897 san francisco police department personnel trained. on the 40-hour training. and then on the tactical, 10-hour use of force and 10-hour tactical de-escalation, where they form a team and respond, i have 1600. >> co-chair blacksten: i see. ok. that's excellent. i'd like to go to staff. do any people, joanna or anyone else have questions? >> lieutenant molina, thank you so much for this presentation. it's always a pleasure working with your office. i keep contact with your accomplishments through donna and it's always a pleasure to hear you come back and report. it's wonderful work indeed. being located in downtown and market, we've seen your officers

in action and it's been wonderful. i have a couple of questions about the makeup of your calls. do you do -- i would imagine you do quite a bit of work with the homeless population? >> there is. >> and crisis situations. would you say what the percentage is between responding to somebody's home who is trying to kill themselves or harm household member, versus people on the streets? >> i don't have that percentage for those numbers, but i can tell you that based on my conversations with the director of the pes, he says that it's 70% of the people that come to psychiatric emergency services are homeless. 70%. >> so that's a very high correlation between being on the streets and mental illness. >> it's a crisis. even if you're not mentally ill, if you're living on the streets,

it's dramatic. yeah, it's dramatic. imagine not having a roof or wall around you to protect you. you're sleeping on the sidewalk, and anything can happen to you. that's why people on the streets are suffering as we all know. so i can just tell you briefly the numbers that i have. last year, san francisco police officers responded to 18,245 calls for mental disturbed person. a person suicide, 4601. a juvenile beyond parental control, 457 of those calls. 5150 call, that is usually from clinicians or mental health workers asking for assistance from the san francisco police department. we went to 839 of those calls. we went to mentally disturbed person in crisis, which means

the person has a weapon, an edged weapon or blunt weapon. we went to 274 calls of that. a person attempting suicide with a weapon. we went to 55 of those calls. so in total, we responded to 24,471 calls last year. and we responded to an additional 28,657 calls on check on the well-being of somebody. so that total of 53,128 calls. >> wow. and those had positive outcomes? >> i can give you -- yes. i can give you some of the outcomes from those calls. because we have to measure how we're doing out there, right? so with the use of force, i can tell you a little bit about the use of force. out of the 53,128 calls we

responded to, there were 184 were force was used. so that's 0 .2%. that's just the mental health. so physical force meaning restraining somebody. we had 184 of those. 111 of those were just doing that, restraining the person in place to handcuff them or take them to a place of safety. 22 were person that had to be either punched or taken to the ground. spray, three of those, the entire year. weapon, the police baton, three of those. the shotgun with the rubber

bullet, 7 of those. out of the total calls responded to. pointing a firearm which is considered a use of force, if i point my firearm to you, 37 of those. the police department responded to 755,629 calls for service last year. out of those, 2,930 force was used. out of the 2930 uses of force, 184 were used for mental health related calls. that brings me to the 0 .02%. >> those are fascinating statistics, thank you so much. >> co-chair blacksten: thank you for all the information. i know we're running tight on time. we could certainly spend a while here. there may be people who would like to ask you more questions.

so anyone else on staff? all right. well i want to thank you, lieutenant, for your time. and those are all the questions we have for you. and so we'll let you sit down. now, i'm going open it up to the public for comment. this includes the bridge line. i think we have two comments? >> two, yes. >> co-chair blacksten: all right. >> thank you, council. again, thank you very much. >> walter park? >> thank you very much, i'm going use my three minutes to combine several comments. first of all, congratulations to the mayor-elect, you probably saw the story in "the chronicle" she had a mile wide smile while

talking to kids at her old elementary school, rosa parks. that's the beginning of the honeymoon, we'll see how long it lasts, but we all feel good about this. you have two important comments today during -- which were not related to an agenda item in the beginning of the meeting. i hope you consider each of those to be complaint. each one was extremely well formed and was a complaint. you don't need a written form to accept a complaint. i would like to hear very much on what the mayor's office on disability reaction is to both of those. because each one is a very separate important issue. on item number 6, this is such a complicated issue. it's one that no one in this room, except for perhaps the last two speakers have much expertise on, but it's important to all of us around the country

