recording in progress. Okay, good morning everyone. I'd like to call this meeting to order. This is Alameda County Board of Supervisors. I'm gonna call it a joint meeting since it's just committee members of Health and Public Protection Committee. I wanna thank my colleagues for being here this morning and can we please start with the roll call. Supervisor Miley. Supervisor Tam. Present. Supervisor Marquez. Present. Thank you. And can the clerk please give the announcement? We will be taking public comment on item one and two after the presentations. But if you could please share with the public how they can participate in person or remotely. For in-person participation, the meeting site is open to the public. If you'd like to speak on an item, you can fill out a speaker's card in the front of the room and hand it to me, the clerk. And for remote participation, follow the teleconferencing guidelines posted at www.acga.org. For remote participation, if you'd like to speak on an item, use the Raise Your Hand function, and we'll be taking comment after presentations on item one and two. Thank you. Again, want to welcome everyone. Thank you for joining us. We have called the special joint meeting of the Health and public protection committees to receive an update regarding implementation and strategies and the progress for the care first Jail's last task force final report that was approved unanimously by this board. Before we move into the presentation, I would first like to honor the legacy of the late supervisor Wilma Chan, who sponsored a resolution in 2021 to adopt a care first Jail's last policy in Elimitia County, as well as my former colleague, Supervisor Carson, who brought forth the final recommendations for its implementation last August. I also want to acknowledge the dedication and hard work done by Elimita County Mental Health Advisory Board. They have worked tirelessly on this important issue. I have had an opportunity to review their report and the attention to the detail and thought put into this presentation is impressive. Alameda County's care first, Jell's last policy resolution and task force final report is an opportunity to close service gaps for people living with mental illness, substance use and co-occurring disorders. It is also a critical framework and tool for addressing the root causes of incarceration and investing in evidence-based diversion support services to effectively assist some of our most underserved and vulnerable residents. In August of last year, the Board of Supervisors officially received the Final Care First J Jail's last task force report, and delegated continued planning and implementation to the Mental Health Advisory Board in conjunction with Elimitate County Behavioral Health. The final report contained 58 recommendations supported by extensive data and research. are board unanimously approved the recommendations and delegated continued planning implementation to the Mental Health Advisory Board. I am truly looking forward to not just learning more about internal implementation analysis, but also the opportunity ahead to positively impact the lives of numerous residents, including those who have experiences or are in connection with someone experiencing mental illness, housing insecurity or have been in custody at Santa Rita Jail. To the community members, advocates, and attendants, we welcome your input. Today marks an important step in monitoring the county's progress on this issue, but your voice remains critical, especially given current obstacles and challenges with the federal and state landscape. So we welcome the community to share their observations and lived experience. As the chair of the public protection and member of the County's ad hoc Committee on reparations, I am particularly interested in hearing about the status of the recommendations that address the Safe Landing Project, court-based diversion programs including pre-trial services, and the African-American Resource Center. Again, I would like to recognize Supervisor Keith Carson, whose longstanding leadership and advocacy laid the groundwork for initiatives like Care First Jail's last and the African American Wellness Center. And his partnership with my office last December to incorporate additional one-time funding this budget year for expanded pre-trial services, centering equity, dignity, and care in our approach to public health and safety. The intersections and the overlaps are clear between the Care First, GELS, LAS, and Re-Imagine Adult Justice Initiative, recommendations which my office continues to shepherd in honor of the late public protection chair supervisor Richard via it. Next I want to highlight our second agenda item. Care courts is the first update we have received since Alameda County began accepting care court petitions in late November 2024. After reviewing today's presentation materials, I am encouraged by the progress being made. The county has held extensive training sessions, particularly focused on working with petitioners and ensuring cross-agency collaboration. Extensive, thoughtful, and intentional effort has gone into building the infrastructure needed for CareCourt to be successful for residents. I'm looking forward to learning more and continuing to support the evolution of this important work. Thank you again to all our presenters with us today, as well as everybody who played a role in launching this new system, including mental health advisory board members that care first Joe's last task force, county support staff, and members of the community. With that said, I staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff and staff raise your hand function to inform that you can hear us? Yes, they can hear. Thank you so much. Welcome. Great. Can we have the slide and I just asked for the next slide. That's the best way to do it. Thanks. All right. There we go. Thank you. On behalf of the Mental Health Advisory Board and the ad hoc care first committee of what we affectionately call the M-Hab, I want to thank all of you, Supervisor Miley, Supervisor Tam, Supervisorquez, for this opportunity for us to share publicly our efforts at even more, huh? Okay. To share with you our efforts in monitoring the implementation of the care first policies and strategies. Supervisor Marquez, I was a lovely introduction. I really appreciate it. In fact, it cuts out some of what I was planning to say because clearly we're knocking on an open door. And it always feels good to be knocking on an open door. So if we could advance the slide, please. We can just go through this to provide us a mark as put this in context. I was going to provide some history in context next slide, please. But let's just jump right to what we think is one of the important metrics of success. The theme here is we can't improve what we don't measure. We can't know if we're fulfilling the promise of care for first policies and strategies unless we come up with metrics of success that are reasonable and intelligent and then monitor and track that success. So the next two slides are going to make an attempt to do that. And as you'll see, the news is we have our work cut out for us. Next slide please. Let me try to orient you to this slide. You can have a fancy little pointer that I can hopefully use to some effect. Because of the Babu consent decree, starting a couple years ago, or less, all incarcerated folks at the jail are assessed at booking and assigned a level of care, mental health, level of care number, level four being the most acute, level three, last level two, and level one. But it's an acuity scale, level four being the most acute. And this is the first time in our, the History of our County where we've actually measured this population and can now make some intelligent judgments about, are we succeeding? You can tell from the numbers, and this takes us from July 23 to the last month, and a shout out to the sheriff. These numbers are all published every two weeks on the sheriff's public facing a website portal. So they're easy to obtain and obviously easy to track over time. We've gone back a couple years to show you that, unfortunately, as you can see for every group, the numbers are not going down. Level one, the least acute category actually has seen a recent uptick for reasons that aren't really clear. Maybe it's an aberration, maybe it'll drop down. But we're not seeing any appreciable decline in any of the mental health levels of care numbers. We can, and one other thing to notice, of course, is to note, I should say, is that in the last two years, the jail population, the jail population has gone down 10%. So the population of the jail continues to decline, but the numbers of mentally ill individuals at the jail has not seen a commensurate decline at all. It's staying about constant. We believe that if we're doing the job right, if the county is really implementing all these tragedies and programs that're going to talk about in a second. To their full potential, we're going to see these lines hopefully start to bend down. Next slide is the same data, just a different slice at it. Here we have combined the levels of care. So that top line there, these are the levels of care one through four. The total population of people at various levels of acuity that are living with behavior health mental illness challenges. That number has always been around 850 about half the jail population. This comprises what is known as the adult forensic behavioral health caseload. In other words, anyone that indicates a need for mental health treatment, again at whatever level. is known as the adult forensic behavioral health caseload. In other words, anyone that indicates a need for mental health treatment, again at whatever level, is on their caseload about half the jail. Then we've broken it down to levels two through four. Obviously, the more acute, the more the individuals that are suffering more. This number averages is about 385 over the last two years. Every night at jail roughly 385 people are there with serious and significant mental health challenges. That's more people on any given night than are at John George, Bill Affairman, Gladman Hospital, and all three crisis residential treatment centers. More, significantly more. If you have those numbers up of the hospitals and treatment centers I just mentioned, that's about 250 people. So, 385 people in the jail with serious mental health challenges, way more than are being treated in the community. And then should drop down to levels three and four, the people with the most severe and acute problems, some really in crises. That number averages that you can see from the graph about 160, 168 actually is the average over over two years, double the number that is a John George on any given night. So these graphs show us the challenge, they show us the reality, and they, I think, leave us with the inescapable conclusion that Alameda County, not different than most jurisdictions throughout the state and the country, unfortunately relies on its jail to be the largest day facto provider of mental health treatment services. That's what care first is designed to address. That's what care first is designed to change. It's like slime. So, and again, thank you to provider markets for providing the context. The care first task force presented the recommendations to the full board in August of 2024. Those were received. I'm not going to go over that. This is a slide that you have seen a version of before. It just shows how Care First is fully aligned with so many of the other important county efforts as Supervisor Marquez says, remanding and reimagining the planning of the justice, the home together plan, our efforts regarding Cal aim. We should have in there, of course, Dr. Trouble and her team's forensic plan that really predates the care first resolution. And also when the full board accepted the 58 recommendations, you tasked, if that's the right word, the Mental Health Advisory Board with analyzing the recommendations, seeing how they're being implemented and reporting back to you as the joint committee and also to the full board. And again, this is our first opportunity to do so. I hope it's not our last. We have a lot to say and we're going to continue in this monitoring process. You should know that we started this ad hoc committee that the M-Hab created started work in December. So we're relatively new. We've been working. I hope as this presentation suggests to you, we've been working awfully hard. So I mean the county is very fortunate is frankly to have such dedicated,, volunteer civil folks who have great experience, great expertise. And people have all been working together. We've created layasons with each agency. At our request, every agency in the county appointed or designated a layazon to work with us. We're meeting with those individuals, we're developing the relationships that we think are going to be important over the long term to fulfill the care first promise. Okay, let's turn to the bulk of our work, the implementation report. And what we're going to do, thankfully, is not talk about all 58 recommendations. We've selected nine that we think are the most important to address today, the most impactful. And obviously more can be gleaned if looking back at the Care First Task Force full report from last August. But here are the nine areas we're going to talk about. And I'm going to share a few and then turn it over to my colleagues on the committee who are going to talk about some of the others. For each recommendation, you'll see we've broken it into three parts. What progress have we seen? What obstacles have we identified that need to be addressed? And what action we're asking the board to take to address those obstacles? So let's just jump right into it. The Safe Landing Project is the first. This is a great example of a county initiative that identified an unmet need, namely the Behavior Health Challenges of folks leaving jail, brought various agencies and an effective CBO in the community together to design a program. Lots of success over the two or three years or four years, I guess, of its since its inception, expansion of hours, both in terms of the days of the week and hours of the day, served almost 11,000 people, recently a transportation element was added at the boards with the boards funding to get people where they needed to be, who are leaving jail. Very successful program, two key takeaways for today. The Safe Landing Project needs a permanent home. It exists in a mobile RV trailer on the parking lot. The power is generated by a portable generator. It's cold in the winter. It's hot in the summer. It has a rickety little stairway to get up to it, folks that have mobility challenges, have a hard time getting in there and availing themselves of the services, no confidential spaces, it needs a permanent home. And the good news is that our understanding from the Roots Community Health Center that runs the program, they secured a modular unit. So it doesn't even seem like this is a cost issue. This is just one of those examples of can we get the relevant partners and parties, the sheriff's GSA, etc., at the table to figure out where to put this modular structure so that they can have a permanent home. It would, the independent auditor, the bridging group that did the evaluation of safe landing has called for that as well. And then the second takeaway for the Safe Landing Project is that this can really be the safe landing project that is can really be a key part of the county's Calam justice involved initiative. It has the potential to serve as a larger reentry resource hub for the just released population. Now that means coordinating the self-safel landing project with the reentry planning that's taking place while folks are still incarcerated. This is that 90-day in-reach benefit. This is the first time in history that the county can get reimbursed for discharge planning and reentry planning taking place in the jail. That is a game changer. But we're still have the committee's understanding, we're trying to learn more, but the committee's understanding is that the county has yet to fully embrace and implement CalA. We don't think any money should be left on the table. We don't think that there should be anything but the full leveraging of CalA and Medicare benefits to provide the in jail services within 90 days of release. It can start that reentry and discharge planning. Safe landing project is uniquely poised to do that work. And we urge the board, both in terms of a permanent home for safe landing and making it part of the CalAIM program to move in those directions. Second recommendation from Safe landing project. We move to subacute. Obviously, there's some great news here. Obviously, the board has made significant progress. Both a few years ago in authorizing the money to buy back the beds at Villa Ferrimont. That was a wise and strategic action, we think. The board took, and more recently, a shout out, obviously, to Dr. Trouble and her team and the CBOs in the community that sought and won, if that's the right word, the 130 million dollars in beach ship grants from the state, it will help us expand this part of the continuum of care. You learned, the board learned just on Tuesday about SB 43 and how the expansion of the grave disability definition will require more subacute treatment beds. So what we're calling for here is, the county's made great efforts in terms of analyzing unmet need. We have a great mobile crisis assessment. It really dove deep into the mobile crisis system what's needed where the service gaps a terrific full service partnership assessment that does the same the home together plan Which really tells us what kind of housing we need over the long term We think that the committee thinks that the same should be done for subacute treatment beds and psychiatric treatment beds in general Let's assess what the the county needs. We've made great strides. We've expanded this part of the continuum