Transcripts For SFGTV Government Access Programming 20240713

Transcripts For SFGTV Government Access Programming 20240713

Highestrisk, highestneeds people. And i think i should have mentioned the drug sobering center. These are other 24 7 facilities which this Response Team could take people to and get them the help they need. Through the chair, i just think its important to talk about how this team is distinct from the h. O. T. Team and the e. M. S. I know it feels like a lot of teams, but we fought to make sure that the language requires coordination amongst all of these teams. They really do have distinct roles. So the h. O. T. Team is not supposed to be experts on Behavioral Health. Their mandate is to outreach and engage with people who are experiencing homelessness. Lets remember, not all people experiencing homelessness have Mental Health or addiction issues. So they are they have another role entirely. Its about well, thats a role that not all of us feel comfortable with now and were always constantly battling out, but it is distinct and separate from the issue of Behavioral Health. The e. M. S. 6 team, the firefighter has to come when there is a physical risk to safety. So its not just that someone lets say someones passed out, for example, or someones injured because they were in psychosis and they walked down the street and got hit by a car. That couldnt be this team. That has to be firefighters who have the medical training to deal with physical impacts that are related to addiction and Mental Health, overdoses, et cetera, but that arent but that requires some sort of physical medical attention as well. This team is for people that are not in a physical risk to bodily harm, but are having a Mental Health crisis, psychosis, or druginduced psychosis and they need a Behavioral Health professional to come and engage with them and get them into treatment and care, but theyre not theyre not overdosing, theyre not they havent been hit by a car. Theres not an immediate risk to their physical need. That is a distinct thing. Believe it or not, we need all of these expertise. Without all of this specific expertise, we are missing a part of the population that is currently living on the streets. Well, im excited to see how the conversations about this team develop. I do think e. M. S. 6 does a lot more folks who may not have had a physical injury. They may be at risk of a physical injury at some point, but their charge is to work with folks to prevent things from being more expensive thats what i was just going to say, then were not spending our resources well because we dont need that level of intervention. Theyre being assigned based on high 911 callers, but those 911 are not always generated by a physical injury. But at any rate, im looking forward to seeing what the Crisis Response street teams look like. Supervisors haney and ronen are asking for big, bold, structural change, as is this board. So i think what we at least to know what it looks like, not just to expand what we are doing now or make it look or make it work smarter or for efficiently and effectively and raech people and have more places to take people, but actually meet the need and the demand. So that i as a san franciscan have an app and a phone number that i can dial and know that i will get a response that is as timely or almost as the 911 response, but is calibrated to this problem were having in San Francisco right now of a ton of folks who are under psychosis or inebriated and need intervention. If thats more money thats needed, we should describe the program, show it, put it on the policymakers i do think that the good thing about Mental Health s. F. Is that its asking us to think boldly about the system that we want. That will in order not to be i think i think for this to fall flat at some point, we need to be honest about what the scale and costs are going to look like if we do this and actually deliver what people are going to be expecting with Mental Health s. F. If we can do this for 6 million, fantastic. I will be not surprised at all if deliver be that response which san franciscans deserve is a lot more than 6 million. May i say sure. Go for it. I think and with dr. Hammers information and speculation, i think we are being asked to in some ways speculate on things with all humility we dont know yet. I think we all are looking for a transformation and we acknowledge that we need to do that. I also think we need to be very thoughtful to apply scientific methods to transformative change. I would be as a provider myself, when i make assumptions and speculate what a patient needs, i am usually wrong. So i just think that part of this effort and also with all forbearanc forbearance, we will test things and some of those things are not work. To be bold, by definition, you have to be willing to take risks. The things that do not work, we will recommend that we no longer invest in and change, and the things that do work we will scale up. I think in this process, we have done great things in the health department. The Behavioral Health team is an Amazing Group providing grate solutions. I think as we look to solutions, in some cases we have become a little bit lax in San Francisco about the possibilities we think about. With dr. Hammer and dr. Nigusse bland, we look outside to other models to say how would this work in San Francisco, take those programs, make the right investments to pilot them, potentially scale them up. I think there are some things that we know, like the