Okay. We are here to get the job done. Good morning. Is it morning still . Ive been up since 5 00 i think. Im trying to keep ive been to so many places throughout the day. This is probably the fifth or sixth, but whos counting . Thank you all so much for joining us here today. With me i have dr. Grant colfax, who is the director of the department of Public Health, as well as dr. Anton nagusablan who is the director of Mental Health reform. Daniel leary, the c. E. O. And founder of Tipping Point community, and matthew state, the chair of u. C. F. Department of psychiatry here in San Francisco. Im excited because these are incredible leaders in our community who are going to help us with some really challenging problems that we know we face as a city. Last week we launched the Mental HealthReform Initiative to help those at the intersection of homeless, Mental Illness, and Substance Abuse disorder in San Francisco. And through our detailed analyst, dr. Nagusablan and the department of Public Health have identified the people in our city who are most vulnerable and in need of help. Now, to be clear, we see it. But now we have clear and accurate data. Of those 4,000 individuals, 41 frequently use urgent and emergency psychiatric services. 95 of those folks suffer from alcohol use disorder. 35 are africanamericans, despite the fact that we have a less than 6 population of africanamericans in San Francisco overall. So we have a lot of work to do ahead of us to provide the Behavioural Healthcare that people need. We need partners to do it. We need to work with our state officials, with our philanthropic organizations and our nonprofit communities. Thats why today im excited to announce that the city has partnered with Tipping Point community and ucsf who share our goals of addressing the Mental Health crisis in our city and providing people with the care that they need. We know that addressing the needs of the most vulnerable requires experts in the field, it requires collaboration and the development of publicprivate partners. Tipping point and ucsf department of psychiatry came together to really understand how to improve the outcomes for San Francisco residents experiencing longterm homeless, but who also have challenges with Behavioural Health. They worked with the city departments and various communitybased organizations who helped to put together information to inform this comprehensive report, including the department of Public Health, the department of homeless and supportive services, the hospital council, p. R. C. Thank you, Brent Andrews for being here and your amazing work. Health right 360. Thank you for your rigorous work on what we deal with in terms of treatment for folks who also sadly deal with Substance Use disorder as well. Thanks to the Rigorous Research conducted by Tipping Point and ucsf. We have a report that we can use to implement datadriven policy decisions that will effectively work and change our city for the better. This report highlights how philanthropic and public funding can work hand in hand to help san franciscans suffering. They have provided several recommendations to improve our system coordination, because we know that it definitely has a few holes in it and it needs to be better coordinated. Enhancing peoples access to treatment. Meeting people where we are. We cant think theyre going to show up at the door of a location for help or for support. We are going to need to go out there in the streets and meet people where they are. Engaging more people in care and services. We are excited to partner with them to implement these recommendations. But also in order to address the Mental Health crisis in our city. We need to build on what is already working. Were going to do that in part by expanding the number of hummingbird beds in a city, in our city. Today im really pleased to announce that thanks to the funding from Tipping Point, well be able to add 15 new hummingbird beds which offer psychiatric respite. That is absolutely amazing and its really expensive. [ applause ]. Mayor breed so with these new beds, well be able to connect people experiencing homelessness with Behavioural Health needs, the care that they need. Im not sure if any of you have visited the hummingbird facility at s. F. General, but it is absolutely amazing. I had an opportunity to not only touch bases with clients, but we also did an announcement last year expanding the number of beds at that location as well. To hear someone say to me that im trying, its hard, but im glad to have help, it makes all the difference in the world. This is an incredible facility and im so proud of the work that they do. As dr. Nagusablan will get into more details, we know that the vast majority of the 4,000 people we have identified unfortunately have alcohol use disorder. The Tipping Point report includes some innovative suggestions for treating those suffering from alcohol use disorder and we are looking forward to making some changes and implementing some of these in the coming months. There will be more could you tell mes to come and dr. Nagusablan will continue to implement our approach to healthcare because thats his job. We will recommend more ways to improve care for our citys most vulnerable residents. We all, as i said, need to Work Together to address this challenge that we face. With policy, financial investments, and working in a collaborative approach. So we truly appreciate the partnership of ucsf and Tipping Point. Now, i want to turn this over to the c. E. O. Of Tipping Point community. Theyve done a lot of work to address homelessness and taking it a step further by digging into the root causes of some of the challenges we face to make the right kinds of investments. This is going to make a world