same amount. supervisor chu: was very reason why we did not include this as part of the budget submission and are coming forward separately? >> i think we always do this, but i'm not entirely sure why. supervisor chu: is not necessarily important for this point, but generally, it is helpful to consider grants we know are coming in. but if it is unanticipated, we come through a separate process. >> i can look into that. thank you. supervisor chu: are there any members of the public who wish to speak and item 1? seeing none, public comment is closed. supervisor alioto-pier: i didn't realize i was here for the entire committee hearing. we're looking at the accept and expend a grant, missing? supervisor chu: yes, this is in

the amount of $685,000. part of the money is going to the mta for pedestrian by improvement, and some of the work is going towards dpw to do curve ramp work as well as sidewalk work. looks like the money is being broken down 40 mta at $335,000 -- for the mta at $335,000 for five facilities, striping, that kind of thing. they also have another $41,000 for biking safety programs. dpw, it is $155,000 for sidewalks as well as $155,000 for culinary engineering curb ramps, said it is primarily an accept and expend a grant. said the items before the committee. supervisor avalos: motion to approve. supervisor chu: there is a motion to approve. without objection. adam two, please.

>> item two, resolution authorizing the implementation of assisted outpatient treatment in the city and county of san francisco, requesting the controller conduct an analysis of mental health funding levels and establish a lauras lot task force to oversee implementation of the measure. supervisor chu: supervisor alioto-pier has brought this item forward, so i will turn it over to her. supervisor alioto-pier: thank you. good morning. as you know, we had a long and informational hearing on laura's law. it is a state law that was passed in 2002 that allows counties to establish assisted outpatient treatment programs for severely mentally ill individuals. i'm coming back to this committee today with a resolution to authorize the implementation of assisted outpatient treatment in the city and county of san francisco. the resolution will allow us to

begin the necessary steps in coordination with city departments and the court to allow for a system outpatient treatment to the most seriously mentally ill who are unable or unwilling to accept treatment. first, i would like to thank supervisor avalos and the budget committee for restoring mental health funding. state law requires counties that implement lauras lot to fully fund a voluntary services. my hope is we can adopt this resolution along with the budget to improve -- or parts of the budget to improve the outcome for mentally ill individuals and reduce costs related to law enforcement and emergency services. the presiding judge of the viscounty stated, implementing laura's law is actually very simple. the benefit to cost ratio is all on the benefit side. the human benefits are huge, both to the consumer and the community. the cost is small and the savings are immense. as i stated at the hearing, we

can look at new york where a simple law -- similar law had been fully implemented. studies show that after new york implemented it, mentally ill persons receiving outpatient treatments that less time in hospitals in jails or less time on the street. over the first 10 years of its existence, studies found that can draw -- kendra's law helped reduce homelessness, suicide attempts, and substance abuse. these studies also found that hospitalization was reduced by 77%, a rest by 83%, and incarceration by 87%. what is great about san francisco is that we have an array of mental health services that are already in place. we also have a model havean ait program in our behavioral court system. the mission is to enhance public safety and reduce recidivism of

criminal defendants who suffer from serious mental illness by connecting these defendants with community treatment services. the problem with our system now is that people are usually connected to these community treatment services because they end up in jail and a criminal record or they end up in psychiatric emergency services and san francisco general because they are a danger to themselves or to others. laura's law is about providing another avenue to the services short and jail cell or hospital visits. it is a compassionate law that will help the most severely ill when they are not able to help themselves. let me be clear about what laura's law is not -- it does not allow for forced medication on an individual, forcible medication anywhere in the united states may only be given in a licensed hospital setting. california also requires that patients be entitled to a capacity hearing before they can be forcibly medicated in the

hospital. in closing, i want to share part of a letter i received from a family in new york who has had an experience with kendra's law after their 38-year-old daughter became inexplicably mentally ill with schizophrenia. the letter states, "we are a bicoastal family, and our daughter fortunately received court ordered assistant outpatient treatment in new york state under kendra's law and we believe it's saved her life and possibly the lives of others about whom she had illusions. furthermore, it saved new york so much money that she no longer is in need of long-term hospitalization and is now working on paying taxes. everyone wins when there is a court ordered assistant outpatient treatment. we must perform a system -- reform a system that places mentally ill patients in jail despite a -- instead of in treatment, despite the fact that it is more efficient.

