seems to be compliant, but then he or she becomes aggressive. so sometimes you have to use force to prevent him or her from hurting themselves or somebody else. so we give 100% view of what is going on with the person. this program is supported by the leadership of the police commission, the command staff and also by you, council. thank you for your support. the public defenders office. the police accountability department and the mental health board. and other agents throughout, providers, advocates in the mental health system. so in the last 2-3 years, we're getting feedback from the officers, having that tactical training that i just described to you. so we created a follow-up

training to the 40 hours. we call this the 10-hour training and it involves responding to a person in crisis and how to handle the situation. so our officers right now are receiving at least 60 -- 50 hours of cat training, 10 hours with use of force. so to give you an idea where we're at, the san francisco police department is divided into two sections we have the metro division, the downtown area and the golden gate, which is the outer part of the city. so in the metro, we have 326 officers that are trained in cit. and the golden gate division, 278. and we also have a specialized unit like the s.w.a.t. team. we call it tactical unit. we have narcotics. we have investigations, homicide, all the other bureaus.

we call that specialized unit, so we have 293 officers trained on that so we have a total of 897 officers. the memphis model requires 20% of training. we're about 46-47% of training. and the chief's goal is t continue to train. our goal is to train the entire department. so lking at 3-4 years to get everybody trained on the 40 hours. now, fort 20 hours, for the 10 hours use of force and the 10 hours of tactil de-escalation, we started that training back in february of last year. right now, we have 1600 officers trained in that. to me, that was very important training because this is the training that allows the officer to form teams and u de-escalation skills when responding to a person in crisis. so what we've been doing for the

last 15 months or so, is having classes twice, sometimes three times a week with the officers. the police department has 2200, it doesn't lose everybody in the police department, so we're 1600. so i'm very optimistic that we'll be done before the end of the year on doing the tactical training. casee the difference on the streets. i can hear the officers on the radio responding to crisis and asking for resources before they get there. so it's working. we also -- part of our goal is to train captains, lieutenants, everybody in charge of the officers, right? the boss has to know what the offices are doing. so we had night captains trained, 30 lieutenant, 76

sergeants and we continue to train them on the tactical aspect of it. the captains, lieutenants and sergeants are reqd to come to training with their officers, so everybody is on the same page from the top to the officer rank. i know i'm here to talk about our partnership with the department of public health. at the beginning of the end of the 2016, the late mayor ed lee asked the department of public health to create a partnership with the police department on responding to crisis. so they created five openings for clinicians that were going to be assisting us. i know right now, there are four. clinicians that are helping us.

we have an mou, that describes our partnership. the department of public health provides srt we ve, for instance, a barricaded suspect, a person, an individual who has barricaded themselves in a room, a house, and is going through mental health isis. it can be two different scenarios, it can be a person who committed a crime and is barricaded or someone who is suffering from a mental health issue. there is two difference, one is a criminal justice component and the other one is not. mental health issue is not a criminal isst all. so at the beginning, we approach the same way as far as time and distance, getting resources there, and if we believe that the person is not a danger to themselves or others in the

house, we'll wait. and we wait. and we talk. and we wait. we go some instances that have been resolved within hours to a day and a half. while waiting for the person to contact us back. like i said, every case is different. so sometimes we have to make entry for the safety of another individual inside the house. but the majority of times, the instances i have responded, we just wait. and we know sometimes it's difficult. especially when the person is using drugs. it's a higher time lapse that we expect for the person to come down to acknowledging that the police is on their side and we're trying to get them to a place of safety. so how do we utilize these

clinicians? so i, myself, get the phone call from the department of communications telling me there is incident involving a person who has barricaded themselves in the residence, or apartment, or anywhere in the city of san cisco. i then contact the department of public health telling them what we have, because of the emergency situation, i'm allowed to ask the department of public health whether this person has any record with them. the reason we do that is to provide support. a good example of that is a person that was in a spectrum, asperger spectrum and i was able to contact department of public health and they were able to give me information about how to w ths individual. we used that to talk to him, to come out of the apartment.

and it worked. the information we received from the department of public health about previous encounters with them, either in the office setting, during the interviews and process, was provided to us under extenuating circumstances and that information assisted the police negotiators that were at the scene and got this person to come out. officers didn't get hurt. he didn't get hurt. and we took him to a place where he was treated forit. that's an example of how we use mobile department of public health. we also go out with the clinicians on wednesdays and thursdays. we have conferences. they have names of people they're working with, but don't safe enough to go to the houses because of previous situations, known history about the person.