of difference. Ladies and gentlemen, daniel leary. [ applause ]]. Thank you, mayor breed for your leadership. We know that the primary cause of homelessness is a lack of affordable housing, but we also know that Behavioural Health conditions, like Mental Illness and Substance Use disorders contribute to homelessness. Without a stable home, these conditions are far harder to treat. In partnership with ucsfs department of psychiatry, Tipping Point engaged a Public Health consultancy called john snow inc. To improve opportunities for San Franciscos existing behavioural system. We convened leaders from city departments, from ucsf, from s. F. General hospital, and a variety of communitybased service providers. We conducted dozens of stakeholder interviews, including a focus group at the respite center. We engaged closely with the department of Public Health throughout the process, checking assumptions and findings against the experience of our city partners. Now, as the mayor said, the findings are in. We need to know the names and needs of everyone who is homeless with a Behavioural Healthcare need, provide Wraparound Services that promote stabilization and a path to permanent housing, and ensure that systems and services proactively address and reduce disparities, especially among black and lgbtq individuals experiencing homelessness. Tipping points role Going Forward will be to fund the Priority Investments in the department of Public Health and the service community, while encouraging our Philanthropic Partners and peers to do the same. We are taking the first steps towards making this vision a reality. Today we are announcing that Tipping Point will invest up to 3 million to create a second hummingbird psychiatric respite center, replicating their [ applause ]. As the mayor said, this is the type of program you want to replicate. This will expand access to a critical supportive step out of homelessness. We invite all of our other funders and friends throughout the city to explore the report findings out today and invest in the recommendations and join us. Now id like to introduce two people that are working every day to improve the Health Outcomes of our neighbors. Please join me in welcoming dr. Anton nigusse bland, who is the director of Mental Health reform and dr. Grant colfax, the director of Public Health. Thank you, mayor breed, for leading the way. If were going to reform our system of care for the nearly 4,000 san franciscans who are most in need, everyone will have to Work Together. Thats why its so important to be standing here with our partners at Tipping Point and ucsf talking about these common goals that we share and advancing our shared vision. I want that briefly highlight a couple of findings in this report that reinforce our own. First, Behavioural Health outcomes are Health Outcomes and they are far worse for people of color. This report points out that black men die as almost twice the rate of white men of liver cirrohsis even though they have lower rates of alcohol disorder. We also found of the people experiencing homelessness, Substance Abuse problems have a higher incidence. Alcohol remains a persistent and enormous Public Health issue that impacts the lives and health of many san franciscans. Our most recent Community HealthNeeds Assessment revealed that two out of five adults surveyed reported a survey of binge alcohol use. Between 2014 and 2016, over 8,000 emergency room visits resulted from alcoholrelated issues. We can help. We know how to care for alcohol use disorders. Weve already begun to work on the kind of evidencebased approaches to chronic alcoholism that this report recommends and particularly exploring the development of a managed alcohol program. The research is very strong that managed alcohol programs, medications, and treatment can reduce the harms of excessive alcohol use. We can create safety and stability for people if we innovate on this problem together. We need to make sure that Proven Solutions are applied in a thoughtful way and extend their reach to people who have not had sufficient access to the help that they most need. We also agree with the reports findings that we should make it easier to get Realtime Data about our system of care. We are launching the very kind of collaboration across city agencies that this report urges us to purview. We expect to be able to provide this transparent information about our beds and our system of care to the providers, clients, and members of the public so that all of us have a better understanding and is have an improved ability to access care. We know that research and philanthropy will play important roles in making these recommendations a reality. We are grateful for that support and partnership. [ applause ]. Good morning, everybody. Im grant colfax. Im the director of health. Id like to thank mayor breed for her leadership, ucsf, and Tipping Point for the ongoing and strengthened partnership that they have with the department. Of course, dr. Nigusse bland for his bold leadership in his vision for us to do better as a community as we address the intersection of the homelessness and Behavioural Health issues. This is an important day. We are coming together focusing on solving problems and improving health for the population of nearly 4,000 san franciscans who are experiencing homelessness, Mental Health, and Substance Use disorders. Today we announced a significant commitment of partnership to meet those goals. A population focus means not only a focus on treatment of the issue patients, but we look at the big picture. We change the way the system responds when a Public Health challenge is this great. We learn. We look at the problem from multiple angles. We draw on clinical expertise and data. We