Clerk yes chair, still providing via comments via telephone. Public access is essential and well be taking Public Comment as follows. First Public Comment will be taken on each item on this agenda. Those attending inperson will be able to speak first and then well take those calling online. Public comment callin numbers across the stream. When connected be in listening only when your item of interest comes up, and public calls, those joining us inperson should call star3 to be added to the speaker line. Please remember to turn down your tv. You may submit Public Comment in writing. You can email them to myself. Aye. Chair march. Aye. March, aye, two ayes. Thank you, madam clerk can you please call yellow light number 1. Clerk yes, item number 1 is a hearing at the conditions Psychiatric Services unit at San FranciscoGeneral Hospital and Psychiatric Services and requesting the department of Public Health sul Crisis Response team to report. Members wishing to provide comment may line up to speak or if youre joining us remotely, please call the public number. Then pound and pound again, once connected meeting, youll be prompted to the line. Please wait until we take Public Comment on this item and when the system indicates that youve been unmuted, that will be your cue to start speaking. Thank you, for all your leadership on really addressing our Mental Illness. And thank you for calling for this special meeting today. The floor is yours. Thank you, chair for making time for this hearing today. The state of pes is not going back as long as ive been on the board, membersed of this board have heard troubling stories and statistics coming out of pes. I remember touring pes on my first year on the board and troubled numerous time when pes was on diversion. The concerns helped drivein conclusion of the proposal that is now four years old for a crisis diversion facility to be included when it was passed in 2019. So i was not surprised but troubled to read back in april in the examiner that conditions are still challenging alt psych emergency and still a capacity problem and staff, there still is or was in april in under staffing problem. There have been positive developments over the last four years of some initiatives that were intended to take pressure. The opening of summer rise as drug sobering facility was thought to be an intervention that might relief pressure on psych emergency as i know that opening of door urgent care years earlier had been an intervention to try to relief some of the pleasure on psych emergency. Im concerned about, you know, psych emergency one because we need a facility. For people who need emergency Psychiatric Care. Who wre see far too often not getting that care on the streets. So we need a place where people can go. So if were not able to accommodate that in San Francisco, thats a problem. If folks are having to go to ghs, we heard from other hospitals that that creates challenges for them there. But we think that the conditions within terms of pressure and staff throughout our response our Behavior Health response who have behavioral needs. How were doing on facilities that do relief pressure at pes. And by folks who need the saoet and take a place who takes a psychiatric emergency. Thats what were going to try to do here today. I want it thank everybody who participated today for all of your help not only scaoepg yourself but all the people in your office. Unless chair thats anything, we will start with a presentation from our director of Behavioral Health dr. Hillary and dr. Mark leaery on behalf of dph. Thank you, chair mar and supervisor mandleman. There should be a presentation coming up soon. There it is, great. Next slide please. Thank you for coming to talk about our emergency services. Staffed by a psychiatric during the 247 hours. We provide emergency assessment and treatment of Mental Health and Substance Abuse and triaage of medical conditions when they arise. We provide linkage to followup services which is crucial. And we received voluntary and involuntarily patients in pes. As supervisor handleman mentioned, people are brought in voluntarily or by police. To reduce the risk of infection in our congregate setting. Next slide please. We have psychiatrist and psychiatric Nurse Practitioners onsite 247, we have psychiatric nurses and license tech who are staffing one staff to four patient level at all times. We have psychiatric social workers who focus on linkage for our patient. Psychiatric occupational therapist provide life skills assessment in pes along with group settings. And then finally were excited about the hiring of a Patient Navigator for pes which is in process right now. Next slide please. I want to emphasize that pes has been open throughout the city throughout the open pandemic. At the beginning of the pandemic with the support of our hospital leadership, we pivoted to have all psychiatric patients who are coming to the campus for care to be arriving at our csfgd the Emergency Department for covid clearance. This technically true, its really a technicality what that read is on the emergency network, that is the communication that lets the ems rigs and Law Enforcement units that they need to go directly to the gsfd and not bring patients to pes. So we dont want patients arriving at pes unscreen and have to bring to that congregate setting. Sol once patients arrive in the ed, they are triaaged and treated by a pes psychiatrist who is onsite in the ed16 hours a day from 7 00 am to 7 p. M. , overnight thats a chaired responsibility between pes and ed. We also have the behavioral emergency Response Team as well as pes support team that helps us with patients in the ed before they get over to pes. And as a result of that process, about onethird of the criminal patients are discharged directly from the ed. And then the other twothirds are transfers to pes after theyve been covid cleared or any other medical concern that they may be present with. I want to emphasize that pes has been open for the city throughout the covid pandemic, weve been opening 82 of the time for an immediate transfer once the patient has been covid clear. 