tv Government Access Programming SFGTV December 10, 2018 9:00am-10:01am PST
family. we alleghenye allegheny -- we eh the family. they had come out to visit this person and they couldn't get this person in care. when the person was cleared from being able to be discharged from the hospital, everything happened from there. we the hospital with the intensive case management and the place to stay and went over and made sure the person was stabilized and continuously works and connect the person with the clinic. now this person i can tell you, there's been no notification after numerous daily notification we had no notification for several weeks and this person is still connected, still with the intensive case management and now is even working on some of the core issues that person had as well as working with the clinic to engage in some
activities. this is an example what it takes that it works. now i wanted -- i will let go the section i have around the audit. >> just before you do that, one other point is, you said some the recommendations that you don't agree with. you should highlight that. >> the four areas that i wanted to highlight, which kind of mimics what la toy where a -- la presented. it falls around case management, around transition to lower level of care and adults who did not stabilize. there were many recommendations and many identified areas that we've already responded to. this these were important sections of the report that we have been working on already. the work started and it's
continuing. i want to highlight this we welcome the audit. the audit allow us to look at the system much more in-depth. we learn a lot from the audits. we have multiple audits from the state and regulatory bodies. this audit was really welcomed. it helps us to look at areas to improve on and showcase what we have worked on. in the area of provider performance. we have our community-based organizations and we have civil service clinics. there's about 60 substance abuse provider organizations about 122 mental health prokerproviders te c.b.o.s. we to annual monitoring on the same standard and same performance objectives for all of them. the civil service monitoring started about five years ago and it's been something that really
is important because we want to monitor everyone on the same level. this monitoring has been going on an annual basis. we're excited about the business intelligence software that we have implemented. we can look at various live, time data. what is happen and who's getting what services and how many people are at what clinic. we're utilizing that. this is something that's been very helpful. what i would want to highlight since it was mentioned in a report, since the report from the b.l.a. was up to 15 or 16, 16 and 15 monitoring report shown improvement of the civil service programs by one point more. if they were two, they already three. which means satisfactory, that means exceeding satisfaction.
i'm very pleased to report that the year following already has been improvement. this year we noticed there was a further improvement. we've done lot of work around having training the staff as well as really looking the plans for the c.b.o.s. we gave them tools how to do that. we're going to be monitoring that. we did the same thing for civil service. we're doing that internal. we're looking at every clinic and also every staff per clinic. i'm very pleased to say this effort is working. the next area is intensive case management. intensive case management, it is an outpatient level of service. it provides more services to the
individual than it a regular outpatient clinic. it's basic the statement -- it's basically the same outpatient and the case load is smaller. they have more time and they can provide more intensive services. we wanted to look at our intensive case management because we agreed that this is an area that needs to be looked at. there's about 1400 intensive case management slots. to we need more slots? yes and no. yes and we've already acted on it. we're opening up 40 slots. we're opening 20 more slots for assisted outpatient treatment. then the hope is that by looking at our reviewing and doing utilization managements, we can open up more slots. if we need to do have more, i
think we should. at this time, i think we're doing lot of things and we have a consultants to look at our intensive case management. we are reviewing that closely and what we have -- we took on performance improvement project to look at how people from intensive case management transition to outpatient. this is a project we took on and the state is monitoring on that to make sure there's handoff it people make the connection to intensive to a lower level. we received two innovative grants that i'm pleased to announce, one is around pier linkage to help people transition from intensive outpatient as well as wellness by peer support. we got those two grants. that would support further this effort. around intensive case management, we're on it.
