Recommendations. At the aids foundation, i applaud mayor breed and for their support to support a task force. It was charged in larp large part to recommend ways to improve our system of care or Substance Use on our streets. The San Francisco aids foundation and our c. E. O. Look forward to partnering with the city to realize the vision of the task force recommendations. I believe when we accept drug users without stigma, and in a state and in all states of health, Mental Health, and Substance Use and misuse, we have nothing to gain but vast improvements in serving all residents with Substance Use concerns to improve health and functioning. Low Barrier Services like those recommended today offer particular improvements for Community Members not ready for more intensive or traditional Treatment Options for easy Access Service options, support, dropin centers, Case Management , more accessible substance treatment and supportive policy on all levels of healthcare delivery. Thank you and please join with us to support the recommendations put forth today. [applause] chair peskin thank you. And another great partner in this effort he will say a few words is what andrews with p. R. C. [applause] it is wonderful to be here. I am just looking down the line here. Thank you for allowing me to be part of the analysis and the processes. You are my mayor and i support you fiercely. We have known each other for years. Thank you for leadership. You and i has have to find a new place for dinner. When the man was speaking, i all i could think is dont say that dont say that because that is in my speech. He will just hear that one more time. [laughter] i want to thank the mayor and the supervisors for understanding the importance of convening the Methamphetamine Task force. As we seek to address the Critical Issues of the day, homelessness, Mental Health, and Substance Use issues, we could not have achieved that successfully if we didnt fully address the growing crisis of meth and its effects that it is having on our community. Over the past eight months, the task force came together with a shared goal of seeking to decrease health risks, identify best practices and reduce the negative social impacts that they are having on San Francisco under the 17 recommendations, the creation of the Sobering Center is key among them. Rather than being an opportunity to take someone to the psychiatric emergency services, the Sobering Center would provide an appropriate alternative, giving them access to Outpatient Services and other Communitybased Mental Health and Substance Use treatment services. It understands the value of an effective program, as many of you know, in partnership with the city, thank you, mayor, we are in partnership with the city on hummingbird place. It is a low threshold barrier removal Navigation Center located on the campus of zuckerberg general. This innovative General Program addresses the crosssection of Substance Use, Mental Health, and homelessness. With many people transitioning into one of our nine residential treatment sites. Sometimes they have been there only for their very first time. They have been on the street this long. They have made the decision for themselves. This homelike environment when someone is off the streets and feeling safe, and supported with three meals a day and shower facilities, and a homelike environment and a beautiful i call it nature therapy. When you are able to be off the street and out of duress and finally make that decision for yourself, that you want to show up for yourself and live a life of dignity. I know we can do that. One out of every four individuals that comes through comes into treatment. These programs are effective. It is clear that when we come together with our shared values leading the way, there is nothing that we cannot achieve. Im pleased to be part of the process and look forward to partnering with the city and the limitation of many of these implementations from the task force. I want to thank the mayor, supervisor mandelman, dr. Grant colfax. I am looking forward to partnering you. I want to acknowledge the many nonprofits who are in the room and across the community. It is across it is reason why we are able to apply this system of care. Thank you. Thank you. Last but not least, i would like to say this is not a new challenge for our city. When we think about even going back as far as 1960s, the heroin epidemic, into the 70s and the 80s with a crack at get epidemic all of the drugs sadly that have really destroyed lives and destroyed communities and destroyed families, we know that we cant just turn a blind eye. We have to think about ways in which we can make sure that providing help, providing support integrated into what we do in our medical system. It has to be something that is accessible to all people and not just those who couldnt afford treatment. I have been out in the community on a regular basis. When i talked about safe injection sites, it is interesting that whether it is a wealthy neighborhood, and in between or poor neighborhood, i always have someone who walks up to me and tells me about their child, about their friends, about their family member, struggling with an addiction. None of us is immune to the struggle. It could be anyone of us. It could be any one of our family members or friends. I do think it is important that we have better access to treatment on demand. That we have better access to supportive