Questions. I can accept and it makes sense to me for the person who is seeking treatment, a homeless person, outreach worker says do you want to go to treatment and they say, yes, there is a relatively short wait. It sounds like that could be several days and supervisor stefani, that is not exactly treatment on demand. There might be work to do there. I am more troubled by the access to treatment for the justice involved population which we had a hearing on several months ago. What we hear from Behavioral Health court and drug court is that they have a very hard time accessing appropriate services, appropriate Treatment Services for people in james or in one of those people in james or one of those courts. Part of the disconnect may be the treatment we are relying on to meet the treatment on demand goals might not be the most appropriate place for someone in Behavioral Health court. I know there are some folks going to health right. Can you talk about if the overall picture is better than what it was in 1996, there are pockets of the picture that are pretty not great sarfor folks in Behavioral Health court. Can you help us understand and if we were being more aggressive around kind of trying to leverage people into treatment through Behavioral Health court, that would just add to the backlog right now. People dropout of Behavioral Health court because they cant access the services. Can you talk about the disconnect between the numbers you are presenting and three day or week long wait which is the problem and many weeks wait which is happening for the justice involved population . A lot of people in the justice involved population would qualify for medical unless they are incarcerated. I think some of those folks that are coerced to treatment are coming in through regular medical. There are specified beds. There is one whole Residential Treatment Program that is and 90 methamphetamine primary drug in those beds that is specifically for prop 47, for example. There is ab109 beds. I believe health right has some of those. There are a lot of people who are in treatment because somebody holds it over them sort of. For example Child Welfare the women in the residential treatment for women which is drug medical are there because the case worker says they have to be there. It is an area there is not parody. If you broke your arm the judge wouldnt decide how long you stay in reman. It is a difficult area to be evidence based and assessing, but we think that the moment every union fiction where the mother and children are put together again i in peri medical care is important. We take that into consideration. Each case worker is slightly different so you cant predict very well. I think the courts, some of the courts have their own person to do the assessment and points the direction where people go. Some get in faster than the ones we manage. Supervisor mandelman if you talk to the people in those courts da or pd, they will say and have said here that they dont have nearly enough access to the appropriate kinds of treatment. It may be in a narrow sense we are close to meeting the treatment on demand goals. If you are affirmatively seeks treatment and not coerced and raising your hand and you have a fair amount of agency and being able to access what you need to access while the slot opens up we are in a better space than we were in 1996 around that, but if you are coerced into it and you may need a higher level of service and you may have committed some crimes and there may be concerns about forensic concerns that my belief, but it is not i guess what is troubling it is not necessarily out of the report. I have a hard time assessing how big of a problem this is. Maybe treatment on demand is not entirely the correct framework for thinking about it. Being able to provide Substance AbuseTreatment Services for everyone that we as the city want to get it to and making them the right services that are most likely to lead someone to stick with it. We are further than the treatment on demands reports are suggesting. I will say that more definite. We are further away than the treatment on demands report would suggest. Then i will let you respond. If there is a significant wait the Department Anticipates these things, sees them, then responds. The stop down beds came from the department. If i am on the street and i am thinking about treatment and my friend just went through treatment and now they are back in the park with me because they got through the 90 days or got to stay longer, but there was nothing to go to afterwards, to disrupt my life, leave my friends and go through a tough process, if i am just back in the same place isnt going to sound superappealing. I might be part of the 370 who like if there were a path that wasnt just treatment but were treatment to something, that i would then. Again, not exactly treatment on demand. That is not what they were worrying about in 1996 or 2008. We need to define it to include support for people who have gone through the immediate treatment and need support and sobriety for a while. Some kind of living situation to support you after the 90 or how ever many days. We need to redefine treatment on demand to include that or expand the priorities of the city to be not just treatment on demand but the additional elf of support which you are working on. I am saying this is a problem that we need to work on. I guess, you know, another question for me and this was hard for on the Budget Committee is for us to understand the scale and scope of the gaps and how much money it would actually take to fix them. I know this is