we're reviewing it. we're going to be doing utilization management on every single case. >> how many staff to you have that work on intensive case management? >> intensive case management is both -- there's south of market and there's hyde street west side community services and felton. there are about six programs all together. >> there's six for the entire city. how many staff is there? >> i don't know the staff for every c.b.o.s clinic. i can pull this. >> the reason i'm overemphasizing -- so it's. hundred staff. the reason i'm asking the question, it seems to me that with 100 staff and the amount of patients that go in and out of those services, if we're talking
about 2200 individuals that accounted for 50% of the uses of emergency care that need intensive care, they are a major cost to the system. i'm wondering who your strategies to deal with that? >> there are three approaches. one is to look at our current 1400 intensive case management slots that we have to make sure those people really need that level of care or could they be transitioned out, that's one. second is to assess anyone who's referred to intensive case management is that the right level of care for them. third, we actually need to address the issue of staffing. not staffing to just increase it but to address the vacancies. we have 11 vacancies in our intensive case management system. those are both civil service and
c.b.o.s. this is very hard work. not a lot of people want to do this work. when they to it's very intensive. it's the impact it has and the traumatic effect. that is hard. salaries is competitive and working in san francisco, they are being recruited. majority are all those vacancies are bilingual position. we need to address the staffing to recruit hire and maintain. then we can look at the current slots and also with the addition ones to make sure we can review who's coming in. >> i guess what i would like -- the thing that jumped out to me the most, we always understood that individuals receiving
emergency care, i don't think that's anything eye-opening to anyone on this panel. i think the thing that is eye-opening to me was that they accounted for over 50% of services use. what that means to the overall system and what we're spending almost $400 million on mental health services. which is a significant portion d.p.a.'s budget. it's needed. it shows up again in the jail system. something that supervisor mandelman talked about. we'll take a second vote to expand the amount. that's one of my other questions. it's something through, it it's something that you highlighted for me. is this a housing issue, is it intensive case management issue? you can say all of the above. there needs to be a thoughtful strategy to reduce the amount of costs. since we're here to talk about
cost and service at the same time, the amount of cost at 2200 individual us out of 44,000 are costing to the overall system. how do we reduce that cost and get the level of services for these 2200 individuals? this an ongoing debate over and over again. emergency care can't be the answer. how do we get out in front of that? what's the strategy? it's not 11 staffing positions. one of the things i will is for from d.p.h. to come back and make a smaller report and recommendation on how you plan to tackle really providing the care and it could be in terms of staffing, it could be in terms of expanding group homes. supervisor ma mandelman's legislation to spend the places without use authorization.
this goes to that. maybe we have to come back and take a look at our rh1 and rh2. in my district in particular, there's been a significant drop in the number of group homes and those that need those services. that's a major loss of services. i want you all -- not just to report respond to this report and give us the data. pinpointing town, working with the department of homelessness in support of offices, how do we tackle these 2239 individuals that account for 52% of the cost of mental health services. that is a significant number. >> this is a serious concern for us as well. we're taking this very seriously. it is a concern. it is impacting our system when they are coming in. not all these cost are in behavioral health services.
it happens in multiple systems. what we are doing -- >> before you say that t i'm sorry. the other thing that has happened to this audit happening, we had prop c, 61% of voters authorized that. 60% of that money was supposed to go for it. hopeful that will come in our fave. we had windfall. this body and the mayor have proposed. i think there's some overlap in designs. there will be a significant portion money allocated to the department of hu -- public heal. it seems to me, where is -- what the efficiency -- have we taken a look at the level of services? here we go, we have a report, the b.l.a. did it.
we have the numbers in front of us. go back and work with the department homeless in support of housing and our crea team ane back with a recommendation. this seems to be the glaring hole. there's legislative solutions before us. maybe we can expand that to include additional housing options. that seems to be a simple solution that could happen very quickly. >> i totally agree. it's to b -- it's got to be multiprong approach. we are looking at ways that we can support. this number that you mentioned, the number of the 2000 -- because we reviewed people who have highest use of our system, we have case reviews and we're looking at each case by case.
the numbers is about 500. the 2000 is a large number. 500 is even more focused one. out of that number it's top 100. >> say that again? >> that number there's about 500 that's higher priority within that 2000. which we know about. we're getting lot of data and we know who they are, how they're impacting our system and then also we're working -- we're coming up with plans various parties. >> i would like to see that in your follow-up report. >> that is about hundred. which we're doing much more high priority review. i think that's exactly what the intention is. we need to understand this group and understand what their need are and mobilize the system that supports this. >> thank you.
>> i want to acknowledge and recognize supervisor mandelman who joined us for this hearing. this an issue he made a priority for his upcoming term. >> we're all in this together. this is our community. we live in the city. we're impacted as a system and community. what you're sharing is our community together. we need to work together. around transition to lower level of care, people who are coming to psych emergency and discharged from psych emergency, they are getting hospitalized and we come up with a specific plan while they're in the hospital. to make that connection stronger and if they are not connected, to make that linkage happen. people coming to psych emergency, this is a very serious area for us as well as it is for the whole city. psych emergency is just one area of our crisis response.
we have our urgent care and we have westside crises. we have multiple ways that we engage and work with people in the crisis situation. we have our engagement specialist. psych emergency gets most attention. we've been doing lot of work on that. one by providing staffing within psych emergency services for linkage and referral if they are not connected. it's the reason why we created humming bird place is to have a place for people. now it's expanding. majority of the referrals from psych humming bird is from psych emergency service. that is is the type of environment we need. place for people to get the support. what we're tracking who's coming in to psych emergency. there are no one leaves psych
emergency without a referral plan. referral to link angle is the area we need to work on more strongly. that's where we need to have the staffing to make sure we're looking at at that time. when somebody discharges and they get their services in outpatient, we put that in performance objective to make sure that happens. >> i like little more clarity on that point. the support said something different. i like to give the department public health the opportunity to explain the discrepancy. >> we really value the report and we value the recommendations. this is one area that i thought it was overarching conclusion.
one example is ref to self. we said let's pull the data. refer to self. we found out no one was refer to self without a plan. we looked at several cases. we find out a person, for example already linked to citywide case management. it was refer to self to go back to citywide case management. not refer to self and go figure out what you need to do. we have process now that we contact the provider saying your client is at p.e.s. and we want to notify you. when the referral goes back we can track to see where that linkage continues.
we believe that this was a category checking as well as misinformation and that how it was documented. if you pull actual record it's a check box. it's refer to self to go back. not they were referred to self to go out with nothing. we have specific come up with performance objectives to making sure no one leaves without a referral. we have a plan to make sure when somebody is given a referral, we can track to make sure that linkage happens and whether they received services. there's a lot of things we started doing. we agreed with scenarios that we ned to -- need to improve on. >> that's reassuring.
the idea is it wouldn't be just referral. people don't leave with a referral. >> a referral is made. a goal is to make sure that linkage happens. we're doing a lot to identify who the people are and putting engagement specialist to identify that report. we can look at the data to say it did happen. if it didn't, let's send out where they are and find out how we can make that connection. just because someone is given referral and it doesn't mean they don't want to go there. we have to do lot of work there. that's a big area that we're working on. >> supervisor safai has another question.
>> supervisor safai: slow down for a second. this is lot of information. someone comes in for emergency patient care, what happens and what does d.p.h. to and how do they stay in contact with that person? it goes back to my original point about the people receiving over 52% of the care. to you document these people? are they in database? to you work with the department of homelessness in support of housing. to you have a history of these people? do they have a profile? is there a plan put in place? i really want you to walk us through that. i want to see where the gap is in terms of at that time data c. i want to see what the plan is and you're describing.
