Transcripts For SFGTV Government Access Programming 20240713

These are other 24 7 facilities which this Response Team could take people to and get them the help they need. Through the chair, i just think its important to talk about how this team is distinct from the h. O. T. Team and the e. M. S. I know it feels like a lot of teams, but we fought to make sure that the language requires coordination amongst all of these teams. They really do have distinct roles. So the h. O. T. Team is not supposed to be experts on Behavioral Health. Their mandate is to outreach and engage with people who are experiencing homelessness. Lets remember, not all people experiencing homelessness have Mental Health or addiction issues. So they are they have another role entirely. Its about well, thats a role that not all of us feel comfortable with now and were always constantly battling out, but it is distinct and separate from the issue of Behavioral Health. The e. M. S. 6 team, the firefighter has to come when there is a physical risk to safety. So its not just that someone lets say someones passed out, for example, or someones injured because they were in psychosis and they walked down the street and got hit by a car. That couldnt be this team. That has to be firefighters who have the medical training to deal with physical impacts that are related to addiction and Mental Health, overdoses, et cetera, but that arent but that requires some sort of physical medical attention as well. This team is for people that are not in a physical risk to bodily harm, but are having a Mental Health crisis, psychosis, or druginduced psychosis and they need a Behavioral Health professional to come and engage with them and get them into treatment and care, but theyre not theyre not overdosing, theyre not they havent been hit by a car. Theres not an immediate risk to their physical need. That is a distinct thing. Believe it or not, we need all of these expertise. Without all of this specific expertise, we are missing a part of the population that is currently living on the streets. Well, im excited to see how the conversations about this team develop. I do think e. M. S. 6 does a lot more folks who may not have had a physical injury. They may be at risk of a physical injury at some point, but their charge is to work with folks to prevent things from being more expensive thats what i was just going to say, then were not spending our resources well because we dont need that level of intervention. Theyre being assigned based on high 911 callers, but those 911 are not always generated by a physical injury. But at any rate, im looking forward to seeing what the Crisis Response street teams look like. Supervisors haney and ronen are asking for big, bold, structural change, as is this board. So i think what we at least to know what it looks like, not just to expand what we are doing now or make it look or make it work smarter or for efficiently and effectively and raech people and have more places to take people, but actually meet the need and the demand. So that i as a san franciscan have an app and a phone number that i can dial and know that i will get a response that is as timely or almost as the 911 response, but is calibrated to this problem were having in San Francisco right now of a ton of folks who are under psychosis or inebriated and need intervention. If thats more money thats needed, we should describe the program, show it, put it on the policymakers i do think that the good thing about Mental Health s. F. Is that its asking us to think boldly about the system that we want. That will in order not to be i think i think for this to fall flat at some point, we need to be honest about what the scale and costs are going to look like if we do this and actually deliver what people are going to be expecting with Mental Health s. F. If we can do this for 6 million, fantastic. I will be not surprised at all if deliver be that response which san franciscans deserve is a lot more than 6 million. May i say sure. Go for it. I think and with dr. Hammers information and speculation, i think we are being asked to in some ways speculate on things with all humility we dont know yet. I think we all are looking for a transformation and we acknowledge that we need to do that. I also think we need to be very thoughtful to apply scientific methods to transformative change. I would be as a provider myself, when i make assumptions and speculate what a patient needs, i am usually wrong. So i just think that part of this effort and also with all forbearanc forbearance, we will test things and some of those things are not work. To be bold, by definition, you have to be willing to take risks. The things that do not work, we will recommend that we no longer invest in and change, and the things that do work we will scale up. I think in this process, we have done great things in the health department. The Behavioral Health team is an Amazing Group providing grate solutions. I think as we look to solutions, in some cases we have become a little bit lax in San Francisco about the possibilities we think about. With dr. Hammer and dr. Nigusse bland, we look outside to other models to say how would this work in San Francisco, take those programs, make the right investments to pilot them, potentially scale them up. I think there are some things that we know, like the Case Management piece that we know enough about that we do need to scale up, theres enough evidence there. On the other hand, as we transform our system, theres not a lot of value in case managing people if we dont have places and resources to case manage them to. I think thats one of the key things that ive heard in talking to our workforce and community partners, one of the great frustrations, because youre basically trying to work with somebody and even if that person is ready. I do think we have to thank you. Through the chair. With all due respect, supervisor mandelman, thats what weve been doing for the past year in creating Mental Health s. F. Weve tried to engage you the whole time. Up until now you havent been willing to really engage with us on it, but we have spent an entire year researching all our systems, talking to frontline workers, writing hundreds and hundreds and hundreds of drafts of this law to put that vision out there. Everything that were trying to engage you in is what Mental Health is, its a vision for a system that will finally meet the actual need thats there based on current Scientific Evidence to engage and get people to a point where they can live healthy lives. Of course we dont know every detail. Theres never been a piece of legislation throughout history that has been able to know every single detail with specificity, but what Mental Health does is take a leap and it says what weve been doing absolutely doesnt work. Its something that all of us can see every single day when we walk the streets of San Francisco. We got in a room with the frontline workers and experts in the field and we said, lets imagine and create a system that would work. Lets put money aside for a minute. What do we actual need . This is what we came up with. This is what we need. Its not only been vetted by every Behavioral Health worker and psychiatrist in the field, its been vetted by the department of Public Health and the mayors office. This is a vision