Skip to main content

tv   Government Access Programming  SFGTV  March 17, 2019 3:00pm-4:01pm PDT

3:00 pm
map with us? so people come to us because they are seeking assistance or because we encounter them out on the streets, an encampment or of course coming and seeking shelter. our street outreach and our mainstream systems, the mainstream systems including hospitals, including the criminal justice system and including h.s.a. benefits program? they come in to coordinated entry access points, and those access points, again, can be the ones we've setup on 10th street, 121 10th street and jennings. people can walk into those spots. we have people going into the coordinated access shelters and the hot team, and they are just deployed where we ask them to go. so we've tried to make
3:01 pm
coordinated entry citywide. the coordinated entry access points and the home ward bound staff do problem solving, and then, those who were not able to problem solve for, we do prioritization assessment. we started with a lens of who is most in need of permanent supportive housing, and through the whole process and homeless person care, we've been looking at how we're using them so that everyone who comes into an access point or who encounters mobile assessment staff can be prioritized for medical care, for psychiatric care, for substance abuse treatment and for shelter and housing and for benefits outreach and
3:02 pm
eligibility. so we currently have, we're working toward a set of common questions that we ask everyone. and then, if they indicate critical health needs or they have no income or they've lost their income, then, they have the add-on for those other systems. we started this last summer and we are working very closely on developing it, but it's still our future state. it's making sure people have access to all systems. >> chair mandelman: how many people are in the coordinated entry at this point? >> it's just over 6,000. last time i checked, there are 4,700 something adults and there were over 1500 family members with kids. >> chair mandelman: how does
3:03 pm
your prioritization change with life experience? so someone is entered into coordinated entry, and they're homeless, but you know, maybe they've been hospitalized once? but then, over the next year, say, there's a lot of 5150s, other kind of hospitalizations. how does that information get into the one system to potentially change -- would that information centrally change their rank, their priori prioritization, and is there a way their information gets added to the one system. >> yes. so people can be reassessed, and we try to gep that to evke every 90 days. a lot of people want to be assessed more quickly? >> chair mandelman: is there any automation to it? >> yeah.
3:04 pm
so right now, if -- like, if someone's at psych emergency services or they're at s.f. general and going to be discharged to apparently homelessness, d.p.h. and ucsf has the ability to look people up in the one system to determine whether they're homeless, and they have the ability to make notes and to, like, put sort of a be on the lookout kind of alert. they don't currently have the ability to change the assessment -- the assessment sort of clock, but they are working really closely with our partners at episcopal community services on coordinated entry, so if someone needs urgent attention, we can bring the mobile access point back to them and reassess if we need to. we're also looking at how our assessments are prioritizing
3:05 pm
people that d.p.h. has considered to be really high needs. we did a data comparison between the high users of multiple systems and we're now doing a pilot with people -- now, like, street medicine and other people in the system, saying this person should be prioritized and i don't see them in this pool. we need to understand, was the person not accurately self-reporting, is there something in a we're missing about the life experience that we need to then incorporate into the prioritization? so that's a pilot where we're trying to, you know, relook at clients who didn't initially get prioritized and priority
3:06 pm
jies the ize them in. >> chair mandelman: are you finding there's significant overlap between the users and folks with high priority in the system or are you doing things to make that lineup better? >> well, that's why we need to do work in the system. some of the people in the high users turned out to be housed, and they have had a history of homelessness in d.p.h. records, so they didn't hit our priority status. that's good. i think that's the right outcome. some of them had not yet been assessed, and so they are put on our list of people given our assessment staff, like, you need to go find these people. that is what we know about
3:07 pm
them? and then some folks had not reported their own disabilities in a way that would trigger status. those are the folks that are trying to figure out if they are seeking housing and they're seeking services, but they are not self-reporting, and d.p.h. has reported a higher level of acuity than they have reported, how do we get that reflected in the prioritization? right now, we have kept d.p.h. referrals into what used to be the direct access to housing, the really higher needs direct housing, we've keep referrals for people who might not have triggered the prioritization and the assessment while we fix it. mandel than >> supervisor mandelman: thanks. >> thank you. >> so the priority gets people
