announcer: big dreams and goodrades aren't enough to get into college. there are actual steps you need to take. finding someone who can help is the first and most important. for the next steps, go to knowhow2go.org.

>> please call the roll. please answer "present" if you are here. >> officer dunn. dr. jones. mr. keyes. miss susan mcintyre. mr. tom purpose. mr. tho-biaz. miss williams. mr. errol wishom.

ms. virginia wright. >> please speak and your microphones. we are being recorded and televised. we want to hear everything that you have to say. i would like to first acknowledge from the senator's office, miss erin keenan. we know that center -- senator yee is a strong advocate for mental health in san francisco and throughout the state of california. we appreciate him sending a representative here to witness the proceedings. thank you very much. i want to welcome you all to the public hearing on the impact of the mental health budget cuts. over the past 10 years, the

severe reductions in inpatient psychiatric bed capacity has led to a crisis in san francisco. these cuts are a great threat to public safety. they expose the city to increasing costs in crime and homelessness while failing to provide humane treatment and the hope of recovery to residents with mental illness. when services are cut, we end up paying higher costs in our hospitals, streets, and jails. tonight, we will hear from front-line positions -- physicians who have seen a reduction in bed and services and the increasing demand from clients. we shall also herar from an officer from the san francisco police department who will speak on the impact of an adequate psychiatric inpatient capacity

and community mental health services, and the frequency of red alerts and diversions from san francisco general hospital's emergency room. members of the sheriff's department will present on the impact of jails of an adequate psychiatric inpatient capacity and community mental health services. the public defender's office and the district attorney's offices will speak about the success of the behavioral health corporation -- court. we will hear from frontline advocates for people were homeless and about the impact of budget cuts and people without homes. we will hear from those who have walked the walk and will tell their stories at this hearing this evening. tonight, the san francisco mental health board and the national alliance on mental illness in san francisco convened the hearing to hear from the men and women on the front line who will testify to

this board regarding the impact of budget cuts on mental health services. the sentence is the mental health. advocates for comprehensive -- the san francisco mental health advocates for comprehensive mental health services. we report to the mayor of sentences go. we currently have five open seats, 34 family members, and two for consumers. -- we currently have five open seats, three of them for family members, and two are for consumers. nami is a passionate group of family members dedicated to informing, advocating, and educating others regarding mental health issues. finally, we look forward to hearing from all of you here this evening. we want to hear from you about your experiences with mental services, your concerns about budget cuts, and your ideas.

i would like to first call to the microphone dr. cameron kwanbeck, a psychiatrist from san francisco general hospital. >> a thank you. i am an acute psychiatrist. i want to review the impact of reducing acute beds. those are beds that are staffed 24 hours a day, seven days a week, by nursing staff who can provide comprehensive care. i did some research and what the impact would be -- on what the impact would be. i turned to a national organization the babylon 2, the truth in advocacy center. this organization -- i turned to a national organization that i belong to, the truth and

advocacy center. indeed 50 beds per hundred thousand population. -- you need 50 beds per hundred thousand population. we do not do it too bad compared to the national average. california does not fare as well. the california average is 17 beds. san francisco currently has 15 beds per 100,000. that is a bit lower than the california national average. about half are in general and half are at private facilities. that includes st. francis, langley-porter, and cdmc. member is likely to drop in the future. -- this number is likely to drop in the future. i like to make things simple and easy to understand. the impact of reducing acute beds creates a bottleneck

effect. -- a bottlenei have lived in sao and now the bay area. i encountered this on the highways of the time. a bottleneck on the highway happens when you have a car that is disabled. they pull over into a lane. you have cars backing up behind a bottleneck. you have cars going in the opposite direction of looking at what is going on. people see this jam. the exit. they take detours. it is not good. it prevents people from where they want to go. it prevents the flow of traffic. it is not a good thing. i am currently working at the general in ps, that is the only devoted psychiatric emergency room in san francisco.

a at p.s., which predominantly see patients that are brought in against their will. there are dangerous to others or cannot care for themselves. as a psychiatrist, i feel like a police officer on the highway. you have mentally ill patients in need of treatment. in a bottleneck with limited resources. -- you have a bottle neck with limited resources. you are trying to divert them or admitting some patients who really need to be admitted. there are a number of ways to relieve the pressure in the spot on the situation. the first is -- there are limited beds.

they put people back in the community. they go back to where they came from. they're brought in and stabilized for a day or two and then go back to where they came from. as a consequence, i am not admitting people today who would have ignited years ago. the threshold for a mission has gone way up. you can also admit to a private hospital. that can be challenging. private hospitals do not have the capacity to take care of our most severely mentally ill patients. the county is set up to handle the toughest cases. that is an issue. then there are times when it is so full, the capacity is 24 patients, that we have to go on condition red. when that happens, the chargers called the police and say that they are too full.

