BCC - Committee of the Whole

fdot fdot fdot fdot fdot fdot fdot fdot F.Y.E. 2425 and as part of that closeout is additional carryover. And in this item is recommending now it goes to reserves. Further in the item at the end fy 2526 midyear and in their we are signaling to this board here's what we're going to come >> the meeting will begin shortly. >>. >> the meeting will begin shortly. >>chair: good morning, commissioner bastien. >>commissioner bermudez: >>commissioner cohen higgins: good afternoon, present. >>senator garcia: >>commissioner gilbert: >>commissioner gonzalez: >>commissioner hardemon: >>commissioner lopez: >>commissioner orbis: present. >>commissioner regalado: present. >>commissioner steinberg: here. >>commissioner mcghee: >>chair: present. >> age members present, you have a quorum. >>chair: don't need a quorum but eight members present. We are going to stand, rise for the invocation and a few words but vicki lopez followed by the pledge of allegiance. >>commissioner lopez: heavenly father thank you for the opportunity to serve this incredible county in today's discussion. MAY we feel your presence in spirit as we attempt to move forward something that is incredibly important to all of us, we ask this in your holy name amen. >> I pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under GOD indivisible with liberty and justice for all. >>chair: you MAY be seated. All right. MADAM Attorney. Can we proceed into the only item on today's agenda. >> you have one discussion item regarding the proposed mental health facility and it would be appropriate to do that now. >>chair: let's take 2 a on the mental health facility and I'm going to start with the administration if they are ready. But look, I called this committee of the whole in response to committee CHAIRWOMAN Vicki lopez request to my office to discuss the proposed mental health facility and so I thank you commissioner for taking that initiative on just getting some off, there was more but you send me the memo. Because ultimately what I've said time and again, I did a couple interviews before this meeting on this topic is there's a lot of unanswered questions that we've asked time and again and have not received the response. And I-4 one could separate not receiving the response I want from just not receiving a response at all and a lot of the questions we've not received any response. So, that's what worries me and as I outlined in the memorandum my response and calling this committee of the whole, the purpose is for us to discuss the proposed funding plan for the facility including projected cost, funding sources, long-term financial impacts and demonstrate a need for the project. It goes to ensure there is a clear and sustainable path forward that addresses the current and long-term demands of this facility. I will let the administration, I understand they have a presentation, who will be doing that chief? >> under the mayor's leadership this project which has long installed was given new life and the administration has worked hard on are the counties commitment to the community and as you will hear from staff we will have a brief presentation and we are fully able to fund operations without any reliance on the general fund or additional general funds for the first three years ripped in our effort to make sure every dollar goes as far as possible we took a hard look at operating costs, thank some of the commissioners that were very I guess put us to make us sharpen our expenses. And we looked at it and we came back and we reduced some costs and I think you'll be happy with the presentation. We were able to reevaluate the cost of maintenance and ship those savings into programming we anticipate operations will be covered for three years rather than two years based on available funding and it's important to point out we are not using a projected savings, not using any savings to offset our cost read the first three years are covered with available funding streams we have those streams currently here. We are, we will develop alternate plans if needed, if the commission decides to change the plan alter the plan or request a change we will provide an alternate plan for the future that we have worked hard to develop this program on gop our lease with the state and the board's discretion for direction under the mayor's direction our team assembled the funds and partners to make it happened and make this project a reality at last. So if you'll entertain us for a few minutes commission chair I will call for kathy burgers, community services director and she will present our presentation, thank you. >> good morning or afternoon chair and commissioners, thank you for giving us the opportunity to present mental health model that focuses on evidence approaches to recovery and resilience. As the chief mentioned I'm kathy burgers and it is our department that will oversee the mental health facility. The mission of this project is to diver individuals who are severely mentally ill through a continuum of care which includes case management and wraparound services. As contracted through the board resolution you directed us to negotiate contracts with two providers. The first one is west care who will be in charge of clinical services or crisis short-term and long-term beds. The second provider you directed us to negotiate with is the advocate for ancillary it resurfaces. We understand this model is in need of wraparound services as well. Such as primary care podiatry, so on and so forth. We wanted to also share that we have two complementary programs that will be involved or being proposed for this project which includes new direction which is a program that's currently our community services department. Focused on those who struggle with mental illness. As well as substance use independency. We are also including in this project another program that complements these services which is the homeless trust with behavioral healthcare and transitional housing. I want to express at this complements the programming. It is not a duplication of services. We also wanted to share with this board the center structure. It is important for us to really present a model that's comprehensive. We've included on the first floor we would have intake and triage. The second floor we will have crisis stabilization which are the 10 beds. That will, these services will be provided by with care as well as short-term beds on the fourth floor and on the fourth and fifth floor we will have long-term residential services. On the fifth floor it is a model I just mentioned which complements these services free of clinical services provided by west care. Which are 24 beds with new direction and then on the sixth floor we have west care and the homeless trust providing behavioral care and transitional housing. On the seventh floor which we plan to build out we will have an opportunity to, for future expansion. We are excited to report that it includes a research and evaluation. The advocate program will contract with an accredited academic institution to independently evaluate the effect effectiveness of this model. Ensuring outcomes are measured reported that we continuously improve this continuum of care. Transitioning to an outpatient. This is a model that focuses on clinical services as I mentioned as well as wraparound services. The current clinical provider which is west care as brought in-kind services to this model. The