18 of the time waoefn closed to that transfer process and patients have had to wait until a space opens in pes. As a point of comparison, prepandemic, we were on condition red, true condition red in pes 35 to 30 of the time. So were actually doing well with this process, i believe. Once patient arrive in pes and are treated assessed and treated we provide linkage to care and this is a look at what is happening here in 2022 year to date, 18 of people who come are admitted for acute in hospitalization. Most of those depending on their insurance coverage. 5 are discharged and admitted to the res pid either on campus or valencia. As you know Behavioral Health urgent care unit. And finally 65 of the patients are discharged without patient referrals including kids management. There have been a number of, im sorry next slide please. Next slide please. One more slide, sorry about that. There have been a number of renovations in linkage between pes for example. 120 increase in discharge medications both psycho petric, between 2021 and 2022. The dph behavioral bridge and services team, the best Team Provides link an managers who actually tom to pes to enhance the linkage process. Dph Behavioral Health has helped to strengthen partnership 360 to provide detox for our patients leaving dps and their Alcohol Treatment Program residential program. We also are making increase intensity Case Management referral to transitional age youth, acute linkage our city wide linkage and reducing residivism program. And finally wanted to give you a picture of what happens when patients leave our inpatient unit at San Francisco general. And you can see here 127 patients or 31 are discharged home. 18 are discharged against medical advise. And this is a group of patients who are voluntarily man holds and are released by court, by commissioner of the court from their legal hold and choose to leave the hospital. Can we stop there for a second. Sure. Thats 72 people where dps is recommending against release and theyre still being released . Thats right. Over between august of 21 and march of 22. Thats interesting, thats interesting statistic, okay. Ill be happy to expand on that. So 12 are discharged, crisis residential, 8 are transferred to our Medicine Service, one of the benefits of being codependent. 8 are discharged to the humming bird psych respid program. 6 go to shelter, 4 go to Residential Care facility or care and board facilities. 4 of patients decline referrals. 3 go to residential Treatment Facility those are longer term residential Treatment Facilities as opposed to the shortterm adus. And very small numbers, 1 go to psychiatric skilled nursing, transitional housing and Residential Care for the elderly. And sadly, the very last bar there, we only get about 1 patient a year into the state hospital. Actually, can i ask a question on this one too. Sure, chair mar. Do you know how much ~ i assume youre speaking the facilities, i dont have numbers on that. I think we could get that data for you. Thank you very much, happy to answer any questions. That was it . Im asking, if that was the presentation. Yes. And then dr. Cunnings is going to speak. I have things to ask but maybe we should have dr. Cunnings and then have you come whack. Back. Okay, thank you. Good morning, supervisors thank you for inviting us to talk about this important topic. And ill just wait a moment for the slides to come up again. Just one note at the to many that ill make. Were working collaboratively with dr. Leaery to strengthen in whatever ways we can both the incoming need for care as well as the discharge related care, knowing that pes, neither pes nor Community Base can stand or stand alone. Soy share with you today some of the work that weve been doing, in that regard, you are familiar with pieces of it and weve tried to put the context here how we are interacting and supporting the work at zuckerberg. So ill speak first about alleviating the demand, followup treatment and i know that you all were interested in our hiring update as well. Next slide. Zoo let me speak about the coverage about alleviating demand either by preventing crisis or innovating early and in community with crisis. I know you all know about our street Crisis Response teams in the month of june alone, skiter engaged with 226 clients. And between november 2020 and june 2021, skiter engaged with more than 5,000 clients. The outcome has resulted in fewer than 15 of clients who needed transport to the hospital. I want to acknowledge my colleagues at the Fire Department with whom this program is in partnership. To our urgent air as already mentioned, directly admits clients from pes who need further stabilization and connects them to next levels of care for example, the acute divert units and residential programs and so forth. In fiscal year, in the current fiscal year, or last fiscal year, apologies, approximately 1600 clients were admit withed an average daily admission of 4. R5 client. Finally outside of the Behavioral Health with whom but is also an Important