so two of my officers and a sergeant would join. they have a brief consultation about what the needs are for this person. and we get into cars and respond to this person's residence or location and we try to contact them. the goal is to get this person to a place of safety. and basically to have everybody around them safe. because that's our basic concern, right? our goal is to avoid crisis. i'm a true believer if we're proactive on the streets and do outreach, reaching out to the person that potentially might encount encounter a crisis, if we get to that person before the justice system gets involved, i think we have done our job. i feel that when we talk about services where the person is going to jail, somehow we have

failed. because he got to that point. he sho't be like that, it shouldn't happen like that. whoever needs help should be given services before we get to that point. that's our goal. to intersect these individuals before they get there. we do that on wednesday and thursday with the department of public health. we recently put a program into place called the liaison officer program which is in san francisco, we have ten of them. they're assigned to a district. they're going to be the person working with the department of public health directly. they don't have to come to my unit. we have sustained training with them already in the department of public health. they met each other. they talk about what the issues are in the district. and now they have direct line of commune ctis between the department of -- communications

between the department of public health and the police department. that is our goal to do that. i don't know if you had the opportunity to see what the chief has been talking about. my unit has submitted a proposal. my goal is to have a clinician riding with a police officer in the car. i think most of the cities south of us, l.a., san ego, metropolitan cities, have those programs. why not here? how come san francisco d have that? san diego has it. san bernardino has it. why not here? so that's our goal. chief has ok'd the proposal, he likes it, he wants to move forward with it, and he presented it to mayor farrell and now we're just waiting to see what happens. but that is some of the goals

we've planned. this clinician with the officer will respond to calls for see. they're not going to be the first unit responding, they're the secondary unit, because i don't want to put a civilian who hasn't had the traininin harm's way. but they will come in and take care of whatever needs to be addressed as far as the trt fen that person. i think that the department of public health will have better access to services that a police officer's knowledge will hav aet that time. it's oy right that the department of public health have a health worker who is able to navigate this person to their system. i think that's a very more efficient way of dealing with referring people to treatment, than a police officer who has limited resources like psychiatric services. if we have a clinician, health services that has access to

their system, they can find a better way to te this person to treatment. so this is some of the goals that we have for 2018. and hopefully we'll see that soon. our chief is very supportive of it. and obviously there is room for improvement in our unit. i think we need to improve on how we collect data and show the good work that the police department is doing in the mental health field. because not often it's been talked about, the good work. only the bad things that happen are being talked about and discussed. but we have to talk about the good stuff that officers are doing. but that doesn't hole us back for celebrating our own officers. so next week, i'm inviting all the council. we had a cit award ceremony. we're going to be recognizing 22 officers that used de-escalaon

skills and brought the situation to safety for the individual and the officers and were able to take this person to a place of care. so we're going to be celebrating 22 officers and one dispatcher. that was able to commu over the phone with a man who was talking about suicide on his way to franancisco. we were able to find this person and get him to a place of safety. so, that's it in a nutshell. i'm here for any questions that you might have. >> co-chair blacksten: hold on. >> so the award ceremony is on thursday, 1:00, june 21. 19th avenue. >> co-chair blacksten: that's great, thank you very much,

that's a very compelling presentation. so what i would like to do is open it up to my colleagues here on the council. do any of you have any questions? for this lieutenant? >> council member williams: i do. perhaps i just wasn't listening closely, but when you were describing the category of weapons, baseball bat, somethi steel, it was a classification of a type of weapon. are there different classifications of weapons,re the different guidelines around using a more lethal weapon like a gun or knife? >> there is a difference. basically, a gun can harm you from here to a block down the street. so it's a different tactic we use when approaching a person with a gun, than a person with a

weapon, a knife. we have different tactics around that, how we approach a situation like that. but we tried to use -- the goal of the training is to tell our officers, the de-escalation technique can be used in every call that you go to. they also get trained on how to handle situations with a firearm. because that's definitely a more immediate deadly weapon. >> council member williams: right. and more importantly, are there guidelines around if they do not, you know, drop their weapon? are there difnt greuidelines for what your response will be? i'm not clear about that right now. so much about the tasers, could you explain that to us a bit. >> i'm not going to discuss the taser, because i'm not in with. but i can tell you that if what

we have is a less lethal option. so we had shotguns that shoot rubber bullets. so when we respond to a person that is holding a knife, we have an officer on the team that i explaive the communicator, we have the officer with the less lethal option which is the rubber bullet shotgun, when it hits you, it's like being punched. so it's a sock in a shotgun shell. and then we have an officer with a firearm that has the leelthal weapon. because if that nonlethal weapon doesn't work and the person advances with the knife, there is potential death to the officers, so we have to have a little cover. and then we have the arrest team standing by with them and a supervisor. so when dealing with the person

with a weapon over blunt weapon, there is less lethal shotgun involved by policy. so you have a less lethal option. but when you confront somebody with a firearm, he has a lethal weapon. that can be shot at you. from any point you're at. and that's a more dangerous situation than the person with the knife. >> council member williams: thank you very much and i want to thank you for your service to our community. >> thank you. >> co-chair blacksten: all right. let's see, thank you, kate. now i understand alex has a question. >> council member madrid: yes, i have a couple of questions for you. one, my first question is, is those officers that you described to us has a body --

that's one question. and the second question is you talked about training and do you do a hands-on training for those officers? and lastly, i understand that some of people that has mental health or has like homeless people, can be on drugs, so how would you train officers?

>> good questions. the training in regards to mental illness and drug use, sometimes the symptoms appear the same. so what we do with our officers, don't try to diagnose what is happening to the person. if it's drugs,s going to mimic the same symptoms, but it might be the same symptoms you see in a person that is mentