laura's law, given that it will pass, that as much as possible tries to address some of the concerns, the legitimate concerns, that have been raised and will be raised by advocates today. so my office and i have sat down with supervisor farrell after consulting with the department of public health for the purpose of crafting amendments to laura's law that we believe will result in at least a net positive outcome for our local mental health system here in san francisco. again, this is a very sensitive issue and it's very complicated and i was motivated to work with supervisor farrell because i know that even though there are differences of opinion on this issue he is trying to do the right thing and not only on this issue but a number of other issues. i know he has demonstrated a willingness and an ability to work with different

sides and i appreciate his openness to understanding our concerns here. and i specifically am happy about two amendments that supervisor farrell, the department of public health and my office have developed. the first would require the department of public health to create a team of advocates to work with an individual to attempt to convince him or her to accept voluntary services every time a petition for assisted outpatient treatment is requested. this team would consist of a forensic psychologist, a family member, and a peer advocate, and the law would actually prescribe the specificity of what the department of public health would be required to do. this team would work with the individual to attempt to convince him or her to engage in voluntary treatment at 3 stages: during the department of public

health's investigation to determine whether the individual fits the criteria for court-ordered treatment, when the court petition is filed and after the petition is filed but before the court hearing actually takes place. again, three different stages where this team would try to work with this individual. if at any point the individual agrees to engage in treatment, the department of public health will provide that individual with services through the full service partnership, fsb fsp allows for not only traditional treatment for mental health disorders but provides wrap around services to assist an individual face any challenge in his or her life that is contributing to that individual's vulnerable mental health state. currently those of you who do this work on a daily basis know that it is very difficult, in fact if not impossible to access fsp

voluntarily and that's why this change is so important and so useful. the other change is if a petition for aot, for assisted outpatient treatment is sought and the county mental health director does not find the individual meets the criteria for court-ordered aot, then the department of public health will still be required to offer voluntary services to that individual using this very team of three advocates as the department would if the person actually met the criteria. i believe that this infusion of resources into our mental health system, togethering with the team advocate approach to engaging individuals in voluntary treatment is extremely positive and it's a very important development. it is also something that is essentially new. many families that currently

want fsp services cannot access the services because there is a long waiting list and this ensures that those services are actually accessed by these families. another amendment which is also very important to me and very important to the advocates is to prohibit the transfer of individuals to court by police officers unless there is probable cause to believe that the individual actually meets the 5150 standard and the amendment requires also that all services be given in the least restrictive setting, which is something that we believe is really important. so again the legislative process is such that often times you find yourself faced with things that you would not want to see but you do have to figure out what the best outcome is and we believe that we have done our best to make that happen. so with those amendments not withstanding my

concerns in the past, i am ready to support this. again, i want to thank supervisor farrell for his willingness to have a conversation. i want to thank the advocates who have provided a lot of insight. this is not a perfect piece of legislation, nothing really is, but i am confident that we have done everything we can to address at least the fundamental concerns and my hope is that as we move forward with this piece of legislation, one, we will ensure that the policy is a policy that is crafted through the board of supervisors so that we have the ability as the implementation proceeds to look back and figure out if the approach is working. that's a lot easier to amend when it's done through the board of supervisors rather than the ballot box. so thank you very much and i look forward to the conversation and to hearing from everyone who came here to speak on this

issue. thank you. and i also want to thank hillary rownan from my office who has been working with supervisor farrell and his staff. >> supervisor farrell, if you'll go ahead and call people up for public comment. >> i have a number of public comment cards here. first of all there are a number of speakers we have here. first of all we have dr. mark leery, deputy chief of the san francisco department of psychiatry, we also have then district attorney george gascon, police chief and fire chief so dr. leery, please come on up and thank you for being here and colleagues dr. leery is acting as representative of the department of public health here today who has been really involved in these discussions. i want to thank you for being here. >> thank you. i'm very happy

to be able to talk today about this laura's law legislation. another term for it that i think covers it well is assisted outpatient treatment, or aot, and aot provides an additional option for families to engage their loved ones in treatment for serious mental illness when other efforts haven't been successful. it will help some patients but as we've heard, it's not a panacea and it's not designed to help everyone. it was created to help a small but important group of individuals whose serious mental illness prevents them from accessing and accepting crucial, sometimes life-saving treatment. like every treatment, it has its limitations and its benefits. the benefits include being able to engage individuals in a voluntary way while they are in the community without the necessity of hospitalization.