this is one of the areas, emergency psychiatric care, it's something that all of us on this panel talked about. i want to make sure that we really drill down on this and i like you to end with maybe a professional opinion on how the whole -- i'm glad the supervisor mandelman is here. i like him to speak about this. how the role of conservativeship plays in discharging those patients. how conservatorship change the outcome. walk us through it. >> also i wanted to mention the
doctor psychiatry is here. when someone comes into psychiatric emergency, they are brought in or they are self-admitting themselves. you have voluntary and involuntary admissions. immediate they will do an assessment finding out what is going on with this individual. we do know that about right now, majority of our people who are coming to psych me emergency are people under the influence and also homeless. we make that assessment immediately as they're in, make that determination of making sure what to they need, what's going on with them and we have database to pull the reports about what the services are and
are they connected or not. one new thing is that if they are in the high priority list, we get immediate notification that this person is at p.e.s. now. we have known about this individual and what their needs are. if they are in the psych emergency and they stay there -- if they are appear to be needing to be hospitalized after the assessment, of course they will be assessed and will be sent to inpatient unit. if they are not and they are sure at the time while they are being assessed, during this 12 or 14 hours if the person is continuous exhibiting symptom this they are actually not doing well and they need hospitalization, of course, that will be course of action. if the person is not exhibiting that, they have now cleared, they are now no longer danger to
self to others or they are not disabled then that time it needs to be a plan for referral to somewhere else. they need to be discharged. we do multiple things. if they're willing to go to urgent care, we refer them to under care. we make this referral. from there, they could to further assessment for additional day and refer them to one of their acute diversion units or housing unit. the person can be referred to humming bird because they may not be ready for something but they're willing to go somewhere because they want support. they will be referred to humming bird. they will be at humming bird again. we have data on these individuals because they're in our system. once they enter the system, we pull the record. if they never been in the system, we look at see what we need to do to prevent this from
happening. at that time, if neither of those work, the person says, i don't want to go to humming bird, we need to give referral. we need to make sure there's linkage. if they're connected, we call the provider and letting them know they're at p.e.k. once we get the referral and they're ready to go, if they're in high priority, there are multiple things in place. we know this person is going and we need to activate the engagement specialist to maintain this person beyond discharge. that part is a part that we can do much better and much better work. i think i covered as far as what happens from p.e.s.p. there's a group of people their mental health condition is not
necessarily where they need hospitalization and the influence of the substances who has made the behaviors and symptoms or activities appear as if it's mental symptom, if that clears you and the person is more logical and knows where to go for food or chooses their own place, we have to make sure we put things in place. if the person keeps coming back, this may become one of the people we have to track. >> supervisor safai: when you say they keep coming back. how many times it take before you make an analysis? >> basic anyone who comes back again, there's two ways we're looking at it. one thing we're looking is to say if that person came back and ended going to the inpatient unit, what did we miss?
if they come back and they are still not needing hospitalization, then that list is reviewed. the hospital has a at tha a daty look at. we have made that effort even more stronger by saying to p.e.s. if someone is willing and ready, let us know. we'll make that happen. we'll make that immediate activated. we've done that number of times. it's a voluntary service. no one can be forced into residential substance treatment or detox. if they are saying they are willing, we are immediately engaging with treatment access program or substance abuse
provider say, we have someone we need to come to detox. we are doing all of that but again the person cannot be forced into that. if not, then we have to work back and forth. it's a pross. it's a relationship. it's a trust. it's something that we have to constantly be relentless and motivated to keep engage. >> supervisor safai: i wanted to just have you speak about conservatorship piece. i want to allow supervisor mandelman to jump in. >> supervisor mandelman: two questions. your list of high users, are you able to access data from the other hospitals in the city?
if someone is taken to st. francis, does that feed into your detention whether that person is a high user? >> the database it i pull from may not be there. we are working with whole person care as well as working with emergency group has eddy system. we can pull that data. we do need to work with system providers and other hospitals to give us at that time an data an. that one individual that i shared never hit our system but had gone to st. francis emergency many times. we actually didn't know about it until we had to follow that information. once we to this unified system as well as this collaboration within the data sharing and emergency room reviews that we do with people who are using the
system that help us a lot. it's something that needs to be improved. >> supervisor mandelman: the other question that keeps coming back, 5150, they don't need to be there for the full three days because their symptom clear. it's taking up a ton of space and you have people sitting in chairs. i've heard the idea of having sort of some other kind of separate, essentially meth sobering facility this will be place to send that particular set of folks. they need to be in a loxed facility. they need to have tricks around but they artrick --doctors arou. is that something you're interested in having? >> we do have detox. we have substance treatment, we have urgent care. humming bird is a place that someone basically we could take people breaking down every barrier possible to be there.
there are places that it will be helpful to say, they're not meeting criteria there. >> supervisor mandelman: there's issue what to do with the pers person. you need more humming bird and you need more all of that. i'm wondering whether you need another 5150 facility for people who is coming in with a meth issue. >> i will have the tric doctor r that. >> my name is dr. mark leary.