Wraparound Services and they may not accept it on the first, second, or third time , but we have to make sure that regardless, it is available , it is accessible, it is easy to get to. And that is why we need to start looking at how we provide services for those struggling with Substance Use, for those who sadly are struggling with mental illness. We need to look at a new way of doing things so it is naturally integrated into our medical system in a more comprehensive, responsible way that has a tremendous impact on peoples lives. That is the goal of what we are trying to accomplish. Using data, using medical experts, using nonprofit organizations, working together with the city to provide something that will effectively deliver so that we can see a difference and we can save lives that is the ultimate goal and i want to thank each and everyone of you for your work on the task force and all that you do to help us advance the goals of what we need to do to make San Francisco a better city for each and every one of us. Thank you all so much. [applause]. Order. Hi, everyone. I will note well, ill take roll call. [ roll call ]. So before we begin, first of all, thank you, everyone for being here. The commission is grateful for all of the Public Comment that weve gotten in the past few weeks, specifically with regard to homelessness and behavior health. There have been some announcements in the news in regard to that. In keeping with our responsibility at the department of Public Health, at our last meeting we had a presentation on the adult residential series. Today it is part of the three presentations laid out by president loyce. We will be addressing some of the needs of the Public Health services. Then at the next meeting we will have a presentation which will be an overall of Behavioural Health programs in the department. In addition, i would like to on behalf of the commission, welcome commissioner suzanne gerardo. She has been the chair of the San FranciscoFamilies First five commission and the founder and trustee of the demerlac academy which is serving underserved children and families. You certainly bring a lot of credentials to the commission, and were very happy to have you. Would you like to say a few words . Yes. Im very happy to be here, and i hope with my background in Mental Health, Behavioural Health, as a practising psychologist, im not just an administrator, i see families and adolescents daily. I look forward to being part of the planning, program, and solutions as the department of Public Health moves forward. So i welcome the opportunity to serve the city. Thank you. Thank you. Welcome, commissioner. The second item on the agenda is the approval of the october 1, 2019, minutes. Okay. After having a chance to review, do we have a motion to approve . So moved. Second. All in favour . Aye. Minutes approved. Thank you, commissioners. Item 3 is the directors report. Good afternoon, commissioners, director of health for the county and city of San Francisco. I also just want to extend my warm welcome to the new commissioner. You were just sworn in about 45 minutes ago and getting right to work. Very much appreciate that. It is with the spirit of the Health Department that we get right to work in solving problems. We are so excited to have your wisdom here to help us figure out how to do it better across the department, but especially with Behavioural Health. As you know, as we talked, theres a lot to do in this area. Im very excited. The Health Department has done big things in the past and we will continue to do big things with your leadership and the rest of the commission. Thank you for being here and look forward to working with you. Thank you. So the a couple of other things in my directors report that you have in front of you. Very exciting announcement from mayor breed with regard to launching the urgent care s. F. Initiative. This is a bold vision to expand our Behavioural Health system, just focus on the people who need it most and for who our system of care is currently failing. It really is about focusing on the 4,000 people that our director of Mental Health reform has identified as the most in need identified by their being homeless, suffering from psychosis, and also Substance Use disorder. The initiative reflects input from community partners, medical providers, and other clinicians, is informed by data and evidence, and i think most importantly reflects the publics passion for addressing this issue. At the end of the day i think from a Public Health perspective and just in general, this initiative will save lives and it will address the Behavioural Health crisis that were currently seeing on the streets. The mayor is proposing, among other things, an expansion of 1,000 beds in our Behavioural Health system from residential law facility to boarding care facilities. Thats a 50 expansion in terms of what we already have. The initiative is built around four pillars. One is creating a more coordinated system of care, reinforcing and expanding our outreach efforts and further creating no barrier and lowbarrier care. Two is strengthening and expanding our Treatment Options. So our programs the programs that work are expanding, and we have new innovative programs being launched and eliminating wait times for care whenever is possible. Three is strengthening our Behavioural HealthCare Workforce both in Civil Service and our community partners. We know that