highly, almost identically, their satisfaction with services. what is the difference? the difference is once you had to be arrested before they could participated in treatment. that is bad for them. they now have an arrest record. it is bad for the community because frankly, the crimes they committed put the community at risk. it is bad for the families who had to help the family members could be arrested before they could participate in treatment. it is bad for services in general that we have been filling up our jails with people who are mentally ill and should be in treatment. our goal is to put our involuntary behavioral health for people out of business and get those folks in -- into

treatment before they get arrested, and we think laura's law will go a long way towards doing this. we also know that this is not an issue of protecting people's civil rights. there is no -- it is not humane for so warrants to be on the streets, a psychotic, delusional, angry, and threatened. thank you. >> good morning. in the interim director of mental health association second direct -- of san francisco. we oppose the resolution authorizing the implementation of a system outpatient treatment pursuant to the call for an alternative section code section, commonly known as laura's law pirie the basic principle of law in united states is that all adults are presumed to be competent. that is, they are presumed be

capable of making their own decisions about their own lives and their own medical care, including mental health treatment. every state has court procedures for determining when and if someone is incompetent. only a tiny percentage of people have ever been declared incompetent under these procedures. is corresponds with reality that almost all persons with even the most serious mental illnesses are competent most of the time. that is they are capable of making their own decisions about whether to seek treatment and support and what treatment and support they should receive. the association acknowledges that a.b. 1421 was passed in the interest of public safety, but we believe that if proposition 36 and other funding resources for outpatient mental health services were fully utilize, there would be far less need for a measure of the source. second, the bill if enacted has the potential to go beyond its value as a tool of public safety. in regard to the safety of san franciscans have the unenviable

job of guarding the rights and dignity of this population of disabled citizens. thank you. supervisor alioto-pier: thank you. next speaker please. >> first of all, i want to acknowledge and make sure that everyone hears that i do know there is real suffering out on the street, suffering here, and that people do behave in ways that could easily be characterized as mental illness. i do not disregard that. i was at the last hearing where we were informed that the dsm 4 has come up with a diagnosis where someone is lacking in side about their mental condition, and this really struck me as a catch-22 because

i remember there was a diagnosis of a slave who did not accept his or her condition of slavery was considered mentally ill. i really think that someone who is unable or unwilling to accept the treatment that he or she knows and now probably everyone in this room has knowledge has severe physical and psychological effects that are irreversible. why that would be a sign of illness -- it really does not even make sense to me. the other thing that i do want to ask -- and i hope you will consider -- is how many people ever get off the assisted outpatient treatment.

is it a leash for life? i mean, that is -- that really seems to be a question of civil rights. and basic dignity of the human. the other thing is i'm going to attach the third rail, perhaps, when no one else will, but who really benefits from these laws? i think ms. jacobs spoke earlier and said what makes it work, according to the statistics, is the fact that it is a combination of a court order and services, but if you tilt the forced or coerced of medication out of it, how many people would still be in favor of this? thank you. supervisor alioto-pier: thank you. next speaker please.

give me two seconds. let me just call up some more people. >> i have no pre-determined thoughts to share. i'm coming up here totally spontaneously, representing those mental health clients. although i have not ever even been hospitalized, i have never had any sort of dramatic episodes in my life. my father, though, when i was hospitalized, and it did not help him. i'm not one to take a stand and

do margins and the sort of thing to prove a point, because i feel both sides, but i would like to tell you that because of what happened to my father, i would not go near the mental health system. i just would not. not until 2006, when my 20- something daughter said that those having mood swings and maybe i ought to do something about it. and i am not pro-medication. so she had some will be trained that the doctor had given her to quit smoking, and i tried it, and it was good -- she had some welbutrin. when i ran out of samples and could not afford to continue my treatment, i went to the county and asked for help to get the medication, which i did not take seriously at all, so the point is i got off the medication when i felt i no longer needed it, and the point of the story is

that it just seems like too much attention is given to mentally ill as serious -- very, very, very serious -- and not to the majority of people who are not mentally ill or not that mentally ill. what is serious? it is a matter of opinion. just like everyone in this room as their experience, has their opinion, so this is an extreme measure, it seems to me. so i'm just stating my experience, which is all any of us can really do, and this is from my heart. thank you. supervisor alioto-pier: thank you. next speaker please. >> i think that'si think it is o decide for me what i need or what i want. i have been on both sides of the

table in regards to this situation with mental illness. i have been labeled mentally ill. i am "mentally ill." i have lived incarcerated. i have lived in the jail system. i have been forced to have to take treatment that i did not feel was the right treatment for me. i went along with it because i was forced into the decision to be free or not be free, to make my own decisions or have them made for me. in that situation, of course i went along with the choices made for me even though i did not agree with them. i was not well at that time. i took the medication. i played the role, but i was not well. if anything, i would say the whole process made me sicker and

