am opposed. there is the issue of up whether voluntary or involuntary things are credible, whether a voluntary, mandatory services are at work. there is a lot of contention of their with mental health services. mandatory outpatient treatment for those who need it. under federal substance-abuse and mental-health agencies, they did a report a few years ago, a national consensus on mental- health recovery. 100 texters, clinicians, care givers, and family members gave 10 fundamental components of recovery and did not mention mandatory services, but,

instead, they talked about choices that people can have for their services, stressing autonomy, independence, and i think that these are the values that many people here incidences go think work. for the people who are proponents of investing -- in enacting this law, i do not think we have an apples to apples comparison. what we can do in san francisco and was inactive -- enacted in york state was kendra's law, and they also approved money to back it. we do not have that here, which gets to the ultimate point about how we enact 1421,

laura's law. we would not be displacing indymac up -- any mental the services, and i cannot think we could look at ourselves in the face and say that we will hold an attack the services we have why we are implementing new services. we know next year, we're going to see enormous cuts to our republic of service, public safety, wrecked and parks, libraries -- rec and park, and these are going to be in jeopardy, as well. i do not think we can never a real conversation about what we have to safeguard while we have a program for involuntary mental health services. i do not think it is possible.

there are some requirements of have to be followed for the implementation of laur'a's law. it would have to be the voluntary services are not reduced. we also have to come the board of supervisors would have to guarantee that the support services are not being reduced, including housing services. we cannot look each other in the face and say that would not be affected by the program. we have to have an open discussion at the local level. we have not had our health commission make a determination about warren's law -- laura's law.

we also have prop 63, which provides dollars for mental health services. we have a county plan for how we will be using and accessing prop 63 dollars, but our current plan does not talk about enacting laur'aa's law, so there are many reasons why i believe we are not ready to look at this. i do not think it would be a good process for us to say that we do. president chiu: supervisor campos?

supervisor campos: can you. i am glad that we are looking back at this item. things a been expressed by a number of my colleagues. but i personally have issues with the involuntary treatment. i think we can have a debate about this. i think if we're talking about that issue, it is important for us to know the efficacy or the effectiveness of what is proposed, so through the chair, i the question for the director of public health, whether, in your opinion as a health-care professional, do you believe that this law would be effected in terms of accomplishing the objectives that are underlined

the law? >> dr. mitch katz, director of health. thank you, supervisors. no, i do not think so. the people we're talking about have psychotic illness. ciccotti illness only response to medication. this is different from other mental health problems, such as depression, which responds very well to group therapy, but psychosis requires medication, and laura's law does not increase our ability to require medication. we are used to the idea, for better or worse, of restricting people's rights. every time i have to sign it koran to the order or in isolation order because a

chemical disease, such as tuberculosis, ibm infringing on someone's rights, and the ethical principle is not infringing on someone's rights unless you have efficacious treatment, and because laura's law does not allow for medication, i do not feel it does that. president chiu: thank you. thank you. supervisor mirkarimi. supervisor mirkarimi: thank you, mr. president. through the chair to dr. mitch katz. he asked the initial question i would ask, but following up, short of the of the cases treatment -- the efficacious treatment allowed in laura's law, is there anything else that remains in the application of laura's law where there is

something meritorious in its effect? >> supervisor, i do not think so. i want to say, also in response to supervisor alioto-pier, your desire comes from absolutely the right place. i can talk about it in my own family. having someone with a serious mental illness is one of the most devastating things. it is incredibly hard and difficult, and i certainly, you know, can understand any but saying, "well, we have to try something. " but, still, we do not try things unless they will work.

los angeles has chosen to do it through laura's law, and we are doing it through the court, where people are told by a judge, where they are represented, that you can take medication, or you will serve jail time, and that is very powerful. it is 22 steps for the creation of a bureaucracy, in in the end, i cannot say what the tour is. t -- ool is. -- tool is.

i understand it, and good for you for being there for your relatives, but laura's law will not authorize us to use medication, and often, they write back saying they did not realize that. i think that we all knew together that we need to redouble our efforts. we need to look at conservatorship in san francisco. that is another option. we do not have as many conservator's as we would like. we do not always edgy providers on what they need to have to have a successful conservatorship, so i think there are other things, but i do not possible -- believe this one. supervisor mirkarimi: two ago, someone was here, and we were not able to benefit from his presence then, which is why we have continued to this conversation until today.

