This is a big need is the longterm programs, a step down and where are people going to. At prc baker places, we have three different types of programs. The first is the assisted Living Program and this is Mental Health driven. You have to have a Mental Health diagnosis but doesnt many you dont have Substance Use. Many are doing the same thing, many are cooccurring disorders. We have our baker supported living disorder. This is another set of coop units and 34 clients are living with positive diagnosis and a Substance Abuse diagnosis and Mental Health diagnosis. These are the hoops to jump through. How do we get to where the open beds are . So, for example, what was happening in the Residential Programs, people would relapse and go out and use drugs or alcohol. One of the options at that point is to say, we might have to discharge you. The olden days, in the past, has been, well have to discharge you and here is a list of shelter, the emergency room and if you have trouble, please call these numbers, thank you very much. Im bringing up hummingbird because this has been a great resource for these types of incidents so that we dont lose people. It is a psychiatric respite where we can help people go, excuse themselves from the residential treatment for a little bit and get some respite and come back in. It doesnt require a new intake or a new system that happens. The hummingbird pe respite provs a soft, quiet space. We talked how people are lost going from p her here to there d this is where hummingbird picks up clients having difficulty navigating the system. Because were connected to them, we have to say because youre ready to for treatment, well connect with you. Its taking it upon ourselves to try to figure it what we do. One of the things weve been doing is working with Progress Foundation, another Residential Program and we have a weekly meeting called flow meeting and we go over all of the beds we have. We go over all of the referrals, who will be discharging from pes into the adus, from the adus and what treatment beds are available . So we talk and see whats going on here. That meeting is used for a back and forth of Progress Foundation may have someone who relapsed on drugs and alcohol. They might be men who have sex with men. We can let them though, give us that referral, well contact acceptance place and get them over there. It really is an interesting meeting that happens in the community. This is one of the strengths or successes, is that these relationships that happen outside of dph, that our agency is creating, i think its a big piece to helping us out. So when you were asking, what is it that we need, is that support to help build that . Lets see here, and barriers. What are we having difficult yeahs with . Ill mention two of them and theyve been mentioned, i want to say add newsum add ad naseum. Well be fighting over it with Progress Foundations. But what happens next . The staffing issue is the other one. We mentioned about the he high turnover, vicarious trauma, the low cost of living in sanfrancisco. When we last looked at it, 90 of staff in our agency lives outside of the city. And its really difficult to address that. When it is, our direct services is paying 21, which is 6 above minimum wage but its not enough. Thats a 45,000 a year job and it doesnt compute at this point in time. So it is something we are running into, is the staffing issue. And i think the other part thats related to the staffing issue and it goes in with the whole drug medical, is when we opted in for the drug medical, we are changing our assessment systems. Youre familiar with the american sit o society of addicn medicine . Previously were using different assessment tools to establish medical necessity. Drug medical says youre using this asam theory and model and this requires training of how to redo this and rethink an assessment. Part of this process is an authorization that needs to be required every 30 days by a licensed professional heeling arts, a license thed clinician. We would have to hire more licensed people. It turns into, where does that come out of the budget and fit into it . Trials and tribulations and getting going with the drug medical, it will be great but at the moment, we have a whole training force. Again, we just started in march, but it is going through and going mandatory Training Need to happen and looking at if its fitting what the state would like. So somewhere in there is the staffing issue related to the drug medical and the effects of the new system put on to the system. And i think thats all i have to say. Thank you, doctor. Next up we have mike decepalo, senior director of service and the stonewall project of the aids foundation. Thank you for having me. Im inspired by the response ans and challenges. Im the senior director of Behavioral Health services for the senior aids foundation and i oversee the patient Substance Use program and i oversee the syringe Access Service and other low Threshold Services. To a large degree, i can go off of a lot of what vica is saying, because my role as a professional is to act from the perspective of our program has been developed as a safety net type service. Soma project was founded in 1997, one effort first finished by the National Treatment on demand process. At that point, it was a Methamphetamine Program for gay, bi and transmen and also looking at methamphetamine for transmission. So part of our services at the aids foundation and stonewall, in particular, are to