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. and i think a large part of the reason has to do with toxic stress. and for those who don't know, toxic stress shows in people who are exposed to trauma, violence, much like what we're dealing with in the city, the number of shootings that we've had in this entire city. so, it's not a surprise that

the numbers would be very high when we think about how many shootings we've had in the bayview and visitacion valley neighborhood alone. it is of epidemic proportion. so, i want to give some voice to what supervisor kim has raised. i think she's nailed it, which is interesting, because i've come to the conclusion to support laura's law because of that, because we need to provide support for people who are hurting. i appreciate the efforts of the colleague bringing this issue forward to the forefront where hundreds of individuals are suffering from mental illness. many who i see encounter my district and quite frankly who i have in my own family. many of the people that i seek to help are unable to recognize their own diagnosis and mental illness and today we have a potential opportunity to help them, to provide them with the type of community-based mental

health treatment services that they need. now, i don't think we can continue to abandon those with serious mental illnesses and let them continue to slip through the crack -- cracks. i don't think we can continue to send these individuals to the street, or to jail, which is where you see a large number of african-american males and latino males, that we need to provide them with the care and treatment that community and peer-based services can provide. and more importantly, we need to include families of these individuals whenever possible in making sure that these individuals are connected to whole family units. i want to acknowledge nami for their advocacy as well the host of others, the mental health association for their advocacy, appreciate the constituents across the entire city that have reached out to educate me better on this particular issue.

i would agree that it is by definition, the definition of insanity to do the same thing over and over again and to expect a different result. and what laura's law provides is a tool to begin to address some of our challenges that we have here in a very different manner. and there are many things that we are as a board here in this chamber and what i'm hopeful that we are bold today and that we are able to move in a direction that we have not gone in the direction before. so, i am supportive of laura's law, thank you. >> thank you. president chiu. >> thank you, mr. chair. first of all, let me also start like i think all of our colleagues and just thanking everyone for this thoughtful and difficult discussion. i don't think there is a single person in this room who does not have a member of their family, a friend, a neighbor who has suffered or is suffering from a severe mental illness. and i think this is a set of

decisions all of us have weighed heavily on. i also want to say i appreciate the comments supervisor kim has made as to some of the changes that she thinks might improve this ordinance. i do think the idea of an outside evaluator could be very helpful. and i'm also very open to the idea of a pilot program potentially maybe a three-year pilot program which have been done in all the other counties that have moved forward with this, just in case. but that being said, i also want to say in 2011 when we first discussed this, i listened to all the sides of debate and i was ultimately persuaded at that time because the leadership of the department of public health, dr. mitch katz, for those of you who remember that time, he was opposed to moving forward because he didn't think that laura alps ~ laura's law could be effectively implemented. today we have department of public health leadership that

think differently, that are ready to implement assistive treatment. and we should give our mental health experts time to do t. that being said, we should put together the best program we can. i do want to thank supervisor farrell for his leadership and advocates who -- who are moving forward because, as supervisor cohen said, we do have to do things differently. and i do support that. i just want to make sure we do it with the strongest program possible. >> thank you. supervisor kim. >> thank you. i just wanted to clarify my earlier comments. my point was not that there are more mental health illnesses documented in the african-american and latino community. what i was referring to was a duke university study of kendra's law, a sister law in the state of new york. they show disparities relating to the youth, of course, of court orders related to race and ethnicity. that if you were african-american or latino you are more likely to receive the

court order than other prevailing demographics. and this despite the fact we see there is a history of discriminatory practices, disparities in the mental health services associated with these communities, that african-americans are more likely to receive poorer prognosis, diagnosis of more severe condition, lower quality and more sedating drug prescriptions and higher levels of long-term institutionalization than their white peers. so, my concern is not, you know, although i am very concerned about the number of mental health cases we see in all of our communities, my concern is there may be a disproportionate impact on communities of color, but also immigrant communities where english is not their first language. which is why i propose the concept of a pilot, b, the outside evaluator. make sure those disparities are not happening here in san francisco as well. i do think an outside evaluator can ensure that, that when we run this program, that we are

