72 hours? >> we do not have an inpatient facility. they go to san francisco general or somewhere else. >> if they are violent, do you keep them? >> if they're violent? if they are in danger to themselves or others, they can be hospitalized. other than that, of tremendous volunteer. yes, some of the more violent. >> do you roll them over to san francisco general? do you have to keep them because of the lack of beds over there? >> we follow the law. we 5150 people. they're turned around quicker. if there is an overflow, they're not kept in the hospital as long. they're kicked out so that they can take the next person we are 5150'ing. they go back to jail. >> what percent of your jail

population are mentally ill? >> i would say between 15% and 20%. >> we're going to let miss gustafson deceit and bring up miss jennifer johnson. you can continue the conversation off line. >> my name is jennifer johnson, i am a deputy public defender. i represent 100 seriously mentally ill clients in our behavior and held court. i have been part of the program since the planning stages. i have seen the evolution of the program. most of mcclintock felony charges and a freezing state prison. about 75 -- most of my clients have felony charges and are facing state prison. all of my clients are in behavioral health court and in the criminal justice system because of an treated mental

illness. if they had been treated, have access to proper treatment in the community, they would not be in the jail. is that simple. -- it is that simple. this is not a problem that is going to get better. it is a problem that is likely to get worse. the state prison system is overcrowded. it is releasing people back to the streets. there has been a change in the law. people in state prisoner serving less time. there are a huge number of people in state prison who have a major mental illness. they will be on our streets. this problem is serious. we should be expanding rather than contracting our services for this population. a haverhill held court heldhealth c -- behavioral health court has begun reversing the trend of people ending up in jail because they have mental illness. we've shown the with adequate and proper treatment, people can

recover. they can get out of the criminal justice system. they can break the cycle they have been in. that is psychiatric emergency services, the streets, to jail. it continues unless we do something to break the cycle. treatment is more efficient. it is cheaper than incarceration. there is no other way to say it. i did choose my words very carefully because i said "proper treatment. of this is what this is really about. we've learned we are treating the whole person. we are treating people with multiple social service needs. it is not just about treating the middle on this with medication. people have medical problems. the child custody problems. they have drug addiction problems. -- they have a child custody problems. they have drug addiction problems. we need to treat all of these at once because then we are

ignoring the others. it is not going to work. if you provided light of housing but in not provide access to medication, it is not going to -- if you provide access to housing but do not provide access to medication, it will not work. if you cannot provide access to intense services, it is not going to work. you can provide them with intense case management, but without housing it will be a failure. there are core things we need to address all at once. san francisco is one of the few mental health courts in the country. it is a national model. we're quite proud of that. it is adding as many evidence- based practices as we can to what we do. anytime we can, we use something that is been working in another community so that we do not reinvent the wheel. we've been very successful at adding those practices to our

program. when we started, we did not have any money. we did not have a penny to start behavior of court -- to start the haverhill held court. we tap into existing mental health services. we learned that we have great and amazing services in san francisco. we just do not have enough. my clients were not able to negotiate the complicated web of social services to get with the needed. we found we had something great. what we were able to do is to apply for grants to be targeted money to places where we needed it. we do now how funding. we also created a system where we are referring people to permanent mental health treatment services. we do not have a parallel system of care attached to the court. it does not and when you are finished with your criminal- justice issues. it continues. my clients to access treatment as long as they want, for the rest of their lives. that is one of the keys to the reduction in recidivism and

violence that our court has clearly shown. lesley is going to talk more about the numbers and outcome data. i feel that we have -- for a long time, we've been setting our expectations too low for the people that we're serving. we do not asked the question -- we do not tell people what we think they can do because you have a major mental illness, if you are only capable of x,y, and z. in the past, that is what has been done. we do not tell our clients anything. instead, we ask what they want to do and how we can help them get there. we cannot continue to ask this question unless we have a wide array of services to offer to address all the problems people are facing. it is not just housing or