look at the intersection of Substance Use and sexual health, hiv infection and transmission and to look at acv and other disease processes, as well. I think its important to look at, in what ways, for example, is stonewall as an outpatient Treatment Facility different than other facilities . I would say that, with know, the philosophy of stonewall is Harm Reduction, the philosophy that the city and county has had for two decades now. I think the way we apply Harm Reduction is different than applied by a lot of other organizations. And i think primarily, the philosophy of care at stonewall, if our participants are not successful, we are not successful. So when people bail out of care or are unable to Access Services or unable go to our services, then we look at in what with are we failing or not meeting where they are . What happens, our programs are expanded broadly and for example, we have 27 groups, approximately, a week, for our outpatient Substance Abuse program and half of those groups are available to people on a walkin basis. Meaning they dont have to enroll in the program or answer any those nosey questions and tn come in and feel an accepted for who they are and we can develop a relationship, that the kernel of the round is love and compassion. And from that place of developing that relationship, we can decide together in what ways we might be able to be helpful to them. For some of those people, they decide to enroll in the Outpatient Treatment Program and when someone enrolls, its generally 16 to 1 month 18 montd its a big commitment of resources. So we appreciate the funding to offer that service. But there are many mean dont relate to treatment in that way. They may not be ready for treatment and some people come into our low threshold or easy Access Services and to define those things, because weve been talking about low Threshold Services, maybe theres massage or acupuncture or book club where theres lots of food and refreshments where we read a paragraph and people talk that paragraph means to them. It could be Harm Reduction and how to take better care of yourself. So what happens, folks make improvements in their life. We have conversations about them about minute details, including how much they may be loading in their rig if theyre loading methamphetamine, for example. There are very few providers in our system of care willing to have those conversations. There are also very few places where people who are not willing or able to get to treatment or dont want treatment can have those conversation. When we talk about low Threshold Services and the need to have places to go to feel safe, precisely these moments make critical changes for people at the interchanges having problems with and folks on the streets that are homeless, marginally housed, et cetera. So i think we talking earlier about Behavioral Health work group and a im excited about ts and i would like to participate and i think we should do it. In terms of systemic gaps or barriers, we need dropin centers, Overdose Prevention centers, more street outreach and low Threshold Services. People were talking earlier about the issues of medical and i wont get into the details about that. Those are in my slides, but it doesnt cover limitations. So this is not a low threshold, so the reason were able to offer the low Barrier Services is because we have city funding through Behavioral Health service, city funding through Community Health equity or promotion or former hiv prevention and own resource. The funding through hiv and unreinstructed fundraising that the organization does allows us to offer what we call the love. The love is throw Threshold Services we cant get them to pay for. There are exceptions to that. So we need ways to be able to have the will to be able to fund some of the services or look at innovative ways for those types of services one of the things happens, well integrating the behaviour center with the Harm Reduction center and its one facility where we offer syringe access. So there ought o all of this, fn get clean syringe and access and thats an important thing to offer. But the opportunity it allows us is expanding beyond gay, bi and trans men and well allow a prop for all for all participants in october. We need more resource, basically. When were asking the question about, do they have enough money for the beds for everyone who wants access to care . We do not have enough money for the folks who come in for services. We have a wait list for folks who want to access a councillor and they can walk no one on one immediately and access groups immediately but what they can not access is a councillor. There are times where there is a onemonth to threemonth wait list and there have been times its up to six months for the service. We need more money to have more treatment on demand. Its just not funded at this point in time. I know my time is out, so i will continue to move it fast. Thank you. Sorry about that. So what works is Harm Reduction. I think from a Harm Reduction perspective, multiple tracks, accepting people to continue to use called Substance Use management and people who want to stop using one but want to use targeted abstinence. That work and works well. There is data there on the programs we have. Finally, theres a lot of things here that we know, so i would say putting together a Behavioral Health task force would be a great way to be able to dig into these ideas, get the best thinking on the table and really, then, to start to