3:08 pm
into a priority section. that's for the priority housing and about half of the navigation center beds. if you're priority status, we can place you in a navigation center? we have other centers for other uses and then, we have our temporary shelter system. we -- another collaboration point about coordinated entry and assessments is we are also working with d.p.h. about how to respond when we assess someone as needing a higher level of care than permanent supportive housing. we have -- so they can -- they will show up in priority status, and we will also know that they have not been able to maintain indepentadent housing thus far, and we're working so that that's kind of a seamless handoff so we're not losing
3:09 pm
those folks back to the streets. problem solving, one of the core components of the system. collaboration point on problem solving is that this is often our first encounter, so we're trying to setup our first encounter at a point where we do an immediate triage, engagement, and connection to the needed services. temporary shelter, this is an inventory of the temporary shelter system. we have the traditional emergency shelters. also within that category, we include the transition age youth shelters, the adult winter shelters, the stablization rooms, and the family rooms. stablization rooms, again, being a tool we have for the hot team, if someone is not going to be able to do well in
3:10 pm
a congregate shelters. navigation centers, we currently have about 500 beds? that changes a little bit. that he ae w that's why we have the approximateli approximate sign. shelter beds for everyone, this is the mayor's initiative to bring 1,000 shelter beds. our goal is to bring on 1,000? these are still low barrier and have services on-site but are doing more to try to leverage the other services. a collaboration point about shelters, we have shelter health working in our tradition shelter sites. we have clinics within the
3:11 pm
navigation centers. we have joint referral system between rumming bird -- hummingbird and our shelter systems. all of these services and connections are in the shelters and navigation centers. we also through whole person center are intending to expand our coordinated assessment. housing and housing ladder. so we have rapid rehousing. typically not for folks with serious treatments and substance abuse, but somebody who doesn't need these additional resources get put into permanent supportive housing and receiving services that they don't need. we have about 200 in our current system, more than 400 through the heading home for
3:12 pm
families. we have 500 new planned for rising up for youth and about 40 more for adults that are launching this month. currently supportsive housing, we have 6,700 units for adulting. some of those are the housing first units that were established by the home services agency and you now are h.s.h. and some are the former direct access to housing. we're bringing on over the next several years, no place like home funded capital unit for additional permanent then supportive housing for people with serious mental abuse problems. the housing ladder, we have the moving on initiative. we were able to house 175 people using housing choice vouchers, moving them to
3:13 pm
scattered site apartments, privately owned units where they now have their own lease and can stay indefinitely. we provide light services mostly for the first 12 months to help people transition. we had a waiting list of over 800 people interested in that program. really helpful having some people involved in movable supportive housing. it's currently on hold because of the lack of housing vouchers, which is a little bit devastating and there's so many people interested in that opportunity, so i'd just like to keep that out there as something that is really critical to our system and we're trying to figure how the how to bring that in. next month, the tenderloin housing clinic is starting residency at the bristol.
3:14 pm
these are larger units, in a nice building and will not have the intensive housing. and there are in addition to the bristol, there are a couple of existing step up buildings within the portfolio. so transitions point, we work with transitions, the intensive case management programs, acas conferences with d.p.h. we also work really closely with in-house support services through h.s.a., through daas. we have done some really exciting pilots, one of them at the kelly cullen supportive housing site, where we try to have clinicians with in home support services.
3:15 pm
one of the few reasons people lose permanent supportive housing is hoarding and cluttering and sort of inability to maintain their unit. so ihss is a critical part of housing andci critical partnership. we -- when we did the retreat on collaboration, one of the things that we came to is that the earlier we case conference when someone else housing is unable, the more likely we are to be able to say exactly where they are and not transition to a higher level of care. that said, we do have people who transfer to a higher level of care.
