organization -- because we are a new startup venture. we all come from many years of mental health advocacy. we are highly experienced. our mission is to eliminate the stigma of mental illness. our target is the general public. we feel very strongly that nothing is ever going to change until the general public fully understands these issues and gets behind it. i think is a real shame that there are no members of the board of supervisors here for members of the mayor's office or even any politicians. we all know that politicians, the majority, are followers, not leaders, and the general public is who they listen to. until the issue of mental health and the stigma that surrounds it is eliminated and the general public understands

this issue, we will continue to battle the same issues of but it, sufficient housing, sufficient community facilities, notwithstanding the wonderful people here in san francisco who are dedicating themselves in such a marvelous way to the mentally ill. again, all of you here in this room know that the shocking fact that 2/3 of people in this country have mental disorders get new treatment at all -- that is coming from the world health organization and the national institute of mental health. 2/3. that is so shocking. do we have any other physical and mental -- medical illness where 2/3 of the people are getting no treatment at all? why is this? because of the stigma that surrounds mental illness. our organization firmly believes that a new approach has to be

taken to stigma. we have to get the public involved in a way that makes mental illness relevant to them, that makes mental illness a community issue. the way we think to do that is to get across to the public this point that again is endorsed by nimh and who that as our organization title says, there is no health without mental health. until medical health. mental health is an integral component of overall health. who has spoken about the interaction between mental health conditions and other health conditions. they are widespread. they are complex, and they can occur at any time to any of us. >> thank you very much for your public comment. we have to respect the three-

minute limit and move on. >> ok, thank you very much for your time. again, www.nhmh.org. thank you. >> thank you. [applause] >> thank you for holding this hearing. members of nami. we need the leadership you are providing to make sure we have services in the city for the most vulnerable population that lives here in the city. in a resident physician. we do the day-to-day clinical work for all sorts of patients -- psychiatric, medical, a pediatric.

i am in psychiatry. there's lots to talk about on the impacts of these. lots to talk about. but i want to focus on two things primarily. first, i'm incredibly perplexed at the moment because the funding for the unit on the seventh floor has been restored by the board of supervisors, and i appreciate the testimony earlier. we know that it is cost- effective. we know that it is scientifically proven. this is not a policy problem. this is not a fiscal problem. this is a political problem. it is a human rights problem, and frankly, it is a back on problem on the part of the mayor's office, on the part of the senior clinical leadership of the hospital, the department of public health. i'm glad that this forum is in place for us to really promote this, to let the public know. one thing that will happen if these cuts go through is we will

reduce the number of acute beds from 42 to 21, and we will have 42 sub-acute beds, people essentially waiting for placement. we will reduce the number of certification ridge nursing staff, and why does that matter? there has been a relative decrease over the course of the last several years, but there has been a slight increase when we went from an 84 acute beds to 42. i'm afraid, as someone who is there all the time, that we will have a hyper acute unit that will be more dangerous for staff, for physicians, most particularly for patients. i have witnessed several patient on patient assaults, and it is devastating. it is most certainly not a therapeutic environment for the patients to improve, and this is critically important.

the mayor's office will say look at the department of psychiatry's utilization review policies, look at the medical data, and you see that there is only 21 of two patients, -- 21 of your patience, and 41 or so administrative patients. this is there justification of why it is ok to reduce services, why is okay to cut nursing staff, why is ok to create the possible hyper acute unit, and i'm finishing now. the medical data of what is an acute patient and what is an administrative patient has no correlation of what is an acute and what is sub-acute clinically. we have a lot of administrative patients who take a lot of physician time and nursing time, so is not a good justification on the part of the mayor's office. thank you. >> thank you. [applause]

>> thank you. i would just like to reinforce what my colleagues have said, and also, the coalition on homelessness. what we have seen in the last year's is sort of a piecemeal dismantling of an integrated system of care, and it is not possible to make this kind of care for the seriously mentally ill worker in little bits here we have to have a smooth flow between. my perspective, since i work in site emergency, i see people at the starting point when they are brought in in handcuffs. is now the way we like to see people need the mental health system, but for many people, it is the unfortunate reality. we have to work smoothly with the inpatient units.

with residential programs and the long-term residents. if any of those things are missing, they do not have capacity. the whole system fails to work. people back up. they stood on the invasion units because there are no places to send into. our current record is 120 hours. that is 5 days, and we had 5250 hearings in site emergency for people we have determined 4.5 days before needed inpatient admissions. i was call that a fluid dynamics problem. that is a problem where we have not realized the flow and how many sub-acute beds you need to take the flow out of the inpatient units of the invasion unit can take people efficiently. when we start dismantling things piecemeal like this, nothing works very well. and it is costing us money we cannot afford and denying care to the people who desperately needed. i you very much.