in-kind services includes outpatient. It's important to point out that as we serve the population when they reenter their communities, there will be support in order to sustain changes the clients have experienced. If the pilot ends, we will really focus on transitioning appropriate care through a network of already established behavioral health providers across the county. We will have an extremely close relationship with our managing entity. To ensure that we have access to the network of providers. No plans will be left without a care pathway. We wanted to share, and is in line with what our chief palmer shared with the group, we do have the two-year outlook. So the fiscal impact to the county, the cost for west care which includes crisis beds, short-term beds and long-term beds for the two-year period, it costs 25 and a half million dollars. For the advocate program when we look at the two-year outlook the cost is $3.6 million. The last cost is our building expenses and within our building expenses is $9.5 million. This gives us a approximately $38 million in total. The revenue sources and this also includes the two-year outlook within the plan we have the 30 point, 34.5, almost $35 million in opiates funding, 5.6 in miami rescue plan funds. 3.85 in the new direction treatment program. 2.2 for which the homeless trust will be contributing to the programming. Not non-county funds will include 7.6 million. This this is for veterans state funds. Secured by west care $774,000 now non-county funding obtained by the advocate. This is a total of $46.3 million. The county will continue to pursue additional opportunity, funding opportunities and the advocate program is contractually obligated to engage in continuous advocacy as well as funding efforts. Thank you. >> thank you for this. So before I open it up to my colleagues I would like to share a few comments and questions of my own. I MAY bounce back and forth between commissioners speaking. So I recently visited our tdk, corrections facility which chief palmer was there. And some others from corrections leadership team. Some from chs I see here today, thank you for coming out and for being so thorough during my visit. And I toured all of the mental health floors. Both male and female. And I was, look it's a site that nobody wants to see. I don't think I was functional the rest of that day. Perhaps the week. But I was pleasantly surprised as to work that both are corrections department and chs the jackson team place are doing. It surprised me and shouldn't have because for one over a decade we were in a consent decree or two decades. We were in a consent decree the fact we were released from the consent decree last year. I think it speaks volumes as to the work that both are corrections department and chs is doing over in our corrections system. But from how patients are assessed and treated, they walked me through that. they walked me through where progress is being made, where it lacks. Where gaps challenge exist. And in my conversations with them, mostly with chs some of the insights highlighted were of course the ongoing challenges of providing consistent mental health care within the correctional system, there was a few. Not as many as I thought but there was a few the one that stood out the most to me and it's important and I encourage my colleagues to really do a deep dive into this and go out there and tour are corrections facilities if you haven't yet. At least if you haven't done the mental health floors. But what really what chs pointed out it almost took them two or three times to say this before I caught on. Is that we have a select amount of inmates. I believe the number they told me a week and half ago was about 65 or so. That's our awaiting to be transferred out to a competency restoration treatment facility. And I said wow, so this could really help. This is a no-brainer. Despite any cost. This would be a no-brainer to open up this mental health facility and transfer these folks over. To my surprise none of these inmates would qualify to go to this facility. These inmates need to go to a state hospital. This facility is not a state hospital. This is an information I'm making up, not information sent by someone on the street. These are the leadership team of the administration and of chs. Side note, surprised that no one has done this, that none of my colleagues has done this, I'm surprised the administration hasn't done this but I've put a hold and distorted legislation directing the administration to make our facilities to be a competency restoration treatment center. Because one thing I learned during my visit and chief was there as that we are equipped. We've got the know-how, we've got the tools, we got the experience, the chs team is experienced and qualified, we have the credentials, we just need to get accredited by the state and we would solve a huge gap we currently have and have had for years in our corrections department. 4 to 6 month wait is the average weight I was told. That's just an average, could be eight months or nine months waiting for a state hospital. 's honestly unconscionable to see these humans, these people, people just like you and I having to sit in a cell because there's no in the state hospitals and we have not taken any action is beyond me. I just learned about it. Especially if the can corrections is telling me it could be fixed. But going back to what we are here to discuss. As we move forward there are important questions I've asked clear answers to. And hopefully we can get to the bottom of it. So first chief, chief palmer or kathy. Chief, in your opening remarks you talked about a three year plan, to me it's a year or 12 months here about you talk about three-year but the entire presentation is based on two years, is one and not talking to the next, your opening remarks talk about three-year funding but the entire presentation is based on two-year funding so was the presentation not updated, not communicated to kathy that you have allocated an additional year. >> it was done intentionally, it's based on the two-year by the project which is the instructions given by the commissions. The three years is we went by at the request of the board, sharpened our pencil, argued in layman's terms and discovered we in fact do have three years of funding so I wanted to put that out there, we have three years of funding, budget management can attest to that, kathy presented two years because that speaks directly to the item in front of us, it was not a miscommunication, not intended that way. >>chair: for the record and I got a call at 7:00 P.M. From the mayor of the county to explain something I understand was explained to other commissioners well over a week ago but the chair of the board did not matter to explain this, what was requested at committee which was not an official directive because it did not go to the board of what was requested to come back with a 10 year plan was not contemplated, not thought to be a good idea to bring back to this committee of the whole. I just find out at 7:00 P.M. Last night it was a two year or three year plan being brought, not the 10 year that was requested. I'm sure you are prepared for that question because you knew this was coming and you will have a clean answer for it but take a stab at it because I wonder how, I'd like to see your clean answer on that and I'm being honest, I'm not. >> I will give you an honest answer, we know