3:16 pm
if someone needs to go to treatment for 90 days, we hold their unit, and we're in pretty constant contact about what that person's status is, and how they will come back and if they're able to come back. with that, i will turn it over to susie smith, my colleague at the human services agency. >> hi, everybody. i'm susie smith. i'm director of policy and planning for the human services agency, and i just want to mention ageing and adult services is also here if there's daas specific questions. just by way of context, you probably already know this, but h.s.a. is three departments
3:17 pm
supported by the same structure. it's the department of human services, daas, and the office of early education. together, we serve about 1 in four san franciscans, low-income, older adults, from birth to graves. so what i'm going to do is provide a little bit of overview with the homeless populations. our county assistance program or c.a.p., we have about 750 homeless i imagines in that program. and everyone -- homeless individuals in that program. and we have 1300 current or formerly c.a.p. clients that are housed through the care, not cash, initiative, and we
3:18 pm
have over 5,000 that were housed whose cap has passed. everyone who applies for cap is screened for s.s.i. disability benefits. and -- so that we have an in-house set aside program which is kind of unique in california where we're -- city staff are screening with clinicians, medical doctors on hand to see if somebody should really be on s.s.i. in terms of calfresh, our nutrition program, there's 6,000 people that are on calfresh. and then, medi-cal, we have 10,000 clients that are on medi-cal. having said that, our systems are complicated, and they're governed by complex state, federal, and local law. it's not always easy for people to get on and stay on benefits,
3:19 pm
so knowing the unique challenges, we decided we need today have a second initiative and a manager to look at how we link our three departments. and the only way to do that is to do that link jake work. so the goal of this benefit linkage initiative, which started last year, is to meet people where they're at. to stream line our processes where state and federal law allow us to do so. it's also enabled us to do pilot programs, assess what's working, what's not working, the flaws in our systems, how we can use data to inform where the gaps are. so i'm going to talk a little bit more about those pilot programs in a little bit more detail. so the first is our navigation
3:20 pm
benefits center out reach. this first started when h.s.h. was first part of the human services agency and now it's a partnership between our two departments. we outstation eligible caltrash at each of the agencies. [please stand by]
3:21 pm
-- so this pilot we will reduce that just one visit that our eligibility worker is doing at the actual shelter. and we're also able to pilot telefonic interviews with calfresh. we can do it on the phone so we're able to pilot that at the shelters, again, through the part with the hot workers and they are hand-in-hand and setting up appointments for eligibility workers and walking them through that process. so looking at just a data snapshot for that program between march and january, we had 285 applications, and we had a 90% approval rate for medi-cal which is high, 85% approval rate
3:22 pm
for calfresh and 68% for caap. we wanted to expand it to link eligibility workers and hot workers to the needed entry assessment process. so now we have hot worker and eligibility workers that are going along with that coordinated entry access points. recently we were awarded a state grant called "the housing and disability advocacy program" it's $2.4 million grant to help homeless people to access s.s.i. and housing. if we could stabilize someone and get them in more housing we're likely to be successful with the s.s.i. application. so the components are casework, outreach and s.s.i. application assistance and then the housing. and this, again, is a partnership with between the department of human services.
3:23 pm
daas, who helps with the care planning. and the stabilization in the housing. and s.s.i., and h.s.h., which is identifying the housing opportunities and administrating the subsidy program. it's still early, we've housed 13 people, awarded four s.s.i. applications. they take a long time to go through the federal s.s.i. process, with another 25 in the pipeline that are eligible. and half of our hdap-eligible clients are eligible for housing. we've had coordinated entry at h.h.s. offices both at 1235 mission where our caap offices are as well as at 170 odis where people apply for calworks, trying to meet people where they're at and have are them come to our building and assess people on the spot has been really important.