moving forward. Its not a mystery about whats going to happen. I worry slightly in this dialog that youre having with dr. Colfax that youre looking for some other vision municipal the vision is Mental Health s. F. The policy that you have cosponsored is that in order to fix the crisis in the streets, we are going to implement Mental Health s. F. We have to find the money for that and were mutually committed to doing that, but this is how were going to fix it. There are devils in that detail that always were going to have to be working out and that is what the Implementation Working Group is. There are things thak the doctor said that we try and dont work, but the vision that if you vote for this legislation that you are voting for is saying that Mental Health s. F. Is a way to fix the crisis on the street every single day, day in and out, and thats how were going to make things better in San Francisco. Dont vote for the legislation unless you believe this is the right vision to get us there. I have two more substantive points i want to make about Mental Health s. F. , and i dont i dont want to get into a back and forth with supervisor ronen about the history of this legislation. I will say and supervisors absolutely have the right to work with whomever they want to on developing their legislation. If the supervisor wants to work with a different supervisor or others and not a third or fourth supervisor, that is completely in the right of the authors. The original version of Mental Health s. F. Was presented to me i think a couple days before it was introduced. I think that was the time it was presented to the department of Public Health. I have been part of the discussions. That has been worked out between the supervisors and the department of Public Health. Im grateful for the work and the consensus they have forged. I do not believe that Mental Health s. F. Is the be all and end all of Behavioral Health reform services. I am happy to vote for and support this. I have two more substantive questions. I really am grateful to see in here the emphasis and the intention to address the Behavioral Health Services Needs of folks in the criminal justice system. When we had our treatment on demand hearing a couple months ago, we saw data that was questionable about whether weve achieved treatment on demand. Were doing better there. It is completely clear to me from my engagements with Behavioral Health court and drug court. We are dismally failing to provide adequate treatment opportunities for people in jail or justice involved. I think that needs to be a priority, and i look forward to you continuing to work on that. My last question is about my new obsession with locked subacute beds. It was a little bit of a fight in last years budget to expand the number of those beds by 14. Some folks thought that money would be better spent in other areas. I insisted that we include those 14 beds. A few weeks bad we had a hearing on conservatorships. That was in part based on some work that the budget and legislative analyst had done. It is, i believe, and i believe that folks at general and in p. E. S. Believe that we are desperately short of locked subacute beds. That means that has implications and all these things are connected, and a shortage in one part of the system affects i know there are shortages everywhere. But this shortage means people stay in jail too long, that the whole system slows down referrals around things like conservatorship. I do believe that is happening and we would be conserving more folks on a short or longterm basis if we had those beds. People would benefit and not be cycling as much. Whether it is 100 beds more that we would need or more than that, its a significant price tag. Depending on how theyre done, i think 100 beds would be in the 10 to 20 million range. I absolutely think we have to make that commitment. We have unfunded and unused beds on the third floor in the Behavioral Health building. We have potential partnerships with some of the private and other hospitals that might be able to provide beds. I really want to push our whole system, this board, the mayor, g. P. H. To look at further expansions in our locked subacute capacity and to do that in the 2021 budget. Not specifically called out in Mental Health s. F. , but i think its part of the spirit of Mental Health s. F. And that is one of the reasons and that understanding is one of the reasons i will be voting for Mental Health s. F. Okay. Thanks, everyone, for indulging me. Thank you. Now supervisor stefani. I would like to congratulate everyone for coming to a compromise on this very important piece of legislation. I think if you look at the history of it and how everybody came together to come up with this solution, it just reminds me what unites us on this board is much, much more than what divides us and we do have common goals here to address a very serious problem in San Francisco. I have a very pragmatic and practical question. Its along the lines of the hiring challenges. Supervisor ronen spoke to a staffing analysis would be done, but i think it goes beyond how difficult it is to keep people in the positions. Its also i dont know exactly how many case workers were talking about. I dont think i heard a number. I heard some math that i might have been able to do in my head, but i didnt, about how many case workers we are talking about with 22 million or how many it will take. I think we need to be mindful of that going forward, how are we looking at recruiting and moving through the department of Human Resources. How are we looking at possibly creating additional regs. We have to be mindful of that. I dont know if the department has looked at that. I know it is a constant strugis truing struggle. If we dont have the money, were not going to be able to move forward. If anyone has an answer, i would appreciate it. Supervisor stefani, ill try to speak to that a little bit. Any hiring manager in the city or certainly department of Public Health knows its exceedingly difficult to recruit and retain workers, given the economy here and the challenges of this work. As supervisor ronen mentioned, the workforce that we need to build, our Behavioral Health workforce, is challenging and gruelling work. When we talk about the 24 7 street crisis Response Team, i mean, that is very, very hard work as any of us who has ever spoken to or spent time doing this work. So we are working with our department of Human Resources. We are looking to see how we can both look at shortterm and longterm solutions. We know that we need to build a pipeline. We need to really figure out how to support training and internship experiences so that so the people are interested in doing this work and can get exposed to our amazing clinicians. Really, i mean incredible people working on the frontlines right now. How can we create more opportunities for people to see up close the work and have a pipeline in for both psychiatrists and then licensed masters level Behavioral Health clinicians. We also are looking to see looking at lessons that we have of other large shortages. So really thinking outside the box and how we do much more efficient hiring of large classes of workers that we may need. So for the Behavioral Health clinicians, i think well need to do this. We also have Major Concerns about psychiatrist