Good morning, everyone.

This meeting will come to order.

Welcome to the regular meeting of the Public Safety and Neighborhood Services Committee of the San Francisco Board of Supervisors for Thursday, March twenty-sixth, twenty twenty-six.

I am Supervisor Matt Dorsey, Chair of this committee, and I'm joined today by fellow committee members, Vice Chair Balal Machmood, and Supervisor Alan Wong.

As always, we're grateful today to our clerk, Ms.

Monique Um Creighton, whom we thank for staffing us and keeping us on track as well.

We are appreciative to the entire team at SFGov TV for facilitating and broadcasting today's meeting, and that is especially true for our producer today, Ms.

Kalina Mendoza.

Madam Clerk, do you have any announcements?

Yes, please make sure to silence all cell phones and electronic devices.

Documents to be included as part of the file should be submitted to the clerk.

Public comment will be taken on each item on this agenda.

When your item of interest comes up in public comment is called, please line up to speak on your right.

Alternatively, you may submit public comment in writing in either of the following ways.

Finally, items acted upon today are expected to appear on the board of supervisors' agenda of April seventh, twenty twenty-six unless otherwise stated.

Yes, Mr.

Chair.

Item number one is a resolution authorizing adoption of the San Francisco Behavioral Health Services Act.

Annual update for fiscal year 252.

Um twenty twenty-five, twenty twenty-six behavioral and mental health services act annual update.

So I'm really um excited to hear about that.

I think this is something that people may recall that voters enacted uh back in March with Proposition One.

So there's some interesting things that I'm really looking forward to hearing up about.

Um, I'd like to welcome Jessica Brown, who is the director of the Office of Justice, Equity, Diversity, and Inclusion, and Behavioral And Heads Up the Uh, Behavioral Health Services Act work.

Um, thank you, Ms.

Brown.

The floor is yours.

I just I just wanted to say I'm not Jessica Brown.

I'm Danielle Marshall.

I'm the deputy director.

Jessica is actually coming up on the elevator right now, so she will be here momentarily if we can have just a moment of patience with with you all.

Uh, sure.

Madam Clerk, should we just take a recess for 10 minutes?

Okay.

Okay, thank you so much.

Okay.

No problem.

Yes, let's recess.

Okay.

Thanks.

We are in recession.

San Francisco government television.

Okay, we are back from recess, and um, as I was saying, we are going to hear a presentation from the Department of Public Health on the fiscal year twenty twenty-five, twenty-six Behavioral and Mental Health Services Act annual update.

This includes updates on key programs, outcomes, and the upcoming transition to the state's new Behavioral Health Services Act.

And I would say that that is the most significant public policy update at the state level since I think the the uh mental health services act was passed back in two thousand four, I believe.

Yes.

Um, so those of us who are um involved in these issues are aware that back in March of twenty uh twenty-four, we cal in California passed proposition one, which made some important updates.

Some of these include um expanding some of the outreach and work to um the recovery community and people who uh struggle with substance use disorder.

These are issues that are close to my heart, so I really appreciate um Jessica Brown, who is the director of the Office of Justice, Equity, Diversion, and Diversity and Inclusion and the Behavioral Health Services Act.

Um leader for the point person for the Department of Public Health.

Uh, welcome, Ms.

Brown.

The floor is yours.

Thank you, Supervisors.

And as you mentioned today, I'll be presenting to you all on our annual update for fiscal year twenty-five twenty-six.

Um, we do plan to come back to the full um board and to provide information on the integrated plan.

Um, that will be some time in May.

So if you have any deeper questions, we'll be able to be able to answer that for you all about what our plan is.

So as you mentioned, we will be I'll be presenting to you today an overview of our 2526 annual update for the Behavioral Health / Mental Health Services Act.

You might hear me use those terminologies in interchangeably since we've been having some changes.

And this looks at the overall three-year integrated plan and expenditure plan.

This update will provide you all with just what has happened in the last few years, particularly for our outcomes for fiscal year 23-24, and also provide you with an overview of the new changes.