Case Management piece that we know enough about that we do need to scale up, theres enough evidence there. On the other hand, as we transform our system, theres not a lot of value in case managing people if we dont have places and resources to case manage them to. I think thats one of the key things that ive heard in talking to our workforce and community partners, one of the great frustrations, because youre basically trying to work with somebody and even if that person is ready. I do think we have to thank you. Through the chair. With all due respect, supervisor mandelman, thats what weve been doing for the past year in creating Mental Health s. F. Weve tried to engage you the whole time. Up until now you havent been willing to really engage with us on it, but we have spent an entire year researching all our systems, talking to frontline workers, writing hundreds and hundreds and hundreds of drafts of this law to put that vision out there. Everything that were trying to engage you in is what Mental Health is, its a vision for a system that will finally meet the actual need thats there based on current Scientific Evidence to engage and get people to a point where they can live healthy lives. Of course we dont know every detail. Theres never been a piece of legislation throughout history that has been able to know every single detail with specificity, but what Mental Health does is take a leap and it says what weve been doing absolutely doesnt work. Its something that all of us can see every single day when we walk the streets of San Francisco. We got in a room with the frontline workers and experts in the field and we said, lets imagine and create a system that would work. Lets put money aside for a minute. What do we actual need . This is what we came up with. This is what we need. Its not only been vetted by every Behavioral Health worker and psychiatrist in the field, its been vetted by the department of Public Health and the mayors office. This is a vision moving forward. Its not a mystery about whats going to happen. I worry slightly in this dialog that youre having with dr. Colfax that youre looking for some other vision municipal the vision is Mental Health s. F. The policy that you have cosponsored is that in order to fix the crisis in the streets, we are going to implement Mental Health s. F. We have to find the money for that and were mutually committed to doing that, but this is how were going to fix it. There are devils in that detail that always were going to have to be working out and that is what the Implementation Working Group is. There are things thak the doctor said that we try and dont work, but the vision that if you vote for this legislation that you are voting for is saying that Mental Health s. F. Is a way to fix the crisis on the street every single day, day in and out, and thats how were going to make things better in San Francisco. Dont vote for the legislation unless you believe this is the right vision to get us there. I have two more substantive points i want to make about Mental Health s. F. , and i dont i dont want to get into a back and forth with supervisor ronen about the history of this legislation. I will say and supervisors absolutely have the right to work with whomever they want to on developing their legislation. If the supervisor wants to work with a different supervisor or others and not a third or fourth supervisor, that is completely in the right of the authors. The original version of Mental Health s. F. Was presented to me i think a couple days before it was introduced. I think that was the time it was presented to the department of Public Health. I have been part of the discussions. That has been worked out between the supervisors and the department of Public Health. Im grateful for the work and the consensus they have forged. I do not believe that Mental Health s. F. Is the be all and end all of Behavioral Health reform services. I am happy to vote for and support this. I have two more substantive questions. I really am grateful to see in here the emphasis and the intention to address the Behavioral Health Services Needs of folks in the criminal justice system. When we had our treatment on demand hearing a couple months ago, we saw data that was questionable about whether weve achieved treatment on demand. Were doing better there. It is completely clear to me from my engagements with Behavioral Health court and drug court. We are dismally failing to provide adequate treatment opportunities for people in jail or justice involved. I think that needs to be a priority, and i look forward to you continuing to work on that. My last question is about my new obsession with locked subacute beds. It was a little bit of a fight in last years budget to expand the number of those beds by 14. Some folks thought that money would be better spent in other areas. I insisted that we include those 14 beds. A few weeks bad we had a hearing on conservatorships. That was in part based on some work that the budget and legislative analyst had done. It is, i believe, and i believe that folks at general and in p. E. S. Believe that we are desperately short of locked subacute beds. That means that has implications and all these things are connected, and a shortage in one part of the system affects i know there are shortages everywhere. But this shortage means people stay in jail too long, that the whole system slows down referrals around things like conservatorship. I do believe that is happening and we would be conserving more