recruitment and retention and so we are working with the department of Human Resources to see how we can remain competitive with our with the other Health Systems in the area in terms of recruiting psychiatrists and incentivizing them to do this work. Also teaching opportunities. So i think there is some good possibilities, and we have some theres some best practices from other Health Systems. Were looking to those for both shortterm and longterm solutions, but its a major challenge. Thanks. Well, i have many comments, but considering the time i am going to actually call Public Comment right now. So i have three cards, mary kate bucalo, c. Fields, and erica frommer. And any other speakers, feel free to line up. You dont have to submit a card. Okay. First speaker, please. I didnt take a card. David elliot louis. I was an early adviser of Mental Health San Francisco. I also do work with the Crisis Intervention Team for the police department. Ive been a trainer for them. Im on the advisory group. My comments are informed by that work as well. First, i fully support Mental Health San Francisco and strongly support it. Its a bold step forward. It really helps to address a lot of our problems. I know theres some concerns expressed, but lets not let them be the enemy of the good. This is good and this is more than good. Im so thankful for all you supervisors supporting it and passing it forward. Here is my next thinking. Imagine you call 911 for a crisis on the street and instead of just hearing do you want police, fire, or medical, you hear from the dispatcher, do you want police, fire, medical, or Crisis Response . There is a city that has that in eugene, oregon, they use a program called cahoots. They dispatch a nurse and a trained crisis responder to incidents on the street that dont involve a crime for Response Team<\/a> could take people to and get them the help they need. Through the chair, i just think its important to talk about how this team is distinct from the h. O. T. Team and the e. M. S. I know it feels like a lot of teams, but we fought to make sure that the language requires coordination amongst all of these teams. They really do have distinct roles. So the h. O. T. Team is not supposed to be experts on Behavioral Health<\/a>. Their mandate is to outreach and engage with people who are experiencing homelessness. Lets remember, not all people experiencing homelessness have Mental Health<\/a> or addiction issues. So they are they have another role entirely. Its about well, thats a role that not all of us feel comfortable with now and were always constantly battling out, but it is distinct and separate from the issue of Behavioral Health<\/a>. The e. M. S. 6 team, the firefighter has to come when there is a physical risk to safety. So its not just that someone lets say someones passed out, for example, or someones injured because they were in psychosis and they walked down the street and got hit by a car. That couldnt be this team. That has to be firefighters who have the medical training to deal with physical impacts that are related to addiction and Mental Health<\/a>, overdoses, et cetera, but that arent but that requires some sort of physical medical attention as well. This team is for people that are not in a physical risk to bodily harm, but are having a Mental Health<\/a> crisis, psychosis, or druginduced psychosis and they need a Behavioral Health<\/a> professional to come and engage with them and get them into treatment and care, but theyre not theyre not overdosing, theyre not they havent been hit by a car. Theres not an immediate risk to their physical need. That is a distinct thing. Believe it or not, we need all of these expertise. Without all of this specific expertise, we are missing a part of the population that is currently living on the streets. Well, im excited to see how the conversations about this team develop. I do think e. M. S. 6 does a lot more folks who may not have had a physical injury. They may be at risk of a physical injury at some point, but their charge is to work with folks to prevent things from being more expensive thats what i was just going to say, then were not spending our resources well because we dont need that level of intervention. Theyre being assigned based on high 911 callers, but those 911 are not always generated by a physical injury. But at any rate, im looking forward to seeing what the Crisis Response<\/a> street teams look like. Supervisors haney and ronen are asking for big, bold, structural change, as is this board. So i think what we at least to know what it looks like, not just to expand what we are doing now or make it look or make it work smarter or for efficiently and effectively and raech people and have more places to take people, but actually meet the need and the demand. So that i as a san franciscan have an app and a phone number that i can dial and know that i will get a response that is as timely or almost as the 911 response, but is calibrated to this problem were having in San Francisco<\/a> right now of a ton of folks who are under psychosis or inebriated and need intervention. If thats more money thats needed, we should describe the program, show it, put it on the policymakers i do think that the good thing about Mental Health<\/a> s. F. Is that its asking us to think boldly about the system that we want. That will in order not to be i think i think for this to fall flat at some point, we need to be honest about what the scale and costs are going to look like if we do this and actually deliver what people are going to be expecting with Mental Health<\/a> s. F. If we can do this for 6 million, fantastic. I will be not surprised at all if deliver be that response which san franciscans deserve is a lot more than 6 million. May i say sure. Go for it. I think and with dr. Hammers information and speculation, i think we are being asked to in some ways speculate on things with all humility we dont know yet. I think we all are looking for a transformation and we acknowledge that we need to do that. I also think we need to be very thoughtful to apply scientific methods to transformative change. I would be as a provider myself, when i make assumptions and speculate what a patient needs, i am usually wrong. So i just think that part of this effort and also with all forbearanc forbearance, we will test things and some of those things are not work. To be bold, by definition, you have to be willing to take risks. The things that do not work, we will recommend that we no longer invest in and change, and the things that do work we will scale up. I think in this process, we have done great things in the health department. The Behavioral Health<\/a> team is an Amazing Group<\/a> providing grate solutions. I think as we look to solutions, in some cases we have become a little bit lax in San Francisco<\/a> about the possibilities we think about. With dr. Hammer and dr. Nigusse bland, we look outside to other models to say how would this work in San Francisco<\/a>, take those programs, make the right investments to pilot them, potentially scale them up. I think there are some things that we know, like the Case Management<\/a> piece that we know enough about that we do need to scale up, theres enough evidence there. On the other hand, as we transform our system, theres not a lot of value in case