So as I mentioned, we'll be focusing on the funding components of MHSA, the funding programs that we've had since fiscal year 25-26, also outcomes as well, and then moving forward how we will be adjusting to the new requirements to Proposition One and next steps as well.

So with the Mental Health Services Act, we have historically had five funding components.

These funding components allowed counties to expand mental health services beyond what's billable through Medi-Cal reimbursement.

Those funding components compose of community service and support, which focuses on an intensive case management, full service partnership services, innovations, which focuses on providing pilot projects to the counties to see if we can test out different strategies to help bring in vulnerable populations into mental health services.

We also have prevention and early intervention, which focuses on providing stigma reduction services and population focused services, as well as workforce education and training and capital facilities and technology needs.

So San Francisco had a unique approach in having seven service categories so that we were able to expand our services beyond the five categories, funding categories that you all are seeing.

So this annual update we have since the enactment of the Mental Health Services Act, we've expanded our programs tremendously.

We have about 95 programs and services that provide support for very lower level or higher level threshold of mental health services.

Again, as I mentioned, our full service partnerships, which really focuses on doing whatever it takes to get the client from wellness to recovery.

Also to our peer support services, vocational and also housing.

We have an expansive housing portfolio, which consists of both emergency transitional and permanent supportive housing support for our clients, as well as mental health promotion and early intervention, culturally congruent innovations program and behavioral health workforce initiatives.

This is giving you all an update of our budget since the enact of Mental Health Services Act, San Francisco has historically got about 30 million dollars per year.

However, that has tremendously increased over the last fiscal year.

And then it has expanded up to 72 million as our recent spending plan shows.

Some of our program outcomes and highlights really show a robust support as we provide full service partnerships for our clients.

As you all can see, with the full service partnership model, it provides a wraparound approach to really help support members and clients, not just with their behavioral health needs, but also their needs outside of diagnosing and treatment, which includes housing, vocational services, and also peer support services.

And because of that, we've been able to see a tremendous uh decrease in mental health and substance use disorders at emergency services, uh, also to uh clients going to physical health emergencies for their mental health services symptoms and also a decrease in arrest with clients that access our full service partnership.

With our population focused programs, we've seen a tremendous increase in the quality of life for our clients and our vulnerable communities, as well as increasing of socialization and less isolation for our clients as well.

Vocational services, we have 100% of our graduates that complete our I ability vocational IT program, and the behavioral health department has a very unique approach to actually hiring people with lived experience within our actual civil service organization.

We have a robust amount of peers that serve in our IT department, janitorial services, and also our front office, front desk, and mail room as well.

And some of those peers have actually gotten to uh civil service classifications as well and have become leaders within our department too.

And then our peer-to-peer support services, we really connect with families, being able to have more understanding of a client's uh mental health diagnosis, increasing the education and support of family members to provide again that wraparound services.

With the Mental Health Service Act, we have a strong emphasis on program evaluation.

So we require all of our CBOs to turn in mid-year and year end reports that provide demographics and narratives about how they are actually utilizing our funding to support and sustain our community's mental health and behavioral health services.

We also ensure that our CBOs use a SMART objectives analysis to really point out their performance objectives, as well as providing site visits.

We also have advisory committee meetings with all of our CBOs to keep them well informed on any changes for the Mental Health Services Act, as well as in and as well as providing a separate evaluation of our prevention and early intervention work through evaluation activities.

With the Mental Health Services Act, our revenue is very volatile.

So we do depend on those personal incomes of over a million dollars.

We take about 1% taxes of that income.

Because of that, we typically don't have actuals until maybe the mid-year.

So our funding can fluctuate depending on how the state is actually doing.

We go a little bit up and down depending again on actual and tax statements that we receive, tax settlements, and as well as again how our fund how our state is doing over the years.

So with that talks about the modernization of the Mental Health Services Act.

The Mental Health Services Act has now been transformed into the Behavioral Health Services Act.