the money we have currently, we can project two years and after sharpening the pencil we have three years I cannot in good conscience tell you what projects we are going to fund or defund in seven, eight, nine or 10 years so I verbalized that to the commission that made the request. I'm being honest, I don't know how to do that. I don't know how to give you a 10 year projections, I can give you 10 years of what events we have now but some of them will expire at some of them will be gained so to give you a 10 year project but it would be difficult and at best it would be a guess for me and I didn't want to do that. So I don't have the answer for that. >> I appreciate that and I trust you're obviously being forthcoming and I appreciate that and I respect you immensely. my question then maybe to carla is when it comes to our budget, doesn't government, isn't our budget five-year versus a 10 year forecast. >> through the chair, yes. Most organizations will forecast or create plans that go anywhere from one, 35 or 10 years, those are the normal typical cycles of trying to project what is needed. So yes. >> the state does it to because I was a legislature as we discussed plenty of times. We can in essence in this county which is a massive county. We can forecast at least the next five years of our budget across the county departments. But we cannot forecast a single mental health facility what it's going to cost whether it's expenses alone or inclement but we cannot forecast anything beyond now I'm hearing three years even though the presentation is only two. So that's not doable for this mental health facility but it's doable for every other massive department and the system that run through our county. >> I just wanted to clarify through the chair we can tell you what the anticipated expenses are. The original item and five years of those anticipated expenses. So yes, our budget we produce for the county shows what our anticipated expenses are based on the current run rate. Revenues we do on an annual basis. So revenue is done on an annual basis but we can project expenses based on our current run rate if we kept everything the same. Revenue is annual. >> so do we have at least the expenses moving forward. >> yes, sir. >> is this two-year plan here for the existing beds which I have a question on whether it's I keep hearing 75, now I hear it's an additional 24 so it might be 99. I'm unclear how many beds we would open if this moves forward, are these numbers based on those beds or based on full capacity on this facility. >> those numbers are based on the programming we have in the existing facility so 75 will be critical beds for significant mental illness, 24 our new direction rib 48 are homeless transitional housing. And it's not a capacity, we still have another floor available we can do for future expenditures left this budget covers all the programming we currently have inside the facility as a wraparound total answer or qualify believe is needed. That's what we have. >> so this budget is for the building of full capacity with exception of the last floor not buildout which we still need to spend millions to build out but this budget is for full capacity not for the 75 beds today, this is for the 200 bed capacity of building will hold. >> through the chair I see what MAY not be crystal clear. The reason why you have heard the 75 number is that because we were directed to negotiate contracts the providers when it comes to our clinical provider west care, they will be serving the 75 beds. But we went back and did our homework. And we saw services that would complement the model of 75. So that's why to the chiefs point you're seeing 24 beds for of new direction which is a population in need as well as the 48 beds with the homeless trust. According to, so that gives you and I did the math quickly for you. That gives you according to the model that we are presenting today that gives you chair 147 beds. When we checked in with our pi od department, they shared with us that in full capacity of facility would be around early to hundreds. It was something like 206, 209. To answer your question specifically. >> chief, tell me what is the criteria for determining which patients will be sent to this facility instead of current facilities within our corrections department. By the way that question I've asked endless times with no answer. Not an answer I don't like, not a partial. Just crickets. So what is the criteria, no one's been able to tell me what is the criteria. How do I get someone, I need to check myself in after this. That's no laughing matter. Ecause it is beyond me how basic questions have not been answered and the ones that have been answered have been answered with different answered one away from one person, a different way from advocates for some better here today. But I just continued to get different answers or no answer, this is one I want an answer, what is the criteria. >> a baker act, routine baker act to be taken this facility and it will receive a big direct rent the amount of betamax we can take as the innumerable it will be difficult to give you a number. However this is a divergent program rib someone is arrested, there they get introduced into corrections. If they have a mental illness they go into our mental health center. At that time the public defenders, private attorneys, the judges request cms and cms is here and they can this to do an evaluation. There is an evaluation done of that offender. Depending on the crime they committed if it's a misdemeanor if it's certain criteria, about that depending on the crime they commit and ability for the state attorney to gain compliance or not from victim and diver. There are right now. >> is different than what I learned. We can diver them or a judge can diver them. >> meaning public safety, the public defenders, the attorneys. But we would physically transfer them of course, we got the vehicles. >> the system would identify them and transfer them to divergent, we would do the physical transport to the facility. >>chair: the judge will determine them. Saying with the criteria. >> nonviolent misdemeanors, most misdemeanors and nonviolent felonies qualify. There is a number and again the criteria is difficult to hit because there's a lot of variables. Depending on the crime they committed and the criminal past it depends whether or not we can diver them. If they committed a crime or personal crime the victim MAY not wish the state attorney to diver the mentally ill patient so we won't be able to do it but in general all misdemeanor crimes and nonviolent felonies can be diverted through the request of the court and court diversion program. >>chair: so what you're saying is accurate. Is what I learned a week and and a half ago. Ut to the naked ear it's not entirely forthcoming. What you're saying is true, it was coming off verbally is true but to the naked ear, it's saying we can diver and all these people. It's not that simple. >> we cannot divergent all of them, I never said that. We can divert a significant amount, it is our fault we can diver some 60 something individuals because we need to make space at the jail and help them with their medical condition but I never guaranteed any divergent because it's not up to me as you stated, it's up to the court to diver them. >>chair: what partnerships have been made with local providers and agencies to ensure continuity of care after we leave the