in san francisco's behavioral court system, we've seen a 72% decrease in homelessness, 23.3% decrease in mentally ill hospitalizations. of 198 mentally ill people, 140 of those people are actively pursuing employment and 85 of whom are already employed. a.o.t. works. it works well and it works efficiently. but unfortunately, in san francisco, you can only get a.o.t. if you first break the law and are lucky enough to find yourself in front of our behavioral court system. under laura's law, in order to qualify for a.o.t. or for laura's law, the person proceeds to be 18 years old and suffering from a mental illness. the person must be unlikely to survive safely in the community

without supervision based on a clinical determination. the person must have a history of lack of compliance for treatment for mental illness that reveals serious, violent behavior within the last 48 hours or required hospitalization twice within the last 36 months. the person is, according to his or her treatment history and current behavior, in need of treatment to prevent a relapse or serious harm to the person or to others. the person needs to be likely to benefit from a.o.t. and the director of the community behavioral health must be able to determine that there are services in the community to provide to the individual before a petition can be forwarded to the court. thus, there's no mandate on the director to file the petition and if the director does not he or she has the services available to the director, they may not file the petition.

this program is happening in nevada county and it's also a pilot program right now in los angeles county. in los angeles county, what they did was took a certain number of people out of the jail systems in los angeles at the cost of $100,000 a head and a $25,000, they put them through an a.o.t. program and that was how they measured their cost efficiency. what our numbers are shown, those in new york and here in san francisco through our behavioral court system is that when given the opportunity, assisted outpatient treatment works and it works very well and effectively to help people live independent lives. colleagues, i truly believe that laura's law will help stop the revolving door that's spins too many people in and out of the emergency rooms and our jails and i urge you for your support. president chiu: supervisor bevan dufty. supervisor dufty: thank you.

i have co-sponsored this measure and i think it's a good thing for the board to pursue. currently, a major portion of our jail population is comprised of individuals with serious mental illness and as the supervisor indicated, this is not the route that we want people to go through to access help. the reality is that being in jail exposes an individual to greater risks, deepening their illness or exposing them to behaviors or potential criminal behavior that they could take with them that only creates a more difficult cycle of homelessness and mental illness to break. when the measure came before us, i voted against it. i felt like it wasn't a meaningful tool. i didn't feel like it would add anything. i didn't feel like it would change anybody. i honestly believe that despite the doctor's reservations about this that san francisco could chart our own path in implementing this approach and

utilizing these tools in our tool box and have a more meaningful impact and demonstrate to the public we recognize that we could do better. we can be better prepared to address the needs in a meaningful matter. i think it does far better for individuals who need a more strongly, focused approach and does not require the criminals. it has a concern and i think there's a way to utilize this process and really to do something meaningful. we've had the occasion this year to look at some of the services. i've gone and visited services

that move me. it happens that because they hadn't been on the budget chopping block that i hadn't had the occasion to see it but i think we recognize that there are large numbers of people who are facing serious mental illness that are unwilling to engage treatment and i think it is the responsible and the right thing for us to chart our own course and so work within the tools that this law provides to help people. president chiu: supervisor ross mirkarimi. supervisor mirkarimi: i would like to thank you supervisor michela alioto-pier for her leadership on this issue. i know the board of supervisors has had two committee hearings on this issue and my ongoing statements has been that i think the county of san francisco is eloquent in not recognizing the complete demands on our city systems in dealing with those who are on the streets with mental health needs and who need the kind of

attention that i think the city has resourced and a little bit dated in their strategies in providing. but this conversation that we're having before us, in my opinion, cannot be entirely delinct from the budgetary discussion before us, too. i have concerns that based on real substantive elements of the budget that will be before us that i think are import of debate, why psych beds were being cut and other elements that subvert our ability to deal with the growing demands of this population calls into question how complete the discussion would be. i would like a two-week continuance so we can wrap our focus on this item so that we then give it the attention that i think it so deserves. president chiu: supervisor ross mirkarimi has made the motion. it's been seconded. let's continue down the roster.