i'm deleting lines 22 and 23 to remove the task force provision of the resolution because this can be done administratively. i ask for your support, colleagues, on this very important will -- law. supervisor chu: thank you. is there anyone you would like to have present information or a presentation? supervisor alioto-pier: why don't we begin with carla jacobs, treatment advocacy center? the morning. thank you for coming back. >> good morning. i have provided you both with a functional inclined of laura's law as well as a briefing paper. supervisor chu: just one second. this is a person who as a member

of the public we will do the typical three-minute time, and if we have questions, we can ask at that time. >> i want to thank the board of supervisors of san francisco because laura's law is a case of saving lives. yes, it is going to make better resource use. it is going to reduce hospitalization by 77%. it is going to reduce jailings and incarceration by 80% or more, but primarily, this is to give citizens in san francisco the ability to get well and stay well. it is the combination of the therapeutic jurisprudence of a court order and intensive community treatment services. studies have shown that court order by itself, services by themselves to this very ill population is not as effective

as the combination. this is for people who are already in the community system but they cannot stay in treatment without the additional help, so they are individuals that are costing community mental health dollars, costing jail dollars, costing hospital dollars. this will give them the right to get well and stay well, and i urge you to support it. supervisor chu: thank you. >> -- supervisor alioto-pier: i would like to ask amanda wilcox to come. and i would like to thank you personally for being here today. >> thank you. we really appreciate the opportunity to speak before you today. a man is going to see her three minutes to me. supervisor alioto-pier: unfortunately, we cannot do that, but speak for your three minutes, and then i will ask you

a question. >> good morning. for the record, my name is nick wilcox. i'm here today with my wife to ask that the city of san francisco take the necessary steps to fully implement laura's law. our interest in this matter stems from the fact that we are the parents of lore wilcox, to the legislation is dedicated -- parents of laura wilcox. nine and a half years ago, laura was working at the nevada county behavioral health clinic when a client is suffering from severe paranoia and schizophrenia and known to be dangerous, opened fire with a semiautomatic handgun. in the end, laura and two others died. three were severely injured. we and our community were left wondering how and why such a thing could happen. until laura's death, the issue of mental illness was barely on

the edge of our consciousness. in time, we came to understand that our local mental health system was in serious disarray and that the situation at the state level was really not much better. we discovered that our streets and jails were populated with the mentally ill and in many instances, treatment was only received after the commission of a crime. further, we came to understand that mr. thorp was not a criminal or a bad person but rather a victim of untreated mental illness. nothing, of course, could bring laura back. instead, we dedicated ourselves to changing the system that we believed had contributed to her death. consequently, we teamed up with assemblywoman helen thompson and the national alliance for the

mentally ill to work for passage of a.b. 1421 in 2002, a measure that came to be known as laura's law. laura's law was modeled directly after new york's kendra's law, which you have heard about, a program which proved highly successful in that state. laura's law holds the same promise, but today, it has not been implemented for a variety of reasons, not the least of which is fiscal. only in our county has full implementation of the program taken place. we were able to do so by utilizing mental health services act funds to establish the required assisted outpatient treatment programs in our existing mental health corp. to provide the framework. though our local experiences have been encouraging, we are a small county and unable to produce the data sufficient necessary to provide fiscal wake

up to a reauthorization of the law when its sunsets in 2012. accordingly, we are very pleased that the city of san francisco is taking the necessary steps to implement laura's law. supervisor alioto-pier: if you would not mind, give us further thoughts, and perhaps, you could also tell us what you think your wife might say if she were up here. >> she would conclude this paragraph in the following way -- we believe that as a society, we have a duty to help those in great need, such as the severely mentally ill. all too often, the mentally ill are left to fend for themselves in the streets where they frequently harm themselves and occasionally others. those who died do so with their rights intact. weaker and more humane world in which people have the right to be well.

