Transcripts For SFGTV BOS Public Safety Committee 20240712 :

Good morning. Welcome to the june 25, regular meeting of the Public Safety and Neighborhood Services committee. Im supervisor rafael mandelman. I chair this committee. Supervisor walton has not been able to be here today. Our clerk is john carroll. I want to folks at sfgov tv for creating this meeting. Mr. Clerk, do you have any announcements . Thank you very much. In order to protect Board Members and public during the covid19 health emergency. Board of supervisors legislative chambers taken pursuant to all local, state and federal orders. Committee member will attend the meet thuing through video conference. Public comment will be available for each item on the agenda. Both cable channel 26 and sfgov tv. Com are streaming the Public Comment number across the screen. Comments are your opportunity to speak during Public Comment and they are available by via phone. Once connected and prompted in the meeting i. D. The i. D. Is 145 8532772. Press pound and pound again to be connected. You will hear the meeting discussion. Youll be muted in listening mode only. When your item of interest comes up, dial star and three to be added to the speaker line. Best practices are to call from a quiet location, speak clearly, slowly. Everyone should account for potential time delays and speaking discrepancies between live coverage and streaming. You may submit Public Comment. You may email me im the clerk of the Public Safety and Neighborhood Services committee. If you submit Public Comment by email, i will include it in part of the legislative file. You could also send your written comments to our office in San Francisco city hall. Our address is room 244, one dr. Supervisor mandelman i want to make a motion to excuse supervisor walton for the entire meeting an. Call the roll call. On the motion to excuse walton and ronnn until she arrives. Aye. There are two ayes. Superve rk, please call the first item. [agenda item read] supervisor mandelman back in october 2018, you will remember, mayor breed and i introduced legislation authorizing the city to opt into new state law which allows San Francisco, san diego and Los Angeles County for small number of people suffering from Mental Illness who might not otherwise qualify for Traditional Co conservership. It reflected the concerns and the intention that this be a pilot. After months of stakeholder meetings, two city hearings and series of amendments on june 11, 2019, just over a year ago n ags board approved implementation. Enabling San Francisco to conserve individuals under the new program. I want to recognize the challenge in bringing any new program like this online. I want to acknowledge the incredible work our department of of health do everything for to care for the most vulnerable in our city. More than a year after hard fought battle, i am perplexed, very perplexed that not a Single Person in San Francisco has been conserved under this new law. Throughout the fall, we were advised that the first petition for sb1045 conservatorship will be submitted by end of the year. I believe at that time, i was frustrated about how long it was taking. Earlier, this year, prior to pandemic time, the Housing Conservatorship Working Group issued its first report. Which we will be discussing here today. Among other things, it shows city has not conserve anything with sb1025. Since then, number of media reports draw attention to issue noting that the city has yet attempt to try a sb1025 with one individual while any trip out into the streets of San Francisco will reveal many folks intoxicated, psychotic, continue to deteriorate. We know that relatively few individuals that was attempt to pilot. The estimates were that as many as 100 people might be eligible. I believed it will be far fewer. As i said over the last few years, its still worth trying. That does presume it will help at least one person. Im hoping that todays presentation and conversation can illuminate to get this program implemented. And how some understanding how we can make progress on these issues when each small progra programmatic change seems to take so long to actually put in place. Were going to hear from angelica from justice and Behavioral Services at the department of Public Health. Wit i believe i am sharing my screen. Everyone able to see that okay . Yes, we are. Perfect, thank you. Thank you so much supervisor mandelman. Appreciate to be here today to get a report out on implementation how the conservatorship and the activities of the working group. Supervisor mandelman, you noticed that you reviewed some of this. Just to to give a brief overview, were experiencing methamphetamine and opioid pandemic but not only in San Francisco but nationwide. These are situations where serious Mental Illness is by Substance Abuse and people are deteriorating in our communities. Unfortunately x existing laws tt we have do not account for active substances and have not had the tools to intervene in these cases. As you identified housing conservatorship was designed to be a tool to help address this gap. Allows for us to place individuals on a conservatorship for six months for individuals who meet strict Eligibility Criteria which in San Francisco is estimated to be 50 to 100 individuals. Weve had