try new approaches. We learn what works. We stop what doesnt. We measure results and we built a track record of success. We figured this out when we look at h. I. V. Look at the numbers being released this week. Weve gone from ground zero in the aids epidemic, to pledging to be the first city to get to zero. That didnt happen overnight. It took multiple stakeholders from across San Francisco. We need to use that experience to address other deep Health Challenges in our city. Progress does not happen and cannot happen in isolation. As with h. I. V. , we know that forging Behavioural Health solutions for San Francisco residents experiencing homelessness and Health Issues will take researchers and clinicians, community stakeholders, clients, philanthropists and the support of the public. I and we are grateful for the contributions of Tipping Point and ucsf. These two robust institutions that were fortunate to have in San Francisco. The Health Department looks forward to partnering with them and many others with the significant Behavioural Health challenges facing people experiencing homelessness in San Francisco. Together we can and we will heal our city. Thank you. [ applause ]. Mayor breed thank you. Now, i dont know if any of you caught this, but john snow inc. Did the report. You know nothing, john snow . Nobody caught that . Okay. Next up we have dr. Matt state from ucsf. [ applause ]. Thank you so much, mayor breed. Truly, im thrilled to be able to stand here today with a group of leaders who are so dedicated to this city and to the most pressing social problems we face, including chronic homelessness. More than 30 years ago, at the height of the aids crisis, local government in San Francisco health providers, academicia, philanthropy, set aside parochial differences and came together to attack what seemed like an insurmountable challenge. This week mayor breed sat with the department of Public Health and ucsf to review the remarkable progress that has been made in this struggle and to double efforts to work collaboratively to be the first city to get to zero, something that must have seemed impossibly out of reach three decades ago. This is the inspiration for our efforts and it is the model that we are pursuing to address the intersection of Mental Illness, homelessness, and Substance Use disorders. This report is a product of all these organizations coming together to help develop a consensus road map that develops tangible, immediate differences in the lives of individuals and families experiencing psychiatric illness and Substance Use disorder. The work that went into it from clinicians, other service providers, and many others. I cant thank mayor breed, director colfax, and dr. Nigusse bland enough for your leadership and inspiration. And to daniel leary and the Tipping Point folks, its been a remarkable partnership. Were tremendously grateful at ucsf. There are several other people i want to mention. First, i really would like to underscore a tremendous contribution from jane hawgood and John Pritzger for their help to launch this collaboration and bring us together. As youve heard today, it will be the partnership of academia and the city and philanthropy that really promises to allow us to move forward on a critically important and admittedly extremely difficult challenge. Ucsf and the city have a Long Partnership beginning 150 years ago, when ucsf doctors began caring for san franciscans in the citys General Hospital. Today ucsf clinicians continue to care for the citys most vulnerable, including children and adults, at San FranciscoGeneral Hospital and in a range of outstanding communityfocused programs for those suffering from Mental Illness and Substance Use disorders. From our division of citywide case management, our division of Substance Abuse and addiction management, our Psychiatric Emergency Services to name just a few. As chair of the department of psychiatry at ucsf, i could not be more proud of our people and our Longstanding Partnership with the city that has allowed us to work every day to make a difference in the lives of our patients and their families. As a representative of ucsf here today, i cant stress enough our commitment to collaborate in taking on these big challenges, our department of psychiatry, the new homelessness and housing initiative, our students, our faculty and trainees are all determined to Work Together to find ways to tackle the most pressing health and Health Equity challenges we face, including the nexus of Mental Illness, Substance Abuse, and homelessness. Thank you again, mayor, director colfax, dr. Nigusse bland, and daniel, for your tremendous partnership and efforts. [ applause ]. Mayor breed so there you have it. Let me just say that we all know that the challenges that we face as a city werent created overnight. There wont be any easy fixes. It will take time. It will take, as every speaker here as said, collaboration, working together, seeking out the professionals who have the expertise in the medical arena and the nonprofit sector, our policymakers to provide the right kinds of solutions. This is so critical because when we look at homelessness and the challenges that, sadly, around 4,000 residents of our Homeless Community face, we know that its not just Homeless People who are dealing with a number of these issues in terms of Behavioural Health. It is time that we take just a different approach towards addressing Behavioural Health challenges in our city and in our country. That we begin to get rid of the stigma attached to seeking health for people who sometimes are dealing with depression and other issues that continue to plague our society. One of the things that i am really committed to is making sure that we have Wellness