that represented spoke affirmatively for laura's law and spoke for the need to it, and i think that confuse some people. maybe you can help clarify. >> so that was a very talented psychiatrist. he and i had not talked about it. i talked to him immediately after it, and he was under two very common misconceptions about laura's law. first, he thought it would allow or mandate treatment, which is not true, because the original log did. it was going to mandate treatment. -- the original law did. he did not know that. the second issue, when i said that to him, he said, "well, there are people like community wide focus, who are not really

participating in their treatment program. we were thinking that this laura's law would help them to participate in a stronger way." and i said actually, since they are coming to you now, by definition, they are participating in voluntary treatment. therefore, you cannot use laura's law, and once i said those two things, he agreed about not going forward with klaura's law. supervisor mirkarimi: there are families and friends that are affected by the need for the mental health care and attention or to neighborhoods who feel distressed because they

see people not getting it. this speaks to a city and a society that does not feel well equipped to deal with mental health needs in the city. i think this goes for many in the country, and yet, this somehow looks like a remedying tool, a remedying strategy, and that is why i in this is a problem. if we do not move forward on this, are we missing an opportunity to do something that is otherwise not getting done? >> -- president chiu: excuse me. i just want to say that the board rules state that we cannot have applause or expressions of

opposition or clapping, and i asked you to respect those. dr. katz? >> i think you have shown a tremendous amount of insight into why this has happened, because it really speaks to the heart of people feeling there is a problem, and is not being well salts, and it is natural in that situation to feel that, well, here is a potential solution, let's try that. i guess in my mind, there is a renewed commitment on the part of san franciscans to do something meaningful, but for people who are impacted themselves and for their family members. but they have often been made to feel this and powered by the system. often on the fringes, watching their relatives deteriorated. we need to be more responsive to that, and maybe we can use this dialogue and this difficult

conversation. i have heard from so many people, to really know go forward with something better. maybe we have not put enough into this issue. supervisor mirkarimi: thank you president chiu: . -- thank you. president chiu: supervisor mar? supervisor mar: i have similar concerns that some of my colleagues have raised, and i want to ask dr. katz to address the funding in the impacts on the existing program, and i know that there was summoned from the mental health association, which supervisor daly read from, that the implementation of laura's law would be an

expense we could not pay for, but could you talk of the impact on existing mental health services? >> thank you, supervisor. the issue is, as it is written now, it is an incredibly cumbersome bureaucracy that has to be created in order to go through the various steps, and i think there are two sides of that. one is simply where does that money come from? we are appropriating it because we have to, because the law states that it cannot come out of voluntary, and so, that relates to your budget crisis, and it relates, i think, to what supervisor daly read in his letter. if we had additional dollars, there -- things we would be to do in a voluntary way. i think we have a good mental health system. i know we do, but that does not mean that it is all that it could be.

we do as much as we can with the resources that are available. we do a lot, and the sport to be very proud in its support of mental health services, but there is more that we could do, and so then, the question to me is to be spending money creating a bureaucracy, for what is a pretty narrow situation. we're talking about people with psychotic illness who we cannot take care wrote, " which means they have not committed any crime, and then we cannot make them take the treatment of a medication. we're going to spend a fair amount of money, which i would say would be better spent on the voluntary system. president chiu: before we go back to the roster, i have a number of questions from my perspective to dr. katz.

first, everyone who has been involved in this come a very difficult conversation. i think everyone of us in the board, we all have very personal connections to these issues, whether through families, friends, or through our constituents, so i just wanted to, again, thank everyone for taking part in this important conversation, and i also believe we all share the very important role of trying to make sure that our system is as responsive and effective as possible in this area of mental health. we have also a lot of time studying this. discerning fact from non fact, and the question i have an awesome to supervisor alioto- pier, there has been a lot sighted around the nevada situation, los angeles,

kendra's law -- a lot has been cited. >> supervise alioto-pier said it correctly about los angeles and for those people coming out of jail. the issue laura's law dozens of people not involved in the criminal-justice system. i think everybody agrees that it is working well, and in the behavioral health corp., you actually have korea cannot mandate treatment. you can offer the personal choice that results in taking treatment. in other words, you can say, you can take your medication on a regular basis, or you can return to jail, and that is often a strong reason for people to go ahead and take me, madison.

