chief with regards to a search for a cit coordinator. we are happy to be part of the process. we want to be able to work closely with the police department. many aspects of our relationship are very positive and very productive. we are happy to be part of the process, and we encourage it to move forward. supervisor mirkarimi: i made reference to this, so it would probably be a great time for you to address it. i want to be careful not to overlap the urgent care model. there have been times in the not too distant past that measures to reduce the beds in the psychiatric unit had come before us, and there had been a spirited discussion about whether that was the right thing to do or not. how does that fold in into this discussion right here? when the terrain of san francisco is that there are quite a few people with mental

health needs that are engaged by the police department. the police department needs to take people to our public health system. based just on the population of those needs, those people, what do you say to that? >> we had an opportunity to speak -- to meet extensively with dr. dupont and major cochrane from the memphis police department when they came to stand in cisco, and one of the things they told us after they had visited clinics and visited some of our treatment venues or given information on the spectrum of care and system of care that we have in san francisco -- one of the things they said was that it is very robust, very strong. this is many times the amount of

resources and services that we have locally in memphis, so what that said to us is that we need to work better in terms of our coordination, in terms of optimal utilization. the department has worked very hard over the last 10 years to create a matrix of services, to respond to individuals who may be having a psychotic episode, and i can go through some of those venues if you are interested. the first that has been mentioned is the urgent care clinic, which is a treatment venue located in the south of market district, located by the progress foundation. it does have an overnight capacity of 12 beds, but it operates as an outpatient and crisis clinic 24 hours a day, and has the capability of being a portal of entry into site emergency services. it is open 24 hours a day.

psyche emergency services, which is based out of sentences could general hospital, does have an overnight capacity of 20. in the term 18. it is actually 20. also functions on an outpatient basis for the police and other human service providers in san francisco that are certified to authorize a 5150. our outpatient services have proven to be critical and important in recent history. again, it is not 24 hours. and operates until 11:00 p.m. on weeknights, and it is open on saturday but not on sunday. we have the silvering center, which has functioned as a crisis center because oftentimes, police officers are under the offender is actively psychotic or is under the influence of substances or drugs.

that has proven to be a very effective venue. we also have the community clinic. we have five mental health clinics throughout the city that can act in addressing the needs of patients or clients who are in crisis, but of course, it is during regular office hours. the department of public health internally is very committed to this effort, and we will engage in diligence to see how our system needs to reorient, needs to be retooled in light of the fact that we have very important, very promising program that is a priority. supervisor mirkarimi: with so many options, which is good for the officer and for the city to be able to direct somebody, who gets first stab at that but they? the police officer or dph, when the need calls for deciding

where that person goes? i imagine it is the police officer. >> it is the police officer. in 95% of cases. supervisor mirkarimi: right, so their training, which gets down to the premise of this hearing is essential in determining how they are going to treat that person with regard to where they are going to take them -- either to county jail or to one of these centers the that much more specialized, and the author has to make the call about that specialization needed, correct? >> that is correct, and the operative word is tree off. to what extent can we put the individual officer with the tools that the team, to what level of care or what level of need a particular center may require, and which then you may be most appropriate for that particular offender. there is a lot of work that needs to be done, and we are looking forward to that. supervisor mirkarimi: with trends of state budget cuts for

mental health programs, with so many veterans now coming back from iraq and afghanistan, which noticeably are also suffering from significant mental health issues, is what we have been seeing, hearing, and reading about -- are we at the pace that is keeping up with that population of demand in san francisco? >> that is an unknown to me. like i said, the system has evolved and developed. capacity has increased to address this specific type of patient that is presenting eight need of care. in terms of those modalities, in terms of creating then use, a high profile entry point for this client has been our focus, and i think we have achieved that to a large extent. but you are correct. there's the issue of enacting increase in the number of individuals presenting who do