facility so now you're therefore x amount of time, it will be temporary and you're only there temporary, several weeks, two or three months but it's not a long-term facility and the idea is to get you better and to get you on your way. What's in place afterwards? > through the chair what a wonderful question. >>chair: kathy, do me a favor, let's get to the question. All my questions are going to be more wonderful mostly because I'm the chair of the board. Et's just get to the answers, I'm sorry. >> to answer your question specifically and directly we will work closely with current partners. And the chief alluded to this, we will set up a criminal justice partnership with everyone from public defenders state attorneys and we will also link with the already existing network of providers because it's an important piece to link to the client once they reenter the community. >>chair: by the way I love the presentation and it was short and sweet. It was. The headline of the cover page got to me. The headline is an evidence-based approach, evidence-based, we have no evidence because a lot of times you ask questions and say it's the first of its kind, there is no data, no evidence but an evidence-based approach to recover. I'll leave it at that but it's a great model. >> through the chair are you okay with me answering that. >>chair: absolutely, this is not a one sided thing, this is supposed to be too resolve this move forward which is my intent but not without the questions being answered and taxpayers of miami-dade county knowing what we are getting into. The voters residents and taxpayers knowing the truth because there's been a lot of misinformation that we will get to today and hopefully everything is replied to adequately with the right answers, not the right ones I feel is right or I want to hear but just the right answers. Hopefully this could move forward, that is my intent and that's why I acquiesced to MADAM Chair lopez request and I should have said that at the beginning. And I think I speak for everyone though I shouldn't do that I speak for everyone when I say we want this to come to fruition. It needs to be done responsibly. So absolutely, whatever you want to address as long as I have the floor and my colleagues can recognize others but you have the opportunity to respond because I want this to be fruitful and informative and to get what we need to move forward. But with that another question I've asked and again we haven't gotten any response, kathy is what data exists if any and maybe it doesn't exist and that's the response I need but silence is not the response I need. What data whether it's west care that provides it or an aggregate of entities that folks, this question came about after my visit to tdk because one of the professionals at tdk actually thought differently than what I've heard in the past. What evidence exists, what data is there to show me that continuity of care will, I don't want to use the word guarantee because nothing in life is guaranteed but where's the data that shows folks that go through this process won't end up back in the system in some sort of system whether it's our correctional system, another mental health facility. What data is there, westcare has to have data. We need to have data because government spends millions and millions of dollars on data and analytics. How do we know that after we do this very feel-good and important facility that it's working. That the folks are going to go and commit another crime and end up in our corrections facility? And I'll put the horse before the carriage here. Your professionals, chief palmer was there said there's no way to do that. if they're going to commit a crime they're going to be back here in our corrections facility. But what is in play, what data exists that if folks get the proper care of the right time and continuity of care, that's what continuity of care is important that they will not end up back in the system. Is there any data that. >> through the chair, this is the reason why we are bringing the 2 year plan. It includes a partnership with university of miami to collect the data you are speaking of. You are speaking of recidivism data. If what we are doing is successful. And if those who have been in the criminal justice system do not reenter the juvenile, the criminal justice system. It's important to point out this would be according to the data and we can send some journals to you, some articles that those who are severely mentally ill, this is the way to appropriately treat them. It takes a comprehensive approach to address those who are severely mentally ill. So we've looked at the different components that make it successful. When you speak of continuity of care, the continuum of care, when we have the local university at the table we will also be looking at those numbers. That's an important piece. Because you want to make sure the change is sustainable. >>chair: that doesn't answer my question, let's take westcare for example, it has several patient facilities rollout south florida. So what I'm asking is I have to have data, they're seeing people already. They're seeing patients today, they have been for years so there's got to be, I'm sure as a company unless they are a startup or something or mom and pop and they don't do this stuff but any company especially if they receive government funds they track this stuff so they have a history. So I don't want to see a journal, I don't want to read a journal published by some editor from new york or california or like, I don't want to see a journal. I want to see data, real numbers. Us putting in this facility is going to save these many lives. >> west care is here if you'd like them to come off. >>chair: this will be a been flowing. >> commissioners MR. CHAIRMAN frank romito senior advisor for west care. 5200 blue lagoon drive miami. Ecidivism the way I think I understand MR. CHAIRMAN 's rearrest. That's what you're more interested in. Rearrest. >> it could be ending up in another mental health facility or a west care work citrus, chs. >> our data shows 11% of the clients we serve dropout and come back to us. We can't track for example if I dropout today if I'm going to show up at citrus. There is no way we can look at that or grasp that kind of data. >> so that's a very direct answer which I appreciate. >> on the rearrest rates the civilian organizations don't have access to the criminal justice database. We did set up many years ago with drug courts through the clerk's office a way to track these cases. It did take some programming, it did send some expense. But it can be done under the clerk interestingly enough is a major player in the data. O there is a way to track but we have to sit down with the clerk. Sit down with whoever else we need to sit down with and the justice system and figure out whether or not we can get that started again or have to reprogram it and someone can cover the cost. We did that years ago through a federal grant. >> so it exists in the universe. >> it did. >> that's what I thought because I suspect and I see carlos from jackson city here with us today. Just like there is for those addicted to opioids you can try to cheat the system but I imagine that the state has a system where hospitals kind of communicate and red flag someone that's addicted and don't give this patient opioids. Were narcotics. I imagine the same thing exists, maybe it doesn't. The state should have the