in terms of nevada county, where laura was killed, they have said they have only used it once, but only one person of action gone through the involuntary commitment, and they were able to engage people vote short of that mandate. but they do not have anywhere near the wonderful system like san francisco, who already has this. we're already inclined to get people engaged. we have a large number of programs. so we can all agree that there is this narrow situation. and in new york, which as the most experience, the research is

not very good, and probably the thing that makes new york most different from us is that in new york, they do not have the cumbersome hearings. so it is simply easier in new york to require medication period. so they do not have all of the steps in hearings that the california law requires, whether or not the lago sport or not, so they are just able to get more people on medication independent of the law, so in that sense, it may be a better marriage, while in our case, -- they are really doing kendra's law with medication, whereas the our case, we have refusing treatment.

our people will still be, if we were to go forward with this, -- in new york, they can get them in kendra's law. president chiu: with what supervisor mar mentioned, being able to get funds from prop 63, being able to get funding beyond what we can currently get? >> no, but what we can do is you can use prop 63 funds to support the voluntary part of any bit of the laura's law hearings up until the court mandate. as you know, part of laura's law

is offering services, so if you're offering voluntary services during that time, you can spend prop 63 funding. we can just spend the money we are already receiving for that purpose. sometimes, people of said you cannot spend proppe 63 money, but that is not true. no new allocation to what we already have. president chiu: and then related to that, and also another component argument i hear is that we are really setting up a pilot program, chairman in for a couple years, and so what is the harm would come forth with that? can you talk about the type of resources you need to set up to implement this for us to get a sense? " >> well, again, i have to go

back to the objection is taking away people's rights without treatment, and i want the next time i put out an order or a quarantine order, people can believe that i am taking away their rights for a efficacious reason. basically, it is a 22 step procedure, and it would require additional funding also for the public defender's office, who would be representing the person, presumably representing them at, that they should not have to go to mandatory treatment. the only reason the person will be having a hearing is because they did not want to be compelled. so you would have court costs and public defender costs, and us on the other side of the public defender, with lawyers,

explaining why it needs to happen. president chiu: and then one final question. it seems to me that the mental health field it designed around outpatient treatment and whether the services are beneficial or not. from your perspective, can you tell me? as i try to go into the literature, it is hard to figure it out. >> you are a smart reader of research, so, yes, i think that is exactly right. i think that part of the is that it depends on state law, and laura's law is a particularly bad example of involuntary loss, and we have to be but realistic.

this was approved seven years ago, and only one county has implemented it. and they have used it on one person in seven years, so i do not think that san francisco is in an extreme position by not going forward to this. the organization that represents the 52 counties, mental-health administrators, is against us, so i think that part of the challenge is, as you might imagine, there are more than 30 such laws in 30 different states, many of which were passed and never implemented, but they are all of the map in terms of what they require. in fact, so few counties in california have implemented this, i think that tells us something about this particular law and how cumbersome it was. thank you.

-- president chiu: thank you. supervisor alioto-pier? supervisor alioto-pier: we are on opposite sides of the issue, but there are none in the mental-health field but i respect more than dr. katz. one thing i want to say, as someone who has been working in the disabled community for the past 25 years of my life, it is very interesting the way that the physically disabled are separated from the mentally disabled, and the attention on mentally disabled has never been near the kind of attention for the disabled in the physically disabled community. this was passed at the state level seven years ago, and only nevada county has taken it up. that, quite frankly, does not surprise me very much. we're talking about, and i think these are important things that

we have to remember, with laura's law we are talking about less than 1% of the population that would even qualify for laura's law. these are very severe cases of bipolar or schizophrenia. to go through an aot program to qualify for laura's law, you have to have a very serious problem. i will give you some of the qualifications. you have to have a lack of compliance which has revealed serious violent behavior within the past 48 months or required hospitalization at least twice within the past 36 months. one example of this is the woman who, as awful as it is, the woman who threw her three children off of the bridge two years ago. she has said, her family has said that they were trying to get her help, and there was no

avenue to get her the kind of help that she needed. she had been hospitalized five times. she would have qualified for a program under laura's law. in the state of california, and k as dr.atxz, as -- dr. katz has mentioned, i do not know if we want to go out there and medicate people in a mandatory way, as many people would like you to believe but lauara's -- laura's law is like. an aot program much like our behavioral quirk program can be put in place before these people go into the jail system -- our behavioral court program. so you look at the behavioral court system, our behavioral court system is falo