medication. that is too simple. it is a complex problem. it is not intractable. it can be solved. we're doing it in haverhill held court -- and behavioral health court. to take away the services will collapse the whole. it does not work that way. bair interdependent in all essential. -- they are all interdependent and all essential. access to medication, supported employment. my client's work. we put them to work and they're doing phenomenal job getting their lives back. people recover one-of-a-kind. that is what we've done. -- people recover one at a time. that is what we have done. when we focus on one person and get out of the criminal-justice system, it is a permanent solution. this court is reducing violence. it is reducing recidivism. it is cost-effective. over the long term, it is reducing the criminal justice

dollars and mental health dollars. there is no downside that i can see. my question is, if we know what works, why are we not doing it? we can. we should. that is what is going to help solve really solve this problem. it can be solved. thank you. >> those are all excellent points. thank you. [applause] >> i would like to ask if there are any questions. miss mcintyre? please speak and the microphone. >> [unintelligible] >> you worked for the behavioral court -- you work for the

behavior of court? what about the justice court? >> they're completely separate. the committee justice center is located in a particular location meant to address social service needs of the population in that area. those clients we are serving in haverhill held court -- health court have much more serious mental illness than the clients in the community justice system. all of my client and the major mental illness. if they do not, they cannot get into the program. we're focusing on the most acute, most treatment resistant population in the community. it is the one that has really been cycling through the system for many years. the community justice system is more local. >> thank you.

i see another question. miss milfray? [unintelligible] [no audio] >> absolutely. i also think it is important people are treated right off the bat. the more time they have psychotic episodes, the more serious their mental illness can become. i think that jail is a horrific place to get treatment. i think it would never end up in the criminal justice system if they have what they needed. i think they would never end up in the criminal-justice system if they had what they needed from the start. >> we like to hear from miss leslie cockbogan. thank you for joining us this evening.

please talk into the microphone. >> california has one of the highest recidivism rates in the entire country. san francisco conducted a study exclusively for behavioral health court called "the effectiveness of mental hea lth court for reducing recidivism and criminal violence. though it has reduced those things more than jail alone. this was a peer-reviewed published study published in the "american journal of psychiatry." this study compared 172 behavioral health court clients to other clients similarly situated in jail that had mental disorders -- similar mental disorders. they occurred at the same time. the controlling data was taken

into consideration for a criminal history, demographics, etc. a follow-up study after 18 months showed that the estimated risk of any new criminal charges was about 25% lower for clients who participated in behavioral health court. additionally, the behavioral health court participants charged with new violent crimes was about 38% lower than that of comparable detainee's. 18 months after the participants graduated from behavioral health court, the risk of them been charged with a new offense was 40% lower than the general population. the risk of a behavioral health court graduate been charged with a new violent crime was 54% lower. this is something that the district attorney's office does

and can stand behind. this program works. it increases public safety and reduce recidivism. cutting services in the budgets would put many sentences go -- many san franciscans at risk of harm to themselves and others. behavioral health court will not work and cannot work without the central services we rely upon within the community everyday to provide care to these clients. these services are the backbone and the success of our court. more importantly, they are necessary for the clients to succeed so that their life is not their mental illness, but their mental illness is a part of their life. let's keep money in the program. what's truly make the criminal justice system justice for all. -- let us truly make the

criminal justice system justice for all. [applause] >> thank you very much. do we have any questions? mr. peurvis? >> are there more people to conserve more services? >> yes, we currently only taking clients. they are waiting months just to get into a program because of the cuts in community services. we are unable to even consider taking out of custody clients because we do not have the capacity to do that. >> do we have another question? board members, please pull the microphone and speaking to it so that you can be recorded for the momentous event this evening. can we now hear from mr. martin?

