Transcripts For SFGTV Government Access Programming 20240714

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 Abuse Treatment 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 Francisco Health 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 services, either through the primary care clinics or as part of Substance Abuse disorder. 950 receive detox services. This statistic says 61 of the clients experience homelessness that is of the total 9,000. That is everybody who has come to see the dentist or primary care or reproductive health. When you drill down to people for Substance Abuse disorder. That is 94 of those who come for residential treatment. Most people are experiencing homelessness. That number has been consistent for the period of time before drug medical. That hasnt shifted over the past two years. 94 of the people who come for Substance Abuse treatment are experiencing homelessness, most are sleeping outside, unsheltered. As a substance treatment snapshot we have 239 residential treatment beds if San Francisco. 16 in a program for Pregnant Services for women. Then 223 residential Substance Abuse Disorder Treatment beds. 178 are funded by dph. There are other purchasers who purchase beds for low income. Parole purchases beds. They are all for san franciscans, not all purchased by the county. It was difficult for us to pull data on what percentage of our clients have a reoccurring Mental Illness. When we pull the data it pulled a number that said 1495 people which is the equivalent of the people receiving addiction treatment. It was pulled by diagnosis. Some have more than one Mental Health diagnosis. At least half if not more of the clients we serve have a reoccurring Mental Illness. There is a perception we dont take those people with Mental Illness and we do. We take people who have been hospitalized or coming out of the hospital. Stand stand i have a whole slide and the next slide works through the intake process and it will show you where there are a lot of places to fall off and im interested in that, as well. For detox services, we can do the sameday placements because its an emergency service. They meet medical necessity, we can place them in the same day and we have the opportunity to do the intake work because ill walk you through that. Some clients come into and they sign in the morning and learn about the programme and we register them but they leave before they come back to complete the assessment. On the other side of the page, it has the overview of the orientation and screening process into treatment and its a parallel pass, the same doing both and based on what a person needs but a parallel pass for detox first or residential treatment. So follow me here. So the top little work flow is people coming in for detox. So a person for deto detox or withdrawal management, they come in and its conceivable if a person comes into for detox and theyre psychotic with no medication, theyre significanting aggressive or violent behaviour, net may not be taken into detox that day and i dont know if any of you had a chance to visit the residential houses but theyre big facilities. So if people are not able to be managed in that environment because they are aggressive or psychotic, well work with them to get them seen but we need to be stable. Its how theyre presenting. But for the most part, people walk in and we do a medicationassisted treatment assessment and that means theyre sent from the fifth floor to be seen if theyre at risk for withdrawal of any kind, so particularly true for people using alcohol or opioided because we have medications to address that and theyre sent to the fifth floor to be evaluated. The wait time at the clinic can vary and they could be there 45 minutes or two hours because its an openaccess appointments. They come back down and theyre assessed. We do the first part of their assessments to residential treatment and then theres a whole bunch of paperwork to do and then we transport people to the facilities. So they get through that process and theyre transported. At that time, if they express an interest than or i then or in dy stay in detox three or seven days ar we schedule them for a residential treatment assessment where all of the stuff on the bottom row starts. So if youre coming on from detox into a residential assessment, its fairly the process is a bit smoother because were transporting people from the detox to the residential and they have an appointment and we know theyll be seen that day, ok . So lets walk through that set of slights and then, the little arrows at the bottom show the places where people can drop. So a person comes in tor an orientation and often, i think its been habit we did change our practise and asked people to come in the morning and whenever you come in, theyll do an orientation for people and then if lots of people show newspapee morning, well schedule them for an assessment and if we find out they dont have medical, we need to send them to harrison street to get enrolled. If theyre enrolled in medical in another county, we send them to harrison street to have them transferred. So to the best of our ability, we send navigators with them and we have somebody who accompanies with them and if they cant, this is an absolute break point people are coming into treatment and anything you put in the way will make is a barrier, obviously. We send them to the medic laxerl office . What percentage is this. I have a slide to show you a percentage. It will give you numbers on the next slide. So then, we do an assessment on level of care. So coming back to when i said drug medical has and impact, its a managed system and the protocol says we do an assault and make a recommendation for level of care, send that to the county to bhs and they review it and they either concur or do not concur with that level of assessment. We say, we dont think that person needs residential or we agree with you. That process takes a minute for them to get back to us sometimes, as i think dr. Martin eluded to. But if we do an assessment and to our determination, the person doesnt meet the medical necessary thannecessity for resl treatment, that means they do have housing. If you ask the feds cms will say housing alone should not be a reason why you put somebody who has a Substance Abuse disorder in residential treatment and i think thats bureaucratic crazy talk, ok . Like, no one who works in that field thinks that makes any sense whatsoever but thats what the words are. So housing alone isnt the case. So flip that over, if a person is housed and based on kind of the level of their Substance Abuse, it may be the outpatient is the best place for them and thats rare that happens but occasionally it happens. We do an assessment. Band then we move them into outpatient and thats rare that happens. So then we need to get approval from the county if the person is not already in a detox bed, but if theyre comi