have a diagnosable mental illness who may be in crisis, may be actively psychotic, and we engaged in ongoing discussions internally in terms of how we are going to optimize capacity. supervisor mirkarimi: thank you very much. very much appreciated. thank you very much. is director vega here? thank you for your patience. >> thank you very much. i want to actually truly thank you for investigating in this issue, looking into it with what i can see is real commitment on your part as supervisors. i am new to the community. i've been here about three months. but i have been actively

involved as an advocate and also previously as a service provider on these issues. i want to say that what came out of the police commission, i think, really represents the best result for police interaction going forward with people of mental illness. i'm very much in support of the men this model -- the memphis model. i do think you guys have some 40 questions about how it is going to work here. i was also gratified to hear the person from the dispatch office because i think that really gets to the key question and probably in particular for san francisco because it does not have an integrated 911 system. as an addition to that dialogue, i think it is important to note that in a lot of places, if you are a mental health client, and

it is after the working hours of the clinic, and you call the clinic, or alternatively, if you have a therapist and you call your therapist's office, and they are closed, the message you are going to get is, "if this is an emergency, call 911." i personally feel like that is not the best message. if it were my preference, the number to call would be a psychiatrically train mental health worker, somebody who can listen and then give referrals to the right resources. i do not really believe that it is in a perfect world the job of either 911 dispatchers nor the police to respond to issues of mental health crisis. they do it, and they have to as part of our safety net, but what i would hope is that emerging

from this discussion and in partnership with the mental health department, the behavioral health department will be more forward-looking about getting people what they need that does not necessarily involve always the emergency response teams. you guys have brought the question forward, and i think it is relate an important question to ask. what could we be doing better? as an example, -- supervisor mirkarimi: i'm just curious. you use the example of if you're going to have any emergency, call 911. what would be the alton bit? >> there are a few things you could do a. as an example, you could say, "if you are in serious distress, call the national suicide prevention lifeline." they are trained like it -- trained counselors in every area. there could also be a number for referral to a 24/7 mental health hot line that gives them

the next referral. sometimes, it would have to be to the police. supervisor mirkarimi: to speak to that reality, we do not have that? in sentences go? a 24-hour hot line beyond the 911? >> other than the suicide prevention crisis centers, that is true. however, i guess what i'm saying is i think what would be great to sit the behavioral health department was able to institute that. if we had 24/7 mobile crisis rather than mobile crisis only available during the times, frankly when not quite so many people are having prices, and if we had a system that was able to respond to people when they were in crisis without necessarily having to put the weight right on them, i feel very good that the police commission and police department are willing to take a leadership role in this going

forward. i just want to say because, i mean, probably everybody knows -- if you are having a hard day, if you are actively psychotic or suicidal, and i have been in this position myself, the police are not necessarily the people you want to see walking down the street. that is no offense to them. it is just part of the reality, i of the killer when people are psychotic or paranoid. -- in particular when people are psychotic or paranoid. supervisor mirkarimi: thank you very much. colleagues, questions? welcome to san francisco, director. thank you very much. mary kate conner, please. thank you for your patience. >> thank you very much for holding this hearing. not only this one, but on the

other issues of tremendous importance to people who have disabilities. you may want to ask why it is that the reentry council would be about people with disabilities. it is because at this point, nationally, in every form of incarceration, whether it is cities or county or state prisons or jails or federal facilities of incarceration or private facilities of incarceration, the federal department of justice has found that 65% of the populations in those places of incarceration have what is considered to be a serious and that -- serious and diagnosable psychiatric illness, and it comes down to the heart of what we're talking about here. supervisor mirkarimi: could you introduce yourself and your organization? >> i'm sorry. i just launched right in. my name is mary kate conner, and

in the executive director of a nonprofit organization that was called caduceus outreach services. it is no longer doing what it was doing for the past 15 years because it was defund3ed. we are not dead. we are not going anywhere. we just are not going to be able to provide services. we are visiting the little remaining staff time that we have toward engaging with the issues of why is it that people with a particular kind of disability are over represented in relationship to incarceration and in relationship to what is euphemistically but in fact legally known as death by legal intervention. there are a series of things that happened to people who have psychiatric disabilities. any time there is contact with institutions that refuse to acknowledge that this particular