>> to what extent does the nature of the fact inhibit your activity? >> i am sorry. i am not familiar with that act. i am just a criminal attorney. [laughter] >> it is the act under which a hearing is required within 72 hours for anyone with a mental illness. if you send them to mental health court, and then they come out of the normal court system. >> you are talking about people who might be having civil commitments? >> i guess. >> it is a different court. that is a civil proceeding. that is separate from the criminal proceeding. i personally do not access the court. it is not necessarily true that just because they have the

hearing that the case will go away. >> i and a stand. maybe i should get back to what you said about the importance of the behavioral health court. do you have a bottleneck in terms of getting people into the behavioral health court system that takes them out of the criminal justice system? it is a parallel system for the mentally ill. >> correct. >> have they been kept back in their ability to provide guidance? to what extent do they have access to the housing for the homeless and for their clients? >> with all of the budget cuts happening, the programs are taking fewer people. people are staying in jail longer. we cannot get them into the community. there currently waiting lists for intensive case managers. all of our clients have case management.

most people need dual diagnosi'' services or stable housing in the community. many social support services, etc. people are literally waiting months in jail in order to get any kind of bed in a program that might be able to help treat them in the community. >> think you very much. >> thank you. >> i would now like to call miss jennifer freedenbach from the commission on homelessness. >> thank you for asking me to speak tonight. i want to talk a little bit differently from the others. i want to give people ideas of how to get involved. i wanted to start out by talking about the coalition on homelessness and our role. for the past 15 years, i have

been working every year on budget work. that is budget justice work. that is calling the budget and looking what the cuts are and what the impacts would be. i also look for potential savings in the budget. i look for expenditures that are harming people or wasteful. and then try to shift those funds over to services to homeless people or to help stave off major cuts. for the past 15 years, whether there has been a surplus or deficit, mental health services have been targeted. they have been targeted for cuts. there are a few different reasons for that. one of the issues is that whenever the city is in a shortfall, they are looking at those programs that receive general fund support. they are looking at programs that do not have any licensing requirements or mandated

spending for the voters or any of the other things that tie their hands. the city of san francisco has about a $6 billion budget. about $5 billion of that is basically spending that is scripted. they have to spend it because of either voted mandates or licensing, etc. we have about $1 billion that is called a discretionary fund. this year, the projected deficit is $520 million. we're looking at a deficit that is more than half of the discretionary fund. what happens in terms of the budget process is that it starts out of the department -- al qaeda the department. they're given instructions by the mayor. this year, the mayor gave each of the departments, including the department of public health, instructions to do a 20% cut, plus a 10% contingency cuts. this is still going to leave 8

$102 million shortfall even if the departments to a full 30% cut. what she did in the department of public health and looked at all of the region once you get into the department of public health and look at it, you are talking about mental health cuts. it is highly targeted. the process this year is very different from previous years. this year, we're seeing the department of public health does not know what the revenues will be it. for the first time, they are not clear on how much money, and hospital fees they will get. there is a medical waiver that needs to be extended. they've not presented the budget yet. that is very unusual. typically by now, they would have presented the budget to the mayor's office. if all the money comes in, and it is dependent on congress, congress has to decide how much money that will put through in various bills.

then when it is to the state, the state might want to use that money for its own deficit and not give thany of that to the county. it is a long process before we find out what will happen there. even if we do get all the money, if the money is still short, a department of public health retarded. there been several cuts proposed -- even if we do get all the money, if the money is still short, the department of public health may not get any. they're still making substantial cuts. they are looking at one of our shelters on otis that is due to be closed and turned over to permanent housing. that is 51 beds. they will not replace that. they're trying to kill housing rental subsidies for families by not allowing homeless families to get a housing subsidy again. they're doing major cuts to supportive housing. it cuts the support services

that housing is provided ing for folks. most of the buildings targeted serve people with severe psychiatric bonuses. it will not cut housing unit, but the chance that it could increase homelessness in individuals without the support services to would become homeless again rigid the likelihood of that happening is pretty high. -- the likelihood of that happening is pretty high. when we are looking at the budget work, it intersects two areas of our work. we're looking to the civil rights of homeless people. in san francisco, a homeless people get around 17,000 tickets a year simply because of been too poor to afford a place 8 to