-- signs you very much. -- thank you very much. [applause] >> thank you. >> thank you very much for allowing me to speak. i have written a speech, and i do not know how much i want to give of it. i guess i will tell you a little bit about my previous history in regard to my psychology and in regard to my difficulties. 40 years ago, i came from iowa city in the ph.d. program in trauma and wound up almost immediately in mental hospital in san francisco unable to read, write, tight, or talk. since then, as you can imagine,

it has been a very long, little by little climbing -- let's call it jacob's-ladders. i do not mean to demean the intensive this of the site gets a profession in terms of their possibly being a disconnect between the psyche and spirit. i'm sure that is not the case, but in any case, what i have to talk about right now is -- first of all, it is an e-mail that i rode to a couple of people who work for fox news, which i deeply respect, by the way, and just so you know, i have the tendency of correspondence with karl rove, who, by the way, responded to an essay that i said to him. he thanked me for sending the

very strong essay. i can go on. i'm publishing a book, but that is irrelevant right now. anyway, i have my glasses, but i'm not going to get them out just for the sake of speeding this up. here's a really tough question for you to ponder, and as you wonderful people ponder it, so i again as i am preparing this little essay to read at san francisco city hall again this coming thursday were mental health budget cuts will be discussed. it is a question reasonable people, if they wrestle with it, cannot, i believe, reasonably disagree. the question is -- is america's money more important than america's meaning? pardon me while i go through my kitchen for a tall glass of h

20. i wrote this last night. in the budget debate here in san francisco and in washington, the question of what holds america's most together are meaningful after diaz, public and private, for economic at to be its public and private? i do not think the country has really grappled with this question before, and at this juncture -- sorry. and at this juncture, plan our and the world's history where there are people -- sometimes angry people -- on both sides of the question, shall we have a go at it? at least in a preliminary fashion? ok -- >> thank you very much. >> thank you. by the way, i have copies of the introduction to my book for all those of you who are interested in good literature. [applause]

9 q bric >> thank you for letting me speak. my name is suzanne killing, and i have several different perspectives on the mental health system here. i work as a psychiatric best practitioner in the tenderloin with older adults with severe mental illness. that is my full-time job. are also run a family support group that i have been doing for the last eight years for families and friends and loved ones of the mentally ill, and that meets weekly, and i also run a schizophrenia support group, and that is open to anyone with schizophrenia in the entire bay area. we get people from the south bay

and north bay because there is nothing like it, so i feel i have a good perspective from a lot of different ways. i am gravely concerned about what is happening to our mental health system. i used to really feel proud to work for the san francisco public health system because i came from other community health places, but the priorities in the last two years are concerning me, and i wanted to bring to the attention of all of you that not only are we having these budget cuts that are coming down the pike, but there's another agenda happening, and that is really the dismantling of the mental health system. the focus right now is on primary care and on integrating mental health with primary care, which is a wonderful idea, and we are for that, by we all know that people with serious mental illness do not make it into primary care, and the plan right now that is being rolled out is that they're going to take that into primary care clinics, colorado behavior, and have them do 15-minute interventions with

people to help him with obesity, with anxiety, 15-minute interventions, and we know this is not the population i serve. they are taking our staff a way that has already been 5 to do this kind of work, so i think how the san francisco is a wonderful idea. i'm really concerned that it is a priority for this difficult financial times. it is a hard financial times, net think everyone deserves health care, and i would like to see that. i do not want it to be on the backs of the poor and mentally ill. i'm the person that has to with people in the face, and i go to family groups, and people have families that are crying and asking why there is not this or that, and i do everything i can to help them access what there is, but there is a lot of pain and suffering beyond the person who suffers from the mental illness, and i just wanted to make sure that we really

understand this as a community and ask for your help as this agenda goes forward because it is going forward. [applause] >> thank you, very much. you do great work in the community, and am very happy to see some of the results that occur from your work. next, we would like to hear from piers mackenzie. them a good evening -- >> the evening. -- >> good evening. i'm just here representing my daughter, who was taken ill about six years ago. she was diagnosed. she was 5150-ed taken to the

general hospital and into the site ward. after a couple of weeks, she went to the mental health of the have facility, which is next to the general hospital. from what i remember at the time, the general hospital had about 200 or 250 beds in the site once. i think that is about correct. at the time, my daughter went into the rehab facility, the city tried to close the rehab facility, and one of the things we heard a great deal was that many patients were being sent out of county at great expense. i come here this evening, and one of the things that brought me here was that i learned that the beds in the general hospital are being further reduced, and i simply do not understand that

here at the time, we learned that it costs the city more to send patients out of county rather than treat them in the city. and this is just my main concern -- i did not have a great deal of information before i came this evening, but i cannot understand the humane and fiscal thinking, which persists in reducing the beds of those in the city and sending them out of the county. i just finish by saying that my daughter -- six years ago, she was taken ill -- if it happened to her day and there was no place for her in a general hospital, what happened to her? we could not send her out of the county, and if we did not have our home, which is out of the question, then she would have nowhere to go. now, i'm happy to say that because of the facility she had

