n. it requires the complainant and the officer to be interested and most of the time we have complainant and the officer interested and we have many community trained mediators who are involved. our agency a ranges the mediation but we are not actual mediators, we have community based mediators. >> great, thank you. >> thank you. i want to check in with the bridge line. >> anyone there? no. we are going to close public comment. thank you very much for being here. >> thank you very much. >> we are going on to information item no. nine. i would like to welcome cecilia o'connor executive

director doer clinic. >> my name is cecilia o'connor. i work at the doer clinic. it's a psychiatric community based clinic for people experiencing crisis. prior to that, i worked at san francisco psychiatric emergency for the last 10 years. and a psych nurse. my experience with law enforcement with this experience, i have a lot of firsthand experience. i am one of the early members of the cit. i was quite excited and thrilled that this was going to go forward. and one of those reasons is that one of the unintended positive consequences of that entire project was that in a health care system that is

incredibly siloed to the detriment of any client trying to seek services. an example of that and probably many of you in this room are aware of or know people who have experienced this. one individual maybe working with so many different providers, but none of those providers speak to each other. so we have this incredibly complex and extremely difficult to navigate system for most people. if you add to that, the challenges of being in crisis and having the several mental illness and having disabilities and being homeless and having a substance abuse problem and having a medical problem like hiv, it's a miracle to me that people get help at all sometimes. the unintended consequences of the cit, for the first time i was able to meet many of

my sort of community providers and individuals who work with the same clients, but we had never spoken to each other our paths had nerve crossed and it was a unique and positive experience and the beauty was for the most part in a somewhat very hyper structured system there was the health department, human services agencies but there is no care coordination for people. i bring this up because the police are at the affect of that and that was something i learned early on. when police officers started to come into, when i was at san francisco general and someone brought the person to us, many times they brought the person because they were extremely concerned about them and this person wanted help. they were

not coming involuntarily and this person was seeking treatment. and that seem individual appearing equally disorganized would be on their beat and on the street again. so one of the questions that is asked and what i do with the cit with law enforcement is try to do a very brief history of the treatment and why they are that way. and explain the patient rights and explaining this service system we have and on the side my own cohort agencies and jennifer talks about the courts and a lot of contention

relationships between mental health and law enforcement that is also the history. i think for many of the police officers statistically if you look at the fact that 25% of the calls that they get currently involve a behavioral health crisis and as many of them said they don't feel completely equipped to manage this and they are at a loss why we as behavioral providers can't provide these services to people and need their help and we call them for help and tell them how to offer that intervention which does not go well. a lot of what we are trying to do with through the cit training with the clinic is develop these relationships. i have met some incredibly empathetic and compassionate men and women in law enforcement. it's always amazing to me and i think part of what we are really hoping as an outcome from the cit is

more understanding of our roles, more understanding of the challenges we both face so instead of directing this at each other, we together look at what can we recommend systematically as some of the things we can all support. one example of this is within san francisco at the moment we are experiencing an epidemic of methamphetamine abuse. it has unbelievable consequences for law enforcement and health care providers. truly tempt -- at the moment there is no true services for people who are intoxicated at the point of psychosis for this. the emergency room manages these individuals, we see them at psychiatric emergencies and a lot of people aren't given services and there really is no recourse. i think part of the frustration that law enforcement has is how would we fix this,

how would we go about changing this. one of the long-term goals with crisis intervention is people like us who are front line providers we can unite and find a common ground through cit, through some kind of collected agency response to make policy changes, to make and address the powers that be within the city and say, this is something we are, we have the data, we have the information, we have the people we can subscribe to and we have a plan that we can manage this. unfortunately when we are dealing, we have a health department and we have hsa who deal separately with housing sheltders and we have sort of in terms of behavioral health, the substance

abuse is -- approximately 80% of them also have a substance abuse disorder. it's a significant impact. i think it's much better than it was but i feel there is so much more that can be done. i thank you for having me here. if there is any questions, i like jennifer like most of us we can talk endlessly about our particular issues and the zeal with which we approach our work. i would be interested to know if you have any specific questions. >> thank you, we'll open up to public comment and i believe cochair supanich has a question. >> or two. thank you for coming. the picture you paint is concerning, and i want to welcome you to work with this council and the mayor's office on disability in anyway that we

can help i would be willing to help. the complicated combination of substance abuse, mental health, physical health, homeless is almost in surmountable. i agree with you. i don't know how they get the services they need. i may have misunderstood what you were saying, but other than the cit taking people with mental health issues to the hospital mental health ward, is there any other linkage to services going on for people? >> that was my opening. i do the primary opening and address at cit because what i talk about is sort of what the array of services looks like and how it works in san francisco. prior to the door of the clinic opening, or police if they have to take someone for psychiatric evaluation it was by their general order to a

