Transcripts For SFGTV Government Access Programming 20240713

Accommodation within the third meeting. We might be able to look at a solution. It would seem to me at least that it would be very appropriate that the commission hear an overall broad plan as to the types of services felt to be needed in the city and how we cant reach all of them. Clearly the original intent of the building has sort of been changed by urgent needs otherwise in which we were supposed to be bringing back those who were housed outside on a chronic basis to San Francisco. The needs of the city that has been expressed hearsay if those people at the moment are there still, wherever they are, we cant bring them back because we cant solve our more immediate problems right now. That is the reason for the changes, i believe, at the Behavioral Health center to try to meet the immediate contingencies not forgetting that we have people outside. I think as an overall comprehensive look at the whole situation, we might want to see what happened to those people, too, and if anything could also be done for them in the future, but right now i think we are concentrating on the most immediate neats of the city, which are the urgent needs of people in crisis. Thats correct. That is a pretty fair summary. Commissioner green. I want to echo that. I am impressed by your honesty. He appreciate you educated us and your passion means a great deal and your wisdom means more. I guess the question is a request that i might have. I am confused how if we are embarking on this truly aspirational effort to identify the 4,000 homeless in San Francisco and concentration of 250 how when we find and identify them we can give them the best conveyor car best ce and service. We need to place them where they need to be placed. It seems that will not be successful that we havent analyzed the need. [please stand by] the first thing that i would say is that ive been mightily impressed how this department operates in crisis. I think that its been mentioned before how so many leading accomplishments across this country has been done by this department. And i witnessed how incredible this system has turned on a dime to respond to what is going on at the hospital. Every official has been there, and theyve been committed and thoughtful and proactive. And so given this leadership question that we have within this particular unit, im wondering who we can bring to the table, how we can marshall this skillset that is here within this department to try to act quickly, because i have seen leadership in action in this department and there is no better place to find it. But i want to understand what were going to do on that level to act quickly to give everyone, including the patients and the citizens, and the taxpayers, everyone has spoken here, a kind of reassurance and comfort that that we have the ability to move quickly on your concerns. So thank you for your questions, commissioner green. With the first one, have we analyzed what the needs are . So as you pointed out, the focus on the 237 and the 4,00,000, thy have done a lot of work to hone that population as the one to which we should focus. And as you can imagine the needs of that population will be varied depending where they are in their phase of illness or recovery and that goes the continuum from acute inpatient Psychiatric Care to p. E. S. To board and peers. So to on that end, we actually you remember a few weeks ago that the mayor announced the partnership with usff and Tipping Point. Part of that partnership is looking at the issue of care homes. Is there a way to begin to salvage those, particularly the ones that announced their closure . So thats one of the things pursued right now. Are there some of these facilities that we can approach them before they sell to developers to see if theyre willing to sell to the City Partners to maintain those beds. So all of those activities are going on right now. And we will put together a Performance Improvement plan, for the Behavioral Health and rest assured that the management and the operation of that Behavioral Health center will be a significant component of that plan. I want to acknowledge and thank all who came to speak to us today and directed your comments about what is important for the population and the residents at San Francisco General Hospital. And at the merf. And i want to acknowledge that the nurses from the Emergency Department were here today and we talk about the struggles they have in dealing with the issues of folk coming in on an emergency basis and being stuck there and theyre understaffed and their view of being understaffed. I think that its important to recognize that these divisions are interconnected and something happens at the emergency room or at the merv and inpatient, all is connected to these programs and that one of the things that well talk about here is whole person care. Thats what we need to be talking about. Thats what we need to address is whole person. Because the e. D. , the Behavioral Health, all of those units are connected and its important that we recognize that it is a department of Public Health and the public is out there. And the public demands a request of us and i want to assure you that this is not the end of the discussion and when we have the third reading in november, its not the end of the discussion. This is the departure point. We will work exclusively with the department and we will hear from and work with you as a community because if we dont do this together for solving problems and fin finding where e failures are, well have this discussion next were. We