these days. people with disabilities lives matter. it's kind of what our take comes down to. i would like to know if a council or mayor's office on disability has goals for the relationship between people with disabilities and the police department and to a lesser extent the sheriff's office in san francisco? i don't know that you do. i would like to think that san francisco was doing better on this than many places are, but i read the paper as you do, i know we're not perfect. we have problems. i think that setting some goals and some metrics that relate to those goals on -- i don't know what they might be -- could be tools like the use of cameras, could be events, could be outcome of events, if you would create some goals and come back in six months, how did we do, some this discussion needs to be

focused and that's a way to do it. it's much too important to say, we like you, you like us and then move on. i hope you'll be as specific as possible in replying to all three of what i mentioned. when i was a member of the board of directors of the disability rights advocates, there were a lot of police problems in sonoma county. this was 15 years, and i tried to get them to sue. it's very difficult to do. the first good response is training. the second is community engagement and the third in the end is lawsuits. we'd like not to get there, but in many cases around the country and perhaps here, we will have to go there [bell ringing] i hope you will take leadership in doing that. >> co-chair blacksten: thank you for your comment. we have a second comment.

>> we do. zack. >> hi, thank you. i want to thank lieutenant molina for the thorough presentation and the wealth of statistics and information he shared. i did want to learn a little more about the training that take place, which is a common question from the staff. because to me training don't mean much if they don't include community involvement and disability oversight. this is not just an issue i find with public service, i find this in the medical profession as well, there are trainings being done, but they don't include disabled people in the trainings. so i would love to see community involvement with people with mental health and physical disabilities working with the department to make sure that concerns are being treated appropriately. i personally, would volunteer my time to help with that. i think that would be a wonderful step forward.

i also am very concerned that people with mental health disabilities struggle to understand their rights, the laws are complex, miranda right and all that kind of thing. i was wondering if the local government would be interested into looking into a city government where someone could work as a liaison for people with mental health disabilities that might not understand what a phone call means at a police station. maybe that is already done, i don't know, but that would be very, very helpful for those interactions between the department and people with mental health disabilities. i would hope that liaison would not be employed by san francisco police, but someone from the community or part of city government. lastly, i wanted to address the issue of rubber bullets. i've never felt a rubber bullet. i understand it's quite painful

and i'm concerned that they're going to use shotguns of rubber bullets. i remember reading in the news that u.s. marine scott olsen was shot with a single rubber bullet to the head, it fractured his skull and caused brain damage. it resulted in a $4.5 million settlement, which is expensive and mr. olsen will never have his full brain functionality back as a result of that. i would like to hear more about that. >> co-chair blacksten: thank you. we have one more comment from the public. >> david elliott lewis. >> hi, i'm a community member. i'm somebody with lived experience with mental health challenges. somebody in recovery. i've been part of the cit working group for the last half decade. i'm one of the presenters, one of the people who designed the

curriculum and i wanted to address the prior question about community involvement. what is unique it's a true community-police collaboration. it doesn't happen a lot, but the training is designed and put on by both police officers and members of the community, such as myself, people with lived experiences with mental health challenges. we have people from san francisco suicide prevention, people from national alliance of mental illness, the health of san francisco, the department of public health has been mentioned. and we meet every month in our working group to review the program and to help put forward training. we meet quarterly with the police chief as well to make sure the program is supported and he does support the program. and when officers go through the 40-hour training, they're hearing consumer voices, they're hearing voice was parents who have had loved ones in crisis

and had to have police come to their home because a loved one was in crisis. so they're hearing real world stories from myself and others who have lived experience. that's a unique part of the program and i'm glad they're doing that. i also wanted to address an earlier question about evaluations. as part of the working group, i get to look at the student, the officer-student evaluations of what they thought of the 40-hour training. i read through thousands of them. by and large, they're appreciating it. they're learning things. they know more walking out than they did walking in. so while a few might have said a few negative things, the overall majority has been positive. and i think that's really encouraging to me as an instructor to hear that. and to know that the program is having a positive impact. we've also looked at changes in use of force. and it seems to be in the last few years going down. so i think there has been a

change of culture in the police department, but i think this cic program has had an effect in teaching the core principles of creating time, distance and rapport when responding to a crisis. officers no longer rushing in, guns drawn, but creating a boundary, developing rapport, taking their time, calming somebody down. and it's working, it's actually working, saving lives. and i hope you'll come on the 21st to our award ceremony. you will hear remarkable stories of people with weapons, who just a couple of years ago what have turned out horribly. and these people were saved, toques tacked down talked down. i hope you come. 1:00. >> co-chair blacksten: thank you very much. do we have any comments on the bridge line? no comments. all right.

