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 barriers to accessing care and the lessons that we learn will ultimately help us improve the system of care for more people. Going forward, the recommendations i will continue to deliver to mayor breed will be driven by clinical expertise, by data, by evidence and by the most innovative and best practices we can find or imagine. They will promote equity and transparency in our system of care, that they will advance Harm Reduction and lower barriers. They will build on the legacy of addressing problems that might seem intractable and of making stability, wellness and recovery possible. The clients and staff here at the south of the Health Clinic show us that perseverance every day. With that, id like to introduce Yolanda Morris et. [applause] about 15 years ago, i came to San Francisco because i was being abused and i fled that relationship. I didnt know anyone in San Francisco, i left my clothes and i didnt look back. I was also an au addict and i was an alcoholic and i was homeless. I came here and slept in the alley. Ive been every street out here that you can name and through the years i did want to get help. I didnt know how. And so after more abusive relationships, i finally got a good guy and it was his choice for us to get clean. He said we gotta get clean in order to make it here in San Francisco. Im going to stop doing what i can do so that you can get your act together. And so i decided because ive been in all the shelters out here. I know how the shelters work. I decided to stay next door. I stayed there for a year. And i behaved. From there, i went into an s. R. O. They placed me in a singleroom occupancy is what it is called. A room with a bathroom and i stayed there for five years and prior to me when i first moved into the s. R. O. , my mother was dying of cancer and she didnt tell me because she knew it would take me out. I had a year of clean on me and i didnt look back and thought thats not what my mother would want. Im going to stay clean and im going to fight. Soy went out and found everything that i could find. This is one of first places that i came to because i had a lot of stuff going on mentally and physically. They were able to help me get on medication. They were able to help me get therapy, to get to the root of the problem, what was going on because i had a lot of stuff going on and after doing that, i had a lot of anger issues, depression, suicidal thoughts. I had to do anger management here twice and i finally got it right and i started doing other programs. Glide was out there. Sage was out there. It is not out there anymore. I went to the womens reentry center. I didnt feel comfortable at first because they walk you over there. Ive also been incars rated out here in San Francisco for drug possession and other things of that nature due to my drug use. And so i just slowly said im going to build myself up and started doing things for women against rape and violence. I got an award from the d. A. I like the write. I started writing here. I found out that im a pretty good poet and i do i do poems here every year for the black history month. They embrace me here. Ive been coming here since 2012 getting support and getting help. And i graduated from a lot of programs out there and i started doing peer mentorship through San Francisco state. Ive graduated from ram, ive graduated from nami. I expunged my record. I got my drivers license back. Five years into my s. R. O. There was a program called brilliant corners. They came and gave out vouchers to people who are willing and ready to move out of the tenderloin and i had two weeks left and i fought hard and found me a onebedroom and i got out of the tenderloin. But i still come to the tenderloin because this is an ish yaoufm i know a lot of people here. I always want to do anything that i can to disclose support and help the people in the community. So i continued. Im still with my guy. Were getting married this year. And [applause] thank you. And also i want to say that i was able to get a really good job through help rights 360th called maps and its mentor and peer support. They give you a job and they give you schooling for that. So i was able to do that. And now i teach groups in jail. I teach groups to the men in san bruno on domestic violence. I teach groups to the deputies about crisis intervention training. I go out and volunteer. I do anything and everything that i can to support anyone. We work in all the collaborative court. Now i was an addict nine years ago and this is what im doing now. Through all the help that started here at south end market. You know . They really helped me out an awful lot. They were very patient. I went through several therapists and psychologists. But finally got it right and ill be flying away and graduating from here soon because i am moving on to other things. I have a nice fulltime job now. So, yeah. Thats about it. [laughter] [applause] well, thank you, yolanda, for sharing your story. Its amazing. It is an inspiration to us all. And we wish you the very best as you get your certification in drug and alcohol counseling. Amazing work. Also, by the way, were hiring. [laughter] just putting that out there. Were looking for right people. Im the director of health for the city and county of San Francisco. I would like to thank the mayor and thank you, dr. Bland, and thank you to our host today, Natalie Henry berry and the hardworking staff here. This is one of the places in the citys system of care where people can get their medical care, dental and Behavioral Health care needs met under one roof. Ive seen what the staff here, with persistent compassion have been able to do by partnering with their clients on journey to stability and wellness. They are psychiatrists, pharmacists, Behavioral Health clinicians, nurses and support workers who go out into the community and meet people where they are. Many clients are experiencing homelessness when they enroll in services here and most are diagnosed with both Mental Illness and Substance Abuse disorders. But the work makes a difference. And on my last visit here, i went out with the team. And this is a client, whos now housed, but was ton street for many years. Wheelchairbound, had chronic controlism, refused treatment for many years. But the team continued to engage him, continued to bailed relationship. Helped him when he was ready to get healthy. Helped him when he was ready to get treatment for his alcoholism. And this client, living in the tenderloin, is a valuable member of the community. Is actually continuing to move that forward just like yolanda. Hes now volunteering at the San Francisco aids clinic providing Harm Reduction materials for people who need them. He is moving the work forward and this is the kind of model of peers helping peers in a system that meets people where they are and does whatever it takes to help get them off the street w. This new data and focus on the 200, we can make a difference. I think when people are ready for treatment and volunteer for treatment, that is key. I also think we need to recognize that one of our challenges on the streets that some people will refuse treatment. Some people in the most dire needs of treatment will refuse treatment. So we need to be there when people are ready to go into the services and meet them. When theyre ready. But we also need laws like the conservatorship law to provide people with the support for shorttime conservatorship to help them save their lives. These are lifesaving interventions. And that persistent compassion is what we have seen here and what weve come to expect from our director of Mental Health reform in. A few short months, hes transformed the way many of us think about caring for people experiencing the intersection of homelessness, serious Mental Illness and Substance Abuse disorders. This is a population, as youve heard of 4,000 people who require specialized solutions. Kit take a while. It can take time for them to achieve their goals. But we know that wellness and recovery is possible, as youve heard today. And with our partners at the department of homeless systems and supportive housing, thank you, jeff, for being here today and the Human Services agency. We have agreed for the first tomb on ways to identify, treat and house the most vulnerable population in our city. And mayor london breed to spark the champion of Harm Reduction, someone who understands the inequities that lead to core Health Outcomes and that we must continually push harder to overcome. Under her leadership, San Francisco continues to invest in health care and housing that our city needs. Thank you, mayor breed. And thank you all for be