look at mechanisms and ways to pilot these service. Many providers, some of whom are in the room, have targeted or have piloted these services with success. We have successful models in place. We need for resources to actualize them further. Thank you. Thank you. So next up, our final presentation from dr. Fu dr. Fumi nitsuwishi from Case Management. Thank you for the opportunity to talk about citywide and to participate in this. Im a psychiatrist and the executive director of citywade Case Management. We are part of ucsf and ucsfg. So i think i would lic like to t with thre three questions. Every door is the right door. But who needs the most help in getting to the door . What are the doors and how does an agency like citywide help unlocking these doors . What are the challenges and opportunities. So let me start with telling you about citywade. Citywide. Weve been around since 1980, and under the department of psychiatry since 1985. We rate based on contracts, mostly from dphbhs. We have locations. The main on six and mission. The most help knocking on the doors . I think folks ha are duly diagnosed, ha have substance disorder are the folks who need the most help. We need people with severe quadruple diagnosis. I totally made this up. Weve experienced severe mental challenges, talking about legal challenges, food insecurity, about housing insecurity and folks who experience social injustice in a big way. And also, i want to say folks who experience trauma. And i dont mean ptsd. Im talking about traumatized relationships with our system of care. Im talking about folks ha have a very, very hard time coming tg and knocking on the right language and getting in. Those are the folks who need the most help. So how does citywide or an agency like this go about helping these folks . We have intensive clinical Case Management. Its a long name. How do i define icm . So what is icm . We are trained clinicians who are case managers, psychiatrists, nurses, employment specialists, peer specialists who work as a Team Together and were highly mobile. please stand by . Number one, what we do is engage clients. What that means is that we ask the question of what do you want rather than why dont you do something that we think you need. Number two, we help them enter Substance Abuse disorder treatment, which means sometime we need to do advocacy work to make sure our clients who may have been banned from treatment because of prior behavior, this is reality, too, to make sure she can have a second chance. We help them stay in treatment, which for some folks it means we help them accept medication long acting injectables to make sure that, you know, if they are feeling paranoid they dont leave the program because they are scared of the setting. We also help think about transition. Getting out of treatment is a big deal. Any transition could be potentially traumatic and difficult. We want to usher then. Our folks tend to go in and out. They relapse and reenter the system of care. What we do at city wide is hold them throughout it. We are their family and their constant. I am actually going to skip a few slides to show you something because i think this is really i was not going to cover this, but i think it is probably helpful because we have been talking a lot about this. What is the treatment that has to happen before the treatment . That is the treatment that we call pretreatment. This is the treatment of folks not quite yet ready to enter treatment, and yet it appears they are in distress, their homelessness seems distressing, and so i think and that is where we bring in pretreatment. That is heavy on outreach, heavy on Crisis Management and Harm Reduction. It is about engaging the client, whatever it takings. It is about being where they are. Unfortunately, as you can tell, pretreatment does not cannot be reim percented by medical. That is what we need to think about. Let me go back to my slides about the challenges and opportunities. There are a lot of challenges and opportunities. Number one, engagement. When you use medical billing with documentation requirements and intakes and forms and so on, and put it together with working with superacute clients, very difficult. What i would argue for are other form of reimbursements that are less restrictive and reduced caseloads. It takes reduced caseloads to really do the work. To the bottom, the issue of accessing services for justice involved population is a topic of its own as supervisor mandelman pointed out. In terms what would it look like if icm were extended to everybody who needed treatment . That is a big topic that is entire system is working on. I think, number one, we dont have enough icm slots. We need more slots with a flow that works. One of the Simple Solutions is to actually integrate the icm so they contain an Outpatient Clinic within it to transfer clients within the clinic is easier. Clients have Agency Relationship which is hard to transfer to a new agency. I think that would be something, and, as a matter of fact, not a lot of icns have those foughts. Safety is a big deal. As a matter of fact it is really linked to retension as well. Retention as well. To think about improving the system we need to go toward the quadruple aim to think about client outcomes, what happens to clients. We also need to think about experience, how is it that the setting of the clinical sets is welcoming to them and so on. We need to think about resources. We also definitely need to think about our