you need to take the patients that would come here to a medical ie.r. that is not good. you have patience or acutely psychotic in an emergency room equipped to handle emergencies like heart attack and stroke. the emergency room doctors have a lot of pressure to get these folks out of the emergency room. to relieve the pressure of the bottleneck, they are admitted. when they have been stabilized for fuel is a medication, their discharge. they're discharged when some might consider to be prematurely. they've not realized the full benefits and are released before they have gotten the full benefits. you have all of these stop-gap measures. they provide limited and an adequate treatment.

it feeds back into the bottle neck and creates a revolving door pattern of acute service utilization. i am a forensic psychologist. i have worked a lot in jails and state hospitals and with people who have committed crimes. the worst possible outcome of inadequate treatment is the criminalization of severe mental illness. when one of our patients in up in jail, that is a treatment failure. i want to talk to you about one case that has been called to my attention by my colleagues. i am going to call the patient jason. that is not his real name. i am going to use that. this is a 24-year-old african- american male with schizophrenia. that is a severe mental illness.

when jason is not taking his medication, he exhibits the following symptoms that lead to his hospitalization. he is paranoid delusions. illusions are fixed, false beliefs. when he is off his medications, he believes he is being poisoned, that his food and water are being poisoned. he will not eat. he is very troubled by this. he thinks that people are out to kill him and that they want to hurt him. this creates a lot of fear and anxiety in jason. he acts aggressively. if someone was trying to poison me, i would be aggressive as well. i would want to protect myself. when jason is on medication, it is a whole different story. when he gets in the hospital and it's on his medication, jason is described by the psychiatrist as pleasant, incapable, enthusiastic, and self- motivated. -- engagemable, enthusiastic,

and self-motivated. over the past it appears, has been hospitalized 11 times with an average of two weeks per visit. it usually takes someone about a month to get someone fully relieved of symptoms and have them fully appreciate the benefits of treatment. he is readmitted every time after he stopped his medication. his office medications for a week. the paranoia returns. -- his office medications for we. the paranoia and aggression returns. he is brought back into the emergency room. unfortunately, his last hospitalization which began last month, and jason became very angry, paranoid, and assaulted two of our nursing staff. one of the nursing staff suffered a concussion and is out

on disability. now jason is in jail charged with felony battery. with a wonderful system at pes, we can look at how much a patient costs over time. the treatment for jason costs $250,000. for what? it was a failed treatment. he is now in jail. his wife and the lives of people who tried to help him have been adversely affected. -- his life and the lives of those who tried to help them have been adversely affected. now jason is in jail. what are the consequences? that is the sound of more money going down the drain. [laughter] once jason interested criminal justice system or county jail -- once jason intereenters the cril

justice system or county jail, things change. we could finance his care through a federal entitlement programs. when he enters the jail system, all his costs of care, housing, the legal, court costs, probation costs -- all of that comes out of the general county fund. it is going to be more expensive for jason in the system in the upcoming year. it is very frustrating. everybody is frustrated. i am frustrated. there is hope. looking into the future, with the recession, it is time to take a critical look at our mental health system to try to improve it and make it better. i have been fortunate to be involved in a statewide committee that is comprised of

mental health administrators, lobbyists, clinicians, law- enforcement, attorneys, judges, consumers, nami members. this is occurring across the state, not just here in san francisco. people are getting together and trying to figure out what we can do to improve the care of our mentally ill citizens in california. there are two things we're thinking about. number one is if severe mental illness is a medical illness, we should treat it the same way. as it exists now, it is much easier to treat somebody who is medically ill in hospital that is someone who is mentally ill and a mental facility. -- who is mentally ill in a mental facility. >> i am sorry to interrupt. if you could bring it to a close in the next few minutes.

thank you. >> the second issue is that there is a lot on the books called "laura's law"that allows us to provide intensive outpatient treatment. this is not in place in san francisco county. this is something we're trying to expand throughout the state. my take-home message is that there are a lot of problems with the system. people might be pointing fingers at each other. is it the fault of law enforcement, the psychiatrist? whose fault is it? why are we having all of these problems? i want to conclude that the system is broken. the mental health system is not modernized or structured properly to provide the best care for patients. it will take frontline people what clinicians, law enforcement, and judges working

with policymakers to improve the system and provide high-quality care for our mentally ill citizens. >> thank you, dr. quanbeck. to have any questions from the board? >> dr. mary ann jones. >> based on your experience and the data you have reviewed, what would you recommend it to be the number of beds required to meet a minimum standard of care for the residents of san francisco? >> well, you know, the national average is 37. it should be closer to the national average than 15 or even the california 17. getting people stabilized on

