Good morning.

The meeting will come to order.

Welcome to the February 21st, 2024 meeting of the Budget and Finance Committee.

I'm Supervisor Connie Chan, Chair of the Committee, and I'm joined by Vice Chair Rafayan Mendelman and Supervisor Malgar.

Our clerk, it's Brent Halipa.

I'd like to thank Helena Mendoza for from SFGov TV for broadcasting this meeting.

Mr.

Clerk, do you have any announcements?

Thank you, Madam Chair.

Just a friendly reminder to those in attendance.

So please make sure to silence all cell phones and electronic devices, so as to not crowd proceedings.

Should you have any documents to be included as part of the file that should be submitted to myself, the clerk.

Public comment will be taken on the hearing on this agenda.

When public comment is called, please line up to speak on the west side of the chamber to your right, my left long those curtains.

While not necessary to provide public comment, we do invite you to fill out a comment card and leave them on the tray by the television to your left by the doors.

If you wish to be accurately recorded for the minutes, alternatively, you may submit public comment in writing in either of the following ways.

Email them to myself, the budget and finance committee clerk at B-R-E-N-T.jT SFGO V dot O R G.

If you submit public comment via email, it will be forwarded to the supervisors and also included as part of the official file.

You may also send your written comments via U.S.

Postal Service to our office in City Hall.

That's one.

Dr.

Carlton, B good the place, room 244, San Francisco, California, 94102.

And that concludes my announcements, Madam Chair.

Thank you, Mr.

Clerk.

And just want to welcome Supervisor Hillary Ronin and Supervisor Catherine Stephanie joining us today at the Budget and Finance Committee.

And I think we're ready to call the sole item on today's agenda.

So Mr.

Clerk, please go ahead.

Thank you.

And this is the sponsor of this hearing is by Supervisor Rafael Mendelman, our vice chair.

And so I'm gonna hand it to him to Chair and to uh hold the rest of the hearing.

Thank you so much.

Thank you, Madam Chair.

Thank you for making time for us to um have this conversation here at this committee this morning.

Um it's a little bit of a reunion for uh Supervisor Ronan and I, who I feel like have been having this hearing uh intermittently for um many, many years.

Um I want to thank uh Supervisor Ronan for her co-sponsorship.

I also want to thank uh Supervisor Stephanie um for her leadership on behavioral health issues generally and for her co-sponsorship.

Um and then I want to thank uh uh Dr.

Hillary Cunnins and Tanya Mara from the Department of Public Health and Jail Health Services and Kelly Deerman from the Department of Disability and Aging Services who are gonna be presenting today.

They and their teams um do amazing work every day, uh work incredibly hard.

Um I think there is a tendency in the public and um and in uh among elected officials uh to see the clear evidence of the ways in which government is not working um and to not see the people who are trying really, really hard to make government work.

And so even though it's my job and our job to highlight failure sometimes or to point out the ways in which we are missing the mark, I do um want to again thank the people who uh know way more than me and are trying really really hard every day.

So um now.

Um it is the impacts of of uh San Francisco and California's mental health and addiction crises are painfully clear uh to all of us, and we know there is a connection between the lack of appropriate placements for people with severe mental illness uh and the crisis we see on our streets.

The California statewide study of people experiencing homelessness conducted by UCSF last year, estimated the prevalence of mental illness among the unhoused to be as high as 80 percent.

Um we are also I think familiar with the uh sad and story sorry history of the state's retreat over the last half century from its historic role as primary mental health provider for indigenous indigent Californians with severe mental illness.

As the state pulled back, the burdens on local government uh have grown, um, especially in the state's major metropolitan centers and very much especially here in San Francisco.

Um at some level, I think most of us understand that many of the people who might have once experienced care in state mental hospitals are today cycling among San Francisco's emergency rooms, our acute psych services in lots of hospitals, our jails, uh, and and our sidewalks.

Now, I said this conversation had been going on for quite a long time.

I think it was happening before Supervisor Ronan joined the board seven years ago.

Um it was well underway when I joined the board five five and a half years ago.

In 2020, uh the mayor's uh director of mental health reform, uh, the mental health czar, uh Dr.

Anton Nagusa Bland prepared a rough point in time flow analysis to estimate the number of additional placements that would be required at various levels of acuity to allow consistent patient flow in our behavior health system and to eliminate wait times.

At that time, Dr.

Nagusa Bland identified the lack of locked subacute beds as the most acute need with an average wait time of two months for placement.

He proposed that the city should consider acquisition of its own beds to ensure availability and cost savings by relieving the bottleneck occurring in high cost care settings.

Following Dr.

Nagusa Bland's report, the mayor and Department of Public Health announced their behavioral health residential treatment expansion plan in 2021.