multiple opportunities to engage in voluntary services. Senate bill 1045 was signed by Governor Brown in 2018. It was adopted by board of supervisors in june 2018. In october 2018 Governor Newsom signed senate bill 40 which added some important clarifications and additions to patients rights and due process protection to the legislation. This included clarification of the role of assisted outpatient treatment. The addition of a temporary conservatorship, reduction of the conservatorship length of time to be from 12 months to 6 months and additional due process protections and noticing of individuals that they are on their pathway towards the housing conservatorship. Im happy to be here to provide update on implementation of housing conservatorship as was noted. It takes lot of time to implement a new piece of legislation and particularly one that is as different as our existing conservatorship laws as housing conservatorship is. We used this opportunity to have regular meetings between the department of Public Health and department of disability and aging services. We worked closely with San Francisco General Hospital. Both of these entities develop standard work flow ace talk about individuals on the pathways towards conservatorship and identifying other less restrictive options. Theres been a great deal of coordination between the superior court of california and City Attorneys Office. One of the important pieces to move forward with this legislation has been to both develop and have the court approve paperwork that is needed to be filed in these cases. There have been some unexpected delays around having that. Im happy to report, as of last week, this paperwork has been approved. We have been working closely with zuckerberg San Francisco General Hospital to serve individuals who is on pathway towards conservatorship. Starting at that will be eligible more housing conservatorship, we have to serve individuals 5150 to notify them theyre on pathway to housing conservatorship. I think this really speaks to the work that weve been doing leading up to this point in working with our pattern partneo ensure an effect streamline process. Were hopeful well use this tool in the near future to support individuals. Moving on to the activities of the Housing Conservatorship Working Group. As you will know, this was established in the health code. We had report that was due and submitted in january 2020. This group contains 12 members who are appointed by department head, board of supervisors and the Mayors Office. The goal of this working group is to evaluate the effectiveness of the legislation. Subsequent report will be submitted in january to both the board of supervisors and Mayors Office and starting in january 2021, we have reports that we have to submit to the state legislature. Many of the data points for this report focus largely on individuals who have been placed under conservatorship. As previously indicated, that has not happene happened in San Francisco. We use this opportunity to focus on two data points that look at the landscape of 5150s in San Francisco. And in situations where the police were the ones placed an individual on 5150 and why that was the case. The data for this report is focused on fiscal year 1819. This gives a brief overview of the data we had available to us and ill talk about the limitation and the work that were doing to have a more robust report and Data Analysis and evaluation. This looks at data from the Care Management system. Which pulls information from zuckerberg San Francisco General Hospital and Psychiatric Emergency Services as designated crises facilities. We also were able to gather information from the San Francisco Police Department and i think what was important about this opportunity is that we were able to get client level data from both of these events to remove duplicates counts for individuals. There were roughly 3800 unique individuals that have been placed on a 5150 during fiscal year 1819. Of note, 35 of the cases seen as p. E. S. Are brought in by the Police Department and 64 of the cases that the Police Department shared with us were individuals placed on 5150 were treated at other facilities outside of Psychiatric Emergency Services. This could be for a number reasons. Including that an individual has comorbid medical conditions that need to be treated at the nearest emergency department. Theres some situations where individuals request to go to a specific hospital and this would be included in that account. Supervisor mandelman because the police data is in there, we believe that captures most of the things happening . Yes, we believe that this captures most of the 5150s. Certainly not all of them. One of the things that we have been working on during this interim time is to partner with hospital counsel of Northern California and other local private hospitals to gather that information. We had success in having conversations with hospitals and we anticipate to having that information for this next report. Which will give us a more broader and more robust view. One limitation around that is due to privacy reason, we wont be able to access client level data. It will make it difficult for us to understand the unique count of individuals. It will be really important to understand the amount