Centers in all of our high schools in San Francisco, all of our schools in general, so that when kids are dealing with trauma or any other kind of situation, that they have the help and the support that they need in the place where they study and learn every single day. Looking at creative and Innovative Solutions is how we are going to create a city that is healthy and is thriving. I want to thank all of you for the work that you have done and will continue to do to get us to a better place with all of these leaders, all of these amazing people, all of these incredible minds. I know its only a matter of time before we get to that better place that we deserve to be. Thank you all so much for being here today. [ applause ]. [ ] we spoke with people regardless of what they are. That is when you see change. That is a lead vannin advantage. So Law Enforcement assistance diversion to work with individuals with nonviolent related of offenses to offer an alternative to an arrest and the county jail. We are seeing reduction in drugrelated crimes in the pilot area. They have done the program for quite a while. They are successful in reducing the going to the county jail. This was a state grant that we applied for. The department is the main administrator. It requires we work with multiple agencies. We have a community that includes the da, Rapid Transit police and San FranciscoSheriffs Department and Law Enforcement agencies, Public Defenders Office and adult probation to Work Together to look at the population that ends up in criminal justice and how they will not end up in jail. Having partners in the nonprofit world and the public defender are critical to the success. We are beginning to succeed because we have that cooperation. Agencies with very little connection are brought together at the same table. Collaboration is good for the department. It gets us all working in the same direction. These are complex issues we are dealing with. When you have systems as complicated as police and health and proation and jails and nonprofits it requires people to come to Work Together so everybody has to put their egos at the door. We have done it very, very well. The model of care where police, district attorney, public defenders are communitybased organizations are all involved to worked towards the common goal. Nobody wants to see drug users in jail. They want them to get the correct treatment they need. We are piloting lead in San Francisco. Close to civic center along market street, union plaza, powell street and in the mission, 16th and mission. Our goal in San Francisco and in seattle is to work with individuals who are cycling in and out of criminal justice and are falling through the cracks and using this as intervention to address that population and the Racial Disparity we see. We want to focus on the mission in tender loan district. It goes to the partners that hired case managers to deal directly with the clients. Case managers with referrals from the police or city agencies connect with the person to determine what their needs are and how we can best meet those needs. I have nobody, no friends, no resources, i am flatout on my own. I witnessed women getting beat, men getting beat. Transgenders getting beat up. I saw people shot, stabbed. These are people that have had many visits to the county jail in San Francisco or other institutions. We are trying to connect them with the resources they need in the community to break out of that cycle. All of the referrals are coming from the Law Enforcement agency. Officers observe an offense. Say you are using. It is found out you are in possession of drugs, that constituted a lead eligible defense. The officer would talk to the individual about participating in the program instead of being booked into the county jail. Are you ever heard of the leads program. Yes. Are you part of the leads program . Do you have a case worker . Yes, i have a case manager. When they have a contact with a possible lead referral, they give us a call. Ideally we can meet them at the scene where the ticket is being issued. Primarily what you are talking to are people under the influence of drugs but they will all be nonviolent. If they were violent they wouldnt qualify for lead. You think i am going to get arrested or maybe i will go to jail for something i just did because of the Substance Abuse issues i am dealing with. They would contact with the outreach worker. Then glide shows up, you are not going to jail. We can take you. Lets meet you where you are without telling you exactly what that is going to look like, let us help you and help you help yourself. Bring them to the Community Assessment and Services Center run by adult probation to have assessment with the department of Public Health staff to assess the treatment needs. It provides meals, groups, there are things happening that make it an open space they can access. They go through detailed assessment about their needs and how we can meet those needs. Someone who would have entered the jail system or would have been arrested and book order the charge is diverted to social services. Then from there instead of them going through that system, which hasnt shown itself to be an effective way to deal with people suffering from suable stance abuse issues they can be connected with case management. They can offer Services Based on their needs as individuals. One of the key things is our approach is client centered. Hall reduction is based around helping the client and meeting them where they are at in terms of what steps are you ready to take . We are not asking individuals to do anything specific at any point in time. It is a Program Based on whatever it takes and wherever it takes. We are going to them and working with them