recruitment, retention, and Career Development is a challenge for people and this will make sound investments to make that work. Number four is ensuring that people have access to Housing Options to help aid them in their recovery. Another key component is ensuring that we have evaluation and monitoring systems. So we develop feedback loops to learn what is working. We develop a system to learn whats working and adjust for whats not. We know that recovery is possible for people who have Behavioural Health issues. We know the system is working for most of the 30,000 people who are already in our system. I think its important and well timed for the department to start thinking beyond that number of people and look at where were failing. We need to expand and have the resources to do better using evidencebased ways. From helping San Francisco to addressing the aids crisis, weve done great things and im confident on this initiative and the support of you in the public, we will be able to move forward. A few other things on the directors report. Im proud to announce that mayor breed and a few other supervisors announced the adult residential facility that we talked about a couple of weeks ago at commission. Im pleased to say theres a balance that we agreed to where there will be a continuation of the adult residential facility. The final state after april 2020 is we would be running 41 beds in that facility and maintaining 29 lowbarrier hummingbird beds. In the interim, five people will be moved, provided its clinically indicated or they agree to move to other facilities, to open up a 14bed hummingbird that would last in april. People would be moved from that hummingbird to other hummingbird options and we would reopen to the state of 41 beds. Really pleased that we were able to come to some agreement. I think the staff input and the collective problemsolving let us move in the right direction. The governor just another key piece of news in our rapidly developing Behavioural Health field, the governor signed sb40 into law which helps strengthen our conservatorship and will help more people in what i consider lifesafing conservatorship. We will be able to help people for up to six months, provided they meet a number of criteria with regard to what these bills regarding we see the multiple offers of care. So we are working on this. A work group has been established. We expect to enroll people starting the 1st of the year. Those are my key updates. There are a number of other things in the directors report, but in the interest of time and with the respect of the commissioners, i wanted to stop and take additional questions of what i mentioned and answer any questions that answered you in the report. Commissioner green. Thank you so much. These are wonderful announcements and wonderful news. Do you have any sense for when the plan to reopen the rf beds might actually occur . Is because we have to address the Patient Safety and quality care issues. I think it was uncertain when we could accomplish that and if you had a sense of that Going Forward. The current state of the r. F. Needs improvement. While we dont think at this time any patients are in acute danger, we think things could be better in terms of strengthening our quality of care. Ive asked for a root cause analysis Going Forward to determine what are the staffing, what are the resource, what are the cultural issues that we need to fix in order to improve that. I think one of the key things that will help us understand that better is the working group that this agreement reached. So there will be a working Group Problem solving on a wide variety of issues while we continue to make significant improvements in the r. F. Going forward. The thing is, the r. F. Is not closing. We will have the r. F. As we in the interim between the final state. We will have the r. F. Afterwards, right. So we need to continue our current efforts to make the r. F. Better, but this working group that will be meeting soon and establishing a process for root cause analysis will really, i think, hold the deeper answers. In april when were ready to go to the 41 r. F. S, hopefully, well be able to do that in a way that is optimal for patient care. Thank you. Other questions . Okay sorry, dr. Chow. Im actually quite excited about the Mental Health plan, first of all, because i think it offers many specifics that are really right on the ground. It addresses our workforce problem, allows us to have resources to do what the mayor would like to have as the program for our Mental Health and substance disorder. So its very specific. Do you have an idea within this is there a time frame that some of these will be coming on that we could also be monitoring with you in the Mayors Office . Im glad theres an outcome component at the end, but as some of these come online, would we get an update on these . Now were going into these other units or were in the course of hiring this or were now working. I know were going to talk about the wholeperson program today. So thats one element. Im wondering if we sort of have a map of how were going to work with this, knowing that these details are still in flux probably. As we get more specific, it would be really helpful to understand the road map of this. You certainly put together, and so have with the supervisors the adult facility use and you have a timeline for that, which i think is really good. It would be nice to know how we would be looking