tede to ge need to get whereo be. So with that im ready to move to the next item. Mr. Chair yes, i think that after listening to commissioner green and im reminded that understanding the Component Parts and, yes, you know, people cant move through the system and our transitions process that this needs to be reviewed because some of it seems to be failures in the way that were hearing and if the thought here whether using the 4,000 as an example from the Mayors Office or otherwise is to say that were having a transparency with the number of beds available. Im not sure how well that by itself works because theres all kinds of things also kind of left out of this database. But on the other hand it would be fortunate understand how that program is going to be looking with what we are envisioning for our service programs. And a good part of our psychiatric floor is with nonacute patients who do need care. And theres another group of people who should be in a more proper place with a more an appropriate type of level of service. So im looking for a comprehensive review and i would suggest a transition to at least focus on the Mental Health part of the equation here. We now have transitioned all the way across for even our elderly and others who are chronically ill. But i specifically am talking about transitions in regards to this and the Mental Health program is a continuum of care. Absolutely. That will be part of you referenced the bed tracking system for residential Mental Health and Substance Use. So that is in phase one. And the plan is to roll out that bed inventory website to all of our levels of care in terms of i. T. And programming and the fact that we have data coming from multiple sources. But that is the goal is to have all of our level of care in a bed inventory that is transparent and can be seen. Two more quick comments. One has to do with the emergency room and the nurses were speaking and they were speaking about losing significant staff and managers and longterm employees. And theyre also talking about the trauma they experienced as nurses staff. So i hope that one of the things that were often seeing is that the nursing staff has the ability to access care for them as individuals and as a group. Because i think that is critical. And i think that its also true for the Behavioral Health part of our system. Theres trauma there, not only for the patients who come in, but theres no way that theres not some transference between the patients and the staff that work there is. So i want to make sure when were taking care of our patients we take care of the staff too who take care of the patients. Thank you, commissioner. Obviously, those of us who work in health care are particularly in the Public Sector are concerned with the effects of vicarious trauma. So i will make sure that i followup with all of thigh my t reports and leaders to make sure theyre making the reports available to staff. Thank you. Next item. So, commissioner, i have been asked you have been several items on the agenda and im asked by the president to mirror back to you to postpone those and the meeting but its up to you to do that. I cant make that decision for you. These items will be postponed to the next meeting or a future meeting. Are they here . The staff for items 8 and 9 are here. We should probably go ahead and do it because they sat here all of this time. Im sorry. 8 and 9 are here . Yes . All right, so, sorry, everyone. Item 8 is the 2016 Public Health and safety bond update. Thank you all who came for item 7 and well move to the next item. The bond and item not marked mark primo is not here tonight. He offers apologies, hes suffering adverse reaction to a flu shot that he had yesterday. So he begged off. And so im going to try to do justice on his slides. Weve moved right into it and youre familiar with this slide, this is the scope and the budget of the d. P. H. Portion of the Public Health and safety bond. This one is the first bond sale of the 149 million and were working all the way through. As you can tell im moving at a quick pace through this presentation. And by the way, back to introductions and i skipped over that, im from zuckerberg capital programs and im joined with joe chin from the department of public works. Our city project manager on the bond program. And michael bidai the associate chancellor capital program. And so this is the previous bond breakout was on the first bond sale. We were planning we are planning on a second bond sale. We were shooting for early 2020, but right now because of the current burn rate we may push that out into the late second quarter. This is a breakout for zuckerberg, the spend. We are about 23 through the original first bond sale. A lot of our projects have not hit the construction mark yet. Once we do we expect to have that spending to increase. This is the community Health Center bond, theyre a little bit ahead of us on the spend, theyre at 42 . And, again, as they progress in the southeast they will get a new contractor on board theyll be proceeding and the next one we presented at last presentation and this is the breakout of each individual project and grouping them together in how were working with the budget. Right now we are overall in the black. And even though the political improvements are showing in the red. Overall were juggling the dollars around to make sure that all aspects of funded. And we have some savings in the lower end that are helping with the overages in the top end. And with the community Health Centers, again, theres some projects. This one has the benefit of funding from different