providers. Thank you. Supervisor mandelman thank you. Colleagues, any questions . I will have you come back for a second. There is a fair amount of talk about well, beginning of the conversation about these 4,000 folks who were identified as priorities, folks who are homeless and have serious Mental Illnesses and 95 have alcohol use and many have Substance Abuse disorder and something in the high 30 are users of the systems, low 40 , in that range. I think we dont do we know how many of those have a case manager . This might be a question for dph . I dont think we have that answer . Supervisor mandelman if you have 1200 and there are 4,000 we know we are far short of providing Case Management even for the folks who we would prioritize in an ideal system. Right. I think you may know about this, but i want to make sure that can you put the screen up . Within citywide we have a range of services, some teams are more mobile, have smaller caseloads, general funded and mhsa funded. Their ability to address the high priority is different from the 251 caseload. I dont think we know how many of those folks are case managed, some are. Supervisor mandelman priorit even all of them have assigned case managers. A lot of work to do. Supervisor haney. Supervisor haney thank you. Similar questions across the Different Levels of care, is there a standard ratio of patient to case managers . Standard . Supervisor haney what is it like like for the kind of the higher levels . Let me give the numbers. Citywide stabilization programs, three different teams ranges eight to one to 13 to one. The highest level which is our newest team is eight to one. Supervisor haney they are generally part of once you are going into a certain type of program with which you have a relationship, they are assigned a case manager and you provide the Case Management services for them. What happens if they completely leave the program or they are dropped out, you are still providing those Case Management. The metaphor is we are a little like the family. We are not going to disappear. We will always be there to help folks enter in and out of treatment. Whatever they need based on their wishes. Supervisor haney thank you. Supervisor mandelman thank you very much. Now we will take public comment. I will call some names and the folks could line up over on the right of the chamber from your perspective, left from ours. Laurlaura thomas. Gloria berry, michael lion. I was wondering if i can go first i have to go pick up my son. Supervisor mandelman let me call the rest of the names. Bryan edwards, nato green, liz cody, curtis brad ford. Troy adams, john mccormick. Leann lamonte. Sf Public Defenders Office. Glide, laura sign, hillary brown, june bug and tak fatina. You have two minutes. Speak directly into the microphone. If you have prepared written statements leave those with the clerk. No applause is permitted. In the interest of time speakers are encouraged to avoid repetition. Hello. In the spirit of melvin bell high i want to use demonstrative evidence as my debate. I am the evidence here. I dont have a doctor in front of my name but i do have a ph. D. In drug addiction and homelessness. I was a drug addict for 20 years, 15 of those i was homeless on the street of San Francisco. I had three sons on the street between fifth and sixth on market street. I have been clean and sober for four years. I know the programs today in San Francisco have worked for me. I want to talk about why i am passionate about treatment on demand and i believe we need treatment on demand now. We live in a age in a society. It is now. When i was homeless in the 1990s i had a lot of opportunities and people tried to help me to get to recovery. I felt like there was a lot of problems with getting the access that i needed at that time. 360 wasnt there, citywide was hard to get into. I didnt know about u. C. S. F. This is what my idea is. It is a dream. I know the homeless problem is a major problem in the city. I believe if we were to concentrate on getting people off the street into recovery that would be the easiest way to move half the people on the street. My idea would be get treatment on demand, then call today now havvan that comes around with te help of sfpd. We can jail people because they are probably doing something illegal using the law and giving them an opportunity, we want arrest you if you go into recovery. Supervisor mandelman thank you. Next speaker. Please address the panel from the microphone. I will pick up your papers in a moment. I am cheryl, i am the county patient rights advocate. In the system for 19 years. I am a mother of a 36yearold dual diagnosed Mental Health and Substance Abuse individual who is marginnally housed right now. Sometimes homeless, sometimes not. Has been through the system a lot for two years. Here we are again. I have exhausted my savings, i am in debt 40,000. I cant seem to get a break. What i did was i wanted to focus more oh, no door to treatment but revolving door. We have been hearing for the last 19 years every door one door is the right door. There is no accountability to treat the patient in Behavioral Health. The burden of responsibility is on the client to decide to be treated as if their stubbornness and high risk behaviors is the problem. Treatment is not providing medical monitoring by giving the client prepackaged meds for the day and send them back to homelessness or wherever else they go. Treatment is not giving the client a referral nor following