3:24 pm
finally, we're expanding our s.s.i. advocacy services through a partnership with the tipping point community foundation. so tipping point is helping to fund two community-based legal services provider organizations to help with more of a legal model towards s.s.i. advocacy so they can help with the appeal cases. they are specifically expanding our capacity to serve extremely hard-to-serve populations. it's through the tipping point foundation collaboration that we have c.b.o. attorneys at the shelter and navigation centers. they're focusing on transition-aged youth. they are often not people that want to come into our offices. and so it's a specific focus on this, it's important to us. and then cases that we talked about earlier, the dual diagnosis cases to apply and to receive s.s.i., you have to kind of disentangle the substance abuse disorder from the mental health disorder because if it is
3:25 pm
only substance abuse they're not eligible for s.s.i. and you need to isolate the factors to be able to make that case. so the legal approach can help with that and the attorneys are sort of experts in that. and then we also have focused on clients, caap clients, who we have assessed and we've said through our assessments we think they could do a light work assignment but not a full work assignment. so for those clients if you notice that they're struggling and they don't seem to be showing off or having trouble with what we call light duty work assignments the tipping point workers can say this is really an s.s.i. case and reassess. so there we have about a 350-person target over the three-year contracts. if successful, then we can scale it. so i know that it's been a long hearing but i just want to conclude and we obviously know that there are gaps in our systems. i think that we're working -- each of the departments is working really hard and more
3:26 pm
closely, honestly, than we ever have to address the crisis on our streets. and there are areas that we just need more resources and we hope to try to identify those, to highlight those and we look forward to continuing to partner with the board and with our colleagues in the other departments to work on these issues together and to work on the crisis. happy to answer any questions and if you have any follow-up questions for any of my colleagues or jill nielson from daas, happy to answer. >> there's going to be an opportunity for public comment, but for now i will see if my colleagues have any comments or questions? yes? supervisor walton. >> supervisor walton: thank you, chair mandelman. so right now i just have one question and maybe h.h.s. could answer this, where would you say that the gaps in services are?
3:27 pm
>> i guess i'm up. um, so, i mean, i think that there are gaps throughout this system. i mean, we're talking -- i think that there's absolutely, you know, gaps in community-based residential care programs and whether they're board and care facilities or transitional housing and treatment programs or skilled nursing facilities. there's definitely gap there is so that when people are leaving p.e.s., whether or not there's housing available for them, if they still need care, -- sorry -- if they still need care and we don't either have permanent supportive housing or they still have medical issues that make it difficult for them to get into p.h.s., we really need more of those beds. but also as we're adding more community-based care we have to understand that those folks need to go somewhere. so, you know, for every transitional program that we set up we need to be planning for where those exits are going to
3:28 pm
be and whether they are to permanent supportive housing or whether -- which i think that we have a fair amount in the pipeline, or whether they're going to small co-op programs that i think that are more suitable for folks. we need more of those, but i will say that there has been a fairly robust development of permanent supportive housing over the past -- you know, 15 years in this city. but there's not been the same level of growth. in fact, i believe that there's actually been a shrinking of the community-based residential type programs. >> and i would say from the d.p.h. perspective, the gaps are really in low barrier access programs, like the respite at hummingbird. because not everyone is ready to really be able to go into a full service residential treatment program. they're not always able to meet all of the entry requirements. but having that low barrier access where they're off the streets, they're not either in a
3:29 pm
hospital bed or in p.e.s., but are in a shelter place where therthey are constantly engagedo say, when you're ready -- are you ready today? no. well, i'll talk to you again tomorrow and maybe you'll be ready. that's one. and, also just the whole spectrum of what we call the lower level of care. someone not in an acute psychiatric bed. that could be residential care facility for adults. but, again, it's the -- our goal is to meet people where they are and to provide the lowest level of care that gives them the most freedom and access but the help that they need. >> what's the budget for h.h.s. and the department of public health? >> the d.p.h. budget in total is i think about their 2.1 billion
3:30 pm