considerably. But we still are a little fuzzy about what exactly are the unmet needs in this area. We know, for instance, that every night at John George depends on the night, obviously. But some 20, maybe as many as 30% of the beds of John George on any given night are occupied by individuals who have achieved stability. They don't need to be a John George. They're ready to be dropped down to a subacute or lesser level of care, but they stay at John George because there's no bed available at the lower level of care. Alameda Health System has told us this. And that means that you got a John George bed being occupied by someone who doesn't need to be there. And you got people being turned away from John George because there's no room at the end. So really figuring this piece of the puzzle out, we think is important. And again, a hearty recognition that we made great strides. From subacute beds, we go to the Cares Navigation Center. Now this is the only point of arrest diversion program in the county. We have court-based diversion, we have the pretrial services program that Supervisor Marquez alluded to earlier. This is the only point of arrest diversion program. In fact, you can think about it as safe landing is sort of when you leave jail. You might be called a safe departure. In other words, it prevented from going to jail. It gives officers, law enforcement officers, the opportunity to bring someone that they are going to arrest for a low level crime, to the navigation center for respite, for linkages to services, referrals to behavioral health and housing services. Program has tremendous potential. There again, another independent evaluator has looked at the navigation center and indicates the recidivism rates go down. Satisfaction is high amongst program participants, notable engagement with services, and Prop 47 of the fund, the Prop 47 fund in the state just granted an additional $6 million for the navigation centers work. The challenge appears to be underutilization. It's our understanding of the committees' understanding that many law enforcement agencies and officers do not fully embrace the navigation center and don't bring individuals there. Now this is a challenge for the county with 14 separate law enforcement agencies and a very diverse and diffuse law enforcement structure. But we're urging the board to figure out a way that we can address both the lower-ferral rates from law enforcement as well as criteria that might be too restrictive. Can we expand the criteria so more folks can avail themselves and be diverted at this very early point of arrest stage. The question, go ahead. Yeah. So with the Cares Navigation Center, I'm sorry. The Cares Navigation Center. I just want to make sure I'm correct in my thinking that's the one in True Vale. It was at True Vale up until, I'm not exactly sure when, it's now in a different location at the in West Oakland. It's undergone three separate uh... CBOs running it. So it's been bumpy in terms of not a consistent. So it's just one. There's one now, there's talk about expanding into southeast County exactly. That hasn't occurred, okay. Not yet. Because I thought at some point we were looking to expand it. Okay. No, I think we're still looking at it. But I think the committee's recommendation is let's address why are these low referral rates happening? No, we know why. Because it's located. Yeah. Right. Okay. All right. Thanks. No, thank you, Supervisor. And then, oops, did I speak one? There we go. And then my last slide, and then I'm going to turn it over to my colleagues. Court-based diversion programs, again, Supervisor Mark has alluded to these. There's a lot on this slide. We're talking about the Behavioral Health Court, the Mental Health Diversion Court, which is done by statute in California, and the collaborative drug courts. These are all meaningful diversionary off-ramps out of jail and into appropriate and meaningful treatment. The bright spot here is we've made great connections, the committee has made great connections with the court, our court partners, the judges, and the court personnel working on these programs. And I'll tell you, and this is coming from someone who's a public defender for almost 30 years. I don't think we've ever seen such dedication, commitment, expertise from our court partners in this area. There's real reason to feel optimistic that they want to these programs to be fully engaged, fully and reach their full potential. There are some obstacles that we wanted to share with you. First, data sharing between the various public safety partners continues to be limited. What we need is a centralized system to track the version outcomes, including recidivism rates, quality of life, improvements for recipients, and to monitor the demographics of the diversion participants to ensure that we're addressing racial disparities. There's no centralized systematic way of doing it, and it cries out for that if we're gonna refine these programs and make them better. Second, prompt assessment is essential. You cannot expect an in-custody defendant to wait a month, two months, three months to be assessed to see if they qualify for a diversion program. There's just no way it's going to happen, right? There's pressure to get out. There's pressure to resolve your case to leave the jail. So prompt assessment is key. Third, we have to assess the treatment needs of those 385 folks that I started with. The folks in jail that are suffering the most, if we can learn exactly not everyone needs a full service partnership, not everyone needs a subacute bed, not everyone needs a crisis residential treatment stay for two to four weeks, but we don't know who needs what. So we have to assess that population and then we can build out the continuum of care in a data driven and intelligent way. And then finally to address specifically the pretrial services program, there does not in the committee's estimation, there does not seem to be any meaningful compliance with this board's directive from December of 2024, directing the identification of public safety funds to support the one-time expansion of the pre-trial service program. Through the reimagining of Justice justice and care first the county has invested so much time and energy and good thinking and good planning for pre trial service program. We know it reduces daily jail costs. We know it improves community safety. We know it will address the behavioral needs of the folks that are in custody and yet yet we're still a bit flummoxed, frankly, why there isn't compliance with this board's directive from December. Okay, so with that, I'm going to turn it over to Vance's slide. And we're going to hear, Margot, as sheel is going to talk about the African-American Wellness Hub, and then we'll take it in sequence from there. Thank you so much. Thank you, Mr. Blum. And the following speakers are also members of the Elemental County Mental Health Advisory Board. Thank you. Implementation. Yes, thank you. I do want to say as a family caregiver and a member of a family where there's been a fair amount of mental illness. Mr. Schalk, can you adjust your mic just so we make sure we could hear you. Thank you. And you hear me now. Closer. Okay. Yeah. As a person who's a family caregiver and a person who has other family members with mental illness, this has been the most meaningful process. So I want to thank the board for authorizing it and continuing to monitor it. And thank you, mental health board and Brian for setting this up. He told us that this is the largest holding place, the jail, for people with serious mental illness. And I want to add to that that about 49% of that population are African-American, which is a tragedy. So which brings us to the need for resource center or called the African-American Wellness Center alternatively. On the task force I serve along with Kimberly Graves and we held this particular recommendation and try to expand it and that's what I'm here to talk about. So there's been great progress because the board and behavioral health under Dr. Trouble have committed the resources. So we have a building, we have money to raise the building, we have money to construct a building. That's very rare. So that's very hopeful. That's a big piece of progress. We also have a very amenable behavioral health director and health equity officer in Stephanie Montgomery and they've been open to discussions around this implementation issue. We've had correspondence, we've had meetings and they're open to discussing, you know, our perspectives. So what are the next steps? We have to realize that the original proposal comes with a heavy psychological perspective. They're looking at the tremendous stresses we face in community, generationally, contemporary rarely. All of the pressures, the food insecurity, the justice system, the housing issues, you know, the racism we've met in criminal justice. So lots of pressures there and what we want to see and the author of the proposal, one of them, Dr. Wade Noble said, he's amenable to this. I hear the department saying they're amenable. We want to see a psychiatric perspective also involved. We know pressures can set us up for mental illness, but it's also a brain disorder and it needs often medication management. So we want to see psychiatry and medication management in. I also want to see the family voice at the center. I wouldn't be here today speaking to you. My son wouldn't be in the shape that he is in. If I didn't have family informal family support, we have a number of important organizations, voluntary organizations that help families. And if we don't have that family voice, that peer voice, that voice of others with lived experience in a center, we're going to miss a lot. People don't do well if they don't have knowledgeable family support. And often when we face this in the family, we're lost in the woods and we need other families to tell us how to help us navigate. So we want to see that integrated into the plan. And thirdly, we want to see since the building won't be available maybe in in 2022, we want to see the sharing of the interim community service plan while the building is in construction. And we want to field test and evaluate the service model. We're talking about a lot of moving pieces here, the collaboration of psychologists, psychiatrist, family members, people with lived experience with substance abuse and mental illness who have risen above. So we want to see this very difficult work evaluated tested and as always come from, you know, develop service improvement that way. And lastly, for board action, this is a new funding environment and they're gonna be need for services, need to really support behavioral health in locating sustainable funding for the vital centers navigational and supportive services. And secondly, once the center is open, it's a piece of work in a county that's large to get people to know about it. So to get the promotional work of you in your districts, so we can funnel people in and get the help they need. Thank you. Thank you for your presentation and your perspective. Applause. Do you want to introduce the next couple? Yes, we're going to turn over to Dr. Alice Feller to talk about the first episodes I co-sus programs. Thank you, welcome, Dr. Mugan. Thank you. Can you hear me? Thank you for hearing us today and coming. So I'm going to talk about schizophrenia, basically, which is what we, what these FEPs are designed to treat. So people with schizophrenia live in a delusional world. They're plagued by hallucinations, cruel voices that say things like, your mother's gonna die, your leg's gonna fall off. You lose your children, you're pervert, you should hang yourself. As a psychiatrist, I struggle to treat these folks, but often it's too late to restore them to health. Schizophrenia is like cancer. It starts small, but if you don't act quickly, it takes over. Often resulting in permanent disability. In order to succeed, treatment should begin in the first three months. First episode psychosis care is the only treatment we have to stop the progress of the illness and allow the young person to get back on track. First episode psychosis care, FEP, is an outpatient program with family involvement, psychotherapy, medication management, and voc rehab. FEPs are unusual in their inclusion of families. Families are often excluded from mental health care. And this is not only cruel to the families who are struggling to care for the loved ones, but also deprives us of the clinicians of information we need to treat our patients. The FEP program is housed in a single location so that family members can bring their loved ones for appointments and have their own meetings with staff at the same time. Also, it fostered collaboration between staff members, which is incredible, essential for patient care. to keep up more out. This is very hard to work. Finally, FEPs save money. Serious mental illness is costly. We spend vast sums on homeless services, police services, repeated hospital care, board and care homes, jails and prisons, and a lifetime of disability payments. In our county, people with schizophrenia often end up on the streets behind bars or dead. We have an estimated 900 people with early schizophrenia. Today, we're asking for another FEP to treat another 100 of these 900 people. We desperately need it. Thank you. Thank you. Now, Alison Monroe to talk about boarding cares and housing issues. Thank you. Welcome, Mr. Monroe. Hello. Alison Monroe from FASME. Board and cares are kind of a leg of the old system, a pro, you know, a fundamental part of the old system for serious mental illness. But they've been disappearing. When we talk about permanent supportive housing, people don't always include board and cares. The stats on existing board and cares are poorly organized with the state. It's hard to keep track of what's going on, but it's clear that they're disappearing here and elsewhere. And HHS and HDD are aware of that. They are supporting some existing board and cares through the housing support program, a state program. I mean, state funded, it's an MHSA funded program and through CCE and other state program, which I think was a one time thing. But that doesn't expand, the number, it doesn't reverse the decline. These mom and pop places are folding because they cannot afford to stay in a rental or even an owned property with the tiny funding, the subsidy they get from the state. People with intellectual disabilities, the facilities they stay in can get 10 or 20 times as much as a facility with son of serious mental illness, depending on their level of acuity. Some of our people are heck of a cute and they cannot. They can't be supported at the level of the state subsidizes board and cares that. HCD has offered to lobby the state for this idea of a patch for all Board and CARES new and existing to cover the operating costs of people with serious mental illness. There's no legislation on this issue right now, but there has been, and there will be again. And there are documents say a lot, both those agencies about permanent support of housing, Board warden cares need to be broken out when necessary and the need for warden cares also needs to be analyzed. You know, if acute beds are kind of the missing link in the secure system for mental health treatment, and if crisis residential might be the missing link that's stopping the expansion of court-based diversion programs, Board and CARES permanent license supporting housing, supportive housing for people serious mental illness, illness might be the missing link in the housing system for the seriously mental. Thank you. Oh, and measure W ought to break out board and CARES specifically. Thank you. We should spend my name board and CARES. Thank you. Thank you. Oh, and measure W out of breakout. Board and cares specifically. Thank you. We should spend my name board cares. Thank you miss Now Carri Melkie from the ad hoc committee is going to speak. Welcome. Thank you. So along with the intensive housing interventions that Alice and just discussed we want to highlight the need for deep rental subsidies for residents facing serious behavioral health issues and justice involvement. As the board knows, our county's ongoing housing crisis disproportionately affects these populations, and for thousands of these families and individuals, the primary barrier to housing is actually just a cute economic instability connected to their incarceration and or their behavioral health challenges. Deep subsidies address this need by allowing residents to pay just 30% of their income or less in rent with the rest of the rental costs covered by the subsidy, effectively preventing homelessness for our lowest income residents. But there's currently a huge gap between the need and the availability of these deep rental subsidies and tragically the subsidies that currently exist, like Section 8 housing vouchers from the federal level, are largely inaccessible to the care first populations. More federal funding cuts to HUD, more Section 8 and other subsidies come from, will undoubtedly trickle down to impact the most vulnerable people in our county, and this requires our county to step in to help fill the gap. By establishing dedicated deep subsidies for the care first, Jell's last population through flex pools or other means. We can ensure that folks reentering the community from incarceration and struggling with behavioral health issues get access to the long term housing stability that they need now without the county even needing to spend capital funds and waiting for new housing to be built. This will prevent cycles of illness and incarceration from today going forward. And we also want to highlight that measure W would be a very helpful way to fund these interventions. Thank you. Thank you. And for the balance of the slides, John Lise Poland is going to speak. Welcome. Hi, I'm John Lise Poland. I serve on the Care First Ad hoc Committee. Transparent information about the availability