up with the referral. Treatment is not spending 30 minutes with the client and not offering any further assistance. Treatment is not calling your case manager while you were having a Mental Health crisis and you are told to call 911 or go to the emergency room. When you get there you receive no treatment or 911 when the Police Arrive and escalate the situation. Treatment is not allowing the client to hit rock bottom. I bring this up because it seems the mantra of is system is we blame the client. Parents are told jail would be good for your kid, kick them out, and quit ebbin being an en. I did all of those and this is where we are. Supervisor mandelman thank you. Next speaker, please. Hello. I am liz. I am part of the treatment on demand coalition. I heard a lot of really interesting things today. I think some of what was most alarming was the report that came out in july from the treatment on demand in accordance with proposition t. When that report came out, i sent it out to my staff, i work at a nonprofit, not funded through the department of Public Health. I have a new case manager on the staff who is very earnest, new in the field. He saw in the report there was no wait for residential treatment beds. It says less than 24 hours. He was wondering why his clients werent getting in. He thought maybe they were lost or cant make it there. He came to me upset and said this report says there is no wait for residential treatment beds. I am going with them and i cant get anybody in, and i think it is am alarming, not even that it is happening but the city reports it is not happening. I think that what this report really shows is that we need to get an agency not dph to take an outside look what is going on in the system and why people arent getting there. We heard from a lot of people that these systems arent set up designed for homeless. There might be barriers for Homeless People accessing the services. If you talk to the community it is the people actively using drugs on the street that want served. There is a way to serve those people. I encourage the members of the committee to think about involving people outside of dph and getting oversight. That report was a joke. We need treatment on demand and not just language that says, hey, we are doing a survey to see if we have a problem. This is a crisis. The problem is here happening. You can see it walking on the street three blocks. Supervisor mandelman thank you. Next speaker. Good afternoon, thank you for listening. Today i represent treatment on demand. I am their representative from taxpayers for public safety. I want to thank you because i did have some resistance about having another task force and another hearing, but this is really important. We are very committed to it. What we heard today. I want to focus on the task force. We need the task force. Today we have seen that. Basically, on that task force when you meet the criteria for selection, please find key problem solvers no matter what their content is. Please, all right. We need that. Your questions were problem solving, and that is what we need at this stage. Your job, in my opinion and our opinion is that you really need to monitor this rigorously, not just an annual report, not even every six months. Thithis is a crisis that has grn since treatment since Harm Reduction and treatment on demand legislation. We tried on an incremental and we are too passive in problem solving. Not a blame on this, but we have to change. You dont need to throw more money on the same any. You need to do it different leann then do it better, not the other way around. Please do it differently and some of the contract people in particular are more able to do this and lots of great investment ideas and pilots or whatever you want to call them for the moments of opportunity for people we havent been able to reach are right here. Supervisor mandelman thank you. Next speaker. I am Brian Edwards with the coalition of homelessness and treatment on demand. Before i was here today i was in a demo of private folks that have come up with Substance Abuse apps. I would like to see what the app folks came up with, and it is not good. We really need to beef it up here. I guess i will talk so much of what was said today it is great stuff with dedicated folks. There are folks in the room instrumental in my recovery. I was a train wreck for years. The reason i get up every morning and dont think about using, dont fall under it. It is housing. It is housing. I knew the last time i got into care someone actually was very, very helpful inputting me in a coop. I live in a house with two people i cant fucking stand but i dont have to worry so much about rent. The last time it came falling apart. I hate talking personal experience. It was because i was doing the hotel room shuffle. I had broken up with a girlfriend and doing an air bnb for a month and it was too much. Entering treatment doesnt mean anything unless you know, i am going to have a place to live the life i am trying to rebuild. It is housing. You almost said it. You said treatment to something. It is housing. It is housing. A coop, step down, it is housing. We need to include housing in treatment on demand. Otherwise, you can walk in and just the churn like a hummingbird. Housing on demand, treatment on demand. Thank you. Supervisor mandelman next speaker. I am miriam. I am part of the treatment on demand coalition. I am from denmark. That is quite a socialist place compared to here. What shocked me