have a mental crisis, mental health crisis on our hands across our country. there are far too many who are not receiving proper care and treatment that need to be on the path to recovery. recent studies and reports have shown that over 40 million americans, adults, experience mental illness. close to 10 million of those experience severe mental illnesses such as schizophrenia, bipolar disorder, and major depression and close to 4 million of those people have their mental illnesses untreated. we believe and know that people are falling through the cracks not only across our country but also right here in san francisco. we see it on our streets and in our communities, in our families, every single day. additionally with the current mental health treatment options, families often feel helpless after the loved one voluntarily decide they do not need treatment. it should not need to be this way. i believe family and parents and friends need not feel helpless. they should be supported by the

community and sdi. the mental health offered by the city to meet their unique needs and situations. if lauren's law weren't in place here in san francisco, san francisco would have the community based treatment they need and deserve to put you them on the the path to successful healthy recovery. that's why about a month and a half ago i introduced two identical pieces of legislation with my three other co-sponsors and i want to thank supervisor wiener, supervisor breed, and supervisor tang, that we're discussing today to fully implement laura's law here in san francisco. i said it from the beginning and i mean it, that i do believe that passing it here at the board of supervisors is the preferred option, but i was prepared to take it to the ballot if necessary. i want to thank all the members of the public and all the members of our city, staff that have worked to get this where we are today and in particular, a number of community advocates, our department of public health, and their entire staff, and supervisor campos as well to come up with additional

amendments that were added in committee to what i believe will strengthen this legislation. each year millions of individuals slip through the crackses and laura's law i believe inside of san francisco will help alleviate that issue inside of our own city. while i would argue that our mental health service system in san francisco is one of the best in the country, there are still individuals who fall through the cracks. laura's law falls on those who need it most. half of the individuals who suffer from severe mental illness do not recognize they have a disease or recognize they have an issue. and there is a significant deficit and self-awareness. this same research finds a clear link between lack of insight between onance own mental illness and the ability to adhere to treatment and that's what laura's law seeks to address. 44 out of 50 states have similar laws on the books. similar law in new york called

tenders law, 74% of individuals experience homelessness. 77% fewer individuals experience psychiatric hospitalization. 83% fewer individuals experience arrest and 87% fewer individuals experience incarceration. it has also become a cost saver for different cities and counties that implement laura's law and assistive outpatient treatment where these individuals are no longer burdening our public safety infrastructure and our emergency infrastructure, including ambulances and hospital rooms and emergency rooms. by no means is laura's law a panacea for mental health treatment here in san francisco or for some who are suggested homeless. i view it as a tool in the tool box or our city to help us suffering from a clinically severe mental illness. i do believe we need to do more as a city and we need to change how we help those who are clearly suffering and cannot help themselves. in order to make a difference at the local level we need to

challenge ourselves and challenge the status quo. to me laura's law is about helping vulnerable individuals suffering from mental illness here in san francisco to get the treatment they deserve and for their families. to save our city valuable financial and infrastructure resources and to improve public safety. and most importantly, positively impact the lives of families who are dealing with this illness. those in need deserve better and their families deserve better and our city can provide that option. i want to thank a number of people who have been supportive of this legislation. i mentioned my co-sponsors before. i want to thank mayor ed lee for his leadership. our department of public health, barbara garcia for her support and her staff, [speaker not understood], and all the people and psychiatrist at s.f. general who have been very supportive alongedth way. our district attorney george gas cone, our public defender jeff hadachi, dennis herrera. i recently received a letter [speaker not understood]