laura's law is part of the decision. we ask for your vote on this measure today. thank you. amanda for fits the rest of her time. thank you. supervisor alioto-pier: she can still get up if she wants to. thank you very much, and hopefully, we will pass it in san francisco, and i understand marin county is also taking the steps. maybe we will see a little california creep through the rest of the county slowly but surely. supervisor chu: do you know what other counties currently have in place? supervisor alioto-pier: nevada, and currently los angeles has a pilot program. what they found in l.a. -- and was very interesting because everyone talks about the cost of the program, when in fact, you are saving so much that it does end up paying for itself and saving money for the county that would implement it. i. los angeles, what they found

is that it is $100,000 a year to take care of a mentally ill patient in the jails, so what they did was they took a very select group of mentally -- mental health clients and pulled them out of the jails, put them into a program at $25,000 a year, and with those cost savings, they paid for the program. so it works very well. all right, why don't we begin with cynthia jackson? pam fisher. if you have heard your name called, you can line up. >> first of all, i want to thank you all for having this hearing again. i really appreciate it. my name is cindy jackson. as you know, i and the mother of a son with a severe mental illness who had a terrible psychotic break last year and

ended up being charged with a felony and is in a program now in marin county, which is support and treatment after release, which works out fantastic, but the hell that he has gone through -- and i have gone through -- in the mists of six months of incarceration, being held in solitary confinement -- to me, that was the worst type of course meant. he was literally out of his mind, and there was no forced treatment. i am also with the advocacy committee in marin county, and we recently had a meeting with judge tom anderson in nevada county. as far as the funds go, i can honestly tell you this -- they do have a task force which consists mainly of mental health people, and, of course, the judge in the court. 22 people who were recommended for aot.

out of those 22, only two needed to be petitioned, and the other to be -- 22 got access from the task force reaching out to them. when someone is in the midst of psychosis, they are very fearful, so to go in and get help, or even anyone else, the illusion stops them and prevent them from that, so we have the recidivism rate, but what he did say was that they also had state contracts, which, as you know, really is not for coming out of the mental health community. it is for the people sitting in being incarcerated in jail for long periods of time, who basically are incompetent to stand trial, so they go out to napa state. they have been able to cancel the contract, saving them over hundreds of thousands of dollars, and only two people out of the 22 needed to be petition. through that process, they had their civil rights -- they have

representation. i can honestly say that while my son is in this court order treatment, it has been great for him, but my fear is what will happen when he gets out. he is doing well. he has embraced his illness, but i do not want to see him back in the same position again. marin county is now paying $345,000 for two beds at napa state, which if they had laura's law intact and implemented, the county could be canceled. we also have a $500,000 a year county with a chance for the mentally ill offenders out of the jail to get treatment at a psychiatric facility in santa clara. that is $500,000 right there. you have the money together that could be saved, and these people could have their lives back. i plead with you to implement laura's law. it is a win-win situation all the way around. thank you.

>> i had been at these meetings since 2003 when it was first brought to the board, and in the head of the advocacy committee. i want to give you some statistics that come from the treatment advocacy center. i think this is from last year, that the ratio of the incarcerated mentally ill in new york, per person in a hospital or care bed, is 1.2 to 1. the ratio in california is 3.8 to 1, and i imagine in the -- in san francisco, that number in jail compared to in a hospital or residential treatment facility is 3.8 to 1 and in san francisco might be higher. i want to read a quotation to

you -- this will only take a minute -- in 1848 to the north carolina assembly. it is definitely applicable today. "i appear as the advocate of those who cannot plead their own cause. i come as the friend to those who are deserted, oppressed, and desolate. i am the voice of the maniac whose piercing cries from the dreary dungeons of your jail penetrate not your calls of legislation. could the size and moans and shrieks the route your wide extending glantz reach you here and now? how eager would you be to divide schemes for their relief, plans for their restoration to the blessing of the right exercise of the reasoning facility -- faculties. we now have medication, and we now have the opportunity for