in San Francisco was not the people and misery. It is the lack of treatment on demand, lack of housing, lack of support from the government that create structural barriers to these people. So much responsibility is put on the individual. For me coming from denmark that is insane when you deal with a population like this. I dont have much to say other than just like Housing First and treatment on demand is so vital in order to protect these people in misery. Supervisor mandelman thank you, next speaker. Hello, supervisors, nato green representing the department of Public Health and the nonprofits. We support treatment on demand and what the nonprofit folks are talking about the need to invest in that work force to have what they need to meet the need. Supervisor mandelman asked how much is it going to cost . Our answer is you are already spending that money. The city is pending it in the worst way possible. We have the beds now, it is the hallway outside the emergency room today. Sf general emergency room was on diverse 60 of the time last no, there are dozens of patients in every unit of sf general lower level of care because they have nowhere to be discharged to. The patients who need services are waiting in the most Expensive Services possible in the hospital or jail because the city isnt funding the up treatment investments in the services they are talking about. We want to support you to make those investments to the services that Everybody Knows the patient needs and the people want instepped of paying for it on the back end. Thank you. Supervisor mandelman thank you. Next speaker. I am ben lynch with the glide foundation and treatment on demand coalition. I agree with what everyone said. There are folkses who wanted to speak but couldnt be here because of the time. We see everything said daybyday. We agree with everything from the coalition and with everything in the report. I want to add i have had several years of experience as a Mental Health program evaluator. Mental health is hard to work in. You can get 90 of the way there with somebody if you drop them or if their trauma is restimulated or something adverse happens pothem it can set them back. With as many holes and big gaps and turns people is causing a huge problem, taking that 90 and some percentage is going towards reharming people. The kinds of evaluation work i got to do with nonprofits we had to do tons to do the reporting including having the thorough process will give us the groundwork we need and i really hope that we all push it through. I thank you so much for the work and staying here so late. Supervisor mandelman thank you. Next speaker. I am fatima a social worker at the Public Defenders Office and on the coalition. There is a crisis it is hurting the marginalized people of the city. Too many of our incarcerated clients with Mental Illness who are noncitizens with limited english sil it is it is in jl longer. The majority of program in the city dont have language specific curriculums, not love bilingual staff and not enough beds in those culturally specific programs. They cant sign up while in custody to get an interview, three, the group of clients are from outofcounty and cant sign up for medical while they are in custody for outofcounty medical or dont qualify in the first place. These are all barriers that are often ignored. We need real treat treatment on demand. Immediate access with no barriers for everyone who needs it, especially for incarcerated people. Thank you. Supervisor mandelman thank you next speaker. I am an attorney at the Public Defenders Office. I handle drug court, Community Justice court, intensive supervise court and Veterans Court and Behavior Health court. I want to make it clear there is definitely await list for residential treatment programs. I think my clients wait a minimum a month in jail for the treatment programs. That is really good. Just to let you think about the barrier that causes because that does cause people to often not seek treatment and plead guilty and get out of jail and it does nothing to treat the root cause of crime. I also wanted you to consider some other considerations, the jails are full of drugs. I just learned that today from a case manager we are going to deal with overdoses in jail soon. There are not enough Harm Reduction programs so that if a person who is really well meaning and trying to get treatment uses, which is common in the path towards recovery they are kicked out. They are not allowed to return within that year. There are people in drug court trying to get treatment and nowhere for us to turn them to. I just want to make that clear. Supervisor mandelman thank you. Next speaker. Hello. I am troy. I am on the coalition. I have talked to you before. Basically i want to say that when you become homeless as i was for about a year and a half, your confidence collapses. I would almost argue that every person who experiences homelessness in the city, especially the way the city is right now, is partially suicidal. I thought about it when i was homeless before i got in the shelter i thought about suicide at least once or twice each week. That changed when i finally got into a shelter. What it means to basically have a safe place. I went from being with the coalition it is having a safe consumption site. I live in the tenderloin. I dont want to see people having to be on the streets with dirty hands injecting something into their body to kill them with bacteria. I went to see a place where