six years ago, she has done very well, and she is leading a normal life, getting married, so on and so forth, so i'm very grateful, but my real concern is what what happened to her today, and what happens to everyone else in that situation, especially for an end of privilege sections of the population? what happens to them today in view of these cuts? i find it astonishing and shocking and extremely depressing, and i hope that the commission is going to do all it can to prevent some of these cuts taking place. thank you very much. [applause] >> thank you. >> good evening. i am a psychiatrist at family service agency, and the

clientele that i serve on the chronically mentally ill, and as i learned about the system, i agreed to become the code as president of the residential care association -- the co- president. this association represents about 550 beds in a 70 facilities. most of them family homes having 68 clients, and provided family atmosphere, the opposite of where they came from before. there used to be 1200 beds in the system, and now, there is 550, and it is going down rapidly. the reimbursements have not kept up with inflation, particularly real estate costs. and people cannot pay mortgages,

so there are no new homes. there are no profits in this industry, and the homes are only closing. i related to the comment about bottlenecks. he talked of going in and getting care, and there is also a bottleneck coming out. there are not enough beds, especially these very cost effective step down beds. the homes provide medication administration as well as care. they also provide 24/7 staffing. and a small, family atmosphere, which is really heartening to see. they continue to shrink. as i said, the funding has cut down their numbers by more than half already. more cuts would only be a false economy because it costs the

city $15 a day to the money. the rest is being covered by social security disability and is covered by the client. it saves obviously a tremendous amount of money. it is a very valuable part of the conduit of care that everyone will support when they have the opportunity. thank you. [applause] >> thank you. >> good evening. i and the co-president for the board and care homes as a patient of san francisco.

i just want to reiterate his statement that as of right now, we are only 65 homes existing. and we are taking care of 500 clients or patients under our care. we are a very small organization. i do not even know what this city knows us, but we are very -- we are working very closely with all the agencies that spoke this afternoon. we are familiar with the 5150. we are familiar with the clients going back and forth to the

hospital and back to the homes. what makes this very unique to the people that are mentally ill clients is we tried to give them a home and family environment to all of them that we cared for. we have 24/7 service despite what we are getting from the city, and our rent is only $961 a month. the 24/7 that we are providing for is -- i mean, the money we are getting is not even enough to give one single staff to take care of that 24/7 service. what makes us very valuable is are very close supervision to

their medication and their food. plus, their cleanliness. we tried very hard for them to be as healthy as they can be hygiene-wise. so what i'm asking the san francisco mental-health board and nami is to please look at us and what we can provide for you or how we can help you before most of our people will close their business. because it is not really a profit-making business. it is mostly because of our compassion for the mentally ill people because most of the people that are operators also have mentally ill members of their families. thank you.

>> thank you. [applause] >> thank you for having me here. unlike most people here, i'm pretty removed from the whole mental health issue. i do not volunteer. i do not participate in any organizations. my brother-in-law has bipolar disease, and until very recently, i did not really know much about it. never really witnessed episodes. but i did witness something recently. one of the kindest person i know, one of the most loyal

people i knew going through an episode, a bible a person becoming very manic and it was probably one of the saddest moments of my life -- and bipolar person becoming very minute. i would imagine most people in the government's part might not have that type of experience. as i mentioned, i am pretty removed. i just came here because my wife asked me to. i could be doing something else, but i probably was going to leave early, but i decided to stay because my background -- i am a businessman. i have my own business. i study business. i went to business school. one of the major points during the presentations tonight, people who are involved, there was also a number as part to it, and i do not understand how decision makers cannot see that there is a human cost to it as

well as real pragmatic approach, you know, a very long term solution where if we spend a little bit more today, not to cut some costs today, we could save a whole lot more tomorrow. i believe this is an issue where reasonable people cannot reasonably disagree, but unfortunately, some reasonable people, reasonable decision makers do not always have the personal experience to make their decisions based on -- you know, and is not the personal experience. i think they should really look at the numbers. what is more important? for us to try to save $2 today by cutting costs on certain program and then end up sending this person to jail where we have spent money on the jail food and money, three guards to keep track of the person, money on a jail cell, there's so much

money that is spent any time you put somebody in a jail system, and so much money could be saved if we just did the right thing. from a business perspective, we learn that it businesses do the right things, they can have long-term profitability, long- term solutions. but we asweek, as the city, do e that sometimes. -- we, as a city, do not see that sometimes. >> thank you. very well said. [applause] that is the reason we're holding this meeting. we want to hear from the public regarding the effects of cuts for mental health. would like to hear