this is a very interesting and compelling subject. as i said, mental health is absolutely a leading issue of our time. and we really appreciate everyone's comment. however, we're a little bit behind schedule. we're supposed to be at break right now after the second presenter. >> to the chair? this is joanna, i am wondering if we can actually go ahead and give a break for the interpreters and captioner? and proceed with the presentation after the break. >> co-chair blacksten: i really appreciate that. that's great. so according to my watch, it's 2:16. let's come back at 2:30. we'll see you then.

>> co-chair blacksten: here we go. second half of our program. we're ready for number 7 on the agenda. presentation by tanya mera, jail health services, director of behavioral health. and re-entry services,

department of public health. welcome to the council. >> hi. i'm melanie, i'm the deputy director of the re-entry services, tanya had to go home very sick today, i'm sorry, she apologizes. i'm going to do the presentation. anybody very handy at this? because it seems to have been -- hold on. here we go. ok. so we're going to discuss mental illness and the criminal justice system. the causes and intervention strategies. so we're looking at the prevalence of disorders in the jail population.

in the jail population, 5% of folks have a diagnosed mental illness. in the jail population that rises to 17%. when we look at the census of any correctional facility, we're looking at 17% of incarcerated folks having a diagnosis of serious mental illness. but of the 17%, 72% have a co-occurring substance use disorder. 28% don't. so our research shows that folks of various form of mental illness are highly overrepresented in our criminal justice system. but what we're still not clear about with data, and research, is the exact relationship between mental illness and criminal behavior, paying particular attention to violent behavior. and how to best reduce offending and folks with serious mental illness who have come in contact

with the criminal justice system. so historically, we placed blame on the institutionalization, like closing state hospitals, cuts to mental health spending, tougher civil commitment laws and that's the narrative we generally have whenever there is a major argument or case, or something goes awry and it's a big story. we'll hear, well, they closed all the mental hospitals, or there is not enough mental health resources out there. this suggests that because people are not locked in a hospital setting, they ended up being locked up in a criminal justice setting. which raises questions. are mentally ill people more likely to commit crimes because of their mental illness? is the blame to be placed on the lack of community resources?

is treatment the solution? all the research so far shows no. those questions and those common mutterings we hear, that we ourselves probably say, are not what research has pointed to. the existence of a serious mental illness alone without a co-occurring substance use disorder, affects 78%, i not linked to increased likelihood of criminal behavior of recidivism. and that's very important. folks with serious mental illness who do not have a substance use disorder are typically not the folks we're seeing most often coming to jail. the existence of serious mental illness alone is noted linked to

likeliness of recidivism. increased mental health services often do not translate into reduced recidivism, even sta state-of-the-art services. even the best treatment planning, where money is not a barrier, even with that we're not seeing results. the institutional population of the united states has not been stable and proportion of the population in prison and jails has grown dramatically, while the decline in mental hospital beds has slowed. we did see in the 80s a huge decrease in beds, but we've seen the jail population go like this. and seen the closing of beds slow down significantly. declined instate hospital admissions cannot account for the increase in the prison and jail populations. incarceration is not always the direct product of mental

illness. typically, it's not. when we look at this grax, what we're seeing -- graph, what we're seeing is 66% of folks are not booked as a result of their mental illness or even their substance abuse. more are incarcerated due to their substance use disorder than their mental illness. that is still significant, both in the population of folks with mental illness and population of folks who don't have a diagnosis. substance use is a bigger factor all across the board. >> council member madrid: can you tell us -- >> let her finish. >> council member madrid: just ask if you could describe what is on the screen, because most of us can't see. >> so sorry about that. we're seeing a pie chart. and the pie chart is a code of