able to look at race, ethnicity and language and make sure there aren't disproportionate impacts. i just think it's important that when we do something like this, especially something as sensitive as this issue, that we're able to collect this data and show that it truly works and that there isn't bias ease that are implemented throughout the system. ~ biases so, again, if there is an openness by [speaker not understood] two amendments i offer to you, one is to make it a three-year program and the annual evaluation would happen through an outside evaluator. >> supervisor chiu. >> i want to thank the supervisors and supervisor kim's comments. while i appreciate the suggestion, these two suggestions, neither of them is something i would support. and let me just address them briefly. ~. first of all, in term of the pilot program, from my

perspective, pilot program is going to undermine what we try and pass today. the result of alt are positive. they're real across different jurisdictionses. we have proof from other states and counties. and in particular, part of the things we added into this legislation was an annual reporting requirement from our department of public health. at any point in time, if we want to tweak this legislation -- that's why i'd rather do it here at the board -- we want to amend it, we can call hearings on it based upon the annual reports. that to me is exactly why we had an annual reporting requirement from our department of public health. to do so otherwise is a half measure. to do a pilot program, to me we need to take as supervisor cohen said a bold step forward here. put this law into reality, implement it in the strongest way possible which is why i'm so thank. working with supervisor campos's office and our department of public health and advocates to be quite frank who had [speaker not understood] to implement this the strongest way possible. in terms of the outside

evaluator, to me, again, i would much rather have our department of public health be the one coming back reporting on this because they are going to be the ones implementing it and from my perspective, after having worked with them for quite a long time on this issue, they are so sensitive to everyone's concerns, not only legislator's concerns, community concerns, patient concerns first and foremost, i have the utmost faith and confidence they are going to be the right people to come back and report and deliver an honest evaluation and opinion what is going on in the program. i appreciate very much the spirit and comments, but the way we amended it today and the department of public health with their leadership, barbara garcia, collene, joe robinson, these are amazing leaders that have the commitment to work on this process and to see it through. and i feel incredibly confident with where it would be. so, i hope, colleagues, to have your sub mort on this. >> supervisor kim. >> thank you again. ~ support i think there wouldn't be support for the pilot program at this board, but what i would

like to continue to push back on is the outside mutual third-party evaluator. i do think it would be helpful to have them evaluate the efficiency of the program, the cost versus benefit. i have great faith in our department of public health. but i don't think it ever hurts to have an outside mutual third-party lens look at our data and make sure there aren't disparate impacts on a variety of different communities. and, so, what i'd like to offer is a motion to add to page 10 line 12 that the department of public health shall have an external evaluation performed of the alt program to evaluate the efficacy of the program, including but not limited to collecting and analyzing information regarding the demographics of referred individuals and the cost of the program. and the reason, the other reason why i wanted to add this amendment is this is specifically silent in the state legislation on laura's law. no state mandate to collect demographics of the clients they referred and i think it is important that if we are going to have this annual evaluation

of the board that we are able to be able to collect that data. >> supervisor yee? >> so, just for clarification, supervisor kim, in terms of outside evaluator, would you be asking that if the outside evaluator would be part of the annual assessment or is it maybe in three years this outside evaluator would really come in and look at all the data? >> actually, that's a really good question. i had initially viewed it as being part of the annual evaluation that would happen with the board of supervisors. i understand that maybe there wouldn't be enough data to collect within that first year. my suggestion would be for it to be with annual evaluations, but i'm open if there is support for the amendment to extend it to three years if you felt that that would make the outside evaluation more

