and Substance Use care for people experiencing homelessness in San Francisco. Thank you, dr. Colfax, for embracing the scale of the change we need in order to make a difference for this population and for the entire city. Thank you also jessica for your partnership in this important work as we endeavor to trace safety and civility for our neighbors. I also want to acknowledge the communitybased providers and philanthropists, clinicians and researchers, advocates and clients who dead indicate themselves to improving and saving lives in San Francisco. We will need everyone working together if were going to make the kind of impact that this population in San Francisco needs. Heres what we found out about our population. We looked very closely at who used San Franciscos health care and social services in the most recent fiscal year. And as the mayor pointed out, out of nearly 18,000 people experiencing homelessness, we found that close to 4,000 of them also have both a history of serious Mental Illness and of Substance Abuse disorder. We found racial inequity in the population. 35 are black or african american. When just 5 of San Franciscos population is. 41 of these individuals are high users of urgent and emergent Psychiatric Services and 95 suffer with an alcohol use problem. Now we have seen other large cities analyzed our high use of Emergency Services usually from a cost perspective. But as far as we know, San Francisco is the first to [inaudible] health diagnoses of people experiencing homelessness to identifying a population and tailing solutions to that populations needs. This is how we solve problems in medicine. When a patient comes to us with a complex set of issues, we are not haphazard in our approach. We test. We collect information from collateral sources. We diagnose and we treat. We use data to precisely target our problems. We inknow vaitz and, most important of all, we persist. We are here to solve problems for the entire population and confront a crisis for our city. These are the people who need help the most. Helping them will make the biggest difference for them, for our health system, and for the entire community. When we talk about Behavioral Health, we mean Mental Health and Substance Use. We know that when someone is suffering from a Mental Illness or addiction, it is a lot like a Chronic Health condition such as diabetes or even hypertension. When people are in treatment, they do better. When they have a setback, we dont give up. And when 4,000 san franciscans find themselves in the intersection of Mental Illness and Substance Use disorder, business as usual does not work for them. We have to find ways to use the system to bend in their direction. Im happy to say that this work has begun. As we rolled out the first in what will be a series of recommendations we can say we are entering a new era of collaboration with the department of homelessness and Supportive Housing. Jointly identifying the people in greatest need and relentless about getting them on a path to civility and wellness. With other city partners, we will be able to keep track of these individuals and wherever they touch our system a Care Coordinator will respond. When we say were increasing access to Behavioral Health care and we can promise, we promise that were going to focus on these 200 most Vulnerable People in this group right now. And Work Together to get them connected to housing, treatment and care. We will be meeting weekly to discuss each of these individuals and tracking their progress. We will outreach to them wherever they are. We will problem solve and remove bar