managing people if we dont have places and resources to case manage them to. I think thats one of the key things that ive heard in talking to our workforce and community partners, one of the great frustrations, because youre basically trying to work with somebody and even if that person is ready. I do think we have to thank you. Through the chair. With all due respect, supervisor mandelman, thats what weve been doing for the past year in creating Mental Health<\/a> s. F. Weve tried to engage you the whole time. Up until now you havent been willing to really engage with us on it, but we have spent an entire year researching all our systems, talking to frontline workers, writing hundreds and hundreds and hundreds of drafts of this law to put that vision out there. Everything that were trying to engage you in is what Mental Health<\/a> is, its a vision for a system that will finally meet the actual need thats there based on current Scientific Evidence<\/a> to engage and get people to a point where they can live healthy lives. Of course we dont know every detail. Theres never been a piece of legislation throughout history that has been able to know every single detail with specificity, but what Mental Health<\/a> does is take a leap and it says what weve been doing absolutely doesnt work. Its something that all of us can see every single day when we walk the streets of San Francisco<\/a>. We got in a room with the frontline workers and experts in the field and we said, lets imagine and create a system that would work. Lets put money aside for a minute. What do we actual need . This is what we came up with. This is what we need. Its not only been vetted by every Behavioral Health<\/a> worker and psychiatrist in the field, its been vetted by the department of Public Health<\/a> and the mayors office. This is a vision moving forward. Its not a mystery about whats going to happen. I worry slightly in this dialog that youre having with dr. Colfax that youre looking for some other vision municipal the vision is Mental Health<\/a> s. F. The policy that you have cosponsored is that in order to fix the crisis in the streets, we are going to implement Mental Health<\/a> s. F. We have to find the money for that and were mutually committed to doing that, but this is how were going to fix it. There are devils in that detail that always were going to have to be working out and that is what the Implementation Working Group<\/a> is. There are things thak the doctor said that we try and dont work, but the vision that if you vote for this legislation that you are voting for is saying that Mental Health<\/a> s. F. Is a way to fix the crisis on the street every single day, day in and out, and thats how were going to make things better in San Francisco<\/a>. Dont vote for the legislation unless you believe this is the right vision to get us there. I have two more substantive points i want to make about Mental Health<\/a> s. F. , and i dont i dont want to get into a back and forth with supervisor ronen about the history of this legislation. I will say and supervisors absolutely have the right to work with whomever they want to on developing their legislation. If the supervisor wants to work with a different supervisor or others and not a third or fourth supervisor, that is completely in the right of the authors. The original version of Mental Health<\/a> s. F. Was presented to me i think a couple days before it was introduced. I think that was the time it was presented to the department of Public Health<\/a>. I have been part of the discussions. That has been worked out between the supervisors and the department of Public Health<\/a>. Im grateful for the work and the consensus they have forged. I do not believe that Mental Health<\/a> s. F. Is the be all and end all of Behavioral Health<\/a> reform services. I am happy to vote for and support this. I have two more substantive questions. I really am grateful to see in here the emphasis and the intention to address the Behavioral Health<\/a> Services Needs<\/a> of folks in the criminal justice system. When we had our treatment on demand hearing a couple months ago, we saw data that was questionable about whether weve achieved treatment on demand. Were doing better there. It is completely clear to me from my engagements with Behavioral Health<\/a> court and drug court. We are dismally failing to provide adequate treatment opportunities for people in jail or justice involved. I think that needs to be a priority, and i look forward to you continuing to work on that. My last question is about my new obsession with locked subacute beds. It was a little bit of a fight in last years budget to expand the number of those beds by 14. Some folks thought that money would be better spent in other areas. I insisted that we include those 14 beds. A few weeks bad we had a hearing on conservatorships. That was in part based on some work that the budget and legislative analyst had done. It is, i believe, and i believe that folks at general and in p. E. S. Believe that we are desperately short of locked subacute beds. That means that has implications and all these things are connected, and a shortage in one part of the system affects i know there are shortages everywhere. But this shortage means people stay in jail too long, that the whole system slows down referrals around things like conservatorship. I do believe that is happening and we would be conserving more folks on a short or longterm basis if we had those beds. People would benefit and not be cycling as much. Whether it is 100 beds more that we would need or more than that, its a significant price tag. Depending on how theyre done, i think 100 beds would be in the 10 to 20 million range. I absolutely think we have to make that commitment. We have unfunded and unused beds on the third floor in the Behavioral Health<\/a> building. We have potential partnerships with some of the private and other hospitals that might be able to provide beds. I really want to push our whole system, this board, the mayor, g. P. H. To look at further expansions in our locked subacute capacity and to do that in the 2021 budget. Not specifically called out in Mental Health<\/a> s. F. , but i think its part of the spirit of Mental Health<\/a> s. F. And that is one of the reasons and that understanding is one of the reasons i will be voting for Mental Health<\/a> s. F. Okay. Thanks, everyone, for indulging me. Thank you. Now supervisor stefani. I would like to congratulate everyone for coming to a compromise on this very important piece of legislation. I think if you look at the history of it and how everybody came together to come up with this solution, it just reminds me what unites us on this board is much, much more than what divides us and we do have common goals here to address a very serious problem in San Francisco<\/a>. I have a very pragmatic and practical question. Its along the lines of the hiring challenges. Supervisor ronen spoke to a staffing analysis would be done, but i think it goes beyond how difficult it is to keep people in the positions. Its also i dont know exactly how many case workers were talking about. I dont think i heard a number. I heard some math that i might have been able to do in my head, but i didnt, about how many case workers we are talking about with 22 million or how many it will