Im the first to say that we have a problem that we have some services for those people who have the most severe, most complicated needs, that they dont want you know, as many people as we put on the streets say thats not how people want to engage, and thats what i hope we get to moving forward on in these main areas around that Mental Health s. F. Legislation. Supervisor mandelman but i would just point out and i think i have a couple more questions, and ill feed to the other members of the committee. You know, the meth Sobering Center was i mean, what is it many different people on the Meth Task Force had many different ideas what the Sobering Center would be and what services it would have, from a place to get out the streets to more of an altern e alternative to p. E. S. From what ive heard on the streets, there was a real need to reduce pressure on p. E. S. And how a Sobering Center does that i can see stories how it does a little bit on the margins, but unless it has more, unless it is built to deal with people in acute crisis, it may not achieve that, and i know there have been conversations over time about potentially an alternative acute crisis facility in addition to p. E. S. Seems like neitheither my s is that we need that. If we dont, im happy to have that explained to me, but i do think its you know, thats key to getting someone someone whos psychotic on the street is not going to go to a sober like, the Sobering Center is not an option. They need to be taken somewhere else, i think, a. And i guess my last question is, ive heard from multiple people supervisor ronen, but also people within d. P. H. , that this care coordination is among the most and i think this is right is among the most important functions that we should be trying to build out over the last year. We had that extended conversation about Case Management, but really keeping track of who needs our services, and what those services are and getting those services aligned into what makes sense is really critical, and Mental Health s. F. Envisions that as an office of care coordination. I dont know if that is to happen in the next year, but what is your thinking if you had some resources, how you would begin to build out care coordination in a way that we would feel . Like, we would see in the data, we would experience in the city . Not the full gold plated version of this because, obviously, were not going to do that right now, but whats the obvious sort of beachhead plan that, okay, were doing this . So with your permission, im going to ask our acting director, marlo simmons, to answer your question. Shes been looking carefully at the office of care coordination idea and how we move forward on care coordination, building that structure, even before its fully funded, so im going to ask marlo to start. Supervisor mandelman great. Good afternoon, everybody. Marlo simmons, acting director of Behavioral Health within d. P. H. The legislation and how Mental Health s. F. Talks about the needs, i think, is really right on and reflected a lot of the problems that we have in our system. One of the first things that wed like to do is really build out a linkage function and what that looks like, for example, in the s. I. P. Hotels, to supervisor ronens example that she shares, is that the staff and hotel would have a place to call when they see a concern about a client, and that that call there is someone who immediately answers the phone, talks with them about what theyre seeing, whats the best response. And in that case, it sounds like someone should have come out and helped that client get access to medication or whatever services are needed. Weve started that with the shelter in place hotels. Its very new, and obviously, to get people to use that kind of service, they need to know about it, so thats where you get the Marketing Campaign thats involved in the office of care coordination. You need to train the staff in what to expect when they get calls or what will happen when they call the line, and then, you need Quality Insurance when the staff calls the line, they get a person on the line, so they understand the response, theres follow up. So theres a lot of details at every stage. I think we also need to really expand the streetbased outreach that were doing. Some of us talk about it as relentless streetbased outreach, and that is what it is with people. Theres a lot we have to show that it works. With the care coordination, if you identify someone whos willing to engage, how do you get them in the front door . Thats what we hear from people involved in the system, in the jail system, in the prison system, in the foster care world. Its helping people understand whats available, whats the best match for the client, and helping them actually get there, and that takes a lot of time and engagement and real conscious work and being aware that the services have high quality or meeting the needs of the compliantlients. And looking at the data, the outcome, what were trying to achieve. A lot of information around accessing where we are. So people like the folks at p. E. S. Are able to say oh, heres the outpatient provider, so its kind of a lot of glue in between of all the silos of services that you have. Supervisor mandelman so that takes resources . For sure. Supervisor mandelman dollars, and although it is a high priority for the department, i am my understanding is, you know, that it is not dp the best priority may not be included in your budget. So if the two stated things end up and a place for people to land if the outreach happens, and they are brought in somewhere like, those things would all need to get added either in the next month by the mayor, finding money