is 113 post booking jail diversion cases. how likely is it that the inmates' offenses were a result of a serious mental illness or substance abuse? 4% of those folks, not a big number, were as a direct result of their mental illness. so that person, for example, that i will see in jail on a daily basis, but is a minimum part of the population, would be for example an adult woman with schizophrenia who was very symptom attic and hit her mother who cares for her. it's a very small percentage. 4% are indirect effect of serious mental illness. this could be poverty or homelessness. could lead to a crime. we'll speak more about poverty in a later slide, but poverty can be direct effect of mental illness. someone can end up in jail.

or shoplift. 4% would relate to those. 19% are a direct effect of substance abuse. not in the direct population, but the folks in jail, 19% are there due to substance use as opposed to mental health or anything else. indirect effect of substance abuse is 7%. so someone spoke earlier to lieutenant molina, somebody committing a crime because they were under the influence, we'll see something like that. and then 66% have nothing to do with any of those. not with mental illness, not substance use and as we'll see in a later slide, poverty, criminal thinking, socialization. we'll get to that. other contributing factors, substance use. rising numbers in jails and prisons for drug offenses, since the 1970s, we've seen a significant increase in drug

use, particularly in the seriously mentally ill folks population. punitive policies that can sentence people for longer amounts of time based on a variety of factors, mental illness being one of them. self-medication and vulnerability to drug use among folks diagnosed with serious mental illness. and i think mr. madrid, you're the one who asked about how to distinguish between somebody who is showing symptoms of a serious mental illness versus somebody who may be under the influence of methamphetamine. so we'll see exacerbation of the symptoms if someone using substances does have a mental illness. there is a bar chart at the bottom that looks at numbers. state prisons, federal prisons

and jails, in 1990 and 2010, we are seeing very, very significant chart of people who are incarcerated due to drugs. way more than we used to see. other contributing factors. poverty. some people with serious mental illness may engage in offending and other forms of deev yant behavior, not because they have a mental disorder but because they're poor. their poverty separates them and places them at risk. we see that throughout san francisco. we can walk outside and everyone here walked in and walked by something going on that is just a result of where we are right now. this is significant. the other contributing factors, the eight dynamic risk factors.

we know that certain risk factors predict involvement in the criminal justice system for the general population. including anti-social cognitions. criminal thinking. rationalizing criminal behavior. or belief that the crime was justified. blaming others and showing lack of remorse. we have a good amount of that in jail. anti-social friends and peers. peer influence that per swadz the individual to engage in criminal behavior. a poor ability to control temp ra mment, running away, skipping school, fighting, possessing weapons and damage to animals or property. many of those start in youth or adolescence and we continue to see those and they end up in jail unfortunately. family and marital factors, lack of emotional support, inability to problem solve and communicate

effectively. difficulty expressing emotions in an appropriate manner. substance use. it's very important, which is the use of drugs or alcohol that significantly affects someone's ability to engage in a successful and productive lifestyle. a lack of education, developmental disorders and neurocognitive impairments, both organic and acquired. few leisure activities and poor employment history. all of those things can contribute to incarceration, both in the general population and population of folks with mental illness. those with mental illness have significantly more central risk factors and these predict recidivism more strongly than the illness itself. people with mental illness on this graph, 52% of folks without

mental illness presenting with specifically more central 8 dynamic risk factors. we'll see anti-social behavior, substance use, a lack of family support, a lack of support of community. things when people are more vulnerable, they can get taken advantage of or put into situations where they're not fairly treated and end up coming to us that way. we cannot address these risk factors without treating the mental illness. what we have here is a circle that lists mental illness in the middle and the other eight factors all around it. the lack of education, anti-social attitudes, anti-social personality patterns, peers, substance use, family and marital factors, leisure, activity. if we pick any single one of those out, poor employment history, and we only focus on that and not the mental illness, we're doing a disservice to the