this issue of how to address this really crucial patient population, people that use meth repeat think anedly and heavilye are several ways to address it. i think that most cost efficient way for our city to address it will be to be able to treat the patients that are now waiting on our inpatient unit at san francisco general at the appropriate lower level of care which would create bed space on acute unit at san francisco general. we can admit those patients who are suffering from the meth induced psychosis for two-day stay and then discharge them if that was appropriate thing to do. it this is not my decision, i would think it will be costly to
open a second unit. having them to be admitted in inpatient, if they needed 36 to 72 hour stay, we allow psych emergency to stay open for the people that need psych emergency services on a shorter basis. >> supervisor mandelman: i wanted to hear your opinion o on the role conservatorship with play with this overall population. >> the population of people that use meth repeatedly, there's a role for conservatorship. the key thing, i'm very
supportive of the state legislation and the local initiative supervisor mandelman is supporting and authoring. this group of patients can be treated on an involuntary basis for a relatively brief period of time to try to break that cycle and get them involved in treatment. i think it will be important to do that. you should be able to do that. to answer the larger question about conservatorship and its value, we try to treat everyone in a voluntary way whenever possible. there's a role for involuntary treatment and conservatorship. it's only helpful if there are treatment resources available. if our case managers don't have a place to go to meet the patient, whether it's a hotel, whether it's treatment setting, whether it's bed where they are staying, then the conservatorship isn't all that valuable. it may have some margin value in
terms of allowing involuntary medication. that's only helpful if the patient comes in for services. >> supervisor safai: if you can stand ton that little bit. do you mean place of resident, place that they can -- housing. i wanted to make sure that's what we were talking about. we weren't talking about an institutional setting. >> not necessarily. >> supervisor safai: you can do conservatorship through a group home? >> yes. one great step forward in the city in this past year has been the post acute community conservatorship that's been a partnership with the office and the court system and public defenders and district attorney to allow people to be discharged from acute hospital care into the community with the conservatorship in place and a link to treatment and housing. >> supervisor safai: the data that i have, in the last 10 year, we've lost 300 boarding
homes have closed in san francisco. i think that -- crust going to be to the legislation, we're trying to move in a different direction to facilitate the expansion, the re-expansion of that. >> when we say we've lost civilization rooms, we lost border homes and supportive houses, our residential care facilities and those we've lost 195 in the last four years. what happens is lot of these are owned by parents and they choose not to operate them anymore. their kids decide not to continue this service or sell the facility. we are losing that lower level
of civility and support for people who could be in the community and still have that intensive case management. >> it's a crucial level of care that can stabilize patients with serious mental illness for many years at a time. >> thank you.>> supervisor safal man did you have any other questions that point? that's what we were looking for. you can continue. >> i wanted to end by saying that we take this also very seriously. we are concerned also how our emergency rooms are being used and how we can coordinate the care best.
that's why we have implemented strategies whether it's operation centre, humming bird place or engagement specialists. sb1045 has a possible tool to use. there are multiple ways we are trying to address this and coordinate the care. i think we've highlighted around the individual who do not stabilize. we're working closely with department of homelessness in support of housing. we have regularmeetings. they are right there. we are meeting regularly to review cases as well as find placement for these entry systems. this has been really effective. the case that i mentioned earlier the individual is if i didn't have that support from them to offer immediate place for that person, i think this plan would have not worked.
but because the intensive case management and the housing was right together, we were able to make this more effective. then with the whole person care, which is a competitive grant that we received we're looking at the data and coordinating our efforts. i want to highlight the behavioral health workforce. that's a big issue. currently in our civil service system, i looked just yesterday, we have 30 behavioral health clinicians positions vacant as of yesterday. that's a lot. >> supervisor safai: i wanted to emphasize the point. >> it's multiple reasons. it's people are not applying. people applying taking other positions. people not wanted to do this work. it's a lot of work. people have to be really committed to public health.
those people are working extreme hard and dedicated. we want them to stay with us. i want to say the population has changed. we know the opioid epidemic and the meth use has change the dynamics. we have majority of people coming to psych emergency with methamphetamine use or substance use. that is huge. this not something that just happen -- it's been going for years. also because i meet with other directors across counties these are regional issues. we work with each other. these are regional issues. we have individuals that go through multiple counties. we have to see how we can best coordinate. i also wanted to mention about the lower level of care, the reduction of that. question came up when we met
around out of county -- >> supervisor safai: i was going to ask you end on this. >> i maybe want to mention one thing and i'll go into additional things that we've done is our lead and law enforcement assisted diversion has been effective and street medicine expansion. basically bringing treatment into the streets. we know we're very good with services with people coming in and want the services. we need to do people who are not seeing what we offer. we need to be more versatile and more on the street. drug med cal is evidence-based and specific model we can enhance our system of care. providing substance services is higher level. on the issue of out of county.