people can go to do their drugs and this is coming from Harm Reduction model completely. I worked at the foundation and we had needles in the 80s and 90s, it was against the law but we did it anyway. I want the city to stand up and take care of the citizens. Supervisor mandelman thank you. Next speaker. I am the Community Organizer with Community Housing partnership. I will echo what a couple other folks said. I myself experienced homelessness. I still suffer from Mental Health and dont have the ups and downs i did when i was homeless because i have a stable housing environment. Any time that that stable environment seems to be in flux, i will end up having ups and downs. I definitely echo that big part of treatment on demand is housing access. The trauma and wealth and equality are on demand. One of the mothers here earlier wanted me to mention the drugs are on demand on our blocks. The opportunity is on demand. Criminalization of homelessness is on demand. When is the treatment for Substance Abuse on demand. The causes are on demand. We need the solutions. We demand supporting housing now a task force to navigate within Mental Health alongside social and economic opportunity. Thank you. Next speaker. Good morning, i am troy adams. I represent 250,000 drug addicts in San Francisco. A few years ago i was in a low point. I was using meth 35 years addicted. I went to a drug rehab center. They said can you wait an hour . Can you wait one hour, we are really busy right now. I went back out and started using drugs and fell in another deep hole and stayed there three and a half, four years. Didnt think about treatment. It takes an hour for someone to go back to what they are doing especially when they have done it so long. I dont want this shit to happen to anybody else. It is painful for me to think about it. Thank you very much. I am leann drew. A native of San Francisco. I went to high school here. I feel like i was a victim my life until i got treatment and went to recovery now, i feel like a walking success story. I want to appreciate everyone in the seats. We are altogether with this. Thank you for giving me some time. Good afternoon. I am hillary brown. I am one of the residents at tenderloin for 15 years. I treat people with Mental Health issues. I am an advocat for health justice. There should be treatment if there is people using might be caught with federal Law Enforcement and incarcerated for many years by Law Enforcement. That is my support. As you are aware it the jails are overcrowded. The people in james are serious offenders like victim crimes. I believe there should be a treatment with a demand for people especially the people on the streets. Personally i never was a user. I knew a lot of users who spent years in prison for using in the streets. That is all i wanted to say. Supervisor mandelman thank you. Next speaker. Good afternoon, board of supervisor i am june bug a former San Francisco youth commissioner. I am a member of the treatment on demand coalition and work with all kinds of organizations, born and raised here, child of addicts. Prior to me becoming a San Francisco youth commissioner there was a conversation in 1997 around treatment in demand. The conversation has been delayed as well not Just Services implemented. This is long overdue. We really need this. Treatment on demand would enhancervises and create wraparound services. We need treatment on demand, not delayed treatment. We have a city that needs to take responsibility right now for what is happening in the streets. We have an epidemic of people overdosing. My friend died one year ago, someone i care about had to be incarcerated to get services. This is something that should not be a criminal approach. Treatment on demand is more humane to make sure people are not delayed. We have a system with gridlock creating to me delay equals depth. We need this now in our city. A lot of traumatized people end up having Mental Health issues which then lead to having Substance Abuse issues. Please, treatment on demand. Thank you. Supervisor mandelman thank you. Next speaker. Jessica with senior disability action and treatment on demand coalition. I am the only one here representing senior disability action today. We have a new group of people with Mental Health disabilities coming together. That is happening because people feel there is such a need we need to do major advocacy around these issues. We brought people together earlier this year and last year about posing the expansion of conservatorship until people get the services they need. There was an idea people are turning down services availability. Everyone who had lived experiences couldnt get the services they need. People were deathly afraid of being institutionalized. They said it wasnt what they needed. They needed to have Good Services available. I appreciate there was a comment earlier about the services out there are not always the Services People need. I think that is true in a lot of ways. Sometimes services arent available after 5 00, not toward seniors, not accessible or not provided with housing. As pointed out there is not enough services to meet the incredible need in our city. We are glad to see this conversation happening. Thank you for looking at these issues today. Also, it is important to change the conversation so that it is really by, for, about and led by people with Mental Health disabilities who know better than anyone what we need
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