effective. >> yeah, i would support a three-year point where maybe an outside evaluator come in, confirm hopefully what our department of public health is including in their assessments. the other piece of that, and i mentioned this to the staff, that laura's law requires or ask for a certain type of information to be collected from the data and they assured me that some of the thing we're interested in, in terms of if this be and other issues, they could actually stand the data collection. and one of the things that i was concerned about, with laura's law, the data already talks about who actually gets into the system. and i'm more -- i'm more interested or i'm interested

also on collecting data of who are the people that actually were -- the case is made that they would attempt to put them in the system. in other words, i'm afraid one of the things that may happen is people will misunderstand laura's law and think the application is much broader than, than it's intended for and all of a sudden all these people are being dragged into the discussion, even though they never get to the end point. so, i'd like to have that type of data collected also. >> supervisor farrell. >> thanks. supervisor kim, just to clarify, then, as supervisor yee mentioned, so, this would be an outside evaluator at year three? >> i'm happy to accept the friendly amendment. so, three years after effective date of enactment. >> just to address that point,

i would say for me my big objection was around the pilot program. for me that's creating a half measure. that's not what this is about. in term of the outside evaluator as you are describing it, supervisor kim, all of the data you talked about, supervisor yee talked about, is stuff that we've actually been very much discussing with the department of public health to gather. so, from my perspective, if it allows some people to be more comfortable with this to have an outside evaluator come at year three, that's fine from my perspective. this is a minor part of an evaluation. data, we always talk about is an amazing thing we need to cleatctiontion more of here at the city. if people are comfortable with it, i'm absolutely okay with that and would support that. again, i would just say and with we'll work with our department of public health to make sure that that data is collected in a similar fashion so year three it's allredly available and we can work collaboratively with individuals on that. so, i'm happy to accept that amendment.

>> supervisor campos. >> thank you. i do think that this is a very important discussion. so, and i appreciate the ideas and i appreciate the willingness of supervisor farrell to, to be open to that. so, if supervisor kim makes that a motion, i'd be happy to second that amendment. >> supervisor kim? do you want to restate motion? >> sure. so, the motion is, again, on page 10 line 12, department of public health shall have an external evaluation performed of the alt program three years after effective date of enactment to evaluate the efficacy of the program including but not limited to collecting and analyzing information regarding the demographics of referred individuals and the costs of the program. >> it looks like our city attorney has something eade like to say. mr. givner. >> sure, deputy city attorney jon givner. i would just ask that

understanding supervisor kim's amendment that we may want to just tweak the language a bit consistent with what you're going for here. but i wanted to clarify that the -- so, three years after the effective date is going to be sometime in the end of august 2017. going forward after that time, each annual report that dph produces should include the external evaluation data. is that the purpose of the amendment? >> i hadn't anticipated going beyond because initially this was envisioned as something that, you know, would accompany a pilot program. being that the legislation as it's moving forward would be an ongoing program, i think it's important at the three-year mark we're able to look at the data and demographics just so we can evaluate the efficacy of the program. so, my amendment is only on the first three years. >> thank you. >> okay. supervisor kim has made a motion. seconded by supervisor farrell.

colleagues, can we take the motion without objection? without objection, that should be the case. [gavel] >> any discussion? let's take a roll call vote on the underlying ordinance as amended. >> on item 56 as amended, supervisor cohen? cohen aye. supervisor farrell? farrell aye. supervisor kim? kim aye. supervisor mar? mar no. supervisor tang? tang aye. supervisor wiener? wiener aye. supervisor yee? yee aye. supervisor avalos? avalos no. supervisor breed? breed aye. supervisor campos? campos aye. supervisor chiu? chiu aye. there are 9 ayes and two no's. >> the ordinance is passed on the first reading as amend. [gavel] >> item 57, madam clerk. >> item 57 is an ordinance authorizing settlement of the lawsuit filed by cole anderson against the city and county of san francisco for $35,000; the lawsuit was filed on february 25, 2013, in san francisco superior court, case no. cgc-13-528964; entitled cole anderson, a minor vs. city and county of san francisco. ~ san francisco superior court. >> roll call vote.