president pro tem of the california state senate, police and fire chiefs, numerous doctors and public health professionals from the california hospital association to the california psychiatric association, and the numerous mental health advocacy organizations. namis.f. and treatment advocacy center and suicide prevention network. and a number of homeless services providers such as saint vincent de paul society and other labor and business organizations. lastly i do want to thank jeff from my staff who spent countless hours on this issue and my entire staff, but jeff in particular for his tireless work on this issue. colleagues, i know there will be lots of comments on this issue. i want to thank my colleagues for their support, and supervisor campos to find what i believe will be a great solution in terms of implementing laura's law here in san francisco. >> supervisor campos? >> thank you, mr. president. i know that a lot of my colleagues want to speak on this issue so i'll try to be as brief a possible. i know this is a very difficult issue for many of us and that

passions run very high on this issue. facing mental illness is clearly one of the most difficult challenges that any family must face and i completely understand why some members of some families are requesting new tools to help -- help them help their loved ones. i think that i've been very clear for a very long time that i have a number of questions about laura's law and doubt whether it is the right answer for people with serious mental health illnesses that refuse treatment. but i do believe that the worst thing that can happen as the city and county of san francisco moves forward with the passage of laura's law and the implementation of laura's law is to have this item decided at the ballot box. which is why, notwithstanding my reservations and my own

personal concerns, i thought its was important for me to sit down with supervisor farrell after consulting with the department of public health. and i want to thank hillary ronan in my office. we sat down. i want to thank supervisor farrell for his willingness to listen, his openness to have a conversation, and the point of the conversation for me was if we are going to implement laura's law in san francisco, which i believe we will, then the question is can we craft amendments that address some of the concerns, some of the very legitimate concerns that happen by those of us who have questions about laura's law. i believe that the amendments that we have crafted, even though do not lead to a perfect law, they are a net positive outcome for our local mental health system here in san francisco. i believe that these amendments will bring new resource he into

the system for the provision of voluntary services. it is i believe for those reasons that people like jeff hadachi, our public defender has come out and supported this approach. and i want to specifically talk about the two amendments that we drafted in consultation with supervisor farrell, the department of public health, and which i believe are important to increasing services that are offered through the department of public health. the first amendment would require dph to create a team of advocates to work with an individual to attempt to convince that individual to accept voluntary services every time a petition for assisted outpatient treatment or alt is requested. the team would consist of forensic psychologist, a family member, and a peer advocate. this team would work with the individual to attempt to convince that individual to engage in voluntary treatment at two stages during the department of public health

investigation to determine whether the individual fits the criteria for court ordered assisted outpatient treatment. and after the petition is filed, but before the court hearing is held. if at any point the individual agrees to engage in treatment, the department will provide that individual with services through full-service partnership. sfp full service partnership allows for not only traditional treatments for mental health disorder, but provides wrap around services to assist an individual who faces challenges in his or her life that are contributing to that individual's vulnerable mental health state. currently it is difficult if not impossible to access sfb voluntarily and by making sfb more available i think that we have made a great deal of progress. additionally, if a petition for a alt is sought and the county mental health director does not

find that the individual meets the criteria for court ordered alt, then the department is required -- required to offer voluntary services to that individual using the team of three advocates at the department that the person did meet the criteria. i believe that this infusion of resource he into our mental health system together with the team advocate approach of engaging individuals in a voluntary treatment are things that are extremely positive. and it's also new to the existing system. many families that currently one sfp cannot access services because there is a waiting list for those services. this makes the services available. also important to note is that written into the legislation is an annual review process which means that the law will be before the board of supervisors in one year and we can look at the data and determine if this

law has been effective at meeting its goals of whether or not it should continue i also know that supervisor farrell has committed to creating an oversight body that will oversee the implementation of this law. i do believe the impact and effectiveness of this law is ultimately dependent on implementation. and i know that a number of ideas have been floated [speaker not understood] including this idea of making this a pilot. the benefit of having this issue resolved at the board of supervisors and not at the ballot box is that by the issue coming here and remaining with the board, it allows for us as a legislative body well beyond the current makeup of the board is here, when we have future members of this board to actually come back and revisit this issue. and if we want to see how things are going on a regular basis, we have the ability to do that. but the reason we have that ability is because the issue is being resolved legislatively,