and use of funds and the constraints on those funds is critical for this board to make sound decisions regarding care first goals. Recommendation 6A calls on the CAO to transparently report the funds that are available. You're marked, budgeted, and- First goals. Recommendation 6A calls on the CIO to transparently report the funds that are available, earmarked, budgeted, and allocated to support care for the population and update this information on a website every six months. This includes the funding source, amount of allocation, intention for funds, and agency receiving the funding for the following. Realignment and reentry funding, Checking of Cal-E-M-M-M-M-M-M-M-M-M, including for county and contractor staff and Santa Rita Jail, and funding allocated for the Babu settlement. Since January, Care First Committee members and behavioral health reached out to the CAO seven times to request a meeting to discuss progress in implementing these recommendations. An hour ago, the CAO wrote to us to signal a willingness to calendar a meeting. We ask that the board give direction to the CIO to fully implement these recommendations and meet with committee members to discuss progress. Now I'm gonna discuss the data needed for all of these different recommendations. The original care first resolution centers the importance of data in implementing the care first policy.. It says that county agencies will gather and share data with behavioral health, were permitted by health privacy law, to one coordinate the systems of criminal justice, behavioral health care, wraparound services, and including housing, and two, identify and measure unmet needs for behavioral health and other wraparound services and to the extent possible measure the impact of services. This is key as Brian noted at the outset. Several county agencies have created data dashboards, responded to data requests, and provided some data analyses that are responsive to these objectives. But there are still numerous large gaps in data, both that which is gathered by the county and that which is shared with the public. To gauge unmet needs in diverse areas, measure services and outcomes, and assess the extent to which care first recommendations are actually being implemented. Behavioral Health has produced reports on mobile crisis services and the Safe Landing Project, including data on services provided and estimates of unmet needs. We await a completed assessment on full service partnerships and on the unmet need for psychiatric beds. These have already been done. Some data on program outcomes, such as in collaborative courts, is tracked by county agencies to report on grants, but is not disclosed or tracked in accordance with care first goals. Several care first recommendations seek financial data as I just recounted. The care first Jail's last task force in 2023 asked the Sheriff's Office and DA to office to provide the behavioral health department with information on justice involved persons, including stays in San Areida and charging information. It asked behavioral health in turn to cross-references this data with its own data on behavioral health clients to produce an analysis that could indicate what types of criminal charges and jail stays clients face and how these compare with persons without behavioral health diagnoses. The Sheriff's Office provided the information and behavioral health aggregated it to show how many people are incarcerated before and after receiving services. The DA's office, however, only provided information through 2021 and excluded charging information. We are asking the board to give direction to one for the DA's office, Superior Court, Defender office, and behavioral health to coordinate with compiling data on outcomes of each diversion court and to share this data with each other and the committee, this committee. And two, for the CAO to implement recommendations regarding the publication of financial data. And finally, three, for behavioral health to share with this this committee its need assessments for both full service partnerships and psychiatric beds. Thank you. These last slides I'm not going to go over with you. These just summarize what you have heard for the last 40, 45 minutes. In all the various categories, the requests that the ad hoc care first JLS committee of the M-Hab is making. We hope that today your joint committee will approve these actions that we're requesting. And in addition, we'll forward them to the full board for consideration in the near future. So that's our request. I don't wanna take your time or any more time to go over this slide, the next one you have, and then the final one, these just simply summarized and are drawn from literally taken from the slides previously in the presentation. So that is our full report for today. We thank you again and we sincerely look forward to talking with you again, hopefully before the end of this calendar year for updates on what you heard today and for other recommendations and policies and strategies that we haven't had the chance to address today. Thank you. Thank you, Mr. Blum. If you don't mind, maybe stay in close by. I definitely have questions for you. And also, Dr. Trouble, can I ask you, I think you both have to kind of team effort these responses. But thank you for the wonderful presentation and the work that's gone into this. I really appreciate everyone sharing their expertise and personal experiences to get us to this point. Just a couple of things I wanted to note, part of the RHA work we did with obviously the Sheriff's Cooperation, she entered into a contract with Wendy Ware. And so we're expecting an update on her jail analysis. We're shooting for them on the September, but scheduling is really challenging, but so we'll give the public updates. If we end up having to change that, but the goal is to have that update come back to PPC, which meets the fourth Thursday of every month, that 10. So just wanted to flag that. And I have a couple questions. I know my colleagues have questions. So the first question I have is regarding the nine focus areas. And let me just thank you. 58 recommendations is a heavy lift. And thank you for narrowing the focus. I know that's not easy, but it is important with all the threats, federal state level. If we had all the money in the world, of course, we would love to get to all 58. So I really, really appreciate you narrowing the focus. So thank you for doing that. So the focus areas is their low hanging fruit to be considered at what areas might be challenged by more pragmatic or funding so I don't know who has the best response or shared response To my mind the first thing that comes up in terms of low hanging fruit is the safe landing project a permanent home for that important part of our delivery of cares is I don't even think it's going to cost anything since the root has the modular and my understanding is that root has the modular the building just needs to find a home so that that would certainly be one thing. Dr. Trouble. Yes. Thank you and thank you. to Mark as and vice president and supervisor Miley for the opportunity. I think the low hanging fruits for us that are not at all cost prohibitive, at least giving the funding and the current budgetary constraints for and is a sharing of reports, many of which we've already provided. Some are tied to quite frankly legal action in terms of the Alameda County. So we're in the process of releasing that as soon as we're given authorization to do so. The system wide assessments, as you mentioned or as was mentioned to the AHA committee is really very timely in terms of the award. So those things are very easy to do in terms of some of the data analysis in the system work, I can't speak for the other county departments, but I think again those actions are limited in terms of cost, but it would take strategic partnership, agreements, exchange of information that's actually consistent with the RHA process. So I think those things can happen relatively quickly. And I was not asked, but I would have to say, I really do really appreciate the work, and I want to apply the work of the mental health board, the leadership of Chair Bloom. We got to see visibly the incredible amount of hard work that the committee members who again, our volunteers, did. So I really thank you all for acknowledging that initially, and really this this is for me it is a career opportunity to put a pin in this year it's been incredibly humbling to watch this work thank you thank you for saying that and I don't know Tisa I'm going to see if there's any representative from the sheriff's department I don't know if anyone's online I have a a follow question for them regarding safe landing. If there is someone online, if they could raise their hand. Kimberly Gasley. Is she online, director Gasley? I don't know if she's online. It can't release online. She is, okay. So I'm just curious about the status of that. One thing I just want to know. I've been in this role a little bit over two years and within a month. I toured Santa Rita Jail. And I was told then that safe landing was coming inside. It's still not inside. So I really want to know an update on that. Director Gasway. Director Gas Gasleway is not on. I thought I saw her but. Do you have an update? Yeah, from my from my understanding. GSA is working with the Sheriff's Department to move safe landing into the interior safe landing would still have the exterior trailer. Are there some complications in terms of them hooking up and doing everything that needs to happen with an exterior trailer, but the issue is to try to do the inside, have the outside. See how that's working out. But when I say we, I know my office and I have been tracking this for some time and we are equally as eager to move that piece forward. Dr. Dr. Daha, once a month about this as well as GSA in the church department. So that's why I thought Kimberly was online so she could give a more thorough update on where we are in terms of the renovations needed to move it inside, but still continue with the trailer on the exterior. Yeah. Oh, and we certainly appreciate your attention to this. It seems to require the patience of Job to get this done, but we certainly appreciate all of your energy on it. Simurizer, Tim, do you have a comment? I have one more question that I'll refer to you guys, but do you have a comment on this topic? Yes, I do. Okay. So I serve as the County Board of Supervisors, represented on the Alameda Alliance for Health, and our former Executive Director Scott Coffin had entered into a contract with the county to purposely look at the reimbursement and the process for CalAIM and to put those process in place in order to address some of the issues that Supervisor Miley was talking about in terms of getting care at the jail and getting that funded. Thank you. I just have more questions. I'm just going to ask one more and then I'm going to defer to my colleagues. My next question is with regard to the African American Resource Center, it's along with goals of both care first and RHA. Regarding the recess center, what does it mean to fill test a version of the program model that is currently underway? Thank you for that question. So as was stated already, we are very pleased we've been working closely and I will certainly defer and maybe first I'll defer to Ms. Margo. No, go ahead. We have already began to implement training processes and also approved and are funding programs that demonstrate a more equitable approach to the African-American community specifically. We've also been, and I believe Ms. Marguerno, the colleagues have participated in those, been working with our psychiatry leaders and bringing in nationally recognized practitioners to provide some training and work. And so some of our models have already begun. So there are already programs we've been internally referring it to as the virtual hub because the building itself is not created. We're having to strategize quite frankly with the Transition Behavioral Services Act because that will impact some of the funding and how we allocate funds since those specific modalities aren't called out for. But the way that we see it is that we can, and it speaks to the principle of the hub, we can roll out models which we have started to do. But again, as we start to roll out pH, they may look slightly more different in the terms of a lot of what we've done has been preventative to prevent people from engaging into the system but now it will be more early intervention. So again, it is certainly not exclusive from psychiatry that will continue. It will have to. So those are the things that we're looking at right now rolling out those programs. And what's the timeline? When do we anticipate the building will be ready to receive folks? I will have to humbly defer to Director Gasway on that. They are at this point, it has been evaluated and they are planning to raise the building, which we're pleased because now physically it can embody that which the community has said. But what I understand it will take at least a few years, but I don't want to quote. Sorry, how many years? A few, maybe two or three. Two or three. I believe. OK. Humbley would have to defer to her. OK. Thank you. Did you want to add anything? Yeah. Well, of course, we don't want to wait for the building. So the interim services, and you ask, how would we evaluate? And I think it's really important to realize that we're dealing with a really difficult ill population people who probably have not been managed medically, people coming out of the jail. So we need to track the progress as people are coming into the center tracking the results. What is the retention rate? Are we integrating in the family and the peer voice? Are we getting families organized so they know how to support their loved ones? You know, there are a lot of pieces to track. Thank you. So if I may, yeah, to that, I appreciate the nuance, the family member aspect would be something we would certainly be working and willing to hear more feedback about. Currently we are tracking some of the metrics that we've already rolled out and we anticipate and because it's just as rigorous for both prevention and all the other programs. We've also coupled that with some of the funded programs through the opioid settlement. So all of those funded programs we are are working with tri-values to evaluate the success of working with the black communities in different strategic ways. So we've tried to leverage as much different funding opportunities as we have. And if I may just backtrack momentarily, I just remember since the doctors here at the podium, one other low-hanging fruit that you asked about is the transition and adoption of the early psychosis, the first episode psychosis. We have already cost that out, and you see elements of that in the presentation. For us in order to model to secure the funding, we cost it out based on full-service partnership. But I guess, again, as has already been said, we have already adopt and have in this county early intervention. And so when we shift and begin to implement once VHSA is implemented, we will certainly be true to fidelity. So we won't be superimposing that model onto FSPs, but we've already cost it out. So that's again a very low-hanging fruit because we have the slots everything allocated. We will just change the model and work with the state as well. So thank you. Did you want to add something? Well, yeah, I wanted to say that I think the FEP is a low hanging fruit. You know, it would take five staff members. It would take, you know, someone to, you know, someone to talk to families, recruit families. Someone to do voc rehab, someone to do psychotherapy and a psychiatrist. I think we could probably fit into the Eastmont Mall. They have a huge amount of empty space. And the OCSC is there. I worked there for a while. And let's see. Yeah, we just need it really badly. So thank you. Okay, I'm going to see my colleagues also have questions. Go ahead, surprise or mind me? Thank you. Chair, supervisor, I guess. So first of all, the military health advisory commission boardouth Advisory Commission, Board, you know, none of most of you folks for quite a while. I really respect you. We've worked on over the years and since my time on the Board of Supervisors, so thank you for this. I think it would be important for the Board to release two committees to refer your recommendations back to our staff so they can formally respond in writing. So we look at all of this. That's the first thing I think needs to happen for sure. I'll walk through these in terms of what I know. Now in terms of safe landing, the issue about the trailer, as Darrell is reminding me to, and I think Aaron knows, the infrastructure to put in all the necessary connections and things like that, they would need to have the type of functioning trailer on the exterior that we would all like to see happen, it's just cost prohibitive. That's one reason why they're looking to do something on the interior, at the interior, plus the exterior. So that's why I think it's important since there's staffs not here, but at least to give them an opportunity to respond to all of this in writing. That's the first thing. A lot of what you've said, I've had the benefit of hearing, I've been around for a while. supportive cares first, support of Kieres First, G. L.S. Last, to Professor Carson and Cheh, and kind of led this effort as members of the Health Committee. Now, I'm on it with Supervisor Tam, and I'm sure she's kind of up to speed on a number of things you've already covered here as well. I don't have a problem with anything that you're recommending per se, but let me just say, and I've known Allison for a while, I really need to get the staff to analyze the veracity of increasing board and care. I mean, I've dealt with them over the years when I was on the Oakland City Council and as's a county supervisor. So I understand what you're saying. I really need that. And you did say