as you've heard there are a number of efforts contained within the legislation to engage the person in voluntary treatment prior to any court order. it allows family members to be able to engage the individual in treatment and it allows individuals who multiple efforts have been made to engage in treatment and not been able to succeed to get into important treatment. it's important to recognize our limitations. aot does not compel medication, individuals can't be required to take medication through this mechanism. there's no mechanism for enforcement and as we know it does require the court's involvement, which for some individuals can be a traumatic thing. overall it provides

crucial treatment for patients whose mental illness itself prevents them from recognizing that they in fact need treatment and will be able to benefit from it. i want to underscore that in the department of public health there are over 30,000 individuals each year who are treated in a voluntary way. the overwhelming majority of individuals who receive treatment do so in a completely voluntary way. these services that are provided by the department of public health will be accessible to this small population of individuals who are at very great risk for harm coming to them in the

community. it's an effort to provide treatment that can potentially allow them to live a more satisfying and recovery-oriented life. so overall i want to emphasize that this is an important option for patients, for families and for our community and provides necessary treatment to an important group of individuals. thank you. >> thank you, dr. leery. colleagues, any questions? >> yes, question here. in regards to this concept of the intervention team or team advocacy approach, you have a psychologist, a family member and sort of an advocate. what i'm concerned

about is whether or not the department of public health would have the capacity to deal with people that are not english speakers in this team approach. i mean, if there's only one team or -- i mean i know the amendments were just made, but if you could sort of imagine if this gets implemented, how will you deal with people that can't speak english. >> i would say it would be crucial for people to be able to receive services in the language that they speak. that would be an important part and is an important part of the treatment that's provided in the department of public health throughout our programs and that would be something that would need to be provided for and operationalizing this program. >> the cultural linguistic

component is part of the law and will be made available as well. >> i appreciate that is part of the law, but a lot of times a lot of things are part of the law and the implementation is lacking. it's a big concern of mine because in the past when i've heard of cases where, because of the lack of available staff members, sometimes people get placed in the wrong place and in fact it's -- there's a possibility of abuse when we don't have the right staffing. >> supervisor yee, i would strongly concur with your statement that it's very important. it's something that in the department of public health we're very commited to. at san francisco

general hospital we make great efforts and have been very successful at hiring staff who have cultural and linguistic capabilities that are able to serve a very diverse group of individuals seeking treatment and it is a really crucial aspect of treatment, i completely agree with you. >> thank you. >> colleagues, any further questions for dr. leery? okay, thank you very much for being here. appreciate your report. next why don't we have police chief or fire chief greg white, whichever chief, sir. >> good morning chair yee, greg sur, san francisco police department. the police department is in support of laura's law so we might be able to provide the best community-based care

to some of the most vulnerable that are at such degrees of mental illness that they cannot select such care for themselves. while most people who experience mental health issues are not violent as a result of that illness, there is those with severe mental illness who have a higher propensity to exhibit violence to themselves and perhaps to others. though our city has some of the better mental health services in the country, we still need more options to adequately address those on the street that are at such degree of mental illness they can't help themselves and ofb my officers are those who make first contact. lack of service has a tendency to lead to tragic events and potential violence in the community or again to the person themselves and we see this play out almost daily in some of the horrific accounts in the news. laura's law can and will help address both of these concerns and although i believe

it has, it's laden with due process and i know some of the amendments i don't disagree with add additional due process, it is something and something needs to happen. by providing court-mandated to individuals who have had a history of lack of compliance with treatment, laura's law helps provide treatment to help those who pose a potential threat not only to themselves but also to others. by treating these people, the chances of them ever becoming a threat are drastickly reduced and can be well on their way to getting better and living independently and making the choices of again those services that we have in san francisco that are very good. we work closely in the police department with the mental health community. a little bit about what the police department's doing so far to demonstrate our commitment, and i know that some of the mental health professionals we've been working with very closely at least since