same system for all patients including those in the mental health. >> I'll use a term I don't like but it's used. He state does look at what they referred to as frequent flyers. People who just utilize a lot of the system and it costs the system a lot to provide interventions to them. If you're so inclined to want to open up this facility and provide the services, we are looking at a continuum within the same facility. So I can take you by the hand and bring you from the crisis stabilization unit over to the short-term residential treatment. You're not just being discharged from one level of care and hoping through care coordination or some other means that you show up somewhere else in the system that's going to provide you with the next level of care. This is a continuum within the same facility which is extremely efficient when you want to move someone from the deepest end to the non-deep end and get ready for discharge. >>chair: thank you which raises a whole ton of other concerns. A project like this that has been in the making 20+ years that no one, none of it is pioneers or advocates. Let's reinvest in that data so that we can show the community not just the commissioners but the community that this will be effective. Because this is the data that shows it exists, it just needs to be reactivated and invested into it. I don't understand. His is the expertise. This guy represents west care will be running this facility they say at exists in the universe, we just need to pay for it. >> is entirely correct. He doesn't have the data of the rearrest rate. This is once the beauty of this facility because all the data will be in one location and we can all talk the same information and share it with you. Right now corrections. >>chair: you're saying without the existence of a physical building this data, we don't have to capabilities to have this data today, we need to open up. Go ahead. >> we have an organization or a group talking to each other we can do reluctant data, currently there is no group. He has data from all the facilities in his area of expertise. I'm not going to argue with him but he can't tell you how many offenders get rearrested. >>chair: he admitted he doesn't have access but I want to note the aggregate of it soap and it exists somewhere. It's just compiling it and I don't understand why 20+ years of something in the making way beyond the mayor's administration by the way obviously I know she has a term and she's only in her second term so this is definitely not towards the mayor at all. It's just and I said this in an interview. I feel it is an insult not just to myself but and not just to this body but to the taxpayers of miami-dade county. Two bring them in half-baked program situation, item. Especially something that's not been rushed at his vanity for 20+ years. Something that we all know has been in the making for 20+ years, you have said it to me way before my time. Judge wiseman has said it on the news several times and it's been 20+ years has been working on this so why is this being brought to us and what I would call a half-baked fashion. With just a two-year plan which by the way just to correct the rhetoric. This old two-year pilot narrative just started. This is something the administration shifted you recently. This was never in the last two or three years discussed as a pilot program. It was discussed as we have the funding for two years or three years or up to five or but it was never said as a pilot program. It was now it's a more attractive sales pitch to say pilot program because when you say pilot program what have you got to lose. It doesn't work but guess what, pilot programs are free. The average pilot program of miami-dade county doesn't cost miami-dade county anything. If the average pilot program doesn't cost anything. we have the funding for the first two years but it's costing us. It's costing us so it's not free. I don't know I would cause a pilot program but I understand the reasoning behind it. What happens chief, what is the plan and the mayor will be out by then because she's in her second term and she will be turning out at that point but what happens if this so-called pilot program ends up not working. What's the plan? What's the plan for this facility. >> I'm going to call kathy backup for an answer but we had a five year plan and we were directed to readjust our plan to a two-year and I don't like the word pilot because it makes us sound off but you're correct, it's going to cost funds. We have those existing funds but it will not cost any additional general funds and that's what our position is but I will let kathy the point of whether the program is defunded in the future what we will do with the patient's. >> chair, we would transition them into seamlessly transition them into the network of providers. What that means is the population that we will be serving, they will all have treatment plans. We will have multidisciplinary staffing, we are different professionals, we will know the case intimately. Therefore if the pilot doesn't work we would link to one of our community providers according to the service needs of the individual. >>chair: director, and I appreciate that answer and it's probably the best answer you could give, I get it but if that's the case why not do that today? Why not assist these folks today and not drop 40, $50 million a year on a facility. Hy haven't we been assisting them for years passed. What you said is true that there are processes in place, facilities available. There is care about their, why don't we assist them today, why are we allowing our mental health community to grow without assisting them. >> because we don't have a comprehensive system in place. >> but that's my question, if this doesn't work in two years or three years and you found another twelve-month defending that this doesn't work in two years we won't have what you said, that comprehensive network won't exist because it didn't work so why, does it makes sense what I'm asking? I don't think I'm shooting in the dark. What's different in three years than today. And I realize director the line of questioning I'm doing comes off as if I'm not wanting to do this. That couldn't be further from the truth but we need to do it with transparency, that's what an asking. If it's transparent, I'm all for it but we can't do it misleading the public. When this came about, there's some maybe even on this day is that MAY have more history than I do because they've been around longer and been on this longer than I have from what I have looked into, red and been briefed on, when this came about there was a real and we spoke about this one I toured tg ko begin to half ago, there was an issue happening in our corrections facility. Thought that is why this was born, this idea. We got into the consent decree. Here was bad things happening in our corrections facility all the time. Let's not get into what those bad things were but everybody can imagine the worst of the worst. Oday we've come out of that consent decree by a judge. We, I toured it and again it's a devastating scene but it's being operated very healthy. We are not in the same need we were 20 years ago. So we've kind of started with an issue trying to solve an issue in the making of this 20+ year facility we have since solved the core issue. We have solved the core issue but now we are too far along on the facility and we've spent upwards of 40, $50 million