part of doctor blands charge. In thinking what we need to do for folks on the street who either are voluntarily seeking treatment or are going to be kind of produced in that direction through some criminal justice involvement, i still dont think i have any concept of what it would cost to what the distance between where we are in terms of spending and programming and actually providing what we would want to provide, which is real treatment on demand for everybody seeking it in a quick period of time and support for them afterwards. I am hoping some of what will come out of doctor blands work is a map of what would and you suggested maybe it is three or a total of double the step down beds. It doesnt solve Behavioral Health court problem. It is hard for us as policymakers to, you know, work and i assume this is true in the Mayors Office to come up with solutions if we dont have a real assessment of what the gaps are. It is true, i didnt focus specifically on justice involvement in this presentation. We could find out. There are experts that would know better than i. Supervisor mandelman we have that hearing. We will have a lot of conversations about the jail. It does send assessors to the jail. It is difficult even though they are in jail it doesnt mean be they are easy to find or sit down with. A lot of things get in the way of the assessment. Supervisor mandelman superv. Supervisor haney i wanted to understand this. Based on the july report on the availability of Substance Abuse treatment, is the assertion here that there is no unmet demand . No unmet demand. Which report are you talking about . The treatment on demand report . Supervisor haney yes. It is getting better, but im sure we are not perfect. Supervisor haney the treatment system is large enough there are treatment openings every day, it has priority placement, no wait list for residential treatment, residential step down. How do you then assess what the demand is and help us to understand how to plan to meet that demand . Isnt that part of what we should be doing under prop t. It doesnt say anything about demand. My assumption is then that. It may not be accurate. What we are using is 10 to 12 people a day. There are a lot that want residential treatment. We look at the beds we manage at 90 occupancy rate makes sense for that, whether people get discouraged in the intake process that is probably true even though we shorten it to four days. My concern is that, and this is not meant to be an attack on you, it may not be accurate. How do we get Accurate Information . If it says there is no wait for the various things or one week wait, yet what we hear from folks working within the system is that wait lists are much longer than this to the extent they are kept. This information to me is by definition inaccurate, disconnected from what people are experiencing on the street. Obviously, we dont have residential step down beds for everybody. We understand that a lot of people come out of residential treatment and dont have residential step down. We are getting reports as policymakers that seem wildly disconnected from what is happening on the streets and also even by your own admission likely inaccurate. Well, yes and no. What i mean is from the persons experience who comes in to ask for treatment as supervisor stefani mentioned. They are not turning people away. You are offering appointment and intake process. What we are measuring on the slide show is the number of days from initial assessment to time they are in the bed. That is as short as it has been. We want it to be best. We have a high population that is experiencing homelessness. Waiting four days might not be realistic. We patch it up to do what we can to put them in detox and hold them there, but when i say there are probably people dropping out during that period from their point of view it didnt work and makes them more hopeless and they may not come back again and i dont like that but that is how it is right now. Supervisor haney it feels mismisleading if we are not keeg track of people turned away or dont come back. We are making it difficult for people to access things for a variety of reasons we are not reaching effectively or it is not there when they need it we should not be saying that there is an unmet demand. We should be as part of these reports requiring a plan to meet the actual demand, not the people jumping through all sorts of hoops and wait many days and be there at the exact moment to walk in. I feel like it is being cooked to lead to one conclusion, which is that we are meeting the demand, not measuring demand in a real way. Last thing. Has there been an external evaluation of this in any way . Yes, these measures we did it for the aqro. They require it. Supervisor haney is there an outside independent evaluator that they do that every year . They come every year and look at our numbers. Their benchmarks 10 days. From their point of view we are doing great. From the San Francisco point of view we could do better. They dont count it as wait list if you give somebody an appointment within a week. That is different from being on await list that you dont know when you get in. If you come in a week you will get in, in some cases if you are suffering homelessness, that is just semantic. You cant come back to an appointment. From the point of view of our external quality review organization, it would be on demand. Supervisor mandelman thank you, doctor martin. Next up we are going to hear from the treatment on demand coalition. Good afternoon. I am representing the treatment on demand coalition. One alliance of Behavioral Health advocates in support of housing, criminal Justice Reform and health care. We recognize there are enormous barriers that people face in San Francisco when they try to access treatment for Substance Abuse and Mental Health disorders. We are here today to talk about the best ways to overcome those barriers. In 2008 San Francisco passed a ballot measure which stated there we go. In 2008 San Francisco passed a ballot measure which stated the department of Public Health would provide enough free and low cost medical Substance AbuseTreatment Services to meet demand and required the city to maintain funding for the services. 