analysis of this need, but also the veracity of having funding and an increased number of board and cares. So I'm not saying no to it, but we need more analysis, investigation, and determination whether or not this is an appropriate avenue to sue for additional resources to get at the problem. So I just wanted to respond to that. Then let's see, the African American Wellness Center, we're going to have a little photo thing tomorrow. We are. I think we can. Supervisor Mark Kaz and I, and Supervisor Paso be there. It's in West Oakland. You know, we looked at it for East Oakland. We couldn't find a location. So it's in West Oakland. I know Dr. Trouble is at the table with Stephanie, my staff attend those meetings. you I'm monitoring and tracking things. So we're moving along. It's a new model. It's a model that the African-American professionals want to see implemented according to their thinking. And so Dr. Trouble's right there working with them to ensure once again, the veracity of that model too. I think you will have potential limitations because it's just located in West Oakland but that's the best we could do. We wanted to do what in East Oakland but we couldn't ultimately find a location so we're moving forward. I think Kim really is working to get a contractor on board so we can begin the actual construction of that facility. So once again, we need staff to respond to this more appropriately. Let me see here. What else? Can we just focus on clarifying questions right now? We'll do closing remarks. Well, well, also under the one that John's bringing up, the county administrator, I know I've talked to her. So are you asking for the county administrator or self to meet with you or someone from our office? The office. And it is part of the recommendations that the board approved last year. Gotcha. All right. And then I don't know why the staff hasn't moved forward with the funding. I think I have a sense of that around. You're talking about the pre-trial service this funding. Yes. I have a sense of that, why that hasn't happened. But I think once again they need to respond to that as well. Yeah. Since you brought it up, we're actually having a meeting with the Justice Partners and the Court next week. So there will be an update soon with respect to pre-trial if everyone missed that. And then data sharing, we can direct data sharing. We just can't, you know, obviously the staff has to work that out around sensitivities with HIPAA and things like that nature, but they should be able to do that. We can't direct the courts. We'll have to have a conversation with the courts. So that was- I'm sorry. I got what I think is I'm glad we're dealing with this low hang and fruit. Another fruit that could be low hanging is that we have the ability to analyze the need for subacute beds, for board and cares, and for crisis residentials. We have people that know how to do such an analysis. It's been done for crisis services and for SFSP's. I would love to see Indigo and Roberta Chambers figure out on the back of an envelope, what it would take to figure out if we have enough of those kinds of beds. If it's very hard to figure out, I'm sure that company could write out an explanation of what's hard about it. It could be done in a couple of weeks. If you have to make some assumptions, you can make the assumptions clear. I would love to see that done. I don't think we have to wait for guidance on how to implement MHSA to figure out how many beds we need to keep everybody alive and safe and off the street now to jail. I think somebody could do it. I think it could be fun to do. I think we have the ability to do it and it would stimulate a lot of discussion. Joe, sorry. No, sorry. I appreciate what you've given us today. I'm just reacting asking a few questions, making a couple of comments. But I do appreciate this, and I want to have a favorite health, health care services agency to engage with you around these recommendations. Thank you. I have supervisor Tim. Thank you, Chair Marquez. And I also appreciate the distillation of the recommendations. I have served on the health committee since I started on the board and get regular updates on Dr. Trouble and our Alameda County health departments on each of these items. I meet regularly with Alameda County Health practically every week, right? Nika, and we talk about the progress and a lot of these issues. I just wanna highlight the subacute beds concern in my conversations, which we meet regularly with Sheriff Sanchez. She recognizes this need and particularly the concern over not having enough lock beds and particularly the revolving door possibly at John George. So one of the suggestions I had for her is to have that conversation with James Jackson to see if St. Rose because there's a number of buildings that are around the hospital can be utilized And as Dr. Trouble mentioned there's beach ship funding that will be going into St. Rose for a geriatric psychiatric unit and to see if some of the one of the floors could be feasibly used as a locked bed area. But for that to happen, the sheriff said it has to be a law enforcement controlled facility because I didn't particularly think having her go to Glendire and use one of the floors at the former North County jail was the most feasible. So that's what they're looking at right now in terms of the subacute beds or the locked beds for some of the residents at San aree to jail. The other question that I have is, so we're all about trying to reduce incarceration of individuals with mental health or substance use disorders. We're putting in substance use, you know, horizon got funding for that. What I'm trying to understand is we spent a lot of time before I even got on the board on reimagining the EMS service. one of the components that we talked about was having a nurse practitioner that can do potentially a 51-50, declaration of determination, and then we talked about potentially morphing the macro program in Oakland because they don't have medical practitioners that can help people in the field. So has the mental health advisory board members or been part of that conversation are reimagining the MS service? The emergency mental, you're talking about emergency Right because we we let out a request for proposal and and a number of ambulance companies responded including the ones with our fire department and The one component that we had asked for which is different than what has traditionally been part of emergency response is that mental health component as well. Okay, so no, I mean, I appreciate that direction and we can look into that. We focus more on the mobile crisis responses to macro, cat, the various city initiatives. I think our director, AC Ultimate, have a response. Yeah, I just wanted to note, supervisor. I think what you're referring to is the stakeholder engagement process that happened in designing the new EMS RFP. And so that was a few years ago. I believe the mental health advisory board was a stop on that tour, but we can confirm with our EMS folks. But as Mr. Bloom just said, you know, the EMS team and behavioral health crisis team work pretty closely together to make sure that there's a variety of interventions available for people. And that system is also meeting the needs of people with mental illness. Thank you. Thank you for your questions. I just wanted to reiterate comments. I made this past Tuesday. Really excited and come in. Your leadership, Dr. Trouble, and securing over $130 million for our county. That is very impressive. Just want to flag in that press release. Three of the programs are designated to come to Hayward, which is my hometown. Very proud of that support. So just want to repeat what I said on Tuesday. It's really important that we engage city partners at the table, including first responders. And I think in terms of sort of Reservoir Tams comments with respect to possibly some programming from Santa Rita Jail, I think we need to pause on that and make sure we know what we're doing with programs we've already received funding for before we start exploring expansion because I will just tell you from someone that served on Hayward City Council for nine years, that's a lot for one of a community to absorb. So just want to be very thoughtful in that planning and we need to look at the entire ecosystem. So just putting that out there. I have one more question and then we'll open it then we'll go to the next presentation and then we'll go to public comment. But it appeared. Oh, that's not the question I'm going to ask. Regarding court diversion programming, it sounds like we do not have the facilities to divert as many individuals that we would like. How significantly is this limiting the impact of these programs? It's huge. I think it's probably when you talk to the judges and you talk to the court personnel, it's the single most, the greatest obstacle to getting folks out of jail in the treatment. But before you decide where to, they need treatment, you gotta analyze and assess their treatment needs. Then we can make smart data-driven decisions about how to build out the system. Some, you know, crisis residential or a subacute treatment center or an FSB, if they have secure housing on their own. Building out that, building out that system is gonna be crucial. Let me turn it over to Mayor Schwarze, also on the ad hoc committee who's been focusing on court-based diversion. Thank you so much. Thank you, and thank you for that question. And I just wanted to call attention to a subset of the population that hasn't been discussed too much, which is people with co-occurring, SUD and mental health needs. And we are learning that that is a very sizable population and a population that needs specialized treatment, particularly people with substance use disorders who also have significant mental health involvement. Right now, our courts, diversion Virgin and Collaborative courts, are finding that a tremendous limitation in the number of facilities and beds for those sorts of people that really needs to be attended to. We need the needs analysis, a needs gap analysis on that to see how many do we have, how many do we need and to move forward with that quickly. That is something that we've heard repeatedly in talking with court personnel. Thank you. We're gonna move on to just so everyone's clear what we're doing. We're gonna go on to the next informational item here, those presentations. My colleagues up here and I will ask questions. Then we will open public comment on both items. And then there will be some action in next steps given. So thank you so much. So we are ready for the second presentation, which is an informational item on care court implementation. Dr. Treble, welcome again. Thank you very much, Chair Markes. So I'm pleased to be in a position to update you all and certainly the expertise with Dr. Roberta Chambers, our colleagues from Indigo who have done a fantastic job working with so many of the partners that you see on the board. excuse excuse me, on the slides, public defenders, superior courts, our department, and a host of community providers. It has been a rigorous process, and even some of the comments that you've mentioned have been really connected to this work, including the B-chip grants, for which we will continue to apply to the state for every part of our county. We're not able to control the projects that are awarded, but we absolutely agree and value that because CareCourt is representing an opportunity where our teams are assessing individuals directly. So, although it's a microcosm of the populations, so which I'll leave to Dr. Chambers to describe, but it is providing a wealth of data So we look forward to providing an additional Assessment in terms of what our system needs But again, I want to take this time to recognize the tremendous amount of work And you'll hear more about this state as well recognize the work being done in Alameda County So at this point I will defer to Dr. Revingt Roberta Chambers from indigo the President and CEO and a founder and owner and her expertise really is remarkable I'll defer to Dr. Rabin, Roberta Chambers from Indigo, the president and CEO and founder and owner and her expertise really is remarkable. So I'll defer to her. Thank you. Welcome Dr. Chambers. Thank you. Thank you so much for having us here today to present the work of the county and the Care Quirk project. I think this has been, there has been a tremendous amount of collaboration and partnership and frankly sleeves rolled up and people just working together with some of Alina County's most, residents were most impacted by significant mental health problems. So I want to talk first about the planning process and what happened to get us to that go live date just to have a sense of the tremendous work and effort that everyone put forward. Just as a background information for folks, the characters legislation that was signed by the governor in late 2022, it is a required program that establishes a new civil court process to engage a small group of people with very specific diagnoses, particularly psychotic disorders like schizophrenia and schizophrenia and effective disorder, and it uses a civil court process to engage them in community-based treatment. The sole purpose is to engage that targeted group of people in treatment and avoid unnecessary crisis hospitalization, homelessness and incarceration. Alameda County and partners began planning together in October 2023. Behavioral Health did receive some funding and engage us a little bit earlier than that so that we could kind of hit the ground running once everyone was ready to start meeting and start kind of doing the work together. Alameda County was required to begin implementing by December 2024 and with everybody's good work actually implemented a few weeks early. And so receive their first petition before the required go-life date. So this is a summary of the planning activities that we did. We, early on established an interagency work group, which was reflective of leadership from Alameda County Behavioral Health, the Public Defenders Office, the courts, both on the bench and the self-help center, which has a critical role in care court, as well as county council, John George participated, housing and homelessness, and then once a provider had been identified for services, Bay Area Community Services, they also began participating. We met monthly in order to get everything together, to have the conversations that needed to happen and then begin the process of what happens beforehand, what happens when someone's in and then what happens as someone's nearing the end of their participation. We then established a larger advisory group that met quarterly that kind of took here the day-to-day implementers, looked at then who the larger group is, someone who might come into contact with a care court person, someone who might be a service provider, and that took that one step further. So participation from the larger hospital system, consumers, family members, the provider's group, and so a much larger group of people then began participating, also some additional justice partners. We wanted to make sure Carequart got a lot of attention in terms of both the promise and the fear about what it was, and I think many of us remember back when Laura's first past what this was like, and so with Dr. Trouble and her department's leadership, we were kind of authorized and asked to meet with people along the way. So we will tell you what we did at the end to kind of get people engaged with the process and petition, but we did meet with partners, including consumer and family, from the very beginning to dispel any miss, any fear, and ensure that the things that people were most hopeful about or most worried about were considered by the advisory group and by the interagency work group so that any concerns, any hopes were able to really kind of factor in to how the partners decided kind of to implement this, right? They're required to implement but how it was implemented really needed to be with the spirit of recovery and collaboration that you expect from Ellemite County. As part of the planning, the judges, as well as behavioral health visited a number of the cohort one counties, the early implementers, so to get lessons learned, as well as staying really in touch with what the cohort one counties were sharing with the judicial council and the Department of Healthcare Services. And so we kind of learned a lot from what was happening there. Although one thing is that the cohort one county is if we remember at a very slow start, and that's been in the press kind of over the past few months about how few people were affected by this in those first few months. Alameda County as we'll see in a few minutes has had kind of a, I think the staff, I was on a panel yesterday talking about some of the behavioral health staff really feeling like they're drinking from a fryer hose because the petitions have just been rolling in and people are getting the help that they need. The state has kind of recognized that something different is happening here which is amazing but it would have been nice to know how many people would be coming in at the beginning as we were doing planning because we really just didn't know, right? There was also some additional state activities with the state put on that of course when they had the cohort, the cohort to readiness forum in Sacramento. There was both judges, multiple representatives from the Public Defender from County Council, behavioral health, the provider. It really was kind of amazing to see how many people were coming together to make this go. As you'll see when we get into who's been filing petitions in Alameda County, the work group really wanted to make sure and early on identified that Care Court is not just an opportunity to get people who may be experiencing homelessness into treatment, but that this was also an opportunity to offer and from the criminal justice system. And really one of