renovating it so it's like we need to open up a building that's empty now we've spent so much money on so let's spend another 30, 40, $50 million a year to open it even though there is not the same need we had 20 years ago. That in itself is concerning to me. I still recognize it is good for the community. but I'm very realistic from what I learned, not my words, what I learned touring the facility is this will not solve issues for our corrections department. And this was said to me by our leadership team, chs, the folks in the meeting the chief knows and these are the people on the ground. It doesn't matter what us as upper management says. These are the people on the ground saying this isn't going to solve anything. Not the last question I have but for now and I'll move on to my colleagues and I'll probably come back to myself but the last question and I know the answer to it, I just want to put it on the record because it's my one thing to be forthcoming with the people. Referred from some advocates to press after press after interview after interview, after our difficult talking about how this will save a great amount of money for miami-dade county. In fact I've heard numbers thrown around of $300 million, $400 million. Real impactful figures. To whoever would like to answer, chief. Will this save and in answer. >> will this save any funding, any money from miami-dade county taxpayers, would this save money. >> you toured the facility, problem is so significant if you open up the center at full capacity we will still need a center corrections. So the clear answer is no it will not save us millions of dollars and will save us some money as we reduced the population in corrections if the system and program works but I'm not going to get into that. Right now. >>chair: you made one mistake right now it's when we discussed this week and and a half ago it wasn't it will save a little bit of money, it was from your mouth from the entire leadership team of the mayor that was there from the corrections facility itself it will save zero dollars, not a little bit of dollars, zero dollars. Which it's okay to commissioner gilbert has been very open on the record saying that that's his issue is it has been misled about the savings and we just need to get comfortable with the fact that this will cost the county money. But it's going to save zero. That's what you all said and we can have a go unless you all lied to me. >> I'm telling you right now it will not save us any money. >> for the record the hundreds of millions of dollars were not our numbers. Our numbers were articulated by kathy, we spits to pay our numbers and omb and back those numbers. Anything else are not our positions and not our numbers. >> thank you and I will do theater here but I have a compilation of press interviews, after press interviews talking about two to $3 million savings that will bring to this county and it's not happening. ith that, I will open it to my colleagues but guys, I think to commissioner gilbert past points, is we need to if this is going to move forward we need to get comfortable with the fact that this will in a time when uncertainty that the governor and this legislature is talking about reducing or eliminating property taxes, we need to get comfortable with adding another $20-$50 million a year and expense to this facility. If that's the will of this board and that will be the will of this body but we need to be comfortable that the decisions we make today will impact us tomorrow. With no data. Because if there was data showing it was going to save a single life, I would be comfortable with that because just one life is enough for me. I said that back when we talked about the school zone cameras. If it saves one child's life that's enough for me. But there is no data. Real data being provided, there's two directors point there's journals. With that I guess and I wanted to recognize you in a minute commissioner gilbert but who really requested this was commissioner lopez. O commissioner lopez I'm happy to have you lead. The conversation is the first commissioner after myself to speak because you did request this and I'll go around the dais. >> I did, I would like to and i know commissioner gilbert MAY have to leave so I will we've my time. >> you are recognized. >> thank you commissioner for being here today. So I won't necessarily be that long but I think it's important to understand philosophically how I see things when I present with the idea. Because everybody wants government to do something. I asked myself the question is is something we should be doing. Is there a problem we can actually help with. When I answered that question, that drives everything else. I don't and I think that partially this isn't to be critical of specific folks but I think partially we are on the staff right now because prior actions of prior mayors also because how the conversations been framed. Why are we thinking that people who are in need of mental health in this community why are we thinking that needs to automatically have the ability to pay for itself. Why are we there with that, how do we get down on that road. We got on that road because people told us it would save us $300 billion and we all know that's not true. Some people said we might make money, that's not true. I take as true that the CHAIRMAN's supposition that this might not save us any money. And it MAY cost us but what I do know is this, I have a family member who went to the criminal justice system was mentally ill and proper treatment shouldn't be in a jail. I know that. I know that we can't freeze everybody in this building but for those we can we should. I know that for all the other things we do I take a slight exception to what I guess the initial response from administration. We might do projections and forecasts for our funding, we have an annual budget, every year we sit here till three in the morning and we decide what the values of this community want to spend money on. I am prepared to tell the administration work this formula, work with everybody, mitigate the cost as much as you can. A backstop for every service provided for this county is the general fund, period. If we said that two years ago, if you all had said that two years ago we would have voted. We've gotten to this conversation of whether it's true or not that it will pay for itself. I don't think that's true but I pay taxes because I want to help. I pay taxes for services I don't use all the time. Federal taxes, local taxes, I pay taxes because the strong should bear the infirmities of the week. I start from the proposition of is this something we should do, will it help someone. I answer that question yes, we got sidetracked on what I think I called sprinkles on a cupcake. we got sidetracked with this idea that it had to pay, we don't ask police to pay for themselves. They give you all more tickets. We don't ask fire, you don't pay because you got an actual fire at your house or because you were experiencing a medical distress and you are having a heart attack and they showed up and they didn't charge you for the defibrillator. We supplement what is it, 89% of transportation, we are not asking everybody to pay for that fold us right. We're not asking everyone to pay for the full functioning of the parks. This is not a proprietary system, it was not envisioned as a proprietary system. E are analyzing it through the prism of a proprietary system right