individual because we're not addressing something significant that lies at the core of why there is a poor employment history. same with all eight of these. substance use. we can put them in treatment, but if they have bipolar disorder, and we're not treating that, we're not being as helpful as we should be. we address the risk factors. individual risk factors for recidivism. if the risk factor is anti-social behavior, the need is to build alternative behaviors. if it's anti-social cognitions, the need is to develop less risky thinking. if the risk factor is anti-social attitude, the need is to reduce association with criminal others. if the risk factor is family and

marital discord, the need is reduce conflict and build positive relationships. if it's poor school and work programs, we would enhance performance, often use a system of reward. if the risk factor is lose you're or recreation activities, we enhance outside involvement. and if it's substance use, we would reduce use through treatment. not forgetting that mental health is at the core of this. evidence-based intervention, this is kind of my thing is where we focus resources and high-risk cases. we find that the best outcome comes from the highest risk cases. we find that in our collaborative courts. we target needs such as anger, substance abuse, criminal

generalic peers. we use cognitive behavioral techniques, including thinking for a change. which we're studying right now in the jail with doctor scheme and we're calling it change your mind, to see if we can make an evidence based intervention for folks to really change outcomes. and integrated dual diagnosis treatment, we can't treat the substance abuse if we're not looking at mental health. supported employment, supported housing. supported is the key word. we need it, but not good luck, a here's your apartment, we're not going to see as much success if we don't have someone going there to support you when you're making the transition. we have one mental health court. we have behavioral health court, we have misdemeanor health

court. i work in our behavioral health, our misdemeanor behavioral health and the changes i get to see are amazing. i get to see people live lives better than they had ever anticipated. and i'm lucky that i get to do that work. i love it. that's the slide show. that's the presentation sort of what we're doing in jail when folks do get to us. as lieutenant said earlier, we see it as a failure when someone does get to us, but there is no wrong time to start helping. so when folks do arrive in jail, we're happy to help and pick up. and sometimes, unfortunately, that incarceration or arrest is the event that precipitates the actual change, healing and wellness, it's not ideal, but we do the best we can.

>> co-chair blacksten: i want to thank you for your presentation. and this is of real interest, what you're doing in the jails. it's fantastic. i know that there are some community organizations which includes religious groups that come in and try to help as well. so you're all out there doing good things. i want to open this up to the council. are there any members, colleagues, who would like to ask questions? >> council member madrid: i do. i have a question. a couple of questions for you. one question is i know that the problem is that -- >> could you repeat the question? >> is my primary work with jails? >> yes, or community? >> my job is interesting, it's a bit of a hybrid. my office is in the jail. and i'm in the jail every day.

i'm also in court every day. and i'm often in the community every day. and i sort of follow people from the time they get arrested until we get them into some form of stable treatment that will address their needs. and then i'll follow up with them during the court process. >> council member madrid: so my question is, how do you see peop people -- civic center, i understand there is a challenge right now between mental illness and drug abuse usage. so i understand that lieutenant just spoke about trained

officers that identify those issues. can you educate us on what you guys do, specifically on those people, and how many percentage of people that go back to the streets? >> sure. in a crisis situation on the street, as lieutenant said, is not the right time or are the police the right people to make the distinction, this is a symptom of a serious mental illness or what we're seeing, methamphetamine use typically. my staff is really good at differentiating that. we have the luxury that no other social worker in san francisco

has, which is time and space away from the drugs. so folks who come in presenting with psychosis or mania, paranoia, all the symptoms that we see that can mirrored in both mood disorder, thought disorder or substance use, if it's substance use, it goes away typically. there are instances where the substance use has been so significant and so prolonged we'll see the symptoms linger for a really, really long time. for the most part, if somebody comes in and they've been out five days using methamphetamine, in four days after they've slept, eaten and showered, they're not longer presenting that way. so that's a luxury we only have in the jail, that our counterparts in the community don't get to see. they're seeing folks come in every day, using or not and get to know them that way. we get to distinguish them.