the things that the Health Equity Officer Stephanie Montgomery said in one of the planning meetings was, we need care court to be more than just a way for family members to get their loved ones into treatment. We need to make sure that the people who are sitting at the county detention facility also have the opportunity to benefit from these services if that would be more appropriate than what's happening now. And so we looked at all of the people who were eligible to file petitions and we went out and we trained hundreds of people. So between October November September October November we had I think 30 40-ish presentations. We talked to service providers. We talked to ACPH staff. We talked to Berkeley Mental Health. All the subacute facilities that kind of, Alison Monroe kind of referenced. We went to all the emergency departments first responder meetings and made sure that anyone who may come into contact with someone who might benefit from care court and was an eligible petitioner would have the opportunity to have that considered as that person was making a determination about how they would best help the person in front of them. We also talked with multiple family members, clients, and major that everybody knew what this was, what it meant, how they could get help, and how they might participate if they became subject to a petition. And then we also, because we know the first responders all for the most part are embedded in the city government structure, we also met with the city administrators and managers with the director of AC Health as well as Vanessa Baker, the deputy director of plan services at behavioral health and made sure that the city is also really understood what this was and that was on top of the communication they were getting from the governor. So at this point, how have the partners are meeting multiple times a week? We have learned that a project like this serving some of the most acute folks in the community really requires a lot of coordination. The day-to-day folks are meeting almost every day at this point and then the partners are meeting monthly to review implementation and make any changes along the way. The next two slides are just so behavioral health has a host of information on their website as well as someone who answers the phone if you call and have a question or want to make an inquiry about care court. The courts similarly have added to their website a number of resources as well as they have the self-help center where you can chat, call or physically go into to get help with a petition. We learned yesterday from the state that most counties have limited their self-help center to family petitioners only and in Alameda County the courts are actually the self-help centers are not limited and they've actually been supporting first responders with some of those petitions which is kind of on we didn't realize it was unusual it's just the inclusive approach that that the group has taken. Okay so let's talk about what's happened. So just very briefly the way it works is unlike other programs, it starts with a petition to the court. It doesn't need to be a phone call for screening by someone. Someone doesn't have to approve the petition. If you're an eligible petitioner, you have the information. You can get some help filing a petition, either from the self-help center, behavioral health. And it goes directly to the court. The court rules require them to accept all petitions. The judge reviews the petitions. and we have a fantastic Dutch here in Elmita County, Dutch Sandra Bean. She is reviewing petitions within a day or two. So it's a pretty quick review, determines if the petition kind of meets that standard code to go to the next level. If that does, they order ACBH to complete an assessment and a point of public defender. And the public defender in Alameda County is also appointed a little bit earlier than another county so that they get to be involved from the very beginning. And that partnership I think is really important. ACBH goes out, does outreach, conducts the investigation, and then submits a report back to the courts, at which point the Care Act court proceedings commence, the judge determines eligibility, and then if they're eligible, then works to develop a Care Agreement or plan, which says what services the person agrees to participate in. And then they can participate in to care for up to a period of 12 months, or it can be extended for a second 12 months. Simultaneous to character implementation was behavioral health bridge housing. Alameda County applied for and received two separate rounds of funding for this. These are the beds that were created by the first round. The second bridge housing grant that Alameda County received was had infrastructure fund. So those beds will take a minute to come online. But the reason bridge housing comes up and the care court conversation is that people who are enrolled in care court receive priority for any bridge housing bed. So if someone's in care court, they jump to the front of the line in essence. And so we do have a number of people from who are enrolled in care court now who are receiving these bridge housing resources. But that's a list of what was created from the first bridge housing round. Okay, so let's talk about whose filing care petitions. So at this point, Alameda County has filed 23 first responders which which includes macro, the City of San Leandro. They have an outreach team, county fire, have a number of different first responder agencies have filed 19 position petitions, family members 18, and then there are a number of other petitioner categories where there's one or two people so we can't tell you the specifics of each of them, but there have been an additional 11 that came from a director of a hospital or some other petitioner. This is unusual, and when you look at data from other counties, it's predominantly family members filing petitions or people filing on their own behalf who are in a county detention facility. And so when we look here, this really is different. And I'll share in a few slides. The state has actually come out to visit and learn what they can from Alameda County's process because they're so curious about how we've managed to get all of these folks. They're impressed. That how we manage to not only get these folks invested in the process, right? But then along the way, these folks are now having an experience where they're filing petitions. They're getting partnership in that petition filing and that initial outreach. And then they're seeing folks actually get the help that they need. These are a couple of quotes from petitioners. So one is from the ARU, which is a crisis service out in San Leandro. We get to know a client. We have a Cygners practitioner who can sign the CARE 101 form and we've done five that we turned into the Hayward Hall of Justice. We hear back almost immediately from the court and then work closely with Bax. I know Judge Bean and Kelly and that's Kelly from the Public Defender's Office. So the process has been great. I've also come into court and been there as a petitioner. And then we have someone from the macro team. We got training, we learned about care court, and then had people in the back of our mind. The first petition we found was December 20th. I'm very happy with how that turned out. Someone has been living outside for over a decade. People thought he was out of options, and now he's getting care. I'm working with someone who was a community advocate, who's happy for him. So they're getting to see the people they've been meeting with on the streets. Now get the help that they need. So this table kind of walks us through the petitions. So as of 5.7 there was 71 petitions filed I think as of today at 73.75. And we are seeing kind of a steady rate of petitions coming in. Of those 71, 63 met that prima fascia and were referred on to ACBH for that investigation and outreach. Five petitions were pending, meaning they had been filed, but the judge hadn't yet ruled on prima fas Fasha, and then three didn't meet Prima Fasha. They weren't a resident, there wasn't enough information in the petition, or the person required more than care could provide, right? That they were in a secure setting and needed to stay there. Of the petitions that moved forward who met Prima Fasha, 18 agreed to care services, as of May 7, 38 were in the outreach and and engagement phase where they had been determined to be eligible, but they were still kind of getting to the point of agreeing to accept services. And we know that that takes a lot of contacts. It's 95 contacts or four months is on average, is what it takes to engage someone to the point where they say yes. And rather than rush people and push them away and have them go deeper kind of into wherever they are, the approach that the teams are taking is really to kind of work with them and bring them in. And so we are seeing kind of that good outreach, that good rapport building. Seven petitions were dismissed because they needed a lower level of care, they needed a higher level of care. They weren't, they didn't stay in the county, they weren. They were incarcerated. Those are the kinds of things that we see. For the demographics, this will become more interesting as the program goes on. What we're seeing is about 45% African American, 28% white, 27 in any other category. We can't break them down for you in less than 10 people. And so we're limited in how much we can share other than what's here. For gender, two thirds male, one third female, a number, the majority of respondents are middle age, which is from kind of what we would expect, and there are as a smaller number of transition age youth and older adults. These are a couple of stories of people who have benefited from the program. We do have the permission to share these. So one care participant, a middle-aged African-American man, good student growing up came from a tight-knit family, started presenting with signs of schizophrenia around the age of 19, which is what you would expect, dropped out of college, developed alcoholism, and then over the years symptoms worsened, he became increasingly more aggressive with his family. His family had to make the heartbreaking decision to file a restraining order. He was homeless when his family petitioned for CareCourt, the care team engaged with him, and he agreed to accept services. And since he's been enrolled in CareCourt, he's moved into behavioral health bridge housing. He's currently attending regular groups and he started meeting with a psychiatric provider. I don't believe he's accepted medication yet, but he is kind of on the path to considering his options. So another care participant, middle-aged African American woman, cycling in and out of the outpatient system for years. This is one of our kind of friendly faces, we may say, who most people would probably recognize. As a diagnosis of schizophrenia, and also as a regional center client, they have a history of refusing psychiatric medication, leaving services to go back to the park. When the petition was filed for this individual, I believe by one of the first responder teams. She was sleeping outside and was unable to care for herself and was refusing to come in out of the rain. She was also pretty ill. And then since joining court, she's accepted medical treatment. She's addressed some of those urgent health issues. She's been taking her medication. She's now in a permanent support of housing placement, as an IHSS worker to support her in addition to the care FSP. So these are remarkable stories, right? And these are folks who have been in this program for less than four months. So these are some pretty big transformations, or maybe six months, May 5. Because these are some of the early folks. So a third participant, middle age, African American woman, been part of the system since she was a youth, had multiple interactions with first responders, again another friendly face, and had a recent state-to-state hospital. She was referred to Care Court when she was in the county detention facility. The outreach team began meeting with her while she was at Santa Rita. It's our one to two times a week to build that rapport. She didn't have an easy time when she was in jail. She was released and she went directly to a crisis residential treatment program. And then when she was there, she agreed to start taking medication, began participating in groups. She went directly to a bridge housing placement from the crisis residential. And then is now considering whether or not she might go back to community college and wants to connect with her children again. As in any new project, there are absolutely things that we need to continue to improve on and continue to work through. One is, so this is the beginning of what one can expect for reports out from the system and from the program, but there is a fair amount of work to get kind of a regular, kind of reliable set of data that would be available for people to receive on an ongoing basis. And so we are working with the quality improvement in data analytics team within behavioral health to do so. There's also this push notification system. I think you heard about it in our last presentation before the Go Live date. So, when someone has a care petition filed and they're open to that reporting unit, what if they show up at, you know, Rita, at John George, at the emergency, at a number of locations, if they show up in any of these known locations, and the outreach team is looking for them because they've had, they've been identified, having had a care petition filed, behavioral health and then backs get an alert so they can go out immediately, right? So they get these alerts and then backs get an alert so they can go out immediately, right? So they get these alerts and then can go out same day, next day, and be able to connect with people while they know where they are. It is much easier to do that than to try to find someone when they're outside. And so the notification system currently has a group of programs that are receiving data from and then the team is working to build that system out more to include more and more places where someone might show up so that will only become more and more robust moving forward. Also the bridge housing is a new process, care courts a new process and so there have been and hiccups here and there, making those referrals. We want people when they say yes to housing, and they say yes to care, that they get access to those services like quickly. And so really kind of smoothing, greasing those wheels so that everything happens seamlessly is something people have been committed to, but it is a process. And then there are a number of other Justice involved programs that people might be referred to. And so we have now had some people where they've been referred for an evaluation for diversion or behavioral health court. They've also had a petition filed by someone else to care court. And so we're just trying to work through, and really the interagency work group is trying to work through some of those issues to make sure that we're not duplicating services that we're not layering on more than someone needs, but also that they get to the kind of the pathway that's the most appropriate for what their needs are and they get the treatment that they need. Couple of learnings, we know that it requires intensive outreach to engage these folks, right? is something that the area community services is doing under contract with ACBH. We also know that when people make the decision to engage in care, this is a huge transition for them, especially if it includes exiting homelessness where they may have been for a period of, a significant period of time. And so there has been an ongoing dialogue about like what's the right amount of engagement? Someone says yes, we want to get them everything. We also know that they might go into an apartment or an interim housing placement and we don't want them being bored, maybe relapsing, right idle hands. But at the same time, we don't want to overwhelm them with too much activity. And so there's been some conversation what's that right level engagement and I think the team is struggling with that on a case by case basis with individuals. And then finally we know that the court may be stressful for people. And that the judge, the court and the team has worked very hard to figure out how to make it the most supportive environment possible. The judge has little goodie bags. She gives out to people. They get a gift card. She remembers which gift card they prefer when they come time, you know, each time. And when the state was visiting it just so happened. One individual came into care court. They had a backpackful of gardening tools. I think he had some idea that he might be going to work later. You can't take those tools into the courtroom. And so there was a bit of a kerfuffle, right, out by security, because the guards wouldn't let him come in. But he had his care act hearing. The judge stopped the pre-huddle meeting, went out with Kelly from the public defender's office, and managed to talk him into letting the judge hang onto his tools. She stashed them somewhere, right? I don't know where she stashed them. He came in. She immediately said, let's call his case do it right now. Had his hearing kind of got him what he needed, give him the encouragement and support to kind of make sure he had what he needed from that, and then pause the proceedings to go up because he had to go get him his tools and give them back to him. And so it's just one of the ways that this kind of outside of the box commitment to making sure that people get what they need, you can see through some of these stories. Additionally last month the state came out, they saw the data about how many petitions and where the petitions were coming from and were really curious about that when they learned the reason why that was being filed and that way particularly with the kind of this