designated receiving facility. the only designated receiving facility in san francisco in the psychiatric emergency is really small. it should be somewhere around 20-22. i was there one morning when we had 30 patients in that place. to me it was miraculous we didn't have. we were creating more trauma than we were solving truthfully. what i was aware of was we needed an alternative clinic. we are not a designated receiving facility but we can take people and we do take people from police who want help and looking for help and do not need to be involuntarily contained. we do not do any kind of involuntary restraint or medication. however this is one of the tragedies of the system. health

care is pretty good monday through friday, 9-5:00 p.m.. in the weekends or holidays there is a minimal amount of resources. the mental health association has implemented a line because the truth is someone who is struggling doesn't need to go to the hospital at 3:00 a.m.. they need someone to talk to. the beauty of the warm line is someone can call and just talk to. the warm line is staffed by people who have experience. you are talking to someone who can really relate to what you are experiencing. my belief is also that there is an entire range here of a service that we can provide for the community for each other that is based on that because what happens right now is that for anyone, someone you love, someone you care about and whether you have private insurance or none if for the

first time in your life you are experiencing a mental health crisis, to try to access services is extremely challenging because you are forced to go to a medical emergency where i'm sorry there are very many people in an emergency room and a mental health crisis is not in their purview. and being a nurse for almost 40 years, they don't know what to do and they don't have the skills to manage it. we have separated mental health separate from the entire being and what we are looking at is you have to talk to somebody who knows about that. as opposed to just the basis of you can hear what the person has to say. saint frances, ucfs, saint mary's, saint lukes. that was the place in

san francisco. you went to an inpatient unit and the most expensive kind of treatment and not the most effective for many people. we are now looking at some alternatives. the best alternatives would be the prevention for crisis. the best alternatives in my world if i ran for everything because i don't know how familiar you are with this. a month ago a psychotherapist started a psych walk. she got trained volunteers and they took chairs and sat on the street, many of them sat outside here. they sat and had a sign that said "i will listen to you" they encouraged people to sit and talk. it was wildly successful. not only for the people who talked, but the people who

listened. to me it was a godsend because the truth is, i would having lunch with denise sandoval, that developed lava mae. she saw somebody 1 day. she was in a cab ride going through the tenderloin. the taxi driver said, welcome to the land of broken dreams. she's a san franciscans. she came from business, not from mental health and she approached a woman on the street and she was crying and she said what's the problem and she said i will never be clean again. since then she's had one of the best programs that exist in the city. i know for a fact having worked for the city and county, if it had been a county agency which crossed so many

areas, we'd still be talking about it. my belief, my hope is that in this community we have a grand desire to do better particularly with the homeless situation with people who are mentally ill, with all of this. what would support law enforcement would be if they had more recourse. if there was in every community in the city, a place during the day where someone can walk in and sit down and without filling out a mountain of paperwork and just talk to someone. it would have an enormous benefit. it would be cheap, it could be well managed and incredibly effective. that kind of solution, i feel like on the side of where i come from which is the over here with we have to bill medi-cal and we are becoming more and more convoluted with all of our it systems. an emergency room dr. at san francisco general they have four or five different systems to put

information in. how do we find information about a client? how do we track somebody if we don't have a way to follow someone who has a mental illness, who is hiv positive and getting methadone and also on housing list and also trying to get their benefits and all of this? how do we do that? i don't know how the clients manage it. it's a test to the resilience of the people we serve. i would be happy to explore some of these areas where perhaps we can propose to the city, why don't we do some of these things that are fairly simple, fairly straight forward, but would have a huge impact and they don't require a lot of money. i don't know, that's a very long answer to your question. but the truth is that is one of the biggest problems is that if you are new to the system and in crisis and trying to get help, your resources are very

limited. if you call suicide prevention and if you are suicidal, they are going to call the police who then most people don't realize are going to come to your home and take you in handcuffs in the back of a police car to the hospital. most people are appalled and horrified by this, many are. that is the system and unfortunately we don't have an alternative to that. >> thank you. the situation just seems to get more and more complicated the more i listen to you. i just wanted to tell a short story talking about people who just want to be heard. i worked for an organization that has an open house once a week for drug users. my job was

to go around with an ur sac survey that i did but what i did i asked them questions and then listened to their stories. and everybody wants to be listened to. dpa organized during those years trying to eliminate those silos and trying to integrate more efficiently, has that helped? >> i'm a contractor for cds so i have to be tactful. i can only speak for myself and say that i feel that within dph, there is for the most part i think we are still struggling with this

siloed system. the reorganization and some of it, there was a plan to have more of a transitions program where we had one individual managing or helping care management for somebody who had multiple issues and i don't know where it is or why it got stalled. i can only speculate. what i would say is i'm not sure what the answer is, but i do know that's why i love the cit because nobody ran it. it wasn't run by hsa, by the police department, it wasn't run by anybody. we were all in it together. there was no entity like that in the city. that's the beauty of cit. i wish there was more. what we need is a container a framework where people like myself, like jenny, the