this is a very important issue. i looked just november alone, i looked at the data, i wanted to see how many people that we serve in our system, mental and substance use they have a med cal that it not assigned to san francisco. 104 individuals were in our system who do not have a med cal assignment in san francisco. it's 141 service utilization because we have some people using multiple times. they are coming into the urgent care twice. >> supervisor safai: what's the cost to san francisco for this? >> in the mental health section of it, which we can bill the federal portion for the services, not the county portion. we don't get the county portion.
we can bill the federal portion. however, for the substance use. nothing. we do not get paid by any sort of services when it's out of county. there's no other mechanism so we are using general fund. what we are doing e we trying to see if the person is really living here to have med cal to transfer. we helped transfer 25 of those individual med cal to our system. >> supervisor safai: this is where i think working with the department of homelessness in supportive housing coordinating on this particular point. it's not a large number of individuals but i think was one of the intention of creation of that tent. if they are out county and coming to the county here, i think transferring their med cal for reimbursement for us is great. i think working with the homelessness on this point will
be very important. >> obvious if it's an emergency service we'll provide it. what we've been trying to do is to have the person be sent back to the county. i'm working with our local county directors to make that happen. i recognize that many of these individuals are not -- you can't say -- we can't provide services, you're from petaluma and go back to petaluma. there'we have to think about hoe can work these situations. it is something we have to look at. they are in the street. there are a number of peep. not a large number. i can leave it at that. >> supervisor safai: thank you. this is the thing i would end with before we transition to ms,
director of jailhouse. these are two things this i like. i like a follow-up at least with this body, my office on pinpointing down the 2200 individuals and the strategy to reduce the cost overall. whether it's whole patient care and whether it's an expansion of services as we talked about in psych services. whatever the strategies may be, coordination with the tent of homelessness in support of housing. pin point those 2200 individuals and plan and strategy to reduce the cost to the system, 52% of the overall cost of emergency care is significant. then secondarily, one small piece is the last part. these out of county individuals and working in collaboration with the tent of homelessness.
the other recommendations were more intensive care staffing, filling the staffing. those will be the two things if we can, file this report in this body. i'm asking that you follow-up with us. we'll is a follow-up hearing on this. >> thank you. >> supervisor safai: if we can just transition to ms. lisa pratt. >> i apologize that i have to keep our committee on time. we have another very lengthy hearing after this one. i have one slide. supervisors. i'm dr. lisa pratt i'm director of jailhouse. i appreciate the opportunity to dig deeper into thee complicated issues.
the jail population represents nexus of homeless and mentally ill and other people as well. we're not here to talk about the other people. because it's so complicated, jail is a very regressive institution. our jail is a progressive city. what we do is different from what other cities and counties to. that's why it's important for dph to be part of the jail envisions. i wanted to point that out. the other thing about the jail report, unbelievable amount of work just if you think about an electronic health record and the sheriff at that time, somehow connecting, that's what latoya made happen. it's the first time we had the opportunity to look at that stuff.