from somewhere else or, less likely, from the board of supervisors trying to find money to shake out of the Mayors Office to pay for those things. I mean, i think what would be really useful for this supervisor i dont know about for others is for the department of Behavioral Health services similarly along the lines of what the doctor has done with the beds, but to think a little bit along the lines of some way of measuring a meaningful move in these areas, and then a cost associated with it, and i would love to see what it is. I know that supervisor ronen may already have asked the controller for this, or at least in some ways, ill ask the department to look for those. All right. Ill cede the floor. Supervisor ronen, you have this. Supervisor ronen yes. Thank you. Dr. Bland kept referring to a team. Whos on the team . Yes. So im having problems. After this, im going to switch to a different network. If i lose you, ill be back in. So lauren bruner, who youve heard from, is an analyst working with dr. Bland, and there are executive leaders from the behavioral from the d. P. H. , myself included, who sort of morphed from our early work prior to Mental Health s. F. , from Mental Health reform weekly meetings to the Mental Health s. F. Legislation and the projects that we had already started working on with Mental Health reform and the new projects, so, yeah, but its led by dr. Bland and dr. Bruner. And ill be back. Supervisor ronen i can talk to dr. Simmons in the meantime. So a lot of what youre describing in the dialogue with supervisor mandelman, it sounds like youre putting the cart before the horse. I dont know if any of you can answer these questions because its sort of dr. Blands main thing, but i do have a lot of questions about the bed study . To me and i think im agreeing with supervisor mandelman, at least as i understood his comments that how do you even do that study if you dont have a system in place . I agree with that, that the office of care and accountability the office of care coordination, that thats a Different Office that were going to put off till later. The office of care coordination is the most important part of Mental Health s. F. Because if you dont have an office where care is coordinated, and you dont have a structured team of management, etc. , where people check in, you cant have that, and weve never had that before. I just dont understand without that, whats in place . Whos the management . Whats the different level of Case Management . Who are the contracts with Case Management . Whos Quality Control . Who makes sure the same set of standards are being placed up . Whats the tracking system tracking which patient is assigned to which care manager . If someone falls out, how do they get back in . Ive heard none of this system building in your talk or the way that you refer to Mental Health s. F. , and its really worry some to me, when i saw d. P. H. S budget that was presented to the mayor, too, i have to say, i was actually shocked that there was nothing in there, with the exception of a vague reference to hiring more people in the h. R. Department at d. P. H. Very important in order to even begin implementing Mental Health s. F. Because you recognize you need to hire different staff to make it happen, or at least repurpose. So this is, again, why i get so frustrated. It has nothing to do with dr. Bland, whos incredibly talented psychiatrist and physician. If the fact that youre focusing again on these oneoffs, you know, this bed analysis that doesnt fit into a system so its kind of vague and random. Maybe you can explain to me the methodology around it, and im wrong about it. But the rising prices on our street, you know, from a gut level, it just makes no sense. And so, you know, it it its extremely worrying to me nowhere in your presentation, nowhere in your budget submissions to the mayor, and nowhere in talking about your work in the middle of a global kri s crisis is there talk about Mental Health s. F. Its just extremely problematic to me. Im really glad we have a meeting set up in a few days. I think its next week, even, but im really shocked that there hasnt been more thought into what would the first phase look like . Youve told us that street medicine goes out with a hot team. And supervisor mandelman asks, well, where do you take them . Where do they go . Well, we dont know. It sounds like a year ago, when we had to take the reins ourselves to create Mental Health s. F. And not to say that you guys havent worked really hard, because i know that you do every single day. As supervisor mandelman said, no one can underestimate the impact of covid, but i at least hope Going Forward that were thinking about it in the same way, and from the presentation and all the discussion and the drafts of Mental Health s. F. And all of that, that were still in a place where its hard to get answers to question. Supervisor mandelman before you answer, i would just say that this presentation definitely reflected conversations that i and my office have had with d. P. H. Supervisor ronen okay. Supervisor mandelman i did not ask for a report on Mental Health s. F. Implementation. I asked for whats going on on the streets, and it was the thoughts that were in my head about beds and other things, which has overlap with Mental Health s. F. Supervisor ronen sure, and i guess that, and i guess that that wasnt the topic of todays presentation, but the reason that its triggering to me is because in the way that youre answering questions that supervisor mandelman is bringing up, the framework hasnt shifts in terms of how d. P. H. Is thinking about solving these intractable problems that we havent gotten a handle over in years, and