take. I think we need to be mindful of that going forward, how are we looking at recruiting and moving through the department of Human Resources<\/a>. How are we looking at possibly creating additional regs. We have to be mindful of that. I dont know if the department has looked at that. I know it is a constant strugis truing struggle. If we dont have the money, were not going to be able to move forward. If anyone has an answer, i would appreciate it. Supervisor stefani, ill try to speak to that a little bit. Any hiring manager in the city or certainly department of Public Health<\/a> knows its exceedingly difficult to recruit and retain workers, given the economy here and the challenges of this work. As supervisor ronen mentioned, the workforce that we need to build, our Behavioral Health<\/a> workforce, is challenging and gruelling work. When we talk about the 24 7 street crisis Response Team<\/a>, i mean, that is very, very hard work as any of us who has ever spoken to or spent time doing this work. So we are working with our department of Human Resources<\/a>. We are looking to see how we can both look at shortterm and longterm solutions. We know that we need to build a pipeline. We need to really figure out how to support training and internship experiences so that so the people are interested in doing this work and can get exposed to our amazing clinicians. Really, i mean incredible people working on the frontlines right now. How can we create more opportunities for people to see up close the work and have a pipeline in for both psychiatrists and then licensed masters level Behavioral Health<\/a> clinicians. We also are looking to see looking at lessons that we have of other large shortages. So really thinking outside the box and how we do much more efficient hiring of large classes of workers that we may need. So for the Behavioral Health<\/a> clinicians, i think well need to do this. We also have Major Concerns<\/a> about psychiatrist recruitment and retention and so we are working with the department of Human Resources<\/a> to see how we can remain competitive with our with the other Health Systems<\/a> in the area in terms of recruiting psychiatrists and incentivizing them to do this work. Also teaching opportunities. So i think there is some good possibilities, and we have some theres some best practices from other Health Systems<\/a>. Were looking to those for both shortterm and longterm solutions, but its a major challenge. Thanks. Well, i have many comments, but considering the time i am going to actually call Public Comment<\/a> right now. So i have three cards, mary kate bucalo, c. Fields, and erica frommer. And any other speakers, feel free to line up. You dont have to submit a card. Okay. First speaker, please. I didnt take a card. David elliot louis. I was an early adviser of Mental Health<\/a> San Francisco<\/a>. I also do work with the Crisis Intervention Team<\/a> for the police department. Ive been a trainer for them. Im on the advisory group. My comments are informed by that work as well. First, i fully support Mental Health<\/a> San Francisco<\/a> and strongly support it. Its a bold step forward. It really helps to address a lot of our problems. I know theres some concerns expressed, but lets not let them be the enemy of the good. This is good and this is more than good. Im so thankful for all you supervisors supporting it and passing it forward. Here is my next thinking. Imagine you call 911 for a crisis on the street and instead of just hearing do you want police, fire, or medical, you hear from the dispatcher, do you want police, fire, medical, or Crisis Response<\/a> . There is a city that has that in eugene, oregon, they use a program called cahoots. They dispatch a nurse and a trained crisis responder to incidents on the street that dont involve a crime for Mental Health<\/a> instances and they can bring them back to the clinic for treatment. Its a great program. Matt haney has been looking into it. This is not quite ready for us, but this could be for the future. Maybe Mental Health<\/a> San Francisco<\/a> 2. 0 might have a service like this, where we have really true mobile crisis that works with our department of Emergency Management<\/a> dispatching so we can dispatch crisis responders out, bring them back into Mental Health<\/a> San Francisco<\/a> for treatment, and kind of leave the police out of it when we dont really need the police. And the police are supportive of this thank you very much. Next speaker, please. Good morning. Im here representing the 15,000 workers of the National Union<\/a> of healthcare workers, thousands of which are Mental Health<\/a> care providers at nonprofits across the state. On behalf of those caregivers, im here to speak in support of Mental Health<\/a> s. F. I want to thank the supervisors and the members of the Budget Committee<\/a> who have come forward to support Mental Health<\/a> s. F. For far too long, despite numerous expenditures on the part of the city and county to address these issues, the vast majority of us still cant get access to timely care. The simple truth is you cant get care when you need it in San Francisco<\/a>. By creating a comprehensive system that paves a Clear Pathway<\/a> for Service Expansion<\/a> and helps ensure access for patients. I just want to thank you once again for the support you provided thus far and also urge the members of the Budget Committee<\/a> to continue to support the program moving forward. Thank you very much. Next speaker, please. On behalf of the San Francisco<\/a> labor council, were thrilled that were at this point in the process. A year ago i never thought wed get here. I want to thank supervisor ronen for her vision, her flexibility, her determination, and seeing that there was a need for change and being bold enough to take on the system. Thank you. Ive been dealing with the Mental Health<\/a> system in San Francisco<\/a> for many, many years. I got to say, this is muchneeded change. Every detail is not accounted for in the legislation. It wasnt meant to be. It was meant to be a flexible system that will change with the needs of its clients. This is a user, endminded legislation, aimed at what the users need and not necessarily what anybody else thinks. Not what the supervisors think, not what various doctors may think. Its based upon what users are going to eventually mandate and need and how we can accommodate them. And thus, there is a flexibility in the legislation and that is one of the more brilliant parts of the legislation. I want to thank supervisor haney, though hes not here, thank you for his hard work. I think its really important that we move forward in a way that we remain flexible. You know, we know what is needed and right now money is at a critical point. Just within this last month, were losing additional boarding care beds. One in supervisor ronens district. I think theres one in i dont know what other district, sandys district. We need money for those things now. We need to my name is mary kate bucalo. I want to start by saying that investing partially in a solution that fails is not a solution. We need to think bigger and we need to dream bolder. Were only talking where were talking in were talking mostly still about that population of about 4,000 people thats homeless with Mental Health<\/a> and Substance