not better. one of the things i know and have to say is that i have been working on my wellness and recovery. i have done that because i have a treatment team that understands me and allows me to voice my own feelings. we make choices together about what is best for me. i do not have to worry if i am having a bad day and feeling kind of psycho, i do not have to worry about being incarcerated or committed to an institution because my treatment team knows my needs. they know that is not the best thing for me. i believe that voluntary choice is best for the person, the individual. we can spend a lot of money on laura's law or we can spend less money and have it be more

productive by creating a crisis respite centers in the community. society has failed the people labeled as mentally ill. laura's lot is just another escape that. -- glarus -- laura's what is just another way to escape that. thank you. >> good morning. i am dauphine brody from the california network of mental help clients. i am here to speak on behalf of the coalition advocating for rights, empowerment, and services and on behalf of the california network of mental help clients we strongly oppose

this legislation. we urge the committee to reject it. was l-- it is an iron fist in a velvet glove. it is a way to coerce people to what is first turned a voluntary settlement. if they refuse, they are presented with a petition. it is a form of forced treatment. the forced treatment will not include explicitly forced medication. that requires separate hearing for capacity. it is significantly more expensive and less effective to coerce people in this way. voluntary services are clearly the solution that has already been proven. expanding the raid to include -- the array to include a

majority of choices include people where they are is what other counties need to do to meet the needs of people in distress. furthermore, current law already provides an array of involuntary commitment procedures that are more than adequate, including 72-hour holds, 14-day holds, temporary and permanent conservatorship. all this implementation accomplishes is further division within the mental health community, as you have seen today. it undermines the integrity and success of voluntary programs we have begun to implement through the mental health services act. it dramatizes clients. it leaves them to associate voluntary and non-threatening support with coercive treatment. the collective experience of some many clients confirms that

they often have prior negative experiences with involuntary treatment. we urge the committee to reject the legislation. thank you. supervisor chu: thank you. next speaker please. >> hello. i am sandra larson. i am a consumer. i work in the city and county as a patient's rights advocate. i am not representing my organization. i am also a member of the california network of mental health clients and the sentences go network. i have a long history of mental health treatment. i am 69. i started when i was about seven. i have been institutionalized, shocked, treated with medication. when i got to california where there was openness and a sense of freedom with the presidential system, i was taken in. i began to meet my peers working

to change the conditions in the system. i also met for-looking providers and legislators who wanted to change aulos -- the laws. we hope we have come up with the money to the friendlier and more welcome services for people are welcomed and do not feel that they have been coerced and forced into treatment. i know that everyone has a serious and real concern for their family member. i have a son who had his first break. the treatment he received has him terrified. he does not want to go back. there are a lot of people who have this kind of response. they become afraid. that together with their illusions that are not all treatable with medication is

very difficult. i do not think we are ever going to be able to save everybody. someone might be harboring the illusions and not acting on any of them. there might be a violent act. my thought was that this law was supposed to be for acts of serious threat and violent behavior if that was in your history. that is how the law in new york came about. someone attempted to harm themselves and someone else with and so many months. but i hear that we're going to be picking up people on the street and helping them because they are mentally ill and keeping people in the system because they are resistant to treatment. we have a program for homeless adults are diagnosed with serious mental illness. it was very successful. there's a paper on effectiveness of integrated services reports

to the legislature. it is available. i feel we can accomplish so much more without billing in this direction. thank you very much. supervisor chu: thank you. next speaker, please. [tone!] >> hello. i am here with the california network of mental help clients. mental health clients. i wanted to comment that in my opinion, outpatient commitment is outdated and stigmatized. people with mental disabilities

-- sorry. supervisor chu: take your time. >> since time immemorial, the traditional system has used coercion and force in its attempt to solve problems. anything that would use force and force people to have treatment would be going backwards, not forwards. a transformed system will create options that maximize self- determination and autonomy. these are goals of the mental help services act. -- the mental health services

act. in our opinion, course of treatment is ultimately ineffective. -- coercive treatment is ultimately ineffective. it will not stop non-compliance. that is viewed as a problem that more forced treatment was off. researchers have found that forced treatment causes noncompliance. the well-being research project supported by the california department of mental health found that 55% of clients who had experienced forced treatment reported that fear of forced treatment caused them to avoid all treatment. that was for psychological and emotional problems. the study concluded that coercion undermines the therapeutic relationship between a client and his or her therapist. choice is essential for

recovery. choice is an important concept for humankind and human dignity. [tone!] mental interventions should be soundly based in choice. treatment and civil rights are not antithetical to each other. good treatment can only occur in an atmosphere of choice and freedom. we urge the committee to -- [tone!] -- reject this legislation. supervisor chu: next speaker, please. if there is anyone else who liked to, come on up. >> i am program director for the city-wide case management forensic program. i am here to urge you to vote in favor of implementing laura's law in san francisco for three reasons. it makes sense from a treatment perspective.