where they feel most comfortable in the community. It opens doors and they get access they wouldnt have had otherwise. Supports them on their goals. We are not assigning goals working to come up with a plan what success looks like to them. Because i have been in the field a lot i can offer different choices and let them decide which one they want to go down and help them on that path. It is all on you. We are here to guide you. We are not trying to force you to do what you want to do or change your mind. It is you telling us how you want us to help you. It means a lot to the clients to know there is someone creative in the way we can assist them. They pick up the phone. It was a blessing to have them when i was on the streets. No matter what situation, what pay phone, cell phone, somebody elses phone by calling them they always answered. In officebased setting somebody at the reception desk and the clinician will not work for this population of drug users on the street. This has been helpful to see the outcome. We will pick you up, take you to the appointment, get you food on the way and make sure your needs are taken care of so you are not out in the cold. First to push me so i will not be afraid to ask for help with the lead team. Can we get you to use less and less so you can function and have a normal life, job, place to stay, be a functioning part of the community. It is all part of the home reduction model. You are using less and you are allowed to be a viable member of the society. This is an important question where lead will go from here. Looking at the data so far and seeing the successes and we can build on that and as the department based on that where the investments need to go. If it is for five months. Hopefully as final we will come up with a model that may help with all of the communities in the california. I want to go back to school to start my ged and go to community clean. It can be somebody scaled out. That is the hope anyway. Is a huge need in the city. Depending on the need and the data we are getting we can definitely see an expansion. We all hope, obviously, the program is successful and we can implement it city wide. I think it will save the county millions of dollars in emergency services, police services, prosecuting services. More importantly, it will save lives. [ ] i just wanted to say a few words. One is to the parents and to all of the kids. Thank you for supporting this program and for trusting us to create a Soccer Program in the bayview. Soccer is the worlds game, and everybody plays, but in the united states, this is a sport that struggles with access for certain communities. I coached basketball in a coached football for years, it is the same thing. It is about motivating kids and keeping them together, and giving them new opportunities. When the kids came out, they had no idea really what the game was. Only one or two of them had played soccer before. We gave the kids very simple lessons every day and made sure that they had fun while they were doing it, and you really could see them evolve into a team over the course of the season. I think this is a great opportunity to be part of the community and be part of programs like this. I get to run around with my other teammates and pass the ball. This is new to me. Ive always played basketball or football. I am adjusting to be a soccer mom. The bayview is like my favorite team. Even though we lose it is still fine. Right on. I have lots of favorite memories, but i think one of them is just watching the kids enjoy themselves. My favorite memory was just having fun and playing. Bayview united will be in soccer camp all summer long. They are going to be at civic centre for two different weeklong sessions with america scores, then they will will have their own soccer camp later in the summer right here, and then they will be back on the pitch next fall. Now we know a little bit more about soccer, we are learning more, and the kids are really enjoying the program. We want to be united in the bayview. That is why this was appropriate this guy is the limit. The kids are already athletic, you know, they just need to learn the game. We have some potential collegebound kids, definitely. Today was the last practice of the season, and the sweetest moment was coming out here while , you know, we were setting up the barbecue and folding their uniforms, and looking out onto the field, and seven or eight of the kids were playing. This year we have first and second grade. We are going to expand to third, forth, and fifth grade next year bring them out and if you have middle school kids, we are starting a team for middle school. You know why . Why . Because we are . Bayview united. Thats right. San francisco and oakland are challenging each other in a battle for the bay. Two cities. One bay. San francisco versus oakland. Are you ready to get in on the action . Im london breed. And i am oakland mayor libby schaff. Who will have the cleanest city . We will protect our bay by making our neighborhoods shine. Join us on september 21st as a battle for the bay. Which city has more volunteer spirit . Which city can clean more neighborhoods . The city with the most volunteers wins. Signup to be a bay protector and a neighborhood cleaner. Go to battle fofofofofofofofofoo good evening, and welcome to the august 7th, 2019 meeting at the San Francisco board of appeals. The president is joined by the Vice President and commissioners commissioner Darrell Honda is absent tonight. To my left is the deputy City Attorney who will provide the board with any needed legal advice this evening. At the controls as a boards legal assistant. Will also be joined by representatives from the three departments that have cases from before the board this evening