or $2.2 billion. >> and h.h.s. is $260 million. and if i could add one more thing that i think that we did not address around the gaps in the system and i think that this is a really critical point is that prevention needs to be added to the equation. we -- i don't think that we're investing enough money around mental health or around homeless services in the areas of prevention because no matter, you know, how much we add add, e many more units of housing that we add we're helping about 50 people a week to exit homelessness. but we're seeing an inflow of about 150 newly homeless people per week. so until we can address prevention issues around homelessness and i think also around people who are experiencing mental health or other challenges that may put them at risk of losing their housing, i think that is going to be an important equation to longer term success. as well as continuing to make the investments in our systems
3:31 pm
and how they work. and investing time and money in improving collaboration, whether it's face-to-face collaboration or through our data systems. so systems improvements as well as prevention i would add to that list where we have gaps. >> what is the mission of the department of public health? >> to protect and promote the health of all san franciscoians. >> so would you say we're in a homeless and affordability crisis in the city? >> a homeless affordability crisis? >> in san francisco? >> oh, absolutely. we see it every day. in fact, i learned from dr. barry zevin is the simple way -- wee hav we have this mucs and this much housing. and so we are definitely in a crisis. >> by the look at the slide and you look at the behavioral
3:32 pm
health spectrum of care and i listened to the mission of the department of public health and i see the difference between h.s.h.s budget and the department of public health's budget. i know that there are a variety of services that you provide and a plethora of uses for the resources of the budget. why does d.p.h. not provide any housing as a department under this spectrum of care? >> d.p.h. -- so d.p.h. previously provided housing? >> correct. >> and we transferred all of those services to h.h.s. when it was formed. >> when you transferred all of the services did you also transfer all of the resources? >> i believe so, yes. >> all of them? >> yes. >> okay. so what you're saying is that as we focus on addressing the housing crisis and the homeless crisis, that the department of
3:33 pm
public health doesn't have any resources to provide for actual housing? >> i believe that's correct. >> yeah and i will -- i will just add, i mean, this was an intentional decision that was made. there were approximately 800 units that were in what was then called the direct housing portfolio run by the department of public health. and that was their access to housing. those probably turned over at a rate of about 80 units a year. when the portfolio was combine bod a single supportive housing portfolio, bringing in units from multiple departments, we now have 7,700 units available to the clients who are at the highest needs clients in the city. and we see a turnover of about 800 units in that portfolio. so under the current scenario it is actually -- we are doing a much better job at serving higher needs individuals in terms of the volume of people
3:34 pm
that we're able to rehouse, because now those 800 units are really going to the highest needs individuals. and not necessarily based on the d.p.h. list as carey pointed out earlier. what we have found is that there's sometimes a difference between the highest needs individuals and the highest users of our medical system. so i think that we are truly getting to a place where we're focusing on individuals and what their needs and are getting them prioritized into housing. so having, you know, a bifir indicated system of housing or the way that things used to be actually meant that d.p.h. only had 80 units of housing per year, whereas now i would gather that, you know, 90% of our clients are also d.p.h. clients and they're having access to 800 units of turnover units per year. >> thank you.
3:35 pm
>> supervisor mandelman. >> did i hear it correctly? >> that was exiting in-patient psychiatry. >> okay. so what are we doing or what can we do to increase that number? >> it's one that i can answer. thanks. one answer to that is that street medicine met with in-patient psychiatry yesterday and talked about having a backup plan for those patients who don't connect. and they'll be back on the street. and if street medicine is aware of those folks, we have got a lot better chance that we could connect to them as the backup for, hey, they didn't connect to the initial plan. it's a small piece. but i think that those kind of connections that we didn't have before can amount to some really positive connection.
3:36 pm
if not immediately, down the road, because these folks are going to continue to have conditions that need our help. >> i think that is all i have for now. >> can i follow-up -- so what was the statistics? >> 52% of people leaving in-patient psychiatry continue to receive care within a week after discharge. is that what that was? sorry. >> it's 52% we're seeing in the follow-up appointment within seven days. >> it seems very low. i mean, that's not the -- that's not the 51/50, right? that's someone who is actually been admitted for an acute psychiatristic hospitalization? and they've spent some serious time at s.f. general and they have some serious needs.