of psychiatric crises that were seeing in San Francisco. Supervisor mandelman do you have data overtime. Can you compare 5150 up or down or year over year . Theres been some changes in the Electronic Health records. Theres some limitations to that data. We have that information from the Psychiatric Emergency Services. Supervisor mandelman ,thank you. Turning our attention to look more specifically at the population of individuals who might be on their pathway towards housing conservatorship. We pulled information, this is limited to the individuals who are seen Psychiatric Emergency Services. We pulled information for fiscal year 1819 for individuals who had four or more 5150. Why we thought it was important because of the fifth 5150, we have to start serving individuals on their pathway to housing conservatorship. Ewanted to understand the larger potential option tha population. Most individuals are between the ages of 40 and 50 are male and white or africanamerican. Not surprisingly, most of the individuals have freak contacts with urgent and emergent medical services and have average 11. 8 visits to psychiatrics emergency visits during that time period. They have low contacts with ongoing medical and psychiatric services. Have High Frequency of contacts with the San Francisco county jail. While experiencing homelessness is not a requirement for coursing conservatorship, many individuals who are in this population are experiencing homelessness and have extended periods of homelessness. Supervisor mandelman if you dont have an assigned case manager is there anyone whos sort of tracking you in the Public Health system . I appreciate that. Certainly, this legislation is a unique opportunity to look at that more closely. There are certainly other programs like assisted outpatient that works with individuals who are also not agreeing with services at that time. There are some programs that do that in different ways. There are some programs that do that in different ways but not in the intensive and coordinated way with Case Management. Supervisor mandelman it strikes me, whether or not someone has an interest in intensive Case Management when theyre getting four or more 5150, we probably have interest in them having a case manager. Absolutely. We want to make sure people have access to. This is where it gets complicated in terms of individuals consenting to services. Which is why we have other programs that assisted outpatient treatment and housing conservatorship. For individuals who are not able to accept voluntary services that we have other options to support them. We briefly touched on this. Weve been working with the Hospital Council of Northern California and partners across private hospitals in San Francisco to gather this data. We anticipate having this for subsequent report. Department of justice receives information about 5150s. We talk to them about the information they receive. We want to make sure information across systems and reporting are consistent and that we have comprehensive data. Weve also been working with the San Francisco Police Department and our just finalizing our m. O. U. To have access to the incident report. This will give us an opportunity to sampling of the report to better understand situations where police were involved. If there are alternatives, this is an incredibly conversation as were looking at the racial pandemic that were experiencing as well as the legislation of Mental Health to see what other opportunities can be afforded. We look forward to gathering that information. The other piece that is important for all of us from an evaluation perspectives and for the working group, is to gather information on the individuals going through the process. External evaluator, will be partnering with Service Providers to be able to do interviews and surveys with those individuals to better understand what they are experience is during this process. This for individuals who arent aware, we have regular meetings for the Housing Conservatorship Working Group. This is where information can be found about this meeting as well as past presentations and if theres any questions, member of the public are welcome to email us at the email on the screen. Supervisor mandelman im happy to answer any additional questions that you may have. Supervisor mandelman thank you. I do have a few questions. I guess the first is can you oexplain why this is taking a year . To the average san franciscan, thats an extraordinarily long time for a pretty small program. I thought it was perplexing, frustrating, whole lot of adjectives. It seems deeply wrong. Please shed some light where it is taking a year and were still not in a place to have done a Single Housing conservatorship . As i mentioned, weve made Great Strides in just a week of the paperwork being finalized with the court to move forward with that. Were in a really hopeful place now. I completely hear and understand the frustration and all other adjectives that you shared regarding that. This is challenging that this represents a major change in conservatorship. Certainly standing up a program like this takes lot of time and consideration. There are certainly details. We want to make sure we thought through and did so in a very thoughtful way. There were unexpected delays to ha