And while the foundation of that this law has still remained the same, what will now be happening is that we have more directive from the state on really allocating our funding towards direct services, housing, and also to another funding category to ensure that we are capturing the most vulnerable populations.

So as I saw, show you showed you earlier, we had five funding categories in the past.

We now have three.

So what the new Behavioral Health Services Act is requiring from us under Proposition One is that we put about 35% of our funding into full service partnerships.

30% of it goes also into housing, and 35% is going to behavioral health services and support.

So that will include workforce initiatives, innovations programs, early intervention programs, and also capital facilities and technology services under that third category.

So what this does for us is it actually expands our services to now include substance use so that we know that we have clients that have co-occurring conditions with this new changes of Proposition One allows us to provide more support services with substance use as well too.

It also ensures that we are looking at the most vulnerable populations in California, which includes children and youth, chronically homeless, and also veterans as well.

And the goal is to really improve not only services to those communities, but also transparency and accountability statewide on how behavioral health services are using state funding, local funding to provide support for our communities.

This also includes new county planning and reporting requirements as well.

And it also ensures that we are able to really be transparent with our spending again to our constituents and stakeholders for behavioral health services.

If you look to, I think it's my left, your right, one of the two.

Under the new proposition one.

Oh, again, this is giving you a comparative analysis between what was required with MHSA in the past and what's being required now.

The county is required under BHSA to really demonstrate behavioral health planning across all services.

So our integrated plan, which we will come back to you all in May, will not just show the funding that we use for BHSA, but also for all of the behavioral health services.

In addition, we are actually encouraged to even more rev up our community engagement process by also partnering with other county and city departments on their behavioral health needs as well, develop more of a demographic and behavioral health needs assessment, look at extend our community planning process, and also look at a behavioral health continuum of care.

This also would include again workforce strategy and also budget and spending.

So also ensuring that we have a prudent reserve in case there's an economic downfall, but also to how we're actually spending our funding across the board for behavioral health services.

In addition, as I mentioned, we actually have already started the process of revving up our community planning process.

We are required to engage with 26 stakeholders across different groups.

So far, we have held 12 community planning meetings of providers, consumers, and also our advisory committee, our client council, and our behavioral health commission.

Um, our targeted outreach is to again city departments, population health, homelessness and supportive housing, and also looking at labor unions, Golden Gate Regional Center, and independent living center as well.

We are going to also continue to uh rev up our community planning process and also be able to leverage some of our San Francisco Department of Public Health community needs assessment for 2024.

So our next steps it we are currently in the process of submitting our integrated plan that's actually due next week.

Um that integrated plan will be submitted to the state to give us feedback on how we are making adjustments for the allocation.

We will then be a we also are going to be posting that to our website for our public to also make comments and provide feedback.

One of the requirements is that we do have to ensure that we have community engagement in all steps of the integrated plan.

That would be posted on the website as of I believe Monday.

After the 30-day public comment, we'll be able to finalize the plan, submit that by June 30th, and the plan will go into effect by July 1st, 2027.

So the plan requires uh approval from the uh San Francisco County Administration Office, Behavioral Health Commission, and also the Board of Supervisors after we provide the 30-day public comment.

So that's why we're going to be coming back to you all in May to get your all approval, and then also by the May Mayor's office.

Under the new proposition one, it is imperative that we have approval and timely submission of our plan.

It does impact funding in the future if we are not able to submit this plan timely.

And that is all.

Thank you so much.

Great.

Thank you, Ms.

Brown.

I've got a few questions.

First, I really do appreciate that this is expanding to include those with substance use disorder.

And it occurred to me, you know, those of us who've been following the news, there's some stories now about social media, and there's a whole category of non-substance related addictive disorders.

You know, we're courts right now are grappling with social media and how this is playing out with addictive behaviors, which may be triggering dopamine and that kind of thing.

As I work on this public policy area, one of the things that I quite I wonder about is are we is this something we'll have to go back to lawmakers or voters to to change, or are we set up if in the years to come we start seeing issues with young people who are struggling with you know non-substance related addictive disorders?