3:37 pm
>> i'll let dr. o'leary address it. >> so the question is regarding how people receive follow-up after they leave the in-patient units. so everyone who leaves the in-patient unit is given a specific appointment for follow-up at -- with their out-patient provider whether it's a new one or an ongoing provider they have already had a relationship with. and there's a range of whether people will follow-up with those appointments or not. so what we're hearing is that 52% of people actually within seven days came into their appointment and were seen. given our -- i wish that number were higher, but given our patient population, that's
3:38 pm
actually -- i think that it's fairly reasonable. because there are a number of patients that even though we make appointments for them they tell us very directly that i'm going to see that person, i don't need that, i don't want it. so i think that the 52% -- again, we're working to try to make it higher. i think that one of the levels of care that would be helpful to have greater access to is in intensive case management where we could do outreach to try to increase the likelihood that person is going to connect with a mental health professional. >> how many people are being discharged from acute psych each week? >> i'm sorry. >> how many people are being discharged from acute psych on a weekly basis? >> on a weekly basis, 15 to 20. from san francisco general in-patient psychiatry. there are other patients discharged -- >> and supervisor stefani asked, how many of those folks do you
3:39 pm
think that are homeless when discharged? >> from in-patient psychiatry, i don't have an exact number. i would -- it's a minority of the people that we discharge. but i don't want to hazard a guess because i really don't know the exact number. >> it would seem like -- i mean, the 51/50 revolving door is a very hard thing to figure out how we're going to actually -- i mean, given current resources -- what we could even do about. but it does seem like we ought not to be discharging people from an in-patient acute psych hospitalization unless there's a real strong plan including a placement for them to be in following an in-patient hospitalization. i don't know, that's something that i'm interested -- and we're not going to figure it out here but i'm interested in knowing what kind of resources would be
3:40 pm
needed. >> to echo the comment that was made earlier. we need additional resources at all of the lower levels of care. and an important part of that is residential treatment. jeff mentioned the stabilization beds. that's very helpful resource for our in-patients to have access to. again, they can be found by their intensive case managers when we know where they're going to be staying. but, you know, we simply don't have the resources in our system right now to be able to provide a bed in a setting above the level of a shelter for everyone who is leaving both p.e.s. and in-patient psychiatry. >> do those people at least get guaranteed a hummingbird kind of placement if they're leaving? >> no. as has been mentioned, hummingbird is always full. we certainly make use of it
3:41 pm
whenever there's a bed available, but they're not -- there's not always a bed available for everyone who is leaving in-patient unit. >> it seems like something that we should fix. >> we need more beds. >> yeah, no, i get it. all right, thank you. >> supervisor ronen. >> supervisor ronen: yes, thank you. i just wanted to shift just briefly to costs. so one thing that supervisor mandelman has brought up several times is that we know that people are staying in-patient psych sometimes, especially the locked ward, because there isn't a step down. and when they're in a higher level of care that their conditions don't warrant that, we're not reimbursed by medi-cal. what is that costing the city in general fund every year? >> i don't have that number off the top of my head, but
3:42 pm
basically it costs the actual costs of care for an in-patient psych day, which may be a couple thousand dollars a day. >> supervisor ronen: i thought that it was $7,000 a day? >> no, the actual cost in terms of -- >> the reimbursement that you would get if you were making that available to someone else who is probably waiting for that bed -- jackso absolutely. >> the city would be drawing down $7,000 of dollars. >> supervisor ronen: can you get that number and send that number to me? >> yes, we will. >> supervisor ronen: and you're going to also send to me the average waiting time for a residential treatment bed. >> yes. >> supervisor ronen: i just want to make sure that i get those numbers and follow-up. i want to echo that is not just supervisor ronen but all of us on the committee. thank you.
3:43 pm
>> supervisor ronen: sorry, last question -- is there any other place where we are unable to draw down, due to the federal dollars, to help to pay for these services because we don't have sufficient availability of the proper level of treatment in the system? other than the one that we just mentioned? >> yeah, we have issues with not enough lower level of care within our entire system. not only with the mental health and substance abuse but medical and surgical and skilled nursing. so any given day at san francisco general there are probably 20 patients who need some -- 20 to 30 patients who need some form of lower level of care, predominantly on the skilled nursing, but also rcfe,
3:44 pm
board and care. but on the psych side, it's really what i talked about in terms of lset, the locked sub-acute and more of a hummingbird and also some rcfe that is psych oriented. >> supervisor ronen: so on the psych side then, the only place where we're perhaps unnecessarily relying on our general fund, where we could be drawing down state or federal levels is in this area? there's no other area that you can think of? >> i think that the other areas we are -- i think that we're maximizing our ability to draw down dollars through our out-patient system but it's really the in-patient system where we've got the biggest clog. so that's -- i think that's the right answer. >> supervisor ronen: okay, thank you. >> all right, well, then now is