sources other than the bond and theyre identified in the legend at the bottom. You can see how theyre applied by fund type in the chart above. So, again, this one is also in the black. Since we last met a lot of work has been done and ones that ill point out to you quickly for the billion five on zuckerberg, we moved with the i. T. Design, and with that, we have a study for 8090 and one that im excited about is the psych emergency study for the new location for psych emergency. As far as seismic, we have moved through phase one, were into the second half were finishing up the first half of phase bo one which is the removl of the sunshade horizontal elements and then the fiber wrapping. And below you can see the bottom you can see the phases of a fiber wrap. So on section one is the column and you go to number five and thats actually number four is the complete column that is fiber wrapped and strengthened. And number five is what it looks like from the outside. And the majority of care accomplishments, so we have them being seen over at the old urgent care since we vacated urgent care. And we have submitted 95 design drawings in august. And working to create a temp location. With that well pass the baton to joe chin to talk about the upcoming milestones. Thank you. Good evening, commissioners, joe chin, Program Manager for the Public Health and safety bond program. So moving to the first line, well focus this evening on the upcoming milestones and accomplishments for three components under the health and safety. Its a southeast Health Center component and on building five for the team advancing 15 of our core projects under this component. Not much has changed and we still have four projects in construction. One project is completed. And the remainder are in different phases of the planning, design, or plan review project life cycle. And so here on this slide 12, these are the two projects that are in construction, and we have the locations, and the rehab, and were anticipating finishing by the end of the year and then rehab were currently at 45 complete. And then looking at completion early part of 2020. And then just quickly on another project construction site sorry. On seismic retrofit, as terry mentioned were wrapping up the first part of phase one and moving to kind of the interior column strengthening scope and thats the new work that were doing and learning the process and how to best do the work with the occupy facility. And we have a project from planning to design and its the specialty services. So weve moved from plan to design right now and thats a new project that were tracking. And then on southeast Health Center, really theres two key areas that we focus on. We have completed design. We have the drawings submitted to d. P. I. For plan review for permitting. And the next milestone is to get this to bid document and get it bid and construction early part of 2020. Were looking to start bidding probably this month as our target to get this out on the street and start soliciting contractors. And then on community Health Centers, this is its a comprehensive scope and were doing work at two Health Centers, the maxine hall Health Center and maxine hall, i think that we talked about this earlier. And were having our groundbreaking ceremony tomorrow. Happy to report that this is the project where were able to kind of show that weve awarded a contract to a contractor and theres also photos on the slide that show the prefabricated trailers that are now have been assembled. Theyre being worked on in preparation for the staff to move from Maxine Mau Hall into e temporary clinics during the entire construction duration. So a lot of things are happening at maxine and its good to see this project moving. And the Health Center, weve received additional funding for this project from the Mayors Office and kind of focused on the City Initiative on global warming, climate change, and so the additional funding was to add air conditioning to this project. So because of that added scope we now had to push out the design and construction but its this is the best time to do it. The building is already vacated and its a good time to do a comprehensive improvement to the building. And then the last three slides is our typical i think that you have seen this before our high level schedule update on active projects that doesnt include all 19 projects but shows the more active projects. So i wont go through it, and i think that its pretty selfexplanatory. One thing that i do want to mention is on the schedule update for the Health Centers and based on what i mentioned earlier, maxine hall have been the updated schedule duration that shows it being issued for maxine and kind of the construction duration for that project as well as castro missions design and construction schedule being pushed out because of the added scope. So at this point im going to turn back to terry, and well talk about the research project. Just real quickly, this slide is a list of what has been going on to get to the points where were completing the documents to and targeting to have that closed and it will allow them to move forward with their plans. With that and were also working diligently with other city agencies to help the process along with approvals for drawings and as well as providing all of the documentation with the bureau of real estate. And an inventory of all of the space is one of the items that is on our part. And we will move on im moving on to item 9 which is the presentation. As of practice at the Health Commission these items are presented together and then you all