now but we are doing that because of the conversations that folks have been having telling us and I remember when I got briefed by a judge it sounded great and I thought this is something I wanted to do and I didn't believe then that the numbers were right. I didn't believe it then but the numbers weren't right but the mission was so righteous. The numbers don't have to be right if the mission is righteous. It's something we should do as a collective. S a community. Because it's the right thing to do. We backstop everything else, we don't let people pay for services any other time so what we are saying now is people who are experiencing the fragility of mental illness and that interaction with the criminal justice system should pay for itself? I don't subscribe to that. I think that the conversation on the finance has sidetracked us from our core mission of providing services so now we go down this road of questioning because in court what they tell us is false in one, false in all so now when I don't believe your numbers it's fair to question whether the efficacy of the treatment is actually the same and I see how we are going down this road so I would like us to go back to and that's why I came to this committee which I believe should be a county commission meeting because I love the ability to vote on this one way or another but just go back to the beginning, is it something we should do? Will it help somebody? If it does, then our instructions to the administration should be met in mayor, chief, you all work with everybody. I want you to get as close to making this thing pay for itself as possible. Nd then when you bring back our budget you bring us back the delta. You bring us back the difference. This is the difference, we said it's something we wanted to do. This will be the shortfall. You either supplement it or you won't. And I know that because you will have done an extraordinary job of generating press around this, the press doesn't affect me yet I know how to ignore a dog, he's laughing because he knows I do, that will not affect me because from my perspective you make these decisions all the time. Every time we pass a budget we are doing value decisions. I find value in this proposition. And so independent of MR. CHAIRMAN I think your questioning though you know it was exhausting we long but I think it was right on point. On the numbers, the numbers, there's far too much confusion, doubletalk, changing of physicians. There's far too many things in the numbers that make us forget everything we've seen in government. I want you to find one time in government where social service actually paid for itself. You all just find one. MR. CHAIRMAN, through the chair I open it up to anybody, one time where social service paid for itself. It's not going to so you're asking us to believe this one will. It's not. It's just not. It's like saying gravity doesn't exist. I dropped something, it's going to fall. N and out of space, maybe in space it pays for itself, here in miami-dade pay for it and I'm comfortable paying for it MR. Chair, thank you. >>chair: thank you MR. Commissioner. Commissioner lopez. >>commissioner lopez: thank you commissioner gilbert because I could not agree more. I have been a huge champion of mental health services and I agree commissioner gilbert this isn't something we should be questioning whether we do or we don't. I had the pleasure of having an extensive briefing with judge lightman and with the mayor and her leadership team about this and honestly as a budget chair in the florida legislature we appropriated hundreds of millions of dollars to mental health services, all of which go through our managing entity and out into our community-based organizations. There is not one of them that would exist without that funding. In addition I told judge lightman that I hated hearing the word pilot. Because the word pilot appears to almost reflect that we are not sure it would work. It will work like every single mental health cbo today that is funded through the state. They work. We just don't have enough money to expand them because the need is so great not only and forensic beds but in these times of crisis stabilization beds. Got a lot of comfort after my briefing with the mayor and her leadership team because I learned people would be transitioned within the same facility just as MR. Rubino said because I have been, I have experience knowing that the state only funds 60 days of treatment for substance abuse and 90 days for mental health. If you know anyone suffering from either one of those diagnosis that is ridiculous. It's too short of a time and that is why we have to transition people from residential beds to another type of residential or transitional bed with services. Because often times people need up to a year just to stabilize and get ready to move into the real community that we want them to flourish in. So I recognize that this MAY cost us money but I don't want to call it a pilot and I want to make that clear to everyone listening, this isn't a pilot for me. This is yet another facility that will be able to address the needs of our community and in this case specific members who have found themselves in the criminal justice system when they are seriously and persistently mentally ill and could receive the best kind of services in a different setting. So first I'm not calling it a pilot. Think no one should review that word ever again. It is just another mental health facility. 1, 2 but thought I think it should be self sustainable is also ridiculous. There is not one community-based organization in miami-dade county today that doesn't experience the not minimal funding by the government but I would say almost anywhere between 85 to 95% of their revenue stream is of some sort of government fund whether it's federal state or local so for us to think for a moment this facility should be self-sustaining is also a fallacy. And it leads people to believe somehow only this facility has to be self-sustaining. It's ridiculous. No other cbo that is operating currently and providing behavioral health for substance abuse and mental health is self-sustaining and thirdly we have not yet explored the states responsibility. This particular facility, there's no other facility like this across the state. I had a long discussion with an appropriations CHAIRMAN In the state who wants to see this facility opened. He said we've yet to even explore how we can be helpful. So I think it could be a model. We have just explored a different type of continuum of care model. Right now with a cbo in miami-dade county that is testing a new type of continuum of care that MAY be expanded throughout the state. I think that's what we should be looking at. If this facility can open and open as quickly as possible. And I hate when I hear there's going to be an evaluation done after two years, that's also ridiculous. That presumes somehow an evaluation is going to come out that this didn't work. You know what the evaluation should show, that we should have opened the facility and put every single bed to use. That's the forethought of what i thought about. When we talk about the 75 beds saluting those residential beds I don't understand that because once again we have to say it has to be self-sustaining now that I have a better understanding of topics p I talked about the 100 linda's in my district who are perpetually homeless and have intersected with not