supervisor mirkarimi: there's a lot of inanswered questions. i would like to have d.p.h. here. perhaps they could answer some questions for us. also we have questions about the second whereas clause in this resolution that references bill 1421 that we would not be displacing any voluntary mental health programs for adults and for children in the city to enact laura's law. i don't know if we actually have that ability to enact this law without displacing existing services. certainly these services have been cut. over the years there have been lots of consolidations for our mental health clinics over the years and we are facing a huge budget deficit in the next year to think that we could actually implement a new program to pay

for civil court that would mandate assisted outpatient treatment doesn't make a lot of sense to me. also, i am not clear what assisted outpatient treatment is. is it counseling? psycho therapy? is it all of the existing services we currently have in the city and county of san francisco that meet people who have challenges around mental health issues? that is a fancy word that doesn't make a lot of sense. let's have a d.p.h. here to explain that as well. i would be supporting a continuance of this item. i know this is a very, very difficult issue that we're facing to approve or disapprove of this resolution because people really have a lot of emotional stake at this in this resolution and i don't take it very lightly. continuing it or possibly voting against it. but those are the decisions i will make. thank you. president chiu: thank you. i actually also had some

questions to d.p.h. i understand the doctor is not here but is there a representative from d.p.h. i was told the chief of psychiatry is here, dr. james dilly. could you please step up to the microphone? so a couple of questions. we all read in the newspapers that dr. mitch catts opposes this matter. i was actually trading phone calls with him earlier trying to understand what his opposition was based on. could you give the perspective of the department on laura's law? >> i can give the perspective of the department of psychiatry of san francisco general. i'm not sure that the doctor and i completely agree about some of these issues. in particular, i think in the item in the paper this morning, dr. catts, who i guess is not here, you know, i hate to contradict him in public, but my understanding is, for example, that medication is absolutely a part of this bill.

the ability to give medication and i know mitch was quoted today as saying that medication is not possible as part of the treatment planning for these patients so that's -- that is one thing that i think is -- it's important to make clear because certainly the vast majority of the patients for whom this approach would be appropriate are people for whom medication is really the single -- probably the single most important aspect of this care. supervisor john avalos asked about really what is assisted outpatient treatment and it is really a combination of care and treatment, depending on the particular needs of that particular patient. again, medication, of course, being probably in most of these cases the single most important part of that. so i don't know if that is helpful but that's -- that is

our perspective, that this would be a very important tool by which we could continue to help to take care of some of the sickest patients that we see and both to improve their quality of life, decrease costs in terms of repeated hospitalizations and hopefully keep bad things from happening to otherwise good people. for example, supervisor ross mirkarimi was recently at the hospital. we did a tour of the hospital and that very afternoon -- pardon me? that very afternoon in psych emergency, we actually had a young man who i think sort of epitomizes this whole situation for us. this is a 23-year-old man with paranoid schizophrenia and was in psych emergency for the ninth time this year.

someone who does well when he's in the hospital and takes medication. when he goes home to live with his mother and his brother, he stops taking medication. over time he begins to develop a delusion about his mother. his mother is satan. he begins to feel frightened of her and as a result, threatens to kill her and burn the house down. at this point, he's brought back and the process continues. laura's law would give us an opportunity to work with this man when he's out of the hospital and hopefully prevent, again, bad things happening as well as helping him to be in more control of his own faculties. president chiu: thank you. i have to say from my perspective, not having dr. catts here is a bit confusing because as was stated in the chronicle today, he said the legislation would not require a judge to order medication and

that's what he seems to base his opinion on. seems to be a little bit of either factual or legal confusion on this issue. >> perhaps it's not an issue of requiring. it's an issue of permission. in other words, depending on the particular situation, the petition has to go forward to the judge based on an assessment by a mental health provider and that -- whatever that assessment is and includes for a treatment plan, then that goes forward. as i said several times, i believe that for the vast majority of patients for whom this would be appropriate, that would include the use of anti-psychotic types of medications. what mitch was saying in the paper today was that he didn't believe that that was possible, that this did not allow for medication or ordering medication for someone that's

in an acute mental health facility. that's the part that i believe he's mistaken about. president chiu: are you expecting dr. catts back in two weeks? president chiu: you're not here as his representative? >> i'm not. president chiu: supervisor michela alioto-pier. supervisor alioto-pier: one thing. my understanding is that the department is taking a no position on it but one thing to clarify is that right now, the way it works in california is that -- and this is the same as someone who is incarcerated and locked up and they believe they need help and please, if i'm wrong, jump in. you go before a judge in what's called a reef hearing.