Use<\/a> issues, but i think we need to think bigger of the population were targeting here. Studies show that toddlers have Mental Health<\/a> issues over their family being homeless. Theres more than 420 families on the community queue for housing and theres 900 families housed by 15 nonprofits over several sites in San Francisco<\/a>. We need to think about those people too because were raising the next generation of people who are at risk of being in that 4,000. I think on the staff sustainability issue, we need to make sure that these positions are funded in a robust way. I will also add that there is a pipeline of job seekers with lived experience at organizations such as compass. I would urge the supervisors to fund this robustly, think holistically about all the people that are impacted by this crisis, and make sure that staff are funded sustainably. Thank you. Next speaker, please. Good morning, supervisors, my name is steve fields. I had a bland support Mental Health<\/a> s. F. Statement that fits your time frame. Ive been taking notes. You get engaged in this level of discussion, and i want to jump in. Im going to list some things that i dont think very listed adequately. Not just going into settings where we can keep spinning people through the system, but treatment. We havent used that word enough in this discussion. We have a model in San Francisco<\/a> and i do an enormous amount of statewide work that is not replicated that would like to have the continuum of care and array of services. In my 50 years of working in this county, we havent coordinated our care and we have wasted the effort of too many services. Too many clients go down a linear line and almost fall off the edge and then theres nothing for them. There is going to need to be a proper continuum of care, that doesnt drop people into s. R. O. Hotel rooms, that doesnt do cycles through temporary housing, but actually provides enough treatment for people. Progress foundation serves 4,000 people a year. They all come in through the Emergency Service<\/a> system. Those 4,000 are getting treatment and theyre not a different d. N. A. Than the people on the street, theyres just n enough services for them. The need for more beds that are locked and the need for more Case Management<\/a> is all thank you very much. Next speaker, please. I want to first say that we wholeheartedly support Mental Health<\/a> s. F and appreciate this bold we look forward to the ideas and solutions that the Implementation Committee<\/a> comes up with. I work at the coalition on homelessness. On behalf of the coalition on homelessness, we want to thank the supervisors for all of your work putting forward this legislation. Were excited and hopeful about what its going to be bringing. Again, want to emphasize what steve feels that the most important part of this piece of legislation is really expanding the services. Its something that we see on a daily basis. The other thing i just want to talk about is we know its going to take time and its not going to happen until its actually funded. Once its funded, it will take more years to build up the system and the capacity. Thats really just the reality of it. I hear so often people calling me and saying there is someone who is unhoused and has a Mental Health<\/a> condition and in crisis and they dont want to call the police on them because they know that will be harmful to whatever theyre experiencing. We at the coalition on homelessness dont have a good answer for them. I ask that in the interim that all of these systems are being built and were thinking thoughtfully about these things, that we consider the real traumatic experiences that unhoused people are facing. We do not criminalize people simply for being poor and simply for being homeless. I was at an encampment that was swept yesterday at 6 00 a. M. A lot of these folks had a dual diagnosis. Cops were there, h. O. T. Team wasnt there. In the interim, please lets not criminalize people and just let them survive and exist. Thank you. Next speaker, please. Are you proposing to create an auxiliary system to treat Mental Illness<\/a> . How do you intend to structure and monitor it . What kinds of controls will exist to safeguard patients, to monitor prescriptions, program costs, potential abuse, potential fraud, as well as individual Health Outcomes<\/a> and progress . Also, do you propose or intend to provide clients with illicit substances, marijuana or anything else. Will some form of Mental Health<\/a> counselling be mandatory. Will there be a cutoff date on treatment, or will clients be able to obtain the substitute substances such as methadone for years on end. Can you redirect a portion of the existing funds as opposed to seeking additional funds. Im actually seeing a lot more Homeless People<\/a> on the streets all the time. Mayor breeds program where she has this large i mean every country has Homeless People<\/a>. Norway has about 7,000 Homeless People<\/a>. They have a population the size of the San Francisco<\/a> bay area, about 6 million people, and theyve got huge amounts of money and resources. Its a difficult problem. Thank you very much. Next speaker, please. Hello, my name is c. W. Johnson. I want to say congratulations to you working together and making Mental Health<\/a> s. F. A reality. I want to say what is obvious, you probably know this, but we have a lot of people at m. H. A. , they are students, very intelligent, highly skilled workers that are going to school to be therapists and psychiatrists. What im saying is we have a lot of professionals in flight. What i would like to see throughout this whole system is for this to be given to case workers and therapists with previous experience. Without the people that are affected by Mental Health<\/a>, then its going to be challenging or to even have a view of how it should work without peers. Peers need to be in every aspect, especially peer professionals. Thank you very much. Any other public speakers . Seeing none, Public Comment<\/a> is closed. Just a short comment to close. This thought was sparked by sam liu. I want to make clear that while Mental Health<\/a> s. F. The major components of it wont be implemented until we identify and collect the 100 Million Annual Revenue<\/a> that we need to implement it at least, the planning of Mental Health<\/a> s. F will begin immediately upon the creation of the Implementation Working Group<\/a>. So the idea we had always planned that we passed the vision and the policy first because theres so much planning and studying that needs to happen and work to put systems in place. Just putting the Behavioral Health<\/a> Access Center<\/a> into the Mental Health<\/a> center is a project on its own that requires real estate and moving people and admin offices and finding people a new home. Theres a ton of work thats already started. Its happening right now. Its related to dr. Bland and dr. Hammers work. So i want to make sure that people know that this is truly exciting. Its not like were passing this and nothing happens until we find the money. These are simultaneous endeavors. They both need to be successful in order to implement this full vision, but the work starts has already started and will start in earnest once the Implementation Group<\/a> is in panel. I want to make that clear and thank all of my colleagues