2011, but it goes way back before that. we used to do or we have police crisis intervention team training from about 2001 to 2010. in 2011, since becoming police chief actually within the first 30 days we issued an order that asked officers to counter intuitively, instead of moving toward someone in crisis that was only a danger to themselves, to take a step back, create time and distance and call for crisis intervention-trained officers. since 2011 we have trained 269 officers again with help of our mental health care professional partners, which is just about 19 percent, our goal was to get to 20 and beyond. we have two additional classes planned in 2014. officers learn how to effectively interact with those in mental crisis. clues include learning

verbal deescalation phrases to help the individual until we can get to the point we can communicate effectively. we've seen tremendous effect with this team and in the last three-plus years we are very proud we have not harmed a person in crisis that posed only a danger to themselves. we believe implementing laura's law can also help reduce potential crisis and acts of violence in our community, enhance public safety and again get those that are such a degree of mental illness that they can't select these services themselves to a better place. comprehensive individualized treatment plans provided under laura's law ensure those that were gooing untreated receive the necessary care they deserve and need. laura's law in some ways a preventative measure that will help treat the most vulnerable in our community so their untreated severe mental illness never has a chance to escalate into an act of

violence against themselves or others. we have to do something. i talk all the time about predictable surprises, those things that after they happen they say we could see it coming. knock wood, it has been a long time since we have had such an event here in san francisco. i do not want to be that chief of police and i don't think anybody in a position of responsibility wants to say that, hey, now's the time after something's happened. the time to do something is right now. give us some more tools to work with, we will be conscientious and responsible with it and we will get those with severe mental illness the help that they need. questions? >> change you, chief. colleagues, any questions for chief sur? thank you for being here. >> good morning, chair yee, supervisor campos, supervisor farrell, joe

an hayes-white, san francisco fire department. i am here to support the implementation of laura's law in san francisco in ood to provide care to some of those most vulnerable in our community. not a day goes by that our department doesn't receive a call to respond to someone experiencing a mental health situation here in our city. we respond to an average of two or three a day totaling nearly 900 a year. unfortunately it is very xlopb for our first responders to respond to a call and see the same individual we have helped in the past over and over again. it's sad for the individual who keeps continuing to fall through the cracks and not receive the treatment they need and the treatment that they deserve. it also takes its toll on our first responders who feel demoralized when they respond to calls and see the same person over and over again. our first responders do feel the pain of the individual that needs help, but they also feel the pain for the families and loved ones of the individuals who often times

feel helpless themselves with lack of treatment options. the experience of my department every day in our community shows the real human cost that is tallying up without better treatment options available for the mentally ill. i believe the experience of my department in our community shows there are limited options currently available for patients family and loved ones. implementing laura's law could provide an additional treatment option that doesn't exist today. related to some safety concerns and issues surrounding public safety as first responders, first responders do have a higher rate of injury and violence committed against them. every time our department responds to a 911 call for a crisis happening in the community, our members are put at risk. that's what we sign up for. there's a risk in trying to provide care for an individual in crisis and also in trying to deescalate the

situation and hopefully it doesn't get to a violent stage but we have experienced that in our streets. it's my belief by implementing laura's law here in san francisco we can help prevent more crises in our community and in doing so it would decrease the risks my department faces daily while responding to these calls in our community. we know this is a somewhat controversial discussion, but we feel very strongly that the priority of our city first and for matter of fact should be humane care for the individuals that need care, but that laura's law, not a panacea to the mental health issues we have going on in the city, but is another tool in the toolbox for dph to use when they are dealing with people with severe mental illness. by passing laura's law we can make our department potentially more efficient and prevent crises before they occur. by providing the proper community-based outpatient treatment these individuals need and sdief to put them on a path to successful

recovery. i urge the committee and the full board to support supervisor farrell's legislation and implement laura's law to provide another treatment option for those with severe mental illness. thank you very much. >> thank you, chief hayes-white. thank you for being here. i actually have two city staff members that i received speaker cards for. loni from the mayor's office and barbara carlson from the san francisco office of early care and intervention, then we will open up to public comment and i thank you for everyone's speaker cards. if there are any more please feel free to send them up. >> good morning, thanks for having me. my name is loni kent, i am the senior policy advisor for health to mayor ed lee. this past spring the mayor launched a care task force which many of the folks in this room and i know you guys know a little bit about where we wanted to look at some of the very issues

that assisted outpatient treatment looks at. i'm going to share a little bit of the data that we used to guide this conversation. in the past year alone san francisco jails served almost 800 inmates diagnosed with psychotic bipolar or major depressive conditions. we also regularly have 750 people conserved because their disease has progressed to that of a grave disability, which means that they are unable to utilize means available to them to provide for basic necessities such as food, clothing or shelter. symptoms may include severe mental health diagnosis and/or a history of drug abuse, unstable housing, underemployment, limited family connections and as i just