only the criminal justice system but the homeless trust, it strikes me that no one has talked about what police officers have to do on the ground. My police officers in downtown miami will have a choice now. If we open this facility be open it tomorrow they will not have to make an arrest. They will be able to look at linda and say linda, we love you, you need crisis stabilization today and linda will go into the facility, she will have stabilization services and she will soon move through a continuum of care that will treat linda for exactly what we haven't been able to do for the 20 years that linda has been on the street. Linda deserves to live in a safe and sustainable life, not on the streets or in the jail. So I'm going to encourage my colleagues. [Applause] I know all I need to know now. >>chair: I let it slide the first time, we are not in an official bcc meeting but we don't do the clapping thing. You know what to do, all your clapping because okay. >> I do want to say this, we have to drill down on the cost. there MAY be some discrepancy in west cares operating cost for the first two years, I think she is, I think it was shown to be 25 million in the slide. I understand it might be 17 million. I am not going to debate the numbers here. You want to get with them and make sure we have the right numbers. And that same goes for the criteria. If there was ever somebody who was the reentry expert besides jump judge lightman it's commissioner lopez over 20 years has devoted her career to helping people who are leaving both jail and the prison system. Leading them to a better life. The court system knows how many people recidivate, we know the state also knows how many people leave the prison system. What I will tell you is the encumbrance of this particular situation on the state prison system. I do a lot of work with the director, secretary of the department of corrections. When we don't fix it here at the jail you are forcing those people to now be committed to a state prison system when their sentence is 366 days and guess what happens then. That person moves into a much more severe criminal justice situation where there is not enough programming for them there. So we would be saving the state money which hopefully will come back down here on the facility so I encourage my colleagues to look carefully at and I would say philosophically, you are correct commissioner gilbert. This is a philosophical situation we find ourselves in the mood to understand our responsibilities. Listen, we understood all responsibility for the homeless so now we make sure the homeless get the services they need, we need to make sure those that are persistently mentally ill and I'm going to add this because if anyone has been in jail or had anyone in the criminal justice system you know if you have any kind of mental health situation and some are not severe, some are just, I had a moment and I find myself in the system or I've always had these moments and now I'm back in the system. He system exacerbates any mental health condition, it does by its very nature you have to know that to understand why we need this facility. I will not belabor this any longer except to say I hope this facility opens tomorrow and we don't talk about pilots sustainability, here's what we are going to do, we are going to prioritize the small, we have a decreasing pot of money in the general revenue and unfortunately we will have to make the hard choices and for me it will always be people over buildings and in those people vulnerable or not so vulnerable. This is for vulnerable people. >>chair: thank you commissioner. There is no children in the audience, you guys understand? come on. Commissioner cohen higgins. >>commissioner cohen higgins: thank you chair and thank you to my colleagues for the remarks. I know all of us are paying close attention and thank you to the residence here. Knowing you are not able to speak, you're sitting here paying close attention, you don't have the opportunity for public comment so thank you for taking the time to be with us on this important issue and thank you for the administration for the work you've done to get us to where we are today and I appreciate you finding an additional year of funding for this facility and the points raised by my colleague and I look forward to hearing from all my colleagues here participating in this workshop. I think I can't agree more with what everybody has said. Nd I have been the one who has been extremely concerned about the finances of this project because I think it's important. I don't know I need to repeat that regarding the philosophical part of this discussion whether or not I agree with it, everybody agrees with this project philosophically. But I think that's only half of the conversation. The other half of the conversation needs to be addressed which is the financial part of this project. Which is why I asked for the funding going into the future and while I appreciate the three years I understand we have never done a 10 year financial projection to the chief end director but it's my understanding we've never been in this situation either meeting there has been a building constructed that was supposed to be funded by somebody else that has sat around for the duration of 20 years where we are now asked many years later to carry the bill in a time of extreme and extraordinary financial uncertainty so yes, I asked for 10 years of funding because we do five years every year and I authentically want to see the success of this building so I will spend a lot of time at least regarding my remarks on the finances of this because here's the reality and I appreciate those in the audience and I have a philosophical question to ask all of you, everybody is in agreement on the philosophical should week and will it help people, everybody agrees yes. My concern is where is the money coming from to pay it and the question I have for all year in support of this item and do all the residence and to our colleagues is are we willing to raise taxes to support this building and I ask that not because I'm trying to engage in scare tactics, not because I'm trying to be the bearer of bad news but if you look at our financial projections within the next five years in miami-dade county every year we are projecting a financial deficit. A financial deficit meaning we don't have the money currently on hand to fund the next five years based on our already existing line items on our budget. This will be an entirely item on our budget chief, an entirely new line item on our budget at a time when we currently don't have the money to pay for what we currently have on our line items and on our budgets and keep in mind this time last year we were presented with a financial projection that ended up being far bigger in actuality than what was projected so when I see a five year projection and it shows up to $177 million in year five that we will be short, yes an additional 20, 30, $40 million in addition is something we need to take in serious consideration because I authentically wondered in two years are now three years when the money runs out whether the same people that are philosophically so much in support of this item are going to also champion it and ask taxpayers to raise taxes to support it because that is the ultimate decision we will have to make and if we are not willing to raise taxes to support this and what are we going to remove, what are we