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 fabulous. it works great. it would be really wonderful if peop÷ if people in san francisco have access to those services before they broke the law. we do not. we do not provide assisted outpatient treatments for people before they break the law. that is a very important distinction. people with severe mental illness, it is a degenerative disease. if you are not treated properly, you keep getting sicker. laura's law gives us the tools so that if they do need mandatory medicine, they get it.

that is essentially what we are doing. we are taking a program that works, much like los angeles's pilot program. the behavioral courts are pilot programs. we integrate it into the way we do business in san francisco. so much attention on the issue of homelessness and on affordable housing. it is interesting that we do not pay that much attention to the sickest of our sick. that very small percentage of the population that is suffering from schizophrenia or bipolar disease. we have heard from people against it. i have heard many more people in

favor of it. the people at the hospital have been very vocal. the director of city-wide case management forensic program, judge morgan runs the behavioral court system. the national association of mental illness. the san francisco police department psychiatric coordinator, the california psychiatric association, this is not something that has been taken lightly. people are not sitting back and saying, why do we not just give this a try? these are people that are very invested in this. we have a great need in san francisco for this. i think that supervisor dufty is on the roster. i would like to give him an opportunity to speak. supervisor dufty: there was an

article in sunday's chronicled offered by three psychologists who were on the california psychiatric association reform task force. as physicians, they talk about the fact that given the tendency towards the examples of inappropriate psychiatric treatment, we should not give doctors the final say about involuntary psychiatric treatment. medication would be voluntarily administers. the person cannot be hospitalized for a severe mental illness. a legal hearing must be held while the person is hospitalized to determine if the criteria for laura's law are met. after the person is released,

and stops taking medication and begins to relapse, that person can be brought back to the hospital for reassessment. and they refuse to take medication, the psychologists can call another hearing to make an informed decision to review. the second hearing is reviewed. only if the hearing officer does not recognize the stopping medication led to the relapse ken medication be given in voluntarily. if they're worried that this will mean delays in treatment for many people of mental illness. laura's law is a giant step in the right direction. the people that i have talked to here that our family members were known to me because they have been here during the budget process. i believe that many of them felt that the answers to their family

member's needs were in the jail and that is not where it should be. this is an opportunity to create an avenue for individuals not to be in our jails so that they can receive treatment. they should not be in jails in our justice system. >> any further discussion, colleagues? supervisor alioto-pier: given the feeling of the head of our own health department, we need to work through some of the details in more detail. i am sure you are always open to more conversations on this. colleagues, perhaps we can send this back to committee, where we can work through some of the comments that have been made here today and we could come back in the fall with something that people feel more comfortable with.

>> any discussion on that motion? without objection. this item will be referred back to committee. next item, please. >> item 20. the ordinance amending the code to establish public safety and public health training programs for san francisco unified school district high school students. >> colleagues, could we take a roll-call vote on item 20? >> supervisor avalos: aye. president chiu: aye. supervisor chu: aye. supervisor daly: aye. supervisor chu: aye -- supervisor dufty: aye. supervisor maxwell: aye. supervisor mirkarimi: aye. supervisor alioto-pier: aye.

>> there are 11 ayes. the -- >> this ordinance passes. >> this is the extended hours permits. >> can we do the same? without objection. this ordinance is finally passed. >> item 22, the third amendment between the city and the third estates oil. this would extend the term for 1 year. >> this resolution is adopted. >> this recognizes the contract health administration and the purchaser with the organization. this is for a term of july 31, 2010 through june 30, 2011. >> this resolution is adopted.

>> item 24. it authorizes the mayor's housing to expand under certain conditions in the amount of $2.8 million for on-site affordable renting housing units at harrison street. >> this resolution is adopted. item 25. >> accept and spend a grant of approximately $417,000 for a replacement project. >> this item is approved. the resolution adopted. item 26. >> the resolution retroactively approving an amendment to provide property management services at the direct access to housing site. this would increase the contract amount by $25 million. >> this resolution is adopted. item 27.

>> the resolution declaring the attention of the board of supervisors to renew the mission street business improvement district to be known as the miracle mile business improvement district. >> this resolution is adopted. item 28. >> it is an ordinance authorizing the department of the varmint to expend a grant for the talks -- toxic substances control and amending the annual salary ordinance to reflect the addition of one the grand-funded position. supervisor chu: there is one amendment i would like to make to the legislation. the legislation was created a while ago. the reference refers to last year. the test not reflect the current year that was passed by the board. i would like to make an amendment to adjust page one,

line seven to reflect the ordinance number instead of 183- 09. that is on page three, line three. >> supervisor chiu has made a motion. seconded by supervisor mar. the motion passes. can we take the underlying ordinance? without objection, this ordinance is passed on first me -- first reading as amended. >> the judge of the superior court on recommendations. the civil grand jury report entitled the americans with disabilities act in san francisco. supervisor alioto-pier: last week we celebrated the 25th anniversary of the americans with disabilities act. this reminds us