you sort of show your case and go before this judicial process before anyone goes through taking any type of medication. with laura's law, you would still have the same thresholds to meet. you would still be a person with a lack of history or compliance for treatment of mental illness, serious violent behavior within the last 48 hours or required hospitalization twice in the last 36 months. i think we all remember, for example, the young woman who a few years ago threw her three children off of the bridge down on the pier. well, she had been -- she had been brought into mental -- she had been gone through this process, she'd been in the jail five times within the last couple of years before that happened. people knew that she had violent tendencies and when she was interviewed after the fact, she said, well, voices were telling me to throw my children off the bridge. and there was nothing in place that anyone could do from stopping her from doing this.

and what laura's law does is allows loved ones to get a reef hearing, to get assistedout patient treatment for this person in particular before it got to the point of where she is throwing her children off of the pier and ending up in jail again. now she'll stay there for the rest of her life and what we found with a lot of these cases and laura wilcox who the law is named after, the man who killed her, when he was placed into the hospital and put on medication, now he can't believe he did it and he has to live with the realization that he killed three people. and he was sick and he says to this day, my understanding is that he says to this day that he regrets it and wished that he had -- that someone was in a position to get him the help he needed and no one was. so it wasn't until these violent acts were committed that people got the type of help they needed. when we're talking about very

severe schizophrenia and bipolar disease, we're talking about less than a percent of the mental health population that -- with mental illness we're talking about. so a.o.t. services can go on to help a lot of people who don't ultimately need population, although there's going to be a small percentage of people who do need medication. the actual services include, you know, literally whatever the individual is going to need to live a productive life and to stay well. it includes substance abuse, crisis intervention services, benefit applications, money management help, peer support, medication support, housing assistance, vocational training, socialization, recreation plus the supervisor of intensive care management so that the individual can successfully utilize the help provided to him or her. it's important to recognize that we currently have a.o.t. in san francisco. only you have to break the law

to get it. what laura's law does is it gives people who are sick access to that before they actually break the law. now, talking about the financial aspect of it, is that laura's law in the end can be cheaper to run. it costs $100,000 to keep someone in the prison system. if that person is not in the prison system costing $100,000, we can have them in an a.o.t. program that works better for $25,000 a year. to supervisor ross mirkarimi's point, you can't cut mental health services if you're going to pass laura's law. the state basically says we're not going to give you money -- and by the way, one thing i forgot to mention that i should have is that by implementing laura's law, the city of san francisco has access to prop 63 money that can be placed

towards services for voluntary -- people who are voluntarily in need of services. so we have access to that if they're voluntarily -- if they voluntarily want the services. if we don't opt into laura's law, we don't have access to the prop 63 money. i think that's an important thing. i think it's important to recognize that it's more cost -- it costs more to put people into jails than it does to do an a.o.t. program and that is on top of the cost issue and is much more cost effective and that you do have to hold your mental health spending. so i understand the requests for a continuance. i'm not completely -- i don't completely object to the idea but i do think that this is -- in the long term, it will end up saving the city money and it will be a much more effective way and more humane way of dealing with people who have

these very, very severe mental illnesses. not to mention the fact that it will keep other people safe as well. president chiu: supervisor david campos. supervisor campos: thank you very much. this is not an easy issue and i appreciate all of the comments that have been made. you know, the problem that people are trying to address is a very real one and very important one. i do think that reasonable people can disagree about this one. i'm just not convinced that laura's law is the answer to the problems that we're talking about. i think that every example that you can give, that points to the justification of the law, you can also think of examples where that's not necessarily the best approach. i do think we can all benefit from having dr. catts here. i appreciate the insight that

was provided, but i think that something as complicated and complex as this that it's important for us to have as much input as possible and maybe there isn't a big difference of opinion but i'm sure that a lot of it is nuanced. i would like to hear that nuance. i also feel concerned that i feel that the kind of services, professional services that we're talking about are the most effective when there is collaboration between the patient and health provider. and, you know, i do have a concern about the impact on patient trust in terms of some of the provisions of this law. and i do think that we have to along the lines of what supervisor ross mirkarimi indicated look at this in the context of the budget that we're talking about passing this law but as also part of this budget, considering taking