the report represents people who self-report substance abuse. we operate in the jail the biggest detox facility i in the city. we look at the people who told us what they used. they may not require medical assistance support like cocaine or intoxication and withdrawal. this likely represents an over estimation because it's self-report of use and not a diagnosis of a substance abuse disorder. part of that recovery involves support from the behavorial health staff and also medically assisted therapy which we
provide in our jail and we have for decades and it is national model other jails are incorporating that in their treatment. we know there are big chunk of people who shouldn't be if the jail who are there because of these issues that are health issues. jails are places for people with mental illness and trauma. they often to not get better. we're in supportive of these diversion efforts and other opportunities to treat people outside of the jail. people who are there get treatment and we can stratify and stabilize them with regards to who can can lead the jail and
get treatment in another location that's more appropriate and who needs to stay in jail by virtue of their crime and disposition that the legal case, which is settled in the legal case. that's all i have to say. i'm happy to take any questions about what we to in the jail. >> supervisor safai: i want to ask one question. what percentage of the people that are in jail that are incarcerated that are getting public health, to you believe if they receive intensive healthcare would not be cycling in and out of the jail system? >> this is the people if the jail and in general who do not believe they need treatment or are not willing to engage in treatment. if we talk about taking that out of the equation, if they got treatment, however they got it,
i say a good 30 to 40 percent of people would have other opportunities around healing that would not result in this continuous cycle. >> supervisor safai: just one follow-up. what would be a strategy -- what could you do with the ten depart of public health? is that the same population of people? >> yes. these are the same people. they just land in jail sometimes. >> supervisor safai: only thing i will ask you for the time of this committee, if you can give a recommendation for a follow-up and maybe the jail task force has worked on this stuff. you can give a recommendation if they were to receive treatment,
would not be cycling in and out of jail, what will be the strategy? is it some of the things we talked about in terms of expanding, group homes, housing options or conservatorship, treatment. all those things, i would like you to continue to work with department of homelessness supportive housing and or department of public health to come back to this committee and give that recommendation. >> i love to do that. >> supervisor safai: thank you. i don't have any other questions at this time. we have a few speakers. i call those speakers. please come up. it doesn't have to be in order. please come to the podium and
speak. >> thank you everyone. it's wonderful to see five members of the board of supervisors listening to this hearing. thank you for doing it. thank you chair and supervisor kim. i know this was probably be the last public time i can say thank you to you for your leadership over the last eight years, free city college, which helped lot of people we're talking about right now. secondly for making the jail a public health issue, a housing issue. you and several other supervisors have done that for the last term of your supervisor, you and then
supervisor breed led the way and we really truly appreciate this day. i do. my main point for today other than to acknowledge that taxpayers for public safety works on incarceration. we appreciate that five years ago, three years ago you would have had this hearing, any audit that's related to housing or health would not have included that population. thank you. we really appreciate it. the main thing that i would say about this deep audit, is that we need to work at the government level not only at the management and provider level to solve this problem. the governance level the department of public health needs to be in this process. they were not part of the audit. you need to pay attention to
that. if you want a problem solved rather than have descriptions what should happen or is happening, you need the governance -- thank you. >> good afternoon. i'm community organizer with community housing partnership and coalition organization and community members dedicated to broadening access to treatment. i'm happy this report came out because it is a detailed look the our city treatment and care system. this need to be a jumping point from which we not only feel the gaps in the health system and reimagine how that system operates. we are in a public health crisis. as shown in the report how this intersects with homelessness crisis.
as was pointed out, lack of connection between psychiatric care and case management perpetuates this homelessness crisis. we to spend lot of money on emergency services and jails. when you don't have stable housing, people cycle into those jails and use those emergency services more. i think that's something we need to highlight in big way in light of this report. this housing is one of the main issues we need to worry about when talking about this vulnerable population. recommendation number seven, specifically points to how we need to increase support of housing for people living on the streets since behavioral health disorders is a cause and result of homelessness. that's why we continue to implement propositions like proposition c and keep solutions to mental health and substance abuse treatment in the public consciousness. i look forward to having city hall work with the community on
this issue because we need to have our community's voice be centred thank you. >> next speaker. >> i'm with community housing partnership. i spent this need we have for homelessness and mental health and substance abuse. i support it and that's about it. >> i'm with citywide case management forensics program probations team. few things came up for me when we were hearing the audit and the responses.
regarding the 2200 individuals that are currently costing the city 50% of the b.h.s. budget, probably 18 of them are on my case load. speaking from personal experience, it doesn't seem to be a housing issue or financial issue for me. it's a triage issue. my experience is that very hard to find a point person and be able to communicate with them to make sure that when i am 5150 someone or when one of the high users is going to p.e.s. they are actually leaving the emergency room with a referral and not just like being dropped off or sleeping something off and then three hours later, no one gives me a phone call. i