3:45 pm
the opportunity for members of the public to speak. speakers will have two minutes. we ask that you state your first and last name clearly and speak directly into the microphone. those who have prepared written statements are encouraged to leave a copy with the committee clerk for inclusion into the official file. no applause and booing is permitted and in the interest of time speakers are encouraged to not have reputation of previous statements. if you would like to speak during public comment we ask that you line up on the right side of the chamber. okay. good. i do not know. go ahead. >> (indiscernible). >> ace, your time is beginning. >> i mean, let me say one thing for the public here. it is ridiculous for us to be up here and sit here silently while your department is up here talking about most of them shake the egg, yeah, yeah, yeah. i can shake my head and say, no,
3:46 pm
no, no. so what are we going to do -- my name is ace on the case, by the way -- we'll have to put together what they call community reform. you know, reform everything else. how to use the toilet. how to piss and everything. we're going to have community reform. so we can have accountability outside of this city hall frame here. because it's not working for people. let me give you a good example. i am a homeless person. i went to surgery and had surgery on my head. i went to all of them programs. what they're talking about, yeah, it's a no -- no to every one of them. i'm right now living over here on eddie street at a place there -- what is it called -- some hotel, whatever it is, under the care of these doctors. i have care of doctors and psychiatrists and now they want me to take psych medicine. i'll be damned if i take some psych medicine. i'm already crazy. let me say just one thing here. i'm standing here as a black man talking about black issues. this homeless problem is that you go back to the origin and
3:47 pm
the city and county got rich getting money from the state, from the federal and then you tell all of the homeless come here! as soon as they land they go down there and get welfare and everything taken from us. taken from the black folks. let me just say one thing -- y'all let that director here like he got it that way. he need to sit here and to be accountable to some questions that i'd like to ask him. now i ain't going to be able to say what i want to say in 20 seconds here and i'm pissed off now and my high blood pressure is going up. but there needs to be accountability on every department here that is getting millions -- hundreds of millions of dollars. i remember back when ali alto was the first czar of the homeless program. she had them right want and now you have people making millions of dollars... (indiscernible) don't have time to let me say... >> clerk: next speaker, please. >> thank you, ace, thank you.
3:48 pm
>> (indiscernible) i'm going to talk to london. i'm going to talk to her. all of the programs. >> thank you. next speaker. >> get that and a bag of chips. >> clerk: next speaker, please. >> we can't question it. the department of homeless -- all of that money go to him. he's top heavy. >> okay, we've got to keep going. >> if you don't want me to act crazy you better do the right thing for the community. and the black folks. >> please begin. >> do i get my time. i'm dr. alan cooper. for a long time i worked at stanford with patients with liver disease and i have a lot of experience with people with drug use problems at stanford and at the v.a. in the last five years i have done safety net medicine here in the city. first at the arbbury clinic and now working for bury i think at the 5th street clinic as a volunteer in the shelter.
3:49 pm
and i want to tell you about a case that we had -- and i think that barry and his team do an amazing job. incredible, given their resources. and the problems of getting outreach and i have a potential solution if i have enough time. so i saw a man a few weeks ago who had just been discharged from one of the local hospitals in the central line after a suicide attempt. he was sci schizophrenic. he had been a drug user, heroin user and didn't use anymore but used heroin to try to kyle himself. after three days in the hospital he was discharged to the m.s.c. clinic where one of barry's nurses saw him. a guy who i really love because he does a great job. and he said, wow, he has a bad celluliteis on his leg and he had been given some information but he couldn't walk around very well because of his leg. he had three appointments the next day. one of which was critical because he had to get up to see his doctor at the tenderloin because he was having bad side
3:50 pm
effects from the psych medicine. he was coherent, he was interactive and wanted help. okay? there was no way that he was going to be able to keep three appointments the next morning. one at 8:00 and one at 9 one at 1:00, and barry's nurse said that he has to be evaluated for a respite bed and he can't just sit on the street and walk around from place to place. (please stand by)
3:51 pm
>> he was in a drop-in bed. he had been discharged from the hospital to a drop-in bed. he was told he was going to get a permanent bed. he didn't want to go anywhere
3:52 pm