I know that in the recovery community, the gamblers anonymous is kind of the granddaddy of those.

Um but I think what we're starting to see now in some of the cases that are playing out against Meta is that this may be a bigger problem than we think.

Um Anna Lemke is a professor at Stanford has written a book called Dopamine Nation and really went in deep on some of this.

Some of what we're seeing with substance use disorders may be just the tip of the iceberg and in other areas of where it's all it all comes back to dopamine.

And it's often triggering the same kinds of problems.

So I just want to invite you to talk a little bit about what kind of flexibility do we have under the under Prop One and some of the behavioral health issues.

Absolutely.

So the funding category, the BHSS Behavioral Health Services and Support includes our innovation funding.

That innovation allows us to pilot targeted strategies for exactly what you're saying right now based off of community feedback, we're able to pilot programs to see how they're effective.

We've been very successful in doing that within our own programs.

We actually expanded services to include birthing people for post-pre and postpartum depression and anxiety, the disorder that can happen amongst birthing people.

And so the good thing about uh even though proposition one is focusing on housing and uh full service partnership, we do have this flexibility in our state funding to include other initiatives that may come up.

There also also, as we saw with substance use, initially the Mental Health Services Act did not include substance use.

But because of looking at how it's been a co-occurring condition with mental health, we've now been able to expand it.

So I do predict that that may happen.

And in the meantime, we do have that flexibility to include support.

We also have to sub uh provide 50% of our funding to early intervention efforts for uh populations under the age of 25.

So we're able to actually look at different programs that may do what you're talking about as far as dopamine effect and social media.

We'll maybe be able to fund those because that fits our age range as how we have to serve and provide mental health support for.

So there's some flexibility.

Okay.

There was a couple references to full service partnerships under the category of recovery oriented treatment programs.

And I just wanted to invite you to maybe expand on that a little bit.

What kind of what is a full service partnership look like?

Yeah, so full service partnership is a very intensive case management frame.

It requires wraparound services again, not to just focus on treatment and diagnosis, but also providing connection and linkage to care outside of traditional behavior health support.

So under a full service partnership, we're able to provide employment services.

So if a client comes in and says, I want to start working, we're able to connect them under that framework of uh of an intervention.

It also requires an extensive wraparound service as far as staffing goes, ensuring that we have a peer employment specialist to help clients, housing specialists as well, as well as all clinicians, nurse practitioners, pharmacy, psychiatrists.

So it looks more into holistically how to support clients versus just the traditional treatment and diagnosis.

It's going to focus on holistically how do we provide wraparound services and intensive care.

So part of our full service partnership is also having 24 access.

So our clients have 24-7 access to our clinicians in the event that there's a crisis or they need some more attentional support.

Um it's also a higher level of care than most intensive case management.

So there's a there's a pretty intense frame model, especially who we're serving.

So under the new proposition one, we have to provide full service partnership, and then we also have some communities based off of that that we most provide services to those that are justice involved, those communities that have high um high vulnerabilities to mental health services.

It's a part of five providing that wraparound services to ensure there's an intensive case of care, but again, also going beyond just the care, also getting client clients into housing and also support as well too with job job seeking.

Okay.

Um on job seeking, there's a I was very intrigued by some of the issues, the um services around vocational assistance.

Um I probably have too many questions for a hearing.

I probably, if it's okay with you, I might ask to just get a briefing on that because I do think, especially for people who are in early recovery or coming out of substance use treatment, um, they're often particularly vulnerable to relapse, and I think to the extent we can make sure that we as a city um have programs that we are offering to give people a safety net.

Um I'd like that that is a policy realm that I have been working on that I would love to talk to you about.

Um I think the only other thing that I wanted to ask about was I think oh, here it is.

The the 26 stakeholder groups with which uh that you're required to engage.

Um in my work on some of uh on drug policy, I will say there are it's sort of an interesting realm because especially with the recovery community, many of these traditions are rooted in anonymity and you know it's a it's a it isn't necessarily a CBO, but it really is a vibrant um community.