type of disability really does require -- in fact, -- like all disabilities, but it does require what is known as reasonable accommodation. we are, as a city and in the thick of it, city officials require to comply with that congressional accurate as far as i'm concerned, the majority of law enforcement agencies in california but also nationally are completely out of compliance. i do not see you all as public officials welcomed the hammer of the -- wielding the hammer of thea ada to. i'm here today to speak to the issue of the need for the police crisis intervention program and the need for the rest of the city departments to step up. because people in psychiatric crisis do not just deal with the police or they do not just deal with mental health.

they do -- they deal with all of these things. the majority of the work i have done has been i environments that are not clinical, environments that are not detected, environment outside the purview of traditional or mental health. they have been in shelters, on the streets, in bus stations, and in programs that do rely on clinical training for people who work there but are not part of the clinical culture. 15 years ago, there was a group of stakeholders, similar to what was drawn together now. interestingly enough, it included chris daly and included the police department and representatives for the mayors

to study why there was a disproportionate number of shootings. what we came up with after six months was a model that was identical to the mint this model, and we have not heard it. it came out of the issue of why is it that those of us who work in mental health encounter the same people and do not end up shooting them when the police do? we look at the differences in organizational culture, that their training is entirely different. when they encounter someone who is not responding, the command and control tactics, they basically go to the scenario very quickly in their heads of what kind of force? shoot, do not shoot? that is not what people in mental health do. it is not what their training is. ultimately, the question came down to why is it that people go into mental health and other people do not?

they choose a profession of law enforcement? primarily, it has to do with who is affected by this disability. bill has had something in their lives and has been deeply touched by a psychiatric illness, and they have committed themselves to wanting to further work with it, investigated, do something positive or feeling around it, or the opposite. often -- frequently, people who have psychiatric illnesses frighten other people. there is so much misinformation, and that misinformation is perpetuated over and over again by the press and media and just by the majority of people in our everyday language, that officers essentially have been trained to be fearful of people who are in crisis as opposed to compassionate. it is the other way around in mental health. that is the primary difference

between most mental health training for officers and what the training at this point would be about for the mint this model. the officers who would have the -- they would volunteer to have that as opposed to being ordered to do it, and they would also be given the institutional backing to take the lead in a situation. that in combination with working very closely with 911, and i'm very happy that the dispatcher was here. it is a lot more than just providing dispatch with training. i think the officers did a phenomenal job. it has very much to do with how they communicate and how many calls come in at a given time about one incident. we can look at instances of shootings in the last 10 years and see how they related to 911 calls. how many people called about a

weapon? how did the information and grow to the point where there were four precincts, 20 different officers that are arrived at the theater in 2001 and shot a man 48 times, killing him, when he was carrying a knife that was this big. that was a disaster, and that is something that should be studied. unfortunately, what has happened in the culture of the police department and in the culture of mental health is that a wall of silence has come down around these issues, and nobody really wants to talk about what happened. at this point -- and i'm going to cut it short year, because you all do not need a lecture. what i'm hoping to do in this limited time is to say that right now in city apartments and within the board of supervisors, we need to be very honest about what is going on. very, very honest about where our dollars are going and why.

the police department -- every department and every even non- profit is looking to desperately guard their money. they do not want to give anything up because people close to organizations had been cut and cut and cut and cut, so where is it that we can work together? if we look at the genuine interest, from the perspective of someone who has a disability, not just who is in crisis -- right now, we are talking about people who are in crisis and how they respond to them. " we're not talking about is what happens 24 hours later. you were asking other people here about repeat offenders, people picked up by the police over and over in some state of