assertive community treatment, which they did not have in 1848, and my plea is -- why the mentally ill today being treated worse than they were 100 years ago? supervisor alioto-pier: thank you. next speaker please. >> yes, good morning. i'm pleased to be here. my name is ham fisher. i'm a board member of the national alliance on mental illness. i am the parent of a son who has graduated from san francisco behavioral health corp., and i can say the assisted outpatient treatment that he received through the court has turned his life around. he is now registered for classes at city college. he is living in his own apartment. i am supremely grateful to the care he received. i'm sorry he had to go to jail and get in trouble with the law

to receive that care. please pass laura's law. thank you. supervisor alioto-pier: thank you. next speaker please. >> good morning. my name is roberta english. i am a member of the california board of directors, and i was here last hearing, and i stated then that california has always supported the concept and the implementation of laura's law, and our intention and hope is that it will be in every county in california sooner than later because each day that passes means perhaps a life is lost.

we work together to see the county -- the county's implement this. it is really your job, your opportunity to create this historic moment in the next coming days where laura's law can be implemented here in san francisco, and i am very much trusting in all of the work you have done. the materials have been given to you, and i know you have reviewed it carefully and have the best of intentions, but i do want to say because i am the mother of someone with a mental illness -- some years ago, -- this is the city of my birth, by the way. i think that how many times i walked the streets and rode the buses and knew about mentally ill people, i thought, until my own daughter became mentally ill. at that point, i was afraid to bring her to san francisco. i did not want my daughter on the streets of san francisco with a mental illness. i hope in the future, that is

not the same kind of concern that it would be today. she is in marin county, doing well, but the point is really what you are out to do, and it is historic, and i do want you to rise to that occasion in the coming days when you have that opportunity. thank you very much. supervisor alioto-pier: thank you. >> i'm a retired psychiatric nurse and a family member of someone who has a serious mental illness, and for the past eight years, i have been leading a support group for family members, and i want to speak to the anguish that i hear in his meetings. the primary reason people come to the support group is because they have a son or daughter or brother or sister or a partner who is in serious crisis from their mental illness. they are afraid for the person's life. the person is resisting

treatment, so these family members are ready to provide financial help, to provide fiscal help, whatever is needed, and they cannot do that because they cannot break through the delusions' of the person who needs help. one of our family members did lose an adult child to suicide, and they all feel that such an outcome, either suicide or whatever the outcome would be would do great harm to their loved ones, so i just want to speak to the tremendous amount of suffering [inaudible] supervisor alioto-pier: thank you. next speaker please. >> i have a son who started to hear voices when he was 17. it started as radio static, and then he would say, "mom, can you hear the crowds? where are they?"

he heard this mumbling sound, and it developed to the point where he would hear and see seton, and he started to take all the food out of the cabinets in the kitchen because state and had been in there, and thank god we got him to a psychiatrist. he was not so paranoid yet that he had started to miss trust us, which happens. people tend to not trust anyone when they get really sick, but we got him in, and he started right in on medication, and he did very well very shortly after that. he was so relieved. he has always stayed on his medication. he does not feel any negative side effects, so i am one of the lucky parents who has a son who was able to take advantage of the treatment that was offered, but i'm here on behalf, also, of my friends whose children probably just did not want to say anything, and then they got progressively so ill that the

weapons came out. when you are being chased by satan, you really feel you have to protect yourself, and here is where all the tragedy begins. i really want people to be able to help the person they love when this kind of an illness happens, and you save a lot of lives this way, and i beg you to pass laura's law and enforce it. supervisor alioto-pier: thank you. next speaker please. >> i am division director of city-wide case management and community focus. we have been providing case management to the highest risks, the most severely mentally ill adults for the last 30 years. we know intensive case management wraparound services works, and we know very few people are we are unable to coax

into treatment, but there are a significant number whose mental illness precludes them from participating on a voluntary basis. we know that assisted outpatient treatment works because we are doing it in our clinics through the san francisco behavioral health corp. we are the primary treatment for a writer. we have two groups of clients in our clinic. those who are there voluntarily, and those there because of the behavioral health corp., and you cannot tell the difference. they are both severely mentally ill. many of which have suffered severe sleep problems. they're both participating in treatment. when we asked them their satisfaction with services, they are both -- they both rate 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 wayow