lens of getting from the justice system, making sure it wasn't just for people who had an involved family member. It was for those people, but it was for more than just those folks. The Cal HHS Secretary, Undersecretary and Deputy Secretary for Behavioral Health out, all came out to visit with people from the Judicial Council State Bar Association and a few consulting firms. They wanted to know how the group had managed to come together in the way that they had with that collaboration. They wanted to know about the petition partners and they were very curious about ACBH and their commitment to filing petitions into using this tool that have been given to each county. They went and they saw the pre-court huddle, the meeting before proceedings. They watched few proceedings They went to the Washington Inn, which is a bridge housing interim housing site And then they engaged in discussion with the care court partners and then with the petition partners And there's kind of a short list of the folks. This was I was amazed at how many people showed up to meet with this state I think there was kind of one email with an invitation to come and people just came out and said we want to tell you how great this is working. And so that was pretty remarkable. And with that, I think that kind of concludes this part of it. I'm happy to answer any questions. I know Dr. Trouble and Juan Tezon are probably also might need to help. Also Stephanie Regulars here and she might need to help with some of the questions. Okay. congratulations and thank you. This is impressive in such a short period of time. I really appreciate the staying nimble and really meeting people where they're at. It's really impressive to hear the progress made. So thank you all for your great work on this. A couple questions. I think you already answered it. I was wondering who the outreach workers. I think said that's backs their own contract okay. And then in terms of where the petitions are coming from I know that the fire chiefs and police chiefs meet monthly so are there continuous touch points with our first responders? Yes it's actually that component has been taken over by behavioral health. And so some of the behavioral health staff are now meeting with a variety of different first responders on an ongoing basis to make sure that they're aware of care court as well as I hot AOT and some of the other programs that might be available. Okay, can you identify gaps? Are we seeing where like we know there's issues and concerns or there hasn't been a single filing? I don't know that I wouldn't want to comment on that yet. Okay, but they're obviously we're tracking the data to see where okay And then I really appreciate the conversations, but specifically the city managers that is key. So thank you for flagging that um And then CHP are they at the table? I'm sorry CHP. Uh, highway patrol. I am Matt. We train a number of different kind of joint law enforcement groups. I would have to confirm if there was a representative from CHP, but there's so many law enforcement agencies that operate in Alameda County that I don't want to answer without double checking who was there. OK, those are all my questions. Do my colleagues have questions? Sir, Viser Tann? I just have two quick questions. I appreciate the update. The last time we had the update was when the program started. So obviously ours became a model for the state, right? Keep with that in mind, Judge Bean had mentioned at our last briefing that she was going to be encountering some staffing issues in terms of processing the number of petitions. Is that still the case? Or, and then prospectively, you said you've processed about 71 petitions that have been filed. Do we, how many do we expect on the upper end? I'm gonna look to you either Ray or one or Stephanie about the comment about Judge Beenan staffing capacity. I haven't heard anything, I don't know if anyone else has. I think we might need to check indirectly about that. And then your second question. Is we process someone the one file petitions and I'm just trying to see how much we can manage? I think probably the largest issue facing Alamed County's care program at this point is a victim of its own success. This is a much faster scale up than I think anybody was expecting in this type of service with a new program. You tend to hope for no more than 10 a month on an ongoing basis, no more than four. And so I think we're right at the point where we're acknowledging we'll need to have some conversations about capacity. Yeah, thank you, Supervisor Tam. I'll add that we have not heard any staffing concerns from Judge Bean, but we continue to work with the courts very collaboratively. So nothing's impacted the program or ability to enroll individuals and get individuals into the program. In terms of capacity, I will say that as as Dr. Chambers mentioned, we ramped up very quickly and our outreach and engagement teams are doing some great work in connecting with people. So the flow has been pretty steady to the point where we work together, we identify individuals who would benefit and rise them to the top of the care court as needed. We do have capacity for 100 individuals to be in our full service partnerships. So those treatment teams can serve up to 100 individuals. We have not reached capacity there yet. I think one critical component of care court is that if people are connected to a treatment team, they can actually stay with that treatment team. So if it's beneficial for them to receive ongoing treatment and being a part of CareCort just helps to reinforce that treatment or get them access to the housing dollars, there's no need to switch their treatment providers. So there have been examples of that in CareC as well. So I think that that assists with the capacity issue related to our treatment teams. Thank you appreciate that information about the consistency of care. Welcome to you have a response? Yes. You could just introduce yourself. Sure, I'm Stephanie regular in the assistant public defender. Wonderful thank you. And I supervise our mental health unit including care. So I just wanted to respond to the question of, are we seeing any gaps in referrals? And while our county should be very proud that there is quite a bit of diversity in where the referrals are coming from, one gap that I continue to see, which I believe will expand our program are the people who are system involved. So in many other counties a lot of the referrals were coming from family and from the actual client who are put the public defenders were petitioning on behalf of the client and even with those numbers of referrals it was still very low. The public defender office has not yet really ramped up doing assisting clients with self-referrals. We have, we're finally to a point where we're fully staffed, where we have a attorney who is dedicated solely to care, a community outreach worker, and now legal assistance, so that we are ready to start helping clients to self-referral so that we expect to see more clients who are in the criminal legal system referring to care as well. Thank you for that update. Thank you for being here. Supervisor Miley. Yeah thanks for that response because I was a little concerned because everybody's kind of applauding the success and I wanted to look at the petitions as well. So I'm glad the public defender responded to that because I need to hear from all of the stakeholders, nommity, others, I'm gonna hold advisory board, public defender, et cetera. Do they all concur that this is, we're on the right path. This is a tremendous success. Or there are course corrections we need to make. Because quite frankly, a number of us were very supportive of care courts voting for it, wanting to see its implementation, giving our department an opportunity to move ahead with it. So to hear this, I don't wanna be, what's the word I'm looking for. I wanna definitely be assured that we're on the right path, but what we're doing, and I know Aaron from my staff tracks this very carefully as well. So that was one thing I'm glad Bobby defender spoke to this. Secondly, I just want to state, the board collectively, not collectively, there were at least three of us on the board who supported Laws Law and AOT, assisted outpatient treatment. So I don't want the staff or our stakeholders to get the impression, unless this new board changes its direction, that law is law, ALT, the need to try to get people the treatment they need, to get them into having the necessary efforts to stabilize them isn't something we want continue with. And I know care courts is an effort to try to prevent hospitalization, criminalization, conservatorship, et cetera. So just wanna, I mean, unless the board changes, there were three of us on the board who were very supportive of this. Further, I know Judge Bane, before she became a judge, she worked in County Council. I'm very pleased to see that you have such a great admiration and she's doing such a great job with this as well. The other question and I don't know if you can answer to our behavioral health with the implementation of care courts where where we are presently with Prop 1, the fact that we have been very successful and we want to continue with CARES' first Jail's Last in getting more community care. Are we in jeopardy of losing any of our preventive services as a result of all of this compilation going forward? I just need to be assured one way or the other because if we are losing preventive services based on all this other great work, I just to make sure the board knows this so that we can have some type of mindset when it comes to measure W and maybe what we need to do to support preventive services. Thank you supervisor Miley for the question. I hear it is two parts and I'll take the second piece related to this presentation first. It's a wonderful question. That is exactly why we modeled the treatment process and the funding around FSP. Given that the transition to behavioral health services act requires that you have that allocation. In that way, we're not in jeopardy at all. This type of program, we've set it up that way. That was I think some wisdom on our part to model it in terms of funding to do that. That way we can support it. Number two in terms of prevention, yes we are still moving and making sure that the outreach programs are actually early intervention which is appropriate. Now at this point though we are looking at there are some gaps meaning some of the outreach programs that we modeled because we started earlier on will have to evaluate which degree can they actually fit within the models. Sir community services and supports housing and full service partnership. So I would say we're not in jeopardy. This is a mandate. But I am going to say that the funding is compromised. And at this point, I believe when we last came to your board a year and a half or so issue when we started to talk about proposition one and the impacts. We were at 56 million. Now we're looking at a total system gap of 78. But we have some cost saving measures that we will try to implement to keep our, the in terms of unused funding and things that can at least bring us through potentially a fiscal year without having a striking challenge for the treatment programs. But for prevention, that is still in jeopardy. And we will not be able to do that under BHC. All right, well, I think it's going to be important with this recessive care courts and other things that the staff inform us of efficiencies. Yes. So the board has an opportunity to see how we can struggle with, because we don't want to backslide, we want to continue. Absolutely. The success of care courts and everything else, but not kind of whack them all. We deal, we do this, but then we produce or out of the problems. And then my final question is, when we were interviewing the DA candidates, we asked them about care courts. So is there any role for the DA's office in any of this? Have there been conversations on how L.D. sitting back there as well? If you had communication there? Well, what I will say in terms of the new DA's office, there is already a strong indication of partnership and collaboration. I myself have worked with her and spoken to her in different forums and we feel very positively that there will be an opportunity for further co-abulation. I'll defer to Dr. Chambers in terms of who or how the participation has happened, at least in our quarterly and other meetings. And I also think Stephanie Regular might want to jump in as well. So there has been a consistent representative from the DA's office participating in the advisory work group, particularly because it's a civil process. I think as we move more towards the direction that Stephanie suggested a few moments ago, with really maximizing that off-ramp from the justice system even more. I think the DA's participation will become more and more important because of that overlap between the opportunity for overlap between the justice system and care court. So I do just want to make sure that you understand that because this is a civil commitment proceeding it is confidential and so the district's attorney does not play a role. They're not entitled to the confidential information that occurs in care. And one of the reasons why that is so important is to get clients to buy in. We want them to participate. And a large part of that participating is making sure that they understand that the information will remain confidential. It won't be shared with anybody outside of the proceedings. And to your other question regarding any funding gaps, I did just want to alert you with regards to the funding for the public defender office. So our funding is coming from the legal services trust account that this was originally supposed to. The contracts were to go to legal aid first. And if legal aid didn't accept a contract, it was the public defender who would provide representation. So when the funding was initially established, Alameda County Public Defender Legal Aid, it was slightly over $900,000 that was going to be allocated to the public defender. Before the contract was even signed, that amount was cut to slightly over $700,000. And on a nine month fiscal year, it was about $529,000. We haven't seen what the figures are going to be next for the next year yet. We do have some concerns because we don't know, you lot of the reason why the funding was cut was because there was an underwhelming number of petitions that were filed in other counties. And we're not sure whether or not the next round of funding is going to be reflective of just how successful Alameda County has been. And while we currently feel fully staffed, I think we are getting to that tipping point of being able to provide the same level of representation that we are currently providing if the numbers continue to grow. Thank you for that background. If I may, just one more comment. I think Supervisor Miley, when you started your comments, you mentioned wanting to make sure that we weren't kind of sitting on our laurels, if you will. And I do want to say that despite kind of Alameda County being recognized as a trailblazer with the tremendous leadership of each of these agencies and their staff working on this, the Interagency Workgroup is a very motivated group and the conversations, while there's an acknowledgement of success, really are focused on and what's the next outreach, where's the next process improvement, that those meetings remain committed to program improvement, and as the program gets bigger, there will continue to be things that need to get worked through. So I just wanted to assure you that that I towards program and process improvement still lives very well in a live in that work group. Thank you. I have one final question and then we're going to open public comment. And I'm going to combine both topics because I failed to ask this earlier. There's a lot of intersection, cares for us, jails, laughs, care court. And we're going to be talking about measure W in July. So help me understand is staff analyzing that? How are we meeting unmet needs with already allocated funding pots? Most definitely. I will certainly defer measure W to AC health to describe, but absolutely all of these are intersectional and so for us that's why we have the early investment both in our consultant supports, including I should mention RDA working with our mental health board to sustain that work and to make sure there's expert support. But it is interesting that we are having to look at our own resources. So that is again why our modeling, we're looking at forecasting, what does this mean for implementation? Care courts even be chip. We've had to factor in, although we could not control the grants that we were approved for, many of which we looked at, if they're Medicare versus Medi-Cal, what the revenue looks like, what is the state forecasting looks like, what our reimbursement rates will be. And that also includes the work in CalAIN. So, it ticks in, although IE and IE, was talked about the pre-release, that is certainly sheriff, and we're working to collaborate with the sheriff on that. We're looking around. All of these have a sustainability model that we're having to cope with. So, it's complex, but yes, we're looking at it and all of them, have to sustain because there are requirements. Thank you. It was a tad. Sure. Yeah, just on the measure WPs, so I think one of the critical things that we want to be able to highlight for the board is that, you know, all of these various funding streams, we still have this issue of specific things being only able to fund certain things, right? So we want to be able to lay out that spectrum of care and it's actually multiple spectrums of care that are kind of laid out next to each other. So there's the behavioral health staff. Prop 1 is an intersection point. CareCord is an intersection point. There's other places where there's some things that are only available from the housing space for people with mental