psychiatric crisis. why is it that this question is not ask -- what happens to those people after the crisis is finished? they do not get regular treatment. this is not a personal attack on anyone within the health department, but the health department, if they further investigated, if the official further investigated, what happens in each of those outpatient clinics? how do you get treatment there? what is the weight? the latest three months to see a psychiatrist -- the weight is three months -- the wait is three months. they will not get a hospital bed or a place to stay for the night or medicine. it does not happen. it is wonderful that there is cooperation. i look at this hearing as one of infinite possibility because we have a new director of the health department who is far more educated and empathic and

then our past director, who had a series of what i believe were personal problems in relationship to those that have psychic disabilities, and this was seen over and over again. and we have a new police chief, who is -- i was floored at the commission hearing last week. i was so deeply impressed with the way he was actually listening and not rolling his eyes. what he said that he wanted was for all officers to have this kind of training, but the training would be useless unless there are resources everywhere else to back it up and unless the police department understands that this is not just a matter of training. it is a matter of having the -- i'm not sure what it takes. a cultural shift occurring

whereby police officers are allowed to slow down what they do to have a different option between should and do not shoot, where they have the backing and respect of the senior officers, where the senior officers understand that this is a different way of working with human beings. that is also true department- wide. because without looking at what happens when someone is taken to jail -- in the hearing that you all just had about reentry, i think about in the last 20 years, the number of people i have worked with him have had contact with each one of these systems and what happened to them. basically, about 95% of those people have been further damaged in every way you can imagine, and that includes having their income discontinued because they went to jail, being discharged from jail at 3:00 in the morning, not getting any

medication. i'm going to stop, but i would ask you, as members of the health and safety committee, to do a little more detail investigation into each of these departments and what actually happens to an individual who has contact with them, we are never going to get anywhere. if we can ask a city full back in relationship to blaming and recrimination when we talk about these issues. i myself am guilty of that because i'm very angry at what has happened in my experience in the last 30 years with mental health. if we could really get down to it, we might be able to make some changes, and the police department has to be willing to give it up as well. why is it that we have a decoy program going on in san francisco, where by an officer pretends to be extraordinarily dull, has a $20 bill hanging from his pocket, and falls into people on a sidewalk, who while

they are holding them up -- it goes on and on. how much is spent on the? can we take that away and put this into the other program? i thank you so much. i would not take this much time talking normally if i did not believe this was such a critical issue. thank you again. supervisor mirkarimi: thank you again and for all your service as well. i would like to move this to public comment. for anyone who would like to share with us some public comment, please do. it would help round out what has been a very informative hearing on the good work of the police commission and how the city is going to move forward. >> i just hope when you are blue, you will smile a little bit. yes, smile. and -- ♪ when you are feeling sad and lonely, they're is a service the budget can render

if you want to fix it up, go and manner do not be afraid fix up the budget and mental health then you know everything will be around if the budget is not so good now, i want you to fix it up now, and then, the budget, mental health will get better soon, and i know it will be coming up in maybe june fix it ♪ supervisor mirkarimi: thank you. next speaker please. >> i work for my real job as a police officer at san francisco general hospital. it is great that they are adopting the model.

i took my caddy -- academy at san jose. they actually site of the program as being one of the better, more innovative things going on right now. one of the things they said is in our training, it was a towers, but it did not cover counseling. it showed a little bit about it. it covered from a legal point of you. this will be more innovative. edp's tend to be a nightmare. i have a bunch of things i want to talk about. the lady mentioned about house psychiatric patients can lead normal lives as long as they have normal care. we had a lady who came in who was acting out, hitting the

cops, messed up. she had a condominium in the pacific heights and was a graphic designer. she had several accounts in the south bay. she was an independent contractor and she owned the condominium. she was making over a quarter million dollars a year. she had gotten so many counts on not taking her psychiatric me ds. her mother contacted the authorities and said they needed to check on her because she was not taking care of herself. we ended up restraining her, medicating her. she left four days later. you would not be able to recognize her. it is funny how people can lead normal lives. regarding condition red, when ps goes on condition red, it does not take more psyched patients