not by the ballot box. i don't believe that this law is a panacea, as supervisor farrell said, but i do believe that the amendments that have been put in place address as much as possible some of the concerns that have been raised. and with that understanding, i believe that we have reached something that i can support at this time. again, i want to thank supervisor farrell. i want to thank all the community members for their input. and i do believe that it is possible for us to respectfully disagree on something as critical as important as this, but to make sure that whatever policy is implemented, it is implemented in such a way that always takes into account what's in the best interest of all the individuals involved. thank you. >> supervisor yee. >> thank you, president chiu. i also want to thank supervisor farrell for bringing this

forward and for supervisor campos to introduce those amendments that made it much more acceptable for myself. i believe that this is -- this has been a very, very important conversation about how our city can address the needs of people living with mental illnesses. i've learned a lot through the process and through the discussions in knowing what we do have and what we don't have. i had several -- a few concerns originally, one of them being my concerns for laura's law centered around ensuring that people who struggle with mental illness receive culturally competent services. i raised this concern at our hearing at the rules committee about non-english speakers and how they were going to be accommodated through the process. after talking with the department of public health,

staff members, i'm feeling a lot more comfortable that they are seriously taking this as an issue and will address this issue by having adequate bilingual staff. because for me, if you don't have that, certainly i have to say that it's going to lead to abuse of such a law. and in the past, when mental services were a lot more available, there were abuses and much of it was because people didn't have language capacity to talk to people that really had nothing wrong with them. it's just that they couldn't communicate. oh, i can't communicate with that person, must be something wrong mentally. the other concern i had was -- and i still have is basically the mental health services,

mental health in general has been underfunded and it's been cut for years and years now in california. and one of my concerns really was we have this law, but if you don't have the services or the resources to provide the services, then what's the point? and i've been assured that there's at least for the [speaker not understood] people that might be impacted by this law, there will be services. and what i like about this whole discussion is that people are realizing that we are underfunding mental health services in general and people that want to voluntarily seek services can't get it at this point. so, i'm hoping that as we move forward in the future we have a much more robust discussion about how do we strengthen the mental health system in san francisco. i also look forward to robust discussion on the evaluation of

the program and its outcomes in the upcoming years. as supervisor campos pointed out, we're asking for annual reports and i think it's the right thing to do to monitor and make sure that this program is doing what it's supposed to be doing. and today -- but today, i am prepared to support this ordinance. >> supervisor mar. >> thank you, president chiu. i'll be casting a no vote on this ordinance, and i'll just say that it's not because i don't appreciate the hard work of supervisor farrell and the other co-sponsors and supervisor campos for doing his best to make sure that the ordinance protects the civil rights of people with mental illness, but also ha a clear process that involved family members, also others with a care team. ~ has a clear i also want to say i think this is a civil rights issue and

people with mental illness are human beings that deserve rights. i wanted to also say i know it's emotional and painful for many family members from laura wilcox and her family from 2001 to many others, but i really feel that if we move forward without full and adequate funding much our mental health system, this may be leading to a false hope of safety in our neighborhoods and it doesn't address what i would call more of the root causes of problems of why many people -- i think one in five people, according to some estimates, one in five families have someone who is mentally ill, and i worry that there is a danger of further stigmatizing people with mental illness. there are people in my family who are mentally ill and i feel that as supervisor yee said, we need much more culturally com petent community based services. and at department of public health, that uz doesn't reduce the number of beds in a

multi-cultural ~ facilities like s.f. general, but is expanding them and is really looking at stronger services. i also wanted to add that i think disability rights california and the mental health association of san francisco and members of our own mental health board in san francisco have helped me understand more complexly how there may be only about 100 to 130 people that might fall within the guidelines and it's a small number of people that may be impacted, but i feel like it's going down a road of further stigmatizing already stigmatized population of people. i wanted to also add that i think voluntary treatment that's culturally com p/e he tent with strong community based but also san francisco department of public health services is the answer. ~ competent i think healing of families and strengthening of our mental health is critical, and this policy doesn't go anywhere near enough to do that, and i do feel that it may lead to