for the robust hearing and time. Thank you very much. We heard from the b. L. A. We had Public Comment<\/a>. I just want to say thank you to everyone for participating today. I think we did have a robust conversation, but i want us to be mindful that while this call takes time that theres human suffering happening on our streets every single day still. Lets not lose sight of that. We can have a vision and work towards that vision, but concretely every single day and at this moment there is human suffering on our streets of thousands of people. I also wanted to say that in speaking to Police Officers<\/a> also, their level of frustration is they also dont have, according to which the speaker said, is that they dont actually have solutions either. So theyre called out to homeless encampments or unhoused folks and people having behavioral mental breakdowns, but yet they dont have the tools, theyre frustrated. This is not actually something that they actually signed up for in this profession to protect and serve. And i also wanted to say mr. Fields comment about recovery, we would add in a component of employment. Every time i hear about recovery and housing, i never hear about employment. So i think that we should stop talking in silos about this. If were talking about a continuum of recovery, of stability, then we also fold people back into the communities in a productive way. So we must, must think not only just about housing because so often we fall short. We say if we can house somebody, we feel it is done. It is not about that. It is about embracing them back into the community and what are we doing about employment. Today i heard nothing about that. So i just want to make sure that thats on our radar, that were not falling short and not delivering a full delivery of care, continual care and success. I dont think we can do it without also the employment piece. So having said that, i would like to make a recommendation to move this to the board with a positive recommendation as the committee oh. Thank you very much. And then move this Committee Report<\/a> to the full board as amended. Thank you very much, colleagues. [ applause ]. Ms. Clerk, do we have any other business before us today . Confirmed this matter has been amended and it will be referred with recommendation as a Committee Report<\/a>. Absolutely. Any more business . Clerk that completes the agenda for today. We are adjourned. Thank you very much. [gavel] thank you. Are we good, madame clerk . Good. Good morning, everyone. My apology for arriving late to the chambers. The meet willing come to order. This is december 11, 2019 regular meeting of the budget and finance committee. I am sandra lee fewer, chair of the funds and finance committee, joined by katherine stephanie and rafael mandelman. Our clerk is ms. Wang. Id like to thank sfgov tv for broadcasting this meeting. Madame clerk, do you have any announcements . Yes, please make sure to silence all cell phones and electronic devices, complete the speaker cards to be included as part of the file should be submitted to the clerk. Items acted upon today will appear on the january 7, 2020 board of supervisors agenda, unless otherwise stated. Thank you very much. Please call item number one. Resolution approving an updated Emergency Declaration<\/a> of the San Francisco<\/a> Public Utilities<\/a>es commission to repair the southeast Treatment Plant<\/a> final effluent force main for a total estimated cost not to exceed 6. 250 million. And i think we have michael tran here. Thats correct. Good morning, supervisors. Members of the budgets and finance committee, clerk of the board. Im a project manager with the San Francisco<\/a> Public Utilities<\/a> commission. Specifically for the southeast outfall crossing emergency bypass. Im here today to present this project as related to the initial Emergency Declaration<\/a> presented here january 2019. Id like to direct your attention to the powerpoint presentation. As a broad overview, this is a picture of the booster pump station that will be geting into more detail. Id first like the start off with a little bit of background for the project site and a project location. The booster pump station is located at 3rd and arthur, approximately 3 1 2 miles south of oracle park, 1 1 2 miles south of the new chase stadium located in at 3rd and arthur in district 10 of San Francisco<\/a>. The Treatment Plant<\/a> treats approximately 2 3 of the citys sewage. The booster pump station experiences approximately 50 to 60 million gallons per day on average and up to 110 millions per day peak, which is pressurized through the southeast outfall system into a pair of force mains crossing the creek. The longer term project is scheduled in targeting 2023 to permanently replace the crossing at islais creek. Id also like to recap the history of this Emergency Declaration<\/a>. So on october 18 of 2018, waste water staff of San Francisco<\/a> p. U. C. Detect add potential leak at the islais creek crossing. And what is the leaking force mean . The leaking force means continual operations that there is a noncompliance with the southeast plants and in addition this leaking pipe is located inside isslais creek which is identified by Regional Water<\/a> quality board as a list of impaired body water body. Subsequently on october 22, San Francisco<\/a> p. U. C. Issued an Emergency Declaration<\/a> according to San Francisco<\/a> administrative code chapter 6. 60. On december 26, 2018, San Francisco<\/a> p. U. C. Revised the Emergency Declaration<\/a> again, based on findings from project staff that found poor soil conditions and additional challenges which increased the anticipated amount up to 5 million and subsequently approved by the board of supervisors with an authorization under chapter 6. 60 and chapters 21. 15. On september 25, we subsequently revised this Emergency Declaration<\/a> again based on active construction and feedback and recommendations from the project team to increase the not to exceed budget up to 6. 25 million from the 4. 12 million. And ill get into that in a little more detail. One last recap from the initial design that was presented here in january 2019. Id like to illustrate the initial design which is shown on the screen, the blue lines illustrate the approximate location of the crossing of islais creek. The bottom blue line illustrates the profile of this pipeline. The red line illustrate what is we attempted to construct and the initial construction duration we estimated to be nine months. And, of course, we mentioned the overall project including Construction Management<\/a> and design and construction to not to exceed 5 million and the project will be built in guidelines as a statutorily exempt project. Id like to present the challenges, which is the reason why were here today. On the lefthand side photo you can see one of the contractors, twoiing inside a dry hopper dam immediately within the waterway. If you can see the types of soil we were encountering, young bay mud, very unclassified type of artificial fill. The right hand side is oriented a little bit different. This is a result from the survey. At the islais creek bridge is shown on the lefthand side with a reasonably large depression found on the center of the creek under the water and this will help present a redesign that had to