medication is so important. someone to stay an additional week in the hospital and can be a night and day difference. just the capacity to keep people on their medications longer to make the difference between someone leaving the hospital and sang the medications do not work or staying in additional week, they are on their medications and continue with them. they are able to avoid free hospitalization -- re- hospitalization for a long time. >> thank you. >> errol wishom. >> i work in seve7a, 7b, and 7cn san francisco. i noticed that there are always

enough beds. where do these statistics come from for the 15 and 17 per 100 needed? from working up there as a peer counselor, i have seen patients come and go as a revolving door. but i do not understand where the beds come from. >> the data is from the treatment advocacy center. it is a national organization based out of washington, d.c. they are an organization devoted to improving treatment for the severely mentally ill. that is where i got that from. the 15 beds 100,000, i called down to pes yesterday preparing for the stock.

i asked how many beds were available. there has been a reduction. maybe john is around. can john answer that question? >> would you like to step up to the microphone, please? >> as of about 56 years ago, san francisco general had roughly 80 -- as of about five or six years ago, san francisco general had roughly 80 beds, in addition to the beds in the jail's psychiatric center. at that point, cpmc had unit of about 15 beds. st. francis had an inpatient unit. langley-porter had a unit. st. luke's had a unit of the least 20 beds as well that we

could frequently to admit to. since that time, we've cut down to 40 cubebs at san francisco -- 40 acute beds at san francisco. we could be down to 23 the budget process as of march 16. there could also be a couple of step down units. the unit at st. luke's has closed taking others out of the picture over the past few years. >> think you. -- thank you. i like to collop lt. mark solomon from the san francisco police department. -- i would like to call up lt. mark solomon from the san francisco police department. thank you for joining us here this evening. >> thank you. my apologies, i do not have the power point. >> i am working with the

homeless population in the city. what i am going to talk about tonight is not specific to the homeless population, but it will play a part. over the past three years, we have had budget cuts with regard to psychiatric services and our city. this gradually increased on our workload because of the lack of services. we're averaging approximately 65 651 calls. this takes officers off the street. three of the main problems dealing with the homeless are alcohol-related issues, a drug- related issues, and the common denominator on drugs and alcohol is mental illness. one of the problems our officers are dealing with is when they 5150 an individual and

take them to a hospital or private facility, the individuals are discharged quickly because it is mainly due to the alcohol or drugs. the bottom line is that they are dealing with a mental illness. when they are discharged, they are not together enough to go back to the hospital for further treatment. what is happening is they're going right back to the street and engaging in the activity that is bringing this on from the onset. there are many stories we have with regard to individuals we deal with on the street. i will touch on one individual that likes to hang out at night and howard -- night and howard at the old gas station. he is a recidivist 5150. he has been 5150's on numerous occasions. his activity is now turned criminal. the last time we responded out to this individual, he got

violent. an officer got hurt along with a citizen who is trying to assist. once again, he was 5150's. i think if you have received longer-term treatment, he would not have been criminalize. he would have been treated appropriately. i feel the budget cuts have exacerbated the problem. when the officers respond on a 5150 call for service, it could be anywhere from one hour to four hours. more often than not, prior to the officer finishing in his report of the station, this individual has already been released from services. this makes it very difficult for everyone. another thing we deal with is when the main hospitals are on red alert. we go to a private facility. a lot of private facilities feel they are not equipped to handle some of the individuals that we bring in. again, that makes it very difficult. we need more services, that is

the bottom line. i think we need to rethink this and reinstate our old budget. we need to bring the monies back so that the proper services are provided to the individuals who are in need. that is all i have. i think you for the time. >-- i thank you for the time. >> thank you. that was well said. i would like to call kary gustafson -- carrie gustafson. >> as i am sure everyone here suspects, jails are harsh environment. unfortunately for the mentally ill, it can be toxic. it is not at all conducive to treatment. as already mentioned, it is very

expensive. i know this because i work for jail psychiatric services. i like to briefly address what we've seen occurring in the jails over the last couple of years. first, we're treating more people. second, the number of people entering the jails with a severe mental illness has increased. beyond that, the number of times jail psychiatric services staff members need to see people once they're in treatment has gone up. this is a pretty strong indicator that people are coming into the jails already suffering from mental health system -- symptoms more and are requiring more care. we've gone from about 49,000 units of service in 2007 up to 54,600 units of service in 2009.

that is a lot of contact that should not be occurring at all. jennifer will be talking about the behavioral health court. as an aside to that, for people who are mentally ill and participating in the behavioral health corporation, they already have to wait between four and eight weeks for community placement. they're just sitting in jail waiting for a place to go. they're waiting for treatment. the cuts in community programs are starting to make this worse. that is all that i had to say. >> do we have any questions? yes, mr. martin. >> you are getting the overflow? >> we treat people who come into the jail and are referred for mental health care. >>