so thats whats worrying me. I hear you, supervisor mandelman. Its the way that things are being discussed that makes me feel that were not moving in the direction that i thought we unanimously passed legislation, deal brokered with the mayor, would be leading us. So supervisor ronen, i hear what youre saying, and im sorry that our presentation and the way that were talking about our work over the last few months during the covid19 activation wasnt based in the language that i think we all did the language, the vision, the tenets, the different projects are articulated in the Mental Health s. F. Vision. Before february remember, this was incredibly complicated transformational work. You were the author and visionary working with us. Its expensive and requires a lot of infusion of not just staff and changing how people do their work, but also facilities improvements. When you talk about an office of care coordination, when you talk about 247 access, those are huge transformational changing. Im glad that we started it. We talked about the expand of bhac, how we would expand access to 247. We had started work on the street Crisis Intervention Response Team and how that was articulated in Mental Health s. F. You know, the work that dr. Bland discussed, so not just the bed modelling, but how we use this. But because there was this, you know, wellspring of support for, like, i said, major transformational change, we put our effort toward it. And now, here we are. So as i said, you know, if we are able to flatten the curve, and if we can pool some of the huge resources that weve invested in the Covid Response street outreach response is hugely resources intensive. You know, it will take a lot of staff. We will have to hire staff for that and not for, you know, the clinical support thats needed for people if you put them in hotels. So i just want to be realistic that we can only do so much. I do take responsibility and really hear you about that we not only need to talk about, but start thinking about that our transformational work our Mental Health reform work is Mental Health s. F. Until we do something, its what we all were very excited about. The legislation were moving toward something. Early april, we had a meeting date for the working group. We never had the working group meet, but were focusing our energy of hiring a new director of Mental HealthSan Francisco. Those things need to happen before you can see what you need to see and whats urgent. So i think what were trying to convey in this presentation is weve already started working on basically whats sort of i dont want to say low hanging fruit, but its things that are directly related to our Covid Response and what we have to do right now and what we see as the start of building the foundation for Mental Health s. F. I think they are, the work that were doing in the s. I. P. And the street work, thats the start of building that foundation, but were not there yet, as you know. Supervisor ronen i really appreciate that. Your response makes a lot of sense to me. Im happy were having this conversation, and i want to thank supervisor mandelman for calling this meeting and having this conversation because its starting to sharpen whats needed moving forward, and i hear what youre saying. And again, we were moving sort of in the right direction before covid hit, and its thrown everything haywire. So im looking forward to getting together and talking about this in a different way in the midst of covid were both coughing now, but i really appreciated what you said, dr. Hammer. Thank you. Im done. Supervisor mandelman okay. Thank you, supervisor ronen. Vice chair stefani, if you dont have any questions or comments, lets go to Public Comment. Clerk for those who have already connected to our meeting via phone, please press starthree to be connected to this item. For those already in the queue, wait for the prompt. The prompt will be, your line has been unmuted. For those online or on channel 1626 to 4156550001, and then enter 1458532772. Press the pound symbol twice, and then starthree to be entered to speak. Do we have any callers . Yes, we currently have three callers in the queue. I will queue the first caller. Supervisor mandelman and i will repeat our Public Comment rules. Speakers will have two minutes. We ask that you state your first and last name and you speak directly into the phone. If youve prepared a written statement, you can send it to the city clerk for inclusion into the file, and in the interests of time, speakers are encouraged to avoid repeating statements. Lets hear the first caller. Hi, can you hear me . Supervisor mandelman yes, go ahead. Hi. My name is javier. Im a San Francisco resident and community organizer. I also represent the treatment on demand coalition. The pandemic has us in an unprecedented time in terms of health care, and as always, people that are suffering under the status quo are hit hardest by covid19. The Homeless Population has now hit fr moved from precarious on the streets. Our communities have been asking for accessible Treatment Options for decades, and we have the tools to address this. Im glad that were holding a separate hearing on the citys response to unhoused people because we passed Mental Health s. F. Late last year. This bill was to make Mental Health treatment in s. F. Actually accessible at a time when were having a conversation about reducing the police in our every day, our only conversation is finding out different ways to lock people up. Its embarrassing that our city orders its constituents to shelter in place to stay safe when they dont offer how and then continue to complain about unsightly Homeless People who our communities ar