mental health association, like michael who is gone now, if we can all get together and say before the city makes anymore policy decisions about where this money is going to go, let's look at this and have this input. because sometimes we don't share too well together. we don't work too well together. it's an over stressed system and the problem is that often people are working in their own wheel and lose track. services wide, there is a lot we can do but more we can do to make it easier. >> thank you. tactful honesty. >> thank you. council member at that time -- kostanian has a

question. >> thank you, we were facing issues not only from people offering services but the community. they were totally floored that there was no place to go to and nobody to really hear our stories. i think instead of just floundering around, we really have to sit down and ask the community to step forward and be participants and not to be controlling. that's the same thing that patients feel, that they are controlled. you can't do that to human beings. >> that's true. i agree. >> so to step away from that, i would love to be a part of that. >> i'm hopeful. i feel the winds of change are blowing where they will take us, anyone knows but i agree. as a nurse, i think that was the problem that essentially what we are dealing is the history of when behavioral

health was created years ago nobody had ever done it. all they did was unbundle the state health services. we are still dealing with the effect of that because in the state hospital services nobody talked about vocational rehab. nobody talked about this. all they talked about high level emergency care and the case management. it never got beyond that. >> the other part of that is where the funding becomes the problem too. >> but we are penny wise and pound flush. that's the expression my mom used because we are spending lots of money. we are spending the money anyway and we can do so much better. >> nobody is telling where it's going.

>> thank you. any questions of staff? anyone on the bridge line? >> okay. we are going to pro to item no. 10. community perspective on crisis intervention team. jennifer friedenbach. i would like to make a change. is it okay to go to item no. 11 before ms.

frieden en bach comes in. >> thank you. i will keep my report pretty similaring today. i think that cochair supanich has covered the ada celebration nicely. i will skip that. i wanted to tell you a little bit about the city hall centennial and the u.s. conference of mayor's. you might have noticed as you walked in the civic center plaza is set up for a big party, this is the celebration of the 100 anniversary of city hall and the conference of mayor's san francisco is hosting and president obama was here at the hotel. as we leave this afternoon, you may see them gathered. they will be here in the building for a big gala this evening. there are many

break a ways and conferences taking place over the next few days. city hall, when we think about the centennial, what makes me the proudest when we look at this palace is to think about how accessible it is and how successful we were able to make a qualified structure and that is represented by not only in this room where we sit in where the council has the diose that is raised and accessed by ramps but also extends to things like our board of supervisors where we meet to talk about the legislation that's necessary for our quality of life and the fact that the board chambers are fully accessible and that their meetings are captioned and we can all watch them at our leisure on television and be fully engaged in the

process. the celebration is going to be out in the city hall plaza tonight and it's open to the public. there are going to be two bands, one at mccallister and the other one at the grove street corner. later as it gets darker, there is going to be a performer called vand loop and they are going to be trapeziusing down. it's lovely to see them watch and dance suspending from the rope. there will be a light show tonight starting at 9:00. it's nice how city hall gets lit up when the giants win the series it goes orange and black. it's nice that we'll

have this led system that they will be able to adjust the light instead of putting a piece of plastic that is orange to the lights to get that effect. so the light show will be demonstrating that and the lights will be creating patterns and such. but one thing that will be really interesting is that there are these project ors that sit on the top and they will be creating the images across city hall so you can put for pride or put text for the 100 centennial of city hall. basically it's just this great new sort of public art space. so i hope you will join us. i will be out there after the meeting. that's my plan tonight.

speaking of public art spaces. i wanted to profile our mod ada transition project going on now, that's the renovations of the bayview opera house. the bayview opera house is this cultural treasure out in the southeastern part of the city, in district ten, malia cohen's neighborhood. it's an opera house built in 1888 and has a central role where the community can come together where they have civil disobedience in the 1800s where people can protest out in front and about affordable housing. what our office has done is we have funded a barrier removal

project to start the full renovation of that facility. what's going to come out of it is a fully accessible front entrance. no more back doors for people with disabilities which is how we've gotten into this building over time. it's really going to be the universal access perspective that comes comes in the front door, even people with mobility disabilities. that will be the beautiful ramp that will come across the entrance and there will be fully accessible restrooms and along the line of the public engagement and resource there is going to be an amphitheater where people can gather inside and the opera house as well as outside as real public space. we are looking at getting a little bit of press about this that ties in nicely to the

connection between civil rights and disability rights as we look forward to the ada 20th anniversary celebration of our own. look to your newspapers. we hope they will take the bait that we are dangling and this is a great story of our collaboration and coalition of our communities. the last thing i would like to say is i want to put a save the date note on your calendar, saturday the 26, will be the festival. for many of you that attended the disability pride celebrations in the past, the ones that have taken place down in san jose. this is a collaborative effort involving the local independent living centers whether it's silicon valley, or marin or berkel