it's not to say one trumps the other. they're both significant. we want to treat both people coming in, the person with the smi and the person with the significant stimulant use disorder. so we typically see them clear if it's just substances. if it's both, mental illness and substance use, we'll address that, treat the symptoms, we have psychiatry, clinicians, we see people very regularly, we have psychiatric housing units in the jail, where we're doing groups, thinking for a change, thinking safety, where people can talk about what is going on with them. we bring 12-step in the jail also. how many people relapse? both are chronic. serious mental illness is chronic and treatable. and substance use is chronic and treatable. it depends on the person. someone in smi diagnosis is more

likely to relapse than somebody without one. but we've seen people doing great. walking over here to the civic center, i've seen people who are not doing great. >> co-chair blacksten: are there any other people on the council that have questions? >> council member mcdonald: if that's you unprepared, that was very impressive. >> found out an hour ago. >> council member mcdonald: very good. >> co-chair blacksten: i just had one quick question. i know that the group that comes into the jail to do services and you know, hold different kinds of sessions, are you still doing quite a bit of that? >> oh, yes. we host all kinds of groups, everything from the spca brings in animal therapy, pet therapy to our psychiatric housing units where folks get to play with the therapy dog. when i see the dog, i'm having a

better day. so someone who doesn't get to leave at 5:00, it makes a big difference. >> co-chair blacksten: that's great. i heard of one situation, i don't know if it's san francisco, i have a guide dog. and they were bringing -- they had someone bringing in these little puppies to do therapy for the people in jail. so that's what you're talking about then with the animals? >> the spca trains people to bring their pets in, they train the person and the pet to go into hospitals, jails, all type of environments, to do pet-assisted therapy that is to reduce stress. it's beautiful. ever since we started it a couple of years ago, especially with the ladies in the psychiatric unit, we see women

looking forward to monday. it may seem so simple, but acts of humanity and kindness and thoughtfulness, they don't go unnoticed by both our colleagues and the folks we're trying to serve and help. it's pretty empowering. >> co-chair blacksten: of course, i know the service animals they bring in, that works as well. i'd like to open it up to the staff. any questions by staff. >> thank you so much for pitching in and helping us with this presentation. very interesting. i'm wondering if for members of the public and for the council, you can talk about the differences between behavioral court and drug court, how is it working together? >> excellent. in san francisco, we pride ourselves on our treatment courts. we have several. i mentioned a few, behavioral health, misdemeanor behavioral

health, drug court, mental health court, we have young adults court, it targets the needs of 18-24-year-olds. we have a veterans court, that targets veterans. the community justice court up here on polk street, those are quality of life crimes, folks who may not have a place to use the toilet and they get cited for it. stuff we make take for granted. if we're able to be here and showered today, not all folks can. we have different courts to address different needs. behavioral health court, three things are needed. it's voluntary. if you have your case removed and put in treatment court, you have to want to do it. would have to be diagnostically eligible, which means you need a serious mental illness diagnosis

or a cognitive diagnosis and be a regional center client. either you on of those. -- one of those. it can be a little confusing, they both address behavioral health. for drug court, you have to have a substance abuse disorder. that's not enough to get you into the court. so we will have attorneys going, look at him. you know, he definitely needs treatment, but he belongs in drug court. there is not a major mental illness that should be addressed by our court. or by the resources we have in that court. so drug court expects people to go to treatment, be successful. it's san francisco, so we always talk about harm reduction models in all of our courts and that's significant, but what with we hope and the d.a. and the judges hold, is that abstinence is a

part of harm reduction. it's not separate. what is the ultimate harm reduction? not using. it's a continuum. they don't get taken back into custody because they relapse. what it does, it brings us to the table. we have the judge two days a week, the d.a., the public defender, someone from my team and then a representative from city-wide case management and probation. we sit at the table and discuss every client on the court calendar that day, how they're doing, how we can support them. if someone is doing well, we give them a $10 gift card. if they're struggling, the judge may give them a stern talking to. not as punishment, but if the person is doing so poorly they may re-offend in a greater way or harm themselves, they may get remanded until we have a new

treatment plan, but that's always the last. we may have placed them on a 5150. we sent them to a new program. i mean, we've done everything and we're well worried about their safety, we'll bring them back to stabilize. please stand by.