further the danger of violating civil rights of many mentally ill people in our neighborhoods as well. lastly, i wanted to say that the advocates from nami and others have really helped me understand how the system functions for families and the grieving and high emotions among people, but i do feel again that this is a critical issue that without adequate funding and i think more time to think through how our systems could work in san francisco where we are kind of leading people down a road of false hope and not really addressing the root causes of the failure of our mental health system in the city. so, i'll be casting a no vote. >> supervisor kim. >> thank you. (applause) [gavel] >> i just want to remind members of the public unfortunately there is under our board rules no opportunity for the public to either applaud or to express

opposition to statements. i'd like to just remind folks of that board rule. thank you. supervisor kim. >> thank you. mental health i think is probably one of the most challenging issues that we face here as a society and as a country. i think that everyone can agree that this issue is something that not only continues, but i think continues to worsen as our communities and our societies doesn't have the tools and solutions to properly address them. whether brought on genetically, by societal issues that we have not addressed whether it's poverty, domestic violence, poor education, violence in our community, so many things that lead to mental health and so many of our individuals that are members of our community, i continue to see this issue grow. it's something that i see a lot in district 6. poverty, health, all of these things contribute to people's economic well-being and i think we all strive to find the solution and often even the magic bullet to address it. since laura's law was brought

by the state in 2002, what we have seen in the controversial conversation that has begun over the last 12 years only two counties have fully implemented this legislation. i have a lot of questions about whether this is the right tool for san francisco. it's not to say that laura's law won't work. i think it's just a question of whether it will work. we don't have a lot of data to support this is a tool that will actually help those suffering with mental health illnesses to survive out of it. with the two counties that have implemented this pilot they only have data of six individuals and one of those counties were actually impacted by laura's law. on questions i have that include, one, that while supporters complain no one will be forcibly medicated, noncompliance will of course result and a court order compelling a psychiatric reevaluation. if the patient refuses he or she will be arrested, put in handcuffs and forcibly taken to a city psychiatric emergency

services a locked psych ward at san francisco general hospital. that is a definition of coercion and often talked about is the humiliating and trauma advertising for the person that is being subject to it. it's not clear that these types of treatment actually result in better outcome than the treatments that we have today. other questions that bring up is that there is no evidence that a court order is necessary to achieve compliance and outcome or that a cord order in and of itself has any effect on outcomes. this came from the rand corporation of analysts in eight states in existing research. finally, even within our own task force convened by the mayor's office, of the 36 recommendations put forward by the task force, not one included alt. i have a lot of concerns about being the third county to take on this controversial measure that hasn't ben bernanke shown to have impact in the two counties that have i am metved it.

~ hasn't been shown toshiba i have a lot of faith in our public health ~. my concern about laura's law has nothing to do with the individuals that will be implementing it. i do think we have strong leadership here in san francisco and that we have progressive values and i am certain that if dph implements it, they'll be able to do it i think in the best way moving forward. and i also really feel for the families who have individuals struggling with mental health. i think all of us know individuals that are suffering from severe mental health issues and i can't think of something that is more heart breaking and more challenging for family members to deal with. i understand the fear many family members go through that can address their son or their daughter's even violence at home and just want someone to come and take this issue away from them, whether it be the police or department of public health and just make the problem go away. i think the question that i have is of course is this the best way to move forward. i want to appreciate the work that has gone into it this far.