for individuals with severe psychotic symptoms from schizophrenia and bipolar disorder, some do not believe they are ill. they remained untraded. that makes their illness worsened long run. i have worked for 15 years providing intensive service involuntary case management to the sickest individuals in san francisco. even with these services, a small percentage continue to refuse medication because of their mental illness. this is the prevention and public safety measure. i helped create the san francisco behavioral help court to address the problem of the county jail filling up with the mentally ill. these people have committed serious felonies and violence because of untreated mental illness. the victims of these offenses are usually supportive of their perpetrators engaging in behavioral health court. they understand that the court will supervise these individuals closely and mandate treatment. that prevents future violence.

the agency cannot force people to take medications. it does have leverage in ordering compliance with treatment. the leverage of having to appear before a judge or submit to the hospital for an evaluation is often enough to achieve compliance or treatment, as laura's law would do. assisted in outpatient treatment is sound fiscal policy. it saves the city money from expensive emergency services and criminal justice services. i believe implementing this is the right thing to do. we are not talking about every person with mental thomas. we're talking about the people that are a danger to others or to themselves. -- we're not talking about every person with mental on this. the current laws do not have the ability to mandate treatment when someone is a danger to themselves or others. that is a big hole in the mental health laws that we currently

have. i think that laura's law would fill the hole and promote more public safety for all of us. think you. >> a couple of questions. citywide, you see patience dealing with psychoses and psychotic breaks, severe mental health issues. what is the treatment uc as meeting their needs? >> we are working with some of the most severely ill people. the treatment is assertive and intensive. we do not wait for people to come to us. we go to them. we go to their hotels. we out reach people when they are not coming in for medication. when entice them to help them get entitlements and housing. -- we entice them to help them get entitlements and hous anding. medication and intensive case management. it is the package together. >> laura's law does not mandate

medication? >> no law can force medication under laura's law. >> it would essentially allow us to be accounting that would create an plan that could include medication, along with assisted outpatient treatment. that would be part of the treatment plan. >> as long as you go through a hearing and it is court ordered. >> we do have a court system that can create the mandate or planned for treatment. that could include treatment at a hero held court we would like to and from a something new that we're talking about today. >> you have to commit a crime to be in behavioral and help court. that is on the other end.

we are trying to prevent those people from committing those crimes and having the victims. we want to get the mandated to treatment before they do that. >> laura's law would be through that department of public health that would mandate the treatment. there would be other systems in place that would direct a client to petition the court ordered or directed-ordered treatment. it could be hospitals, probation officers, police officers, parole officers with this legislation. there are already this kind of criminal element already involved in a way to mandate the need for the implementation of laura's law. i am not sure there is a need

since we are to have the system. >> their only for great disabilities. they're not for danger to themselves or others. that is a big hole in our voluntary commitment laws right now. we know people and who consistently go off their medications and commit violent acts. we cannot reach them with this. it has to be a great disability. that is the crux of this. supervisor chu: did you want to add anything, supervisor alioto- pier? supervisor alioto-pier: i will wait until public comments. >> i was interested in listening to the various comments. i think there are some important points to make. we recognize there is a broad range of mental illness.

we support the concept that a broad spectrum of services need to be offered. we further feel that involuntary treatment would be the preferred model. nonetheless, there is a small number of people who are a danger to themselves and others who would need this kind of court ordered outpatient treatment. there is the need for that. to me, the data is so overwhelming and astonishing in terms of the effectiveness of this as a tool. it is another tool. you have heard the data about intra- -- kendra's law. nevada and los angeles county have implemented it. lar was killed nine years ago. nick and i miss her every single day.

the mentally ill person who killed laura was found not guilty by reason of insanity. we agreed with the verdict. he was sentenced to napa state hospital. he was very responsive to treatment once he finally received treatment after killing three people. now he has to live every day of his life knowing what he did. he has to live with that. clearly, there has to be a better way for his family and for our family and our communities. thank you. thank you for introducing this. >> i am randall hager, director of government affairs for the california system. maybe i can answer some questions more specifically. the procedures and laura's law are civil procedures. they do not take place in a

criminal court or before, judge. they are in a civil setting. it is the design of the law to be able to intervene when people are deteriorating and have a history that determines that they are going to have a predictable result of either committing a crime, going back to the hospital, or something else. the ability of anybody to petition for this is pretty much as you spoke. the behavior of help department refers the matter for investigation and a petition to the court. the court makes the determination according to the criteria in the law. i do not know if that helps parse out why laura's law is different from behavioral adult court. in terms of what i understand about a system in san francisco, the services are very much the same. the court