10 years later, everyone knows this is not happening. We also understand that there is not just a demand for Substance Abuse treatment for Mental Health treatment, also. These are intertwined. From that ballot measure the treatment on demand proposition, the public is to receive reports for the need for treatment and what is available. We havent been getting the reports. It is time to ask the right questions. Those questions need to come from the communities that are affected by lack of access. When people are denied access to treatment the consequences are homelessness and incarceration. It is known if you have no access to treatment it makes housing less secure. Chronic homelessness is a cause and result of Substance Abuse and Mental Health disorders. People of color and lbgq are especially vulnerable to this. There is talk about people using Psychiatric Services often. You can see them on the street. Our goal is so they do not get to that point. The way they are treated they are stabilized without connection to services to help them. That is unacceptable. Back in march this year the San FranciscoHealth Commission declared incarceration is a Public Health issue. We cant leave this in the bureaucratic hallwayses of homeises unkept. 85 of jail bookings are those with Substance Abuse disorders. Why . The answer to supporting those people with Behavioral Health problems has never been policed. The answer is licensed professionals who understand the people they are working with. We must increase the staffing for case managers on the front line of the Public Health crisis the city has not addressed adequately. Intensive indicate managers and residential beds and housing with those in Psychiatric Care are imperative to change the Behavior Health system. We need a formal Communication System between homelessness and Supportive Housing. San francisco has a 12 billion budget. It doesnt take a genius to understand why there are so many homeless. Substance abuse is ignored by city officials. We need a assessment so we can focus the energy and resources to substantive solutions, the voices of effective communities. The treatment on demand Coalition Says it is time for the city to be act believe with a task force which is the first step to making this part of the public consciousness. We need a change now. When other places werent taking notice about h. I. V. And aids, San Francisco took a stand and said enough is enough. We took action. We held the government accountable for the problems they were ignoring. The treatment on demand coalition which is consisting of Supportive Housing providers, people who are members of the community affected, criminal Justice Reformers, and front line providers say San Francisco is better than that. Lives depend on it. Thank you very much. Supervisor mandelman thank you. We have been blown away from the excellence of your presentation. Thank you. Up next we hear from the executive director of health right 360. I am vicky eye sen. I am the ceo of health right 360. I worked in the field in San Francisco for 25 years. I have seen a lot of changes and policy shifts and the impact that has had on people, and i am a former consumer, former injection heroin user who found recovery from the safety net programs long ago. I am thankful they were there for me. Is there a way to get my slide deck up here . Thanks. While we are doing that i will Say Something that is not in the deck to give you a broad context. Two years ago prior to implementation of drug medical we had the same beds, 500 beds between the treatment beds and they were residential step down beds. About two years ago prior to drug medical we had the same number of beds that were full every night. They are full every night. Today you might have heard, im not sure if you read the paper, we had challenges filling the beds. What has changed . What has changed where we went be from a place two years ago where we had the same number of beds and the beds were full to today we have challenges keeping the beds full . I dont want to say that the sole problem is drug medical. We advocated strongly for it. We believe that it is parody. People with Substance Abuse disorder should have a stable source of funding. There are problems with it. I hope we can talk about that in the slide presentation. I will give you a snapshot who we are. We provide a range of services, substance and residential and outpatient settings. We have primary Care Health Centers with primary care, residential step down and some sober living, outpatient treatment for people with substance and some people through special Health Contract as well. Broad range of services. I want to give you a snapshot of the 9,000 people is pretty much all of them. We didnt count residential step down beds. We looked at the data request from you. We have 160 residential step down beds. We serve 9,000 people each year. Of that 6500 receive primary care, 1500 addiction treatment, 1900 Mental Health serv