illness. And then there will be other resources that are eligible for certain state funding. And then there's a whole pot that we really only need local resources for because they don't exist. So we'd like to be able to articulate that better for you as a part of those upcoming discussions. Okay. Thank you. Thank you so much everyone who presented and for everyone's engagement. We are now going to start public. Actually, you know what? I'm going to call for a five minute recess. I think a lot of people need a bioprax. So five minute recess will reconvene in five minutes. Thank you. you Recording stopped. recording in progress. Okay, everyone. We're going to call this meeting back to order. Thank you so much. We're going to go ahead and take public comment. Let's start with how many are online? Six. Six. Okay, so I'm going to ask, we do need to get to another meeting. I'm going to ask everyone if you're online and you want to speak in public comment to weigh in on the two items one in two. Please raise your hand now. So we can kind of gauge at how many speakers. Okay, so we've got up to 10 now. Okay, let's start with in-person speakers. They'll get two minutes and then we'll go to online. Jennifer Graham. My name is Jennifer Graham. I really want to speak to how important as a parent to a child with schizophrenia that the ability to connect communication is absolutely critical. My consistent comment throughout these many years has been one hand doesn't know what the other hand is doing. And for me, it ended up in a lot of physical damage to my home. My son ended up being killed on the corner by someone else who had mental health issues. He died with $7,500 in his PE account, which tells me the agency was not servicing him. He should have never accumulated that much money. But all throughout the processes of trying to get help, it was the probation officer didn't know what's going on. You know, telecare, all of these agencies just didn't speak to each other, including the jails who were often receiving notices that they should contact telecare upon his release. Often inmates are released at one in the morning. Bart is not running and those phone calls aren't made. So for me, it cost him his life. And it's something that's hard to sit in this room. So I wanted to share that. Sorry for your loss. Thank you for sharing with us. Next speaker please. Mia Cooper-Con. Hello. My name is Mia Cooper-Con. I'm the senior manager of integrated health at Alameda Health Consortium. The network of eight community health centers or federally qualified health centers in Alameda County. I was an active participant, or I am, in the Care First Jail's Last ad hoc, as well as the prior Care First Jail's Last Task Force. I absolutely commend the ad hoc committee under the leadership of the Mental Health Advisory Board, Alameda County Behavioral Health Director Trouble, and the support of RDA. This committee is steadfast in its commitment to moving Alameda County towards its 2036 school to eliminate homelessness, health, and health for all through focus on building up community-based mental health care in Alameda County and moving away from an over-aliance on incarceration. One element I wanted to emphasize to your question, supervisor Miley, around prevention is the importance of prevention, that is preventing people from entering the jail in the first place. The behavioral health programs at Alameda Health Consortium's member FQHCs, which integrate behavioral health services within the primary care and medical setting are a key component of this prevention system. The programs that are at risk due to Proposition 1 and the new Spend Categories under the Behavioral Health Services Act include integrated behavioral health and pediatric care coordination programs, Mental health urgent care services at one of our health centers, the various prevention early intervention programming among other programs across our network. We are seeing some of the county proposed solutions for sustaining some of these programs falling short requiring health centers significantly shift the programs to meet medical cost center requirements So we look forward to briefing the board and Continuing collaboration with our county colleagues to find solutions for this gap. Thank you Richard Speegerman Pass when find solutions for this gap. Thank you. Richard Spiegelman? Tasch when? Looking for Richard. Hey, all I'm Tasch, you know me. As you heard, there are more people sitting in the jail with serious mental illness than those in our hospitals and community treatment facilities combined with 49% of those in our jails being black. These two facts alone should create a sense of urgency to address the crisis of racial inequity in this county. To supervisor Marquez given this political moment I do not believe believe this is the time to address the low-hanging fruit. We have done that for years. It has supported many folks, and it has also meant that black people overwhelmingly end up in jail who are unwell. Now is the time to build a high ladder to ensure that folks who haven't gotten any root fruit get the services that they need. So care providers and families don't have to Frankenstein short-term services to provide long-term care. We also have $650 million that is available to us for these expensive costs, right, that are more expensive on the front end, but preventative and life-saving and cost-effective long- long term. To Supervisor Miley, we have met with every agency multiple times with exception to the CAO to produce this progress report for you. That process has meant that we met with the staff to know what they are ready and able to implement and to figure out what strategically makes sense for us to sequence and implement of the 58 recommendations. So what's needed next is for this committee to take action on the 10 recommendations so that we can focus on the next 48. Also not all of these require funding. Some of them just to require improving our approach like the CARES Navigation Center. Lastly, I'll just say that prior to this effort, we participated in gym for four years, from 2017 to 2020. We've now participated in this with county agencies for eight years. We are so excited to tell our people that these services are coming online, and that's why we're urging you to take action today. Tesla Mekaro. Good afternoon. My name is Tesla Mekaro. I'm Executive Director of Supportive Housing Community Land Alliance, a community land trust based here in Alameda County, funded with behavioral health funding through the Mental Health Services Act, Innovation Funding. SHCLA is here to speak on the recommendation. Number seven related to licensed boarding cares and to speak directly to supervisor Miley's question about boarding cares and current status. So in Alameda County over the last five years, we've lost about 175 facilities, accounting for about 3,368 beds. These closures, we consider a direct pipeline to homelessness and invisible pipeline to homelessness for a very long time within the county. And SHCLA was really created with the intent to preserve and protect facilities before their closure to produce new facilities. And I would say that, you know, the one missing piece or a link for SHCLA thus far in the creation of new license boarding cares is a dedicated source of capital. And so the connection and link from the care first jails last pass for us recommendations to measure W. I think is very clear. We appreciate the the support of Alameda County behavioral health particularly Dr. Troubles leadership and the interagency collaboration between housing and homelessness and HCD, housing and community development. We see all three agencies critical in terms of supporting license boarding cares and production across the county. We have seen really a concentration of closures in Oakland and in Hayward particularly and And so the need to improve or increase access in those two jurisdictions is vital thanks Barb at well you have two minutes Yes, hello, thanks for taking my call my name is Barbara at well I live in Berkeley and represent the Berkeley friends meeting and a member of the Care First Community Coalition. The Quakers welcome today's attention on the crisis level housing needs of the justice involved reentry and seriously mentally ill populations. We strongly support the recommendation from the Mental Health Advisory Board and as to use the measure W funds to meet these needs. We assert that it is time now to democratize the budget process and make it more transparent and public. Reporting on all funds available for care first recommendations, reporting on county reserves and their conditions, funds allocated for Santa Rita Jail settlements, sheriff overtime and unfulfilled staff positions. All $650 million that measure WFUNs are available for housing and support for the most vulnerable positions. This should be implemented as soon as possible and I appreciate your time and attention. Thank you. Katie Dixon. Good afternoon. Thank you all so much for holding this here. And my name is Katie Dixon. I am a resident of Elmita County, and I was a task force member representing district five over the two years that we were engaging to come up with these recommendations. I really just wanna urge the board to please move on the request for board actions today. We have been meeting, presenting to you all and kicking this hand down the road for the whole two years in my opinion. So please move on these direct requests today that these people spoke about. The Safe Land and Project, we need to move on that. Increased and access need for the sub, for the subacute vids. laid out some real time examples of how this stuff works and how this can be beneficial right now in the immediate. Access and expand point of arrest diversion. The cares navigate. Again, we have put money into these things. We have these navigation centers. We know they work. I think we absolutely need to address the lack of law enforcement participation. That is undermining what we all want of the cares navigates the centers. Please move on these requests today and expand the court-based diversion. Again, we have been working on this stuff for almost eight years, as passed just laid out. Lastly, I also want to say to Supervisor Mark Williams. I was just very disappointed that you wanted to ask about low-hanging fruit. We are past low-hanging fruit. I was just so So disappointed with that. have a concrete direct recommendation for the board today. And yeah, you diverted to the low hanging fruit. Please move on these. Of course today. Thank you. Kathy Rodriguez. Hi, my name is Kathy Rodriguez. And I'm the CEO of California Justice. I am a parent who had a mental health child who was born mentally disabled severely. And I have a sister and what I'm hearing today, I am impressed with what's going to take place. but sometimes things get sometimes things get on the role, but then they, you know, things begin to slack off. What really needs to happen is family involvement and training for families as well, because families don't know how to deal with kids that are born with mental disabilities. And it's very hard and very difficult. I advocate now for children who are in the school system and it starts off when they're young and they have a different type of treatment program for kids that are under 18 than adults. It's so different and what they need is a treatment program for adults that's gonna meet their mental health needs and they need to have different levels like level 1, 2, 3, 4, programs where they can live in instead of going to jail. My sister ended up in jail for like 40 years because she had mental health issues because she was traumatized as a kid. She got put in foster care and was raped. And so that began a string of mental health issues. So we need training programs for our adults that's gonna teach them life skills, teach them training skills, teach, you know, have the families involved, the services that are gonna meet the mental health needs of each and every person who is in Santerida County jail. They shouldn't be in jail. There should be different systems put in place so that they can be successful in life because they can. My son now has been serving the Lord for two years and he is doing well. He's doing great. He had a very severe mental disability. He still has that disability, but he's a success story now. Kimberly Graves? Yes, hi. My name is Kimberly Graves and I'm a member of Fasney and I want to thank the Board of Supervisors for hearing this presentation today and then I also want to thank my fellow activists. You guys did awesome. The presentation was amazing. What I would like to speak to is the doctor that spoke earlier about the early psychosis intervention being critical. That is absolutely true because As everyone knows, I'm a family member and my son was not diagnosed with his schizophrenia until 17 years later. And so once he was diagnosed because I had the time and the understanding to support him, he, I don't have to say it was too late. Even after 17 years, it is a possibility that a person can recover, but it is a thousand times harder. And so, yes, early intervention is very critical. I also wanted to speak to the, as Margo pointed out with the African American hub. It is very critical as we just as I just pointed out that we have a psychiatry involved with the meds along with family involvement. And that will help eliminate the stigma and it will encourage involvement because unfortunately in the black community, we struggle to embrace mental illness and it is considered taboo in our community. And as everyone has pointed out, the majority of those that are incarcerated with mental illness, which my son was one of them, are African Americans. So I just want to commend you guys, the Board of Supervisors for handing presentation. As everyone else has said, we would love to have you to implement all of this recommendations from the Care First Jail's last. And then I want to add that the Harris Court sound and is great to hear that our county is making progress and doing amazing work. David Stern. Yes, good afternoon. And then thank you for this hearing and the opportunity to speak. I'm a resident of Albany for 47 years. And I've been following this issue for about five years and it just won't let go of me. I have to speak out. And specifically what I want to employ you today is please approve the actions requested by the Mental Health Advisory Board that give department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health department's health board report, actions 1 and 2, action 3, 4 and 5, 6 and 7, 10, 12 and 16 as enumerated on page 22. These are extremely well thought out and they deserve support now. I've been following this since the Justice Environmental Health Task Force. I read that report. There were a number of recommendations. It's obviously wrong to put a person in jail if they're suffering a mental health crisis or have serious mental illness or co-occurring substance use disorder. It only makes their condition worse. It sometimes leads to death and it's way more expensive than any kind of treatment. So the county is wasting millions of dollars a year. I urge you to take action today Have to hear that a person with mental illness has tragically died in Eugene day Yeah, this Eugene day on the policy coordinator for the crop organization in West Oakland. I would just like to make a first time I'd like to thank you, thank supervisor Mark has to for inviting us to this space. At the crop organization, West Oakland, our primary funder is the state of California, we help people return in from state prison for a 12 month grab or out service But you know our real goal is to be able to serve our local community and Alameda so we can be a better neighbor and just important work public safety mental illness Cooccurring issues. I would just like to say two things came up for me to the slides is that we do have our own data analytics platform as part of our contract with the state that we're building out. But more than anything our newest career track is a healthcare track where we're training, formerly incarcerated people like ourselves with limited lived experience justice involved. as a AOD counselors and peer support specialists and our original goal was to get them working primarily the reentry space but you know listening you know as we try to as we find ways to partner with the county it you know it occurs to me right now that you know we're turning in an army of people with lived experience to do this work. And I just wanted to thank you for inviting us to the space. No specific comment on any of the recommendations. They all sound much needed. But that's not really my purpose for this boss. I wanted to thank you for all the inviting us, the crowd organizations to the space. And we look forward to meet with you in July. Thank you. Angus Arranda. I'm your microphone. Hello everybody. My name is Angus and I first real quick would like to request the opportunity if the board should allow it that I utilize two speaking slots. One for me and one for my teammate who was going to speak today, but unfortunately got called away to attend to a family crisis, but would still like to have her message heard. Both of our speeches will only take a lot of two minutes each to share, is that okay? Sure. Thank you very much. Again, my name is Angus Aranda, and I serve as the IT Manager at the Young Cuffed Project. At Reentry Organization, rooted in Alameda and Salono counties, we also on the current CBO operators of the Cares Navigation Center in Oakland. We provide trauma-informed housing and care coordination and digital access solutions for justice impacted individuals, especially those facing behavioral health challenges, co-occurring disorders, and systemic barriers to stability. I'm here today to urge this board to fully allocate the $650 million in measure W funds to housing and supportive services for our most vulnerable residents. At the