steps that could undermine the number of site beds, reduce the number of site beds that are available. i think that we have to understand the implications across the board and for that reason, i would be supportive of a continuance. thank you. president chiu: supervisor john avalos. supervisor avalos: just to reiterate, if we have a continuance on this measure, i would like to make sure the controller can provide us some -- a report on what the implementation of laura's law would mean in san francisco. would it displace voluntary mental health services and the way -- it says outpatient services is being described to me, it includes substance abuse services and vocational services. these are all services that we have been fighting to preserve and reducing here in san francisco. so i cannot say that we actually have the resources to

make this happen. i'll be very curious to see what the controller provides to us in a couple of weeks. also, the question about the cost doesn't make clear sense to me, either. the city and county needs to provide a plan for the use of the dollars and it would be great to have the department of public health here to talk about the interaction between prop 63 and the implementation of laura's law. president chiu: supervisor michela alioto-pier. supervisor alioto-pier: thank you. thank you, supervisor john avalos and i want to thank, too, supervisor john avalos and supervisor chu. i appreciated that conversation just to one comment that

supervisor david campos brought up, one thing about laura's law and the a.o.t. program is it provides much more of the collaboration. what happens when people do something and end up in the jail system, they don't have a lot of choices. a lot of those choices are taken away from them. if you treat them in an a.o.t. setting before incarceration, they have the opportunity to sit down with their providers, with their therapists to talk about what types of needs they have. if they're on medication, that doesn't make them feel good, they can get the medication changed. they have more -- you know, it is a more independent place for them to be. once they go into the jails, a lot of those choices are taken away from them and that's one of the reasons the a.o.t. programs are so beneficial, because the patient does have more control over the path that they choose to take and getting

themselves better. president chiu: any further discussion, colleagues? so we have a motion to continue offered by supervisor ross mirkarimi and secretaried by supervisor john avalos. do you want to do that without objection? >> may i ask a question? is there a week for two-week as opposed to one week? supervisor mirkarimi: thank you. i think it's unclear based on the state of the city how today may carry over to next week so i think that two weeks gives us a more clear window. president chiu: the motion that be made to continue this to august 3. >> that's correct. president chiu: can we take that without objection? without objection, this item will be continued to august 3. if we could call items 47 and 48, please. 47 and 48 surprise a special

order at 3:00 p.m. board of supervisors sitting as a competent of the whole for a public hearing on amendments made last week to a charter amendment regarding election day voter registration. president chiu: before we continue this, i would like to add my name as a co-sponsor to the charter amendment and why don't we open up the hearing to hear any public comment related to the amendment that was made to the election day voter registration charter. are there any members of the public that wish to speak on this specific item? okay. this hearing has been opened and is now closed. supervisor ross mirkarimi. and we're on item 48. consideration of the charter amendment. supervisor mirkarimi: thank you, mr. president. thank you for your co-sponsorship as i would like to thank supervisors david campos, eric mar and chris daly. i can see that i think the sensibility of us moving this charter amendment might be

spoken by the absence of the public comment. we can take the cue from eight states in the united states, these are eight states that adopted same day election voter registration and they have all seen a bump of upwards to 7% of voter participation. if you compare san francisco in the last 10 municipal elections that we have held, the average voting turnout is approximately 35%, 36% of voter turnout from municipal-only elections in san francisco. yes, five of those states who had the highest voting turnout in 2008 were five states who adopted same day election voter registration. i think it's time that san francisco helps lead the state of california in adopting this particular element because

technology has now enabled us to provide the service that i think a lot of people feel excluded from. for a city like ours that certainly likes to see itself as engaged and sophisticated on so many levels, having that level of deficiency of voter turnout belies that particular reputation. i believe that the rest of california will follow. i would like to thank the senator for his efforts in sacramento of trying to get same day voter registration. it's passed the state senate but it's very unlikely that governor schwarzenegger will sign this into law. this idea had been attempted in 2002 by state proposition 52 and it passed in san francisco by nearly 60% of the vote, even though it did not pass in california. it came close. we're poised to make this happen and do well and quite a

few good government organizations, neighborhood groups certainly support this. colleagues, i'm more than happy to answer any questions. i would like to thank the department of election for all of their expertise and insight in this particular charter amendment and i think it's where our day has come to implement this level of performance. thank you. president chiu: any further discussion? if we could take a roll call vote on the charter amendment. (roll call vote was taken.) president chiu: this charter amendment is submitted. coa