happen last minute. Bottom right hand photo is a snapshot from one of our local medias and this was and you can see on there its identified as a whale sighting. Specifically ali the wayward whale and she happened to visit our project site immediately prior to our mobilization. So, what this necessitated was additional biologist active and very and very adamant type of active monitoring by our Construction Management<\/a> team and also by our biologists on site. A lot of open communications with our contractor as well. What happened with the challenges that we encountered. Immediately prior to that mobilization, we had to redesign. Instead of following the existing blue alignment we actually created a new design to follow to have a direct connection between the northern, southern shorelines. And our construction duration, we actually shortened it by approximately three months. Actual construction and heavy construction was substantially complete as of october 2019. And we demobilized in november 2019 and we are planning for final site work such as sidewalk restoration, fence restoration and permit closeout this month. Now with actual Construction Costs<\/a> in, we are still negotiating final change orders but the project team is confident we can stay under 5. 5 million. Project is still categorized as statutory exempt under ceqa guidelines. Id like to help illustrate the specialized construction techniques that were used. As mentioned earlier, the project was substantially complete as of october 8, 2019, almost a week in advance of the october 15 official wet weather start date in our area. Theres minor site work remaining at this time. The bottom left hand photo illustrates the utilization of a specialized crane and barge configuration which lowered what you can see as a knife gate valve into a dry coffer dam pit t. Middle photo is a relatively uncommon type of construction. Its called floating and sinking and used throughout the country. But reasonably uncommon in the San Francisco<\/a> bay area. And you can see the pipe floating in the center of the creek temporarily before its floated and sunk into place. Righthand photo shows the final connection toward the northern connection structure. In summary, im here today to request that the support of this committee to approve the revised Emergency Declaration<\/a>. Thank you. Any questions to my colleagues . Seeing none, could we have the b. L. A. Report . Good morning, chair fewer. The board of supervisors is being asked to prove an updated Emergency Declaration<\/a> for the slave creek work and the previous resolution was approved in february of this year. I believe mr. Tran has appropriately described the nature of the work. The increase is actually in the authorized amount from 4. 9 million to 6. 2 million in the resolution. On table one, page three of our report, youll see that the aftersbunlt provided by p. U. C. As 5. 5 million. Therefore, we recommend a reduction in the resolution by 750,000 from 6. 2 to 5. 5. We recommend approval as amended. Thank you very much. Mr. Tran, do you agree with a recommendation from the b. L. A. . Yes. Based on the actual Construction Costs<\/a>. Great. This opens it up for public xhefnlt any members of the public would like to comment on item one . Seeing none, its now closed. Id like to maiption a approve the amendment brought forth by the b. L. A. And make a move to advance it to the board with the amended. Item number two. Resolution approving and authorizing a 50year lease with one 16year option to extend between the portion commission and t. Z. K. Broadway hotel venue and Public Open Space<\/a> development at sea wall 323 and 324 with an annual minimum base rent equal to no less than 1 million to commence following board approval. Thank you very much. Id like to make a motion to move this and continue this item to the meeting of january 8. Before i do that, id like to take Public Comment<\/a>. Any members of the public would like to comment on item number two. Seeing none, public sxhenlt now closed. Id like to make a motion to continue this item to the meeting of january 8. If we can take that without objection. Thank you very much, colleagues. Madame clerk, please call item number three. Resolution the department of technology to accept an incoming gift of Consulting Services<\/a> from google inc. For a term of six months to commence upon board approval valued at 750,000. Thank you very much. And we have the interim director for the office of civic innovation. Good morning, supervisors. Good morning, members of the committee. This resolution will allow the department of technology to accept a gift of Consulting Services<\/a> from a civic bridge partner organization, google incorporated. Specifically, under this project, the civic Bridge Program<\/a> team will assist the Planning Department<\/a> and other departments to make the reporting, collection of housing data more efficient. And i have a brief presentation that id like to share with you. The bridge is a program that matches talent with departments to address specific policy or operational challenges facing those departments. Under the civic Bridge Program<\/a>, departments identify Service Needs<\/a> that can benefit from pro bono assistance from outside parties. So this project, we will be working with s. F. Planning and other related departments and a team of volunteers from google who will work full time for six months on this multidepartment city team. Gaog is a Founding Partner<\/a> of civic bridge, having worked with mo cd on the predevelopment of the Affordable Housing<\/a> portal, the onestop shop residents for people. This pipeline project will have the goal to understand, improve and make more efficient the reporting and collection of housingrelate data. The quarterly housing pipeline report helps city decisionmakers and the public understand the volume of units moving through this pipeline. Currently, the housing report is compiled through a cumbersome, time intensive, manual process and consequentially is not timely or accurate. The team the Pro Bono Team<\/a> will assess the data and understand the points of our city staff and project sponsors throughout this housing pipeline. This will help the city provide greater visibility and to the housing approval process, identify and recommend business process and prevents and communicate and coordinate with the production of housing in San Francisco<\/a>. Thank you. Do you have any questions . Im available. Colleagues, any questions or comments . Using none, there is no b. L. A. Report on this. Lets open this up for Public Comment<\/a>. Any members of the public like to comment on item number three . Seeing none, Public Comment<\/a>s now closed. Id like to move this to the board with a positive recommendation. Thank you very much. Thank you. Madame clerk, please call item number four. Hearing to consider the release of reserved funds to the Arts Commission<\/a> placed on the budgets and finance committee reserve in the amount of 2. 6 million to administer grants in the areas of arts education, affordable space, core support for organizations and support for individual artists. Thank you very much. And today we have mr. Tom decane from the Arts Commission<\/a> here. Welcome. Good morning, supervisors. 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