ask questions and the public can make Public Comment during either of those at the end of the presentation. So were moving to item 9 which is the Academic Building update. Thank you, good evening, commissioners. My name is michael bidet, at uscf. We are nearing the end of the design phase for the Research Building and i will show you where the design is at later in the presentation to remind you of where it is on the b. C. Lot. We are, as i said, towards the end of design and we anticipate construction to start in early 2020, once the final approvals are completed. And we are here at the Health Commission today and then in november on the 13th and we will go to the board of regents for the design and final budget approval. Which constitutes the approvals needed to build. And and were on schedule. This is a section through the building. Showing the way that the Program Components are distributed on the dry research floor, so that would be four or five. And this is the design that has been by the Arts Commission and this is what we are presenting to the board of regents. This is a view from the 23rd street entrance, looking up from the west to the east. And the glass corner is the sort of internal kitchen and the breakroom and conference area. With vertical transportation, and the glass lobby at the ground floor is the main entrance to the building. And you can see building five behind it. And the building is clad in terra cotta which is very much like brick in its texture and color. And this is a view of the looking due east, showing the main entrance and one of the connecting stairs going up. And the relationship to building five. I think that is the last picture in the presentation. Can i answer any questions . Clerk i have not received any Public Comment or requests for this item. Commissioner . I have a fairly naive question. So it looks like theres more green lines ahead of red and a few times ago when you presented it seems that youre doing well with keeping to time lines and what im confused about is how do you link, you know, kind of your expected expenditures to timelines . Like if youre ahead or behind, how do you analyze the expenditures compared to where you are and how often do you do it . And how important is it to look at when youre going through the bonding and how you make those decisions. And then my second question is there room for us in this building . Just a Little Office . Just a little one . Please . As far as the budget analysis, we are constantly, joe, myself and mark constantly greg were constantly going over the budget on this. The key milestones that are keying us to where were at are estimates. So we do estimates at the design completion and the project 50 design and 100 design and we estimate on the executive management team. And so we will constantly estimate the jobs. But it didnt get real until we have a contract and we have a bidder and a signed contract. And thats where we get to true up the budget and true up the timeline and match it to our projections. Thats really where it happens. And once were in construction phase it becomes just a regular part of the construction process and tracking the budget and the spend and making sure that we dont have cost overruns. Anyone else . Any other questions, commissioners . So it looks like were kind of slipping in time on the p. E. S. And all. Is that is that, you know, good . Its not good but to be expected. So if you recall the p. S. Program has changed and before we were going to try to do a 10phase project in the same location that was going to be it turned out to be a budget buster and we couldnt do it. So we identified a place adjacent to that that was vacant and we took it over. And so we started the clock on that but were still keeping the same baseline. So once we get to that process where we go through the design process and then we try to get a contract, then well reset all of those milestones. Okay. So youre rethinking the original . Yeah, and its a good move. All right. Absolutely. Thats the only question. Other questions, commissioners . Hearing none. Thank you. Thank you for staying and we appreciate it. I know that its late. So commissioners, item 10 is the person is no longer here, item 11 is other business and i will note that some of you are going to be at the joint hearing with the Planning Commission on the cpm agreement on thursday at 10 00 a. M. And then shall we do the item 12 . The update itheres people here. The report back from the september 24, 2019, zsfg jcc meeting. They discussed reports, including the regulatory fares and the c. E. O. Report and Human Resources report. And also discussed the epic related salary variance issues. And it will be continuing to track the epic program as it moves into its new phases. And at the medical staff report we reviewed the process for the affiliated staff form and approved that. And the registered nurse Standard Practice was a Standard Practice was created for administration of flu vaccines by registered nurses in the hospital. In closed session the committee then approved the credentials report and the minutes. And that ends my report. Thank you. Questions . Commissioners . Clerk theres no public request for that comment so were at the consideration of adjournment, commissioners. So moved. All those in favor . Aye. Aye. Thank you, everyone. 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 Health Reform 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 Health Needs 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 Francisco General 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 ]. [ ]