i know supervisor farrell's office and supervisor campos's office did an immense amount of work i think to make this the best legislation to move forward. but we know if we implement laura's law we can't actually amend what has been put forward by the state policy. there are two thing that i would really like to see happen with this policy if it's going to move forward today and that which would allow me to support it. one, i absolutely believe this needs to be a pilot. maybe i'm wrong. maybe laura's law will work, but why not pilot it the way orange county did. i county asked for two years. i'm open to doing a longer pilot than that. three or four years to fully get that data that i think a pilot is important to understanding whether this program works or not. the second amendment that i'm very interested in is having this program get evaluated by an outside evaluator. if we want to know that san francisco is doing a good job and this policy truly works, i don't think it hurts for us to

contract someone to look at this. i am concerned about some of the data that we've seen in the state of new york with very similar legislation which is kendra's law which showed this disproportionately disadvantaged african-american and latino individuals more than white individual. i am concerned with the issue supervisor norman yee brought up. the state doesn't mandate the reporting include correction on demographic data. it also doesn't mandate that the participants' language is addressed. so, if english is not your first language, ~ this state program will not actually enforce that the language spoken by the referred individual will actually be utilized. i think that it's important for this evaluation to happen and i think that we should look at it in three or four years and see if it's truly had the impact we hope it will have in san francisco and having a disproportionate impact on people of color, on those who

don't speak english as a first language. but i do want to acknowledge that i'm glad to see that this is moving through the legislative process. i think that it's important that this measure not go to the ballot for many reasons. one, one that i've often heard, particularly from advocates in our homeless community, actually the level of hate and violence that rise against individuals that are perceived to be the target of legislation. i would hate to see this go to the ballot and see individuals that save from mental health or homeless and perceived to suffer from mental health be the target of hate crimes. something we've seen when measures go to the ballot in past years. [speaker not understood]. i want to support that. these are two amendments i would really like to see occur with this legislation passing through the board of supervisors. >> thank you, supervisor kim. supervisor wiener. >> thank you, mr. chairman. first, i want to thank

supervisor farrell for his leadership on this piece of legislation. this is long overdue. it is similar to some other recent legislation we passed where you have a really good idea that has been floating around city hall and being discussed in the community for many years, but has never got the traction to move forward. so, i really want to give supervisor farrell and the entire coalition that's been working on this for so long for finally getting the traction necessary to get this passed. and even though i think i have a different perspective than supervisor kim, i want to agree that it's very good that we are doing this at the board of supervisors. if this was forced on the ballot, if the board were unwilling to move this forward at the board, it creates other challenges that we can avoid by just passing it through the normal legislative process. so, i'm glad that it appears to

be happening that way. i was proud to be an original co-sponsor on this legislation and i will be supporting it today. we have in san francisco an amazing network of mental health professionals. despite the fact that we need more resources in terms of mental health care and psych beds and giving people access to the care that they need, whether they're homeless, whether they're not homeless, regardless of the amazing network that we have, what we're doing when you look at it holistickly, it is not working. we see it in our streets every day. we hear from family members. we're just -- we don't have all of the tools that we need to try to address this very

difficult and very vexing problem. and it is something that we see every day and it's something that our constituents report to us every day, and we need to take steps to address it. and what we're doing, while important, is not enough. and i think laura's law by no means is a silver bullet and i know that there are some people who think this is just going to solve everything, it's very rare that you find one measure that's going to solve a problem as difficult as mental illness. but laura's law will provide the city with one additional tool to address the issue of mental illness in our city, including mental illness that we see on our streets. so, i am looking forward to the implementation of this measure once it's passed at the board. clearly we need to monitor it, make sure that it's being used as intended, that it's not being in any way abused, and i have no reason to think that it

will be. we have an amazing department of public health and i am sure the department will implement it in the most effective way possible. so, i look forward to voting for this measure today. >> thank you. supervisor cohen. >> thank you very much, supervisor mar. you know, supervisor kim raised an interesting point that i don't want to just brush over. she brought up that one of her concerns was this disproportionate fact that mental illness is in the african-american community. i don't know if i misinterpreted your fact, but i think there is something very real there, and there is logical reason as to why when it come to health disparities to african-american, latino, largely working class people are off the charts.