mentioned engagement with the criminal justice system. through this process, several recommendations came out. the mayor immediately supported expansion of the community investment placement project, which is an expansion of the conservatorship program that mandates medicine compliance. he supported creating a psychiatric res center at san francisco general hospital, and we also supported adding personalized assistance to the transitional aged yuegtd to families and also smart case managers. through this process we also supported looking at laura's law, we wanted to understand better the risks and benefits of implementation. in doing that what we've come to understand is that there is a small number of individuals that could definitely benefit from assist outpatient treatment and we appreciate supervisor farrell taking a leadership

role in having this conversation. we it as our job to empower our health department with the needed tools to help this population and we understand that assist outpatient treatment can help with very specific individuals. as several folks have already said today we don't believe this is a panacea, but we do believe it is a tool, a critical tool that could be a difference-maker for a handful of individuals and it's important that we have that available to us. so if this passes, and we do hope it does at the board we are committed to our health department to ensure this is enacted in the most compassionate and least restrictive way it can to assure this population gets the care it needs. >> barbara carlson, is barbara here? i had her speaker card. there

is one more staff person, kelly carlson from sf police department. thanks for being here. >> thank you, supervisor farrell and the rest of the board members for letting me speak. i'm what's called the psychiatric liaison so i handle cases that have to deal with when someone has either a psychiatric illness or is in emotional distress, substance abuse issues and they come to the attention of officers. i've been doing it for over 9 years and i have to say, every year there's more and more heartbreaking cases because of the way the services, everybody is doing the best they can but because of budgetary cuts and less inpatient beds, it's gotten even more and more strict. i could go on for a really long time but i was thinking how about i just tell you about last week, a couple of the top contenders as far as heartbreaking. i got a call from our homeless officers and i do want to add

that every year there's more cases of involuntary psychiatric holds that officers end up handling. when chief sur brought up about incidents where we might end up shooting someone, i do the debriefings and i just want to say the last thing that an officer ever wants to do is ever have to shoot somebody. i really believe with laura's law if we have that and people can get in treatment before they get in the place where they think suicide by cop or some other horrible option is their best option, we would be a better place, right? but last week i was handling a case with somebody that has been literally terrorizing a hotel. and she broke glass and said she was going to cut up people, she's been starting fires, she's been bringing in people that are drug dealers into the place and she's probably what you would call

a bipolar manic depressive and meanwhile this entire hotel is terrified for their lives that the building is going to burn down. the police come, she's gone, it went on and on, we went out there and finally got her to the hospital, this is her something like 12th hospitalization in a 2 1/2 month period because she can clear up very clearly. it got to the point where they are now going to evict her out of her home so now she's going to end up homeless due to her mental illness because she's able to win the hearings. that doesn't make sense to me at all. another case was a woman that had a baby on the sidewalk a couple of months ago. she can't say who is the father to the child, how she got pregnant, she doesn't -- she's so what they call psychotic, not in touch with reality, we don't know how that all happened but it's not good and when i got into the

case last week she had wrapped a speaker cord from her waist to her feet so that nobody could get maybe potentially sexually assault her, then she tied herself to a pole. she hadn't moved from that spot so unfortunately had gone to the bathroom on herself. i have to say it ripped my heart out. i don't see how we're do ago service to someone like that. right? so somebody like that deserves to have some time in the hospital so that they can be, then make the right choices for themselves. if they think that that is a good option, to try themselves up and go to the bathroom on themselves, how are we being humane? i think it's heart-breaking. so those are the kind of cases, are there tons of them, thank goodness they are not a huge, huge number but when they are like that

every person that's living like that is not acceptable to me. i want them to be able to get well enough to make good choices for themselves. so i just wanted to say that. >> thank you, officer. >> did you guys have any questions? because i do deal with that stuff. thank you. >> thank you. so at this point we're going to open this up to public comment. i'm going to call a number of speaker cards up and please line up on the side here once i call your name. first i'm going to invite mr. wilcox up. next speaker cards, marty halloran, steven jaffey, martin fox. mr. wilcox i apologize, i did call mr. wilcox out of order, mr. wilcox is laura's father and has been a tireless advocate for laura's law.