because he was afraid he was going to lose his permanent bed. he was afraid if he got readmitted, he was going to lose his bed at the s.c. shelter. >> supervisor stefani: okay. i'm going to give you my card. i'd like to contact you. >> okay. >> chair mandelman: okay. next speaker. >> my name is c.j. and i'm here to speak as someone who has mental health challenges as well as physical health challenges and has basically come here to share a little bit of what i call relay services. i come what they call the relay services era, and what i mean by relay services, i was able to get help from every step of the way, and i see that's missing now. so basically, i dropped into a
3:53 pm
24-hour helshelter, i was feel suicidal. they took me to a place called wes westside crisis. the case manager stayed with me until i seen someone. once i seen someone, they gave medication for me, had a van pick me up to take me to the psychiatric unit because i was feeling suicidal and having some thoughts of killing myself. that person was able to talk to the psychiatric unit. the unit had what they call a discharge plan. after three days of finally getting some rest and some of the medication that i needed, then we talked about a discharge plan. so someone was able to sit with me and make sure that i had stable housing, make sure i had
3:54 pm
a stable way to get services, a self-help mental health drop-in center. so then, i was able to get help. able to get permanent housing, a permanent shelter bed. so what i see missing, there doesn't seem to be that hands-on approach -- [inaudible] >> chair mandelman: thank you. thank you. next speaker. >> my name is diane chee, and i'm a medical student at ucsf? and prior to thaso first off, d to thank everyone for having this discussion this morning. i think everyone can acknowledge we have a very
3:55 pm
fragmented and hard-to-understand caring for individuals experiencing homelessness. i'm here to talk about 5150s as a coordination of medical services for individuals who are housing unstable and living with substance use disorder? and i would also like to express deep concern about bills such as sb 1045 to expand the use of 5150's. 5150s are currently used in the medical system, and they are ultimately a medical decision? 5150s are currently done after significant deliberation with doctors, nurses, social workers and other multidisciplinary social workers on part of the care team and are done as part of a long-term multidisciplinary plan. we know that they can often be a traumatizing process that often involves law enforcement and handcuffs.
3:56 pm
trauma can be extremely disruptive to the patient-provider relationship, and we know that a trusting patient-provider relationship is the foundation that brings people in to access services. we also know that evidence shows that trauma is tightly linked to substance use and mental health. in medicine, we recognize the importance of trauma informed care which is care that acknowledges the trauma or patients experience and -- our patients experience and continue to experience in the community and the medical system? one of the primary out comes is to preserve patient autonomy and patient decision over -- >> chair mandelman: thank you. next speaker. come on up. >> hello. my name is ronnie, and i'm a medical student at ucsf, and i work with patients who experience homelessness and have mental health and substance use disorders
3:57 pm
regularly at the clinic at mcf south? i just wanted to address that there's, like, we're talking about different strategies to address these issues, especially people who are experiencing homelessness with mental illness and substance abuse disorder. one thing that comes up, people supporting involuntary treatment for people? and there's a thought that some people need to be, for example, conserved in order to recover and for their own well-being? i want to say that our medical training contradicts this logic. the evidence-based approaches that inform medical management have shown that long-term recovery is most successful when there's internal motivation from the patient, trust in the provider-patient relationship and approaches to meet people where they're at. they have been more successful in the long-term effective
3:58 pm
recoveries? and a bill such as being proposed, sb 1045 to expand conservatorship and involuntary treatment, there's some studies on a similar program in massachusetts, and there's evaluation from overdose data there that found that people were involuntarily committed were two times more likely to fatally overdose than those who voluntarily went into treatment. you must be including the people who have lived experience of homelessness and daling with these diseases. i would like you to address the prejudice you might be holding inside when you ask people to comment longer and those you don't. >> chair mandelman: thank you. next speaker. >> my name's teresa palmer.
3:59 pm
i'm an m.d.-geriatrician, and i work with senior and disability action. i am against 1045, but i understand the stuff that 1045 is trying to address. someone today did say there's enough stablization beds. that was confusing to me because i know there's not enough. there is some model of -- this model of assertive case management where you go out to the person. it's my understanding that for case management, people are waiting, and even funds like the dignity fund, there's a waiting list for case management and home delivered
4:00 pm
meals. so these programs are not effective at meeting the need at this point. could we develop a division of assertive housing case management with supporting services for these high-need people? could someone explain how that could be done and how the barriers to getting case management could belowered? >> chair mandelman: thank you. next speaker. >> good afternoon. jordan davis speaking for myself. happy pie day, everyone. we should grow the pie for more housing and voluntary services. however, we should also throw the pie at coercesive treatment and skefconservatorships.