Program is whole person integrated care which operates urgent care and sampling of one month, ten percent of clients that they say had an urgent Mental Health episode which they were addressed in that setting. Next slide please. Also as dr. Leaery mentioned, humming bird, or im actuallyto see if this is both humming bird, 433 admissions for overnight stay. A majority of humming bird clients were being referred by pes or the medical emergency room as well as zuckerberg inpatient unit for further stabilization. You can see the further specifics in the table before you. Next slide. Also as you know, there have been a number of resent openings and efforts under way to improve Behavioral Health services, all of which in part support and ideally minimize or mitigate the demand on Crisis Services including pes and so here you have humming bird valencia which was open as you know, 2021, therefore 20 beds for overnight beds. Summer rice which newly opened last month, a drug soebing center for people experiencing intoxication or mental crisis due to drugs. This is intended to be a safe place to rest, stabilize and importantly connect people to on Going Services. This program is still in the process of ramping up in its early weeks. There are currently 12 beds or Spaces Available with the intent to expand to 20. Further, it is currently open 12 hours a day naending to move to 24 7 in the next few weeks. In the first weeks of its launch, summer rise, has served 230 clients. It has proven to be an Attractive Service for our folks in the community. As you already mentioned, supervisor mandelman, we are working on unit. This service will be a crisis unit capable of providing up to 23 hours of care. Next slide. I now want to transition to ways in which Behavioral Health on services are aiming to support pes discharges through pes base program city side has two social workers when its city wide stabilization programs to provide discharge planning support and coordination. As dr. Leaery mentioned it is well integrated into the pes work flow, these are folks with expertise throughout the city and they provide direct referrals to our Case Management bridge teams. The next paragraph discusses our office of coordinated care which has been newly launched in the last month. This office provides followup for individuals specifically around, who have been served by skiter teams, Response Teams and have been placed on 5150s. Additional our expanded team also provide bridge Case Management for individuals who are being discharged from acute levels of care including pes, including patient psychiatry unit. So this is a new resource that has come online supporting hospital and pes discharges. Let me move on to the next slide. As you also know were aiming to open new and Residential Care beds. So far in 2021, 89 beds were open and additional 89 beds have opened as of july 2022. You can see the range of types of beds that have been opened. And we are anticipating an additional 70 beds to open by the end of the summer as our program capacitys grow and new programs open. By the end of the summer, this will get us to approximately 250 of the 400 beds open goal specified in hmsf. The next program that will open shortly is 46 beds at a site called victorias place, this will be rehabitative care. I know you had answers about planning and bed planning that the dph is undertaking. Were aiming to complete a second bed stabilization by the end of 2022. As you know we need to update the original plans. We are also updating our realtime times. We expect well be ranking the wait lines online in the coming months and that will enable us to know what is going on currently and help with planning both near term and longer term. Next slide. And finally, i just wanted to share with you, hiring update that as you know, under the emergency initiative, we undertook a process of expediting hires for the services that will serve people of the tenderloin and beyond. You can see here that our work has continued aggressively to filet needed informations both preexisting to back fill vacancies across our systems of care as well as to fill positions enabled by the new programming under prop c and mhs. In total we have hired, either on boarded or the process of selecting candidates for approximately 400 workers across our systems of care in Behavioral Health as well as whole person integrated care. And that is my last slide, were happy to take questions. Thank you, i have a few. And i guess, maybe wub way do this is go through the more interesting slides. Can we go back to the first presentation on the linkage . Let me pull up the slide that says linkage renovations. There we go. And so linkage is important well, dr. Leaer tell us why linkage is important. Well linkage is very crucial when patients present in a crisis. What is going to determine their ultimate recovery and ability to live with, psychiatric condition is their followup. So thats a crucial part of what we try to do and what our Mental Health system does to be able to link patients so that they can relatively after they leave, they can have an appointment with a Mental Health provider that is appropriate for their need. And i dont know whether this is a question for dr. Or leaery or kunings or somebody else who is not in the chamber today. One of the thing that has had to have happening, i assume its still happening, but had been happening prepandemic, was that a relatively small number of folks were generating a lot of visits to pes and a lot of need for and i think even for more extended stays in patients. One of the findin