And I just wanted to ask if um if some of the stakeholder groups include um either recovery communities or there are in here in San Francisco, we have some I don't I I think most of these organizations don't get by and large, don't get city funding, but I'm thinking of things like the dry doc, Castro Country Club, uh Gratitude Center, places where there's a lot of 12-step meetings and other kinds of meetings, they're definitely part of the recovery community.

I think there's certainly um stakeholders that are relevant to this.

Um I sometimes have found them it's it's it's hard to sort of identify those.

Yeah.

And especially with other languages, one that I surprised me was how hard it is to find recovery meetings that are Chinese language for, for example.

So I want to just invite you to talk a little bit about that, and if you have any strategies to make sure that we're engaging with recovery meetings, recovery organizations, and and those kinds of community-based facilities that are self-funding, like the dry doc and others.

Yeah, yeah, thank you for that.

And so prior to proposition one, we did have a very robust community planning process, which included various stakeholders, those of that were funded, those that were not funded.

We opt we open up our meetings to the public.

We also translate any of our communications in various languages to ensure that we have community stakeholder feedback from all groups.

So we do a combination of both extensive outreach.

We also rely on our CBOs that we fund as well too to provide information about the Mental Health Services Act to our providers' meetings.

In addition to that, um this before we kind of well, San Francisco, we did our own strategy around who we would engage with, right?

It would always include other departments as well as a wide range of community-based organizations.

But now under proposition one, the state is very specific about who they want us to actually interact with, including labor unions, including law enforcement, including the managed care plan, really expanding out our reach to community stakeholders in order to be able to make sure we're getting all the feedback and also too that we're being transparent on our process.

So our strategy is to continue with the that that initiative that we had in the in the past, but also now expand it.

So working with the population focused um, I'm sorry, population health department as well, getting their key stakeholders, working with the Human Rights Commission, also the Office of Workforce and Economic Development, and the Department of Rehabilitation, which is where we do a lot of our vocational trainings with.

We're able to expand and meet the requirements of the state because we had that robust outreach already.

Um now we're just going to be expanding that more to labor union to talk about workforce initiatives, but that's typically how we have always uh done it community outreach.

And then again, as you mentioned, ensuring that the outreach is translated into certain languages.

We've also ensured that some of our program managers go to culturally um culturally specific communities also to translate information on behavioral health service, particularly for our Latinx community as well too.

So maintaining that same approach, but also understanding that now the state is going to really have some, I won't say scrutiny, but accountability on how we're engaging and ensuring that certain stakeholders whose voices weren't heard in the past get included in the new proposition one requirements.

Okay.

Okay.

Thank you, Ms.

Brown.

I don't see anyone on the roster with questions or comments.

I really appreciate um your presentation.

And um I would like if it's okay, as I mentioned, I'm probably gonna reach out.

I'd love to get um just uh better educated on this, and I know that we're looking forward to more to come in May.

Yes.

So thank you for your presentation.

Thank you.

Um Madam Clerk, may we invite up public comment on this item?

Yes, members of the public who wish to speak on this item should line up now on the side by the windows.

All speakers will have two minutes.

It appears we have no public comment for this item.

Thank you, Madam Clerk.

Public comment on this item is now closed.

And seeing no other further questions or comments, I'd like to make a motion to send this item to the full board of supervisors with our positive recommendation.

Maybe we have a roll call on that motion.

Yes, and on a motion to forward item number one to the full board of supervisors with a positive recommendation.

Member Wong.

Member Wong, I, Vice Chair Mahmood.

Vice Mahmood, I, Chair Dorsey.

Aye.

Chair Dorsey, I have three eyes.

Thank you, Madam Clerk.

The motion passes.

Madam Clerk, do we have any further business before this committee today?

That concludes our meeting agenda, Mr.

Chair.

Thank you, Madam Clerk, and thank you everyone for your participation today.

This meeting is adjourned.