sleep. from our perspective, the funds used for those activities should be reallocated for homeless services. we will look to the budget and look at stuff like that. we will look expenditures -- we will look at the expenditures of the district attorney prosecuting homeless people in court. we will get other areas of the budget creating harm. -- we will look at other areas of the budget treating heart. it is where a homeless people are having a more difficult time getting off the street. they may be criminalize for mental illness or something similar to that. we also look a lot that revenue -- we also look a lot of revenue. i bought a long list of a variety of different revenue items. these could be fees. these could be new ideas for revenue that are creative. we try to have something that will be more progressive, that

will allow for folks were not paying taxes or can afford to pay more to help stave off some of the cuts. many of those have to go to the ballot. one of the big issues this year is that we really need to get some revenue items on the november ballot or else we will be in a similar situation next year. each year as the city comes up with savings better not harmful to people with mental bonuses, we have fewer options as time goes on. last year, we had a similar budget crises. there were some onetime fixes. there were also a lot of cuts made in administration. as this gets slammed down, we're not able to find as many of those solutions. the list of alternative cuts get smaller and smaller. we came up with about $76

million last year. it will be a much shorter list this year because they were implemented last year. as time goes on, the risk for people with mental illnesses is much higher. we also have a lot of initiatives around trying to democratize the budget process. we have the lion's share the power under the mayor. the process for input is through the commissions. there are not a lot of things that happen at the commission in terms of changes to the budget because they are beholden to the mayor under the executive branch. the have to follow the mayor's instructions. they have to follow the mayor's instructions. there's the idea of changing the budget process so this is more democratic and there's equal power between the executive and legislative branch. the mayor has spending authority. if we get programs restored, the mayor can turn around and not

funded as a program. the end up getting cut anyway. this is something we see a lot. we want to make sure there is more balance so you do not have an out of what system -- and out of what --out of whack system. it goes to the mayor. it goes to the board of supervisors. the board of supervisors can take money out of the budget and put money back and to stave off some of the cuts. if we have a process where they put it back in and the mayor takes it out later, it does not work in terms of trying to stave off the mental health cuts. from our perspective, we have seen all of these major cuts to mental health. if you go way back, you are looking at the original huge numbers of people with mental

illnesses on the streets in the early 1980's due to the elimination of disability benefits that the federal level in the process of people having to get back on disability. people with psychiatric illnesses have a much tougher time doing that. we saw the huge presence of people with mental illness on the streets. that has intersected with a huge cut to housing. we have the housing cut budget -- housing budget cut that early. in san francisco, we had realignment. we lost a lot of funding through that. we also lost the board and care facilities, more than half of them now. because of the shrinking of resources, the state and residential care facilities have gotten shorter. what you are hearing today as a result of all these pressures. with a very malnourished mental health system that is not anywhere near able to meet the needs.

we've not had any data coming out in san francisco. the last time was probably about 14 years ago. at that time, there were 18,000 people with mental onuses in san francisco that were untreated. they needed mental health treatment and were unable to access it. we can only expect that since that time, given the high number of cuts, that number has gotten stronger. in san francisco, with a system that is very reliant on the high end care. that is either jails 5150's. most people's first experience with mental health care is going into what down with eight 5150 -- with the 5150. we need to build up the community helalth options to be

able to meet a variety of needs. many of them are without housing. most of them do have housing. in order to do that, we also link electronics, inc. model number: pdr-885 software version: 3.0c >> i do not know if this is a question or if you have access, but i recently found out that there has been a directive from department of health from dr. katz to the residential treatment facility saying they can no longer ever accept a repeat client, so that if a person fails, they cannot go back and. have you heard anything abou