folks on a short or longterm basis if we had those beds. People would benefit and not be cycling as much. Whether it is 100 beds more that we would need or more than that, its a significant price tag. Depending on how theyre done, i think 100 beds would be in the 10 to 20 million range. I absolutely think we have to make that commitment. We have unfunded and unused beds on the third floor in the Behavioral Health building. We have potential partnerships with some of the private and other hospitals that might be able to provide beds. I really want to push our whole system, this board, the mayor, g. P. H. To look at further expansions in our locked subacute capacity and to do that in the 2021 budget. Not specifically called out in Mental Health s. F. , but i think its part of the spirit of Mental Health s. F. And that is one of the reasons and that understanding is one of the reasons i will be voting for Mental Health s. F. Okay. Thanks, everyone, for indulging me. Thank you. Now supervisor stefani. I would like to congratulate everyone for coming to a compromise on this very important piece of legislation. I think if you look at the history of it and how everybody came together to come up with this solution, it just reminds me what unites us on this board is much, much more than what divides us and we do have common goals here to address a very serious problem in San Francisco. I have a very pragmatic and practical question. Its along the lines of the hiring challenges. Supervisor ronen spoke to a staffing analysis would be done, but i think it goes beyond how difficult it is to keep people in the positions. Its also i dont know exactly how many case workers were talking about. I dont think i heard a number. I heard some math that i might have been able to do in my head, but i didnt, about how many case workers we are talking about with 22 million or how many it will take. I think we need to be mindful of that going forward, how are we looking at recruiting and moving through the department of Human Resources. How are we looking at possibly creating additional regs. We have to be mindful of that. I dont know if the department has looked at that. I know it is a constant strugis truing struggle. If we dont have the money, were not going to be able to move forward. If anyone has an answer, i would appreciate it. Supervisor stefani, ill try to speak to that a little bit. Any hiring manager in the city or certainly department of Public Health knows its exceedingly difficult to recruit and retain workers, given the economy here and the challenges of this work. As supervisor ronen mentioned, the workforce that we need to build, our Behavioral Health workforce, is challenging and gruelling work. When we talk about the 24 7 street crisis Response Team, i mean, that is very, very hard work as any of us who has ever spoken to or spent time doing this work. So we are working with our department of Human Resources. We are looking to see how we can both look at shortterm and longterm solutions. We know that we need to build a pipeline. We need to really figure out how to support training and internship experiences so that so the people are interested in doing this work and can get exposed to our amazing clinicians. Really, i mean incredible people working on the frontlines right now. How can we create more opportunities for people to see up close the work and have a pipeline in for both psychiatrists and then licensed masters level Behavioral Health clinicians. We also are looking to see looking at lessons that we have of other large shortages. So really thinking outside the box and how we do much more efficient hiring of large classes of workers that we may need. So for the Behavioral Health clinicians, i think well need to do this. We also have Major Concerns about psychiatrist recruitment and retention and so we are working with the department of Human Resources to see how we can remain competitive with our with the other Health Systems in the area in terms of recruiting psychiatrists and incentivizing them to do this work. Also teaching opportunities. So i think there is some good possibilities, and we have some theres some best practices from other Health Systems. Were looking to those for both shortterm and longterm solutions, but its a major challenge. Thanks. Well, i have many comments, but considering the time i am going to actually call Public Comment right now. So i have three cards, mary kate bucalo, c. Fields, and erica frommer. And any other speakers, feel free to line up. You dont have to submit a card. Okay. First speaker, please. I didnt take a card. David elliot louis. I was an early adviser of Mental Health San Francisco. I also do work with the Crisis Intervention Team for the police department. Ive been a trainer for them. Im on the advisory group. My comments are informed by that work as well. First, i fully support Mental Health San Francisco and strongly support it. Its a bold step forward. It really helps to address a lot of our problems. I know theres some concerns expressed, but lets not let them be the enemy of the good. This is good and this is more than good. Im so thankful for all you supervisors supporting it and passing it forward. Here is my next thinking. Imagine you call 911 for a crisis on the street and instead of just hearing do you want police, fire, or medical, you hear from the dispatcher, do you want police, fire, medical, or Crisis Response . There is a city that has

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