UNCUFF project, we don't just talk about second chances. We build the infrastructure that makes those second chances possible. We operate permanent supportive housing and transitional programs that provide wraparound services, mental health therapy, digital access, job training, peer mentorship, and substance use recovery support. But every day we are forced to turn away people because the bed capacity isn't there or the resources don't match the need. Measure W is the solution. With this funding, Alameda County can expand licensed boarding care homes, fund deep rental subsidies for those on pre-trial released or reentry, and staff and stabilize permanent supportive housing sites like the ones we already run. We've seen firsthand what you invest in housing with dignity and accountability. You reduce recidivism, improve health outcomes, and rebuild lives. Without serious investment, we're stuck recycling trauma through jail cells and hospital beds. Care first isn't just a slogan. It's a commitment to fund what works. The UNCUFF project is ready to do the work. We just need your partnership to ensure the systems match the scale of the need. Please direct those funds where they are urgently needed if the housing not handcuffed. Thank you. Good morning, everyone. My name is Eleanor Liffede, but everyone calls me Ellie. I'm the lead care manager for the Uncuff Project and program manager at the Cares Navigation Center in Oakland where I also serve as a peer support specialist. I work with our clients every day, many of whom who are living untreated with untreated trauma, severe mental health struggles and chronic health homelessness after incarceration. I'm speaking today because MeasureW was designed to protect people like them, and now it's time to follow through. I urged this board to fully allocate the 650 million for MeasureW to housing and care, not cages. At the Navigation Center, we help stabilize people who have been tossed between jail cells, ERs, and shelters. We provide restorative services, peer-led healing, medication support, and housing navigation. But too often we're up against a system that doesn't give our clients anywhere to go after they stabilize. There's no true reentry without housing. What's the point of treatment if our folks are discharged back into the street? What's the point of therapy if they're still sleeping in tents? We need licensed board and cares for those who with co-occurring disorders, permanent supportive housing with wraparound staffing, residential subsidies for those re-entering with no income or family support. Those aren't just recommendations from MHAB. This is our daily reality. I've seen lives change when people are housed. I've also seen what happens when we delay. They relapse, they disappear and they die. The care first model means we put our money where our values are. So today, I'm asking you, don't let this moment pass. Fund housing, fund healing, fund our humanity. Thank you very much for this opportunity. Everybody have a great day. Can I have a great day. Jennifer too. Unmute your microphone Jennifer. Hi, sorry about that. My name is Jennifer too. I'm a D5 resident and I work for the American Friends Service Committee. Thank you for hearing the Care First Ad hoc Committee's recommendations today. I drawing all of the speakers earlier in urging this committee to fully endorse their recommendations. Their presentation showed the Care Firsters AdHoc Committee has just poured a lot of thought and work into understanding the problem and identifying the most impactful recommendations. And it was also clear from their presentation and the answers to the Supervisors' questions that the AdHoc Committee both analyzed quantitative data and also they built this deep understanding of the real needs of families seeking care for their loved ones. So I urged this body to recognize that deep personal expertise that comes from lived experience and also that rigorous data analysis that went into the presented report and recommendations. Like some of the other speakers have pointed out, now is not the time to be Pennywise Pound Follish. Please approve the actions as requested by the Mental Health Advisory Board and give that direction that they've requested to the public protection and health agencies. Thank you. I'm Lonnie Hancock. I'm a resident of Alameda County and I work now primarily with the East Bay support of housing collaborative. Today was a really amazing day. I want to thank everybody on the staff and in the community and on the mental health advisory board for the really brilliant and thoughtful work. There is now a roadmap for where we need to go and we need action. We need a couple of things that I noted, the continued coordination of staff, consultants, community and the board and data collection. We need now really strong positive leadership from the board of supervisors. You set the policy direction and support staff in getting just done. Third, we really need to focus on housing. A place to go so that before you become Nellie Hill, after, if you're in reentry, from subacute to board and care to permanent supportive housing. I'm wondering, for example, if we have enough bridge housing for everyone who needs it, if not, how many more slots do we need, and then what do we have to invest to get there. Also, I couldn't help but think in light of our hearing last week. It also shows why a very mission-driven and collaborative healthcare system in Santa Rita Jail could seamlessly impact and improve our ability to get the results we want. Thank you so much. Laurence Abbott. Hi, thank you. My name is Laurence. I'm speaking on behalf of my late brother, Theodore, my baby brother, who like so many other people aren't here anymore because the system failed them. The lack of continuity of care, the cracks in the system, the lack of early psychiatric intervention. It's beyond tragic, but Ted didn't, he was, he lived to help everybody. He helped so many people. He was absolutely brilliant. And he wouldn't hold a grudge against anybody. He just wants to see the right things moving forward. So obviously, I'm a member of FASB by now. A lot of us have found each other and a lot of us are losing loved ones. So ending the revolving door is probably the most important thing to prevent recidivism and save the county massive amounts of money. I think my brother costs the county about $2 million. Can you imagine if they found them early? And like somebody else I know with Schizophrenia is a teacher and a protective member of society tech could have easily have been that also. So the data sharing and data tracking data calculations for the right number of subacute board and care crisis residential beds to keep everyone alive and you know ASAP. The last thing I think I wanted to say was that we need to measure WFUNs to be spent on homelessness and especially the seriously mentally ill board and care and permanent supportive license housing. Thank you so much. I yield my time. Natasha Baker. Hi, my name is Natasha Baker. I'm a district five resident. I'm also a member of the Care First Jail's last coalition and I want to emphasize the importance of adopting all of the ad hoc committees recommendations related to care first, specifically and most importantly around diversion from jail to care. And I wanted to note my opposition to supervisor Tam's recommendation to increase locked beds at St. Rose. This would be further incarceration of people with serious mental illness. People with serious mental illness need care, not cops. We do need more treatment beds, but not locked beds. There has been plenty of recommendations about what kind of beds we need, where they need to be, and making sure that there are residential beds, not basically jail cells within a hospital. So I urge the, excuse me, I urge the joint committee to approve the actions requested by the Mental Health Advisory Board that give direction to public protection and health agencies and that we truly implement care first, jails last, which again was unanimously approved by this board and we are still waiting for full implementation. Thank you very much. Natalia Pumani. No more speakers. Thank you. Thank you everyone for your patience. Just have some closing remarks before we go to directions. So just want to thank all the presenters for being here for your thorough and thoughtful contributions. It is clear that we have much work ahead of us addressing this issue of helping those suffering from mental health challenges to obtain the support they need. It will be important for us to continue to monitor the impact of these recommendations. I believe a dual focus on the macro and micro outcomes of these programs would be helpful going forward. I would like to have benchmarks in place so that the future meetings will allow us to better gauge program successes as well as opportunities for improvement in areas and need of increased focus. I also welcome the opportunity to learn about first-person experience from those directly impacted by these services. After all, we are talking about real people who are dealing with several issues. Sometimes a graph or a spreadsheet doesn't tell the whole or even real story. CareCourt is a powerful example of how systems change can be paired with individualized support. As this program rolls out, I hope future updates will include how it's connecting with people to care and reducing justice involved in a meaningful away. Following today's presentation, I am confident that we have the right infrastructure and individuals in place to drive this forward and allow opportunities for actual impact across our county. Wanna thank Brian Bloom and the Mental Health Advisory Board for providing this in-depth information and helping us better understand the barriers and opportunities before us and how we can engage more meanfully moving forward. As the Chair of the Public Protection Committee, I remain committed to ensuring that our oversight is active, grounded in equity and aligned with the values of our county. We will continue to engage our community members including those suffering from mental health challenges, and those justice impacted individuals. In these discussions, as we work toward real, measurable improvements. Now, I do have a direction that I'd like to give as the chair of public protection. However, I do feel strongly that there's a serious lack of understanding in the community of what a joint committee can and cannot do. So I'm going to ask council just to explain for the public what is under our purview when we're not sitting as the full board. Sure, Rayleigh on Deputy Cannon Council, because there are three members of the Board of Supervisors present. This is a joint committee that constitutes a majority of the Board of Supervisors. So the only action item that you can take today as a joint committee is simply to refer the matter to the full Board of Supervisors. Okay. So with that said, I am going to recommend that we direct that this joint committee, PPC and health committee recommend to the full board. So this is advancing it, but it still has to come back to the full board. That's the, that our staff here in Elimita County, Analyze the recommendations made in care first, Jell's last prioritizing the nine recommendations that were brought forward and focused here by our board members. So basically focusing on the Safe Landing Project, the Psychiatric Treatment Beds Assessment, Cares Navigation Center, Court-based aversion, African-American Resource Center, and Home Together Analysis of SMI and SUD needs. So basically, the recommendations from the Advisory Committee directing that this committee bring forward to the full board to ask staff to conduct analysis of those recommendations in terms of the cost and timeline. And the way that I envision us doing that is by bringing forward a board letter. So it's clear on what we're asking staff to do. So that board letter I would like to work in partnership with the chair of the health committee. We could do a joint board letter advancing that to the full board. So that we are tracking and ensuring that we're getting accurate information and updates to the community. Is that clear to my colleagues? Chair does it chair? Is this a motion? It's a direction. I can make it an emotion. Should it be a motion or just either way? I'll move it as a motion. I'll second it. If it's okay, can I speak to the motion? Yes, please. Okay, thanks. First of all, I want to thank all the participants, speakers, et cetera. I also want maybe thank John for asking us last week when we had the other joint meeting to make this an action item. Understand the relevance now of why having it as an action item was important. So I appreciate that. The navigation centers, or the care center, care navigation center, you know, I have a sense of why it's limited in terms of participation from law enforcement, but I do think all that will come out as a result of the motion going to the full board and having our staff respond. The board and have our staff respond. The board and care, I don't have a problem with once again of what's being recommended, but I do think it's important that we consider unintended consequences because I know I've had a committee working on group living facilities, I'mincorporated area for years and they meet constantly with my chief of staff and others around group living facilities and when I was on the Oklahoma City Council you know I dealt a lot with board and cares. There's a reason why that has diminished. It isn't just because of funding you know there's been neighborhood pushback as a result of board and cares. So if we moved on that track, and if that's a viable approach, we need to make sure there's support for that in communities because I've seen how communities have really been very, let's say charged, particularly in Oakland when it comes to board and cares. If I, so just. I just want to say that. But I do support the motion, and then I also want to just say, we do have a process around measure W funds. It will be coming to the board. I'm like a broken record on this in July. The county administrator is working with other key agency and department ads on coming up with a process as well as some key recommendations for the board to consider in July. Once we adopt a budget for the next fiscal year. So I think people's, you know, advocacy around that is being heard of. And then I also wanted to say one last thing from our meeting we had last week too when we looked at services of the joint meeting. The same three of us, a joint meeting dealing with well-pathed services in the jail, medical services in the jail. We do know there is that same disconnect. I think that's producing problems. Why we still have a large population of folks who are in jail who aren't receiving the necessary services they need around mental health. And I think once we can effectively address that disconnect between medical, behavioral health, the GL staff, electronic records, all that, that's not a fantasy about thinking what help. So there's just some of my comments, but I do support the motion. Thank you so much, Supervisor Tim. Thank you, Chair. I appreciate the intensive work that the mental health care advisory board and the care for a sales last former time. Some of our members have put into this. So I want to acknowledge that the motion is consistent with two of the speakers requested actions that we look at under safe landing project. This is actually page 23, not 22 of the Care First Jail's last implement Tation Report, which is consistent with the request to look at action one and two of the safe landing Project under the psychiatriciatric Treatment Beds, Action 3, Point of Arrest, Diversion and Cures Navigation Center, 4 and 5, the Court-based Diversion Program, 6 and 7, the African-American Resource Center, which is Item 10, basically using all platforms to outreach, and then under license board and care facilities, action 12, and the housing subsidies for individuals and justice involved in serious behavioral health concerns, action number 16. So I'm supportive of the motion because it is consistent with this request. Thank you. Before we close this item and get to just general public comment, I also wanted to thank Brenda Gomez on my team. She's our advisor on public safety and my chief of staff, Alex Boskovich. They were tremendously hard not only on this meeting, but on last Friday and Aaron Armstrong as well. Thank you so much. It's been great collaboration and thank you, supervisor Tam, for making yourself available, because I know this is a different reoccurring meeting and you were just here with us on Friday as well. But this is what we're doing. We're getting to work and getting stuff done. So thank you all for your support. These two items are now wrapped up and now we're going to open public comment and this is for items only Review of this committee So county council people start talking to me about ROV. Do I have your permission to them to hang up? Yes, thank you. Okay public comment I I have no speakers. Oh, I'm sorry. I have one speaker. Okay. Lawrence Abbott, we're on public comment. You have two minutes. Unmute your microphone, Lawrence? Oh, I see it. Thank you so much. Sorry, they should only take 10 seconds. I yielded a half a minute earlier. And then the commenter after me was saying how important it is to have non-lock facilities because they're just gales and disguised. That wouldn't have helped theodore at all or so many people in psychosis. So it's releasing people to their death. It's like letting somebody with Alzheimer's go out on a cold night and say, you want to go out here, you're life free. It's exact same thing. I just wanted to say that because people that don't understand serious mental illness, they have a good heart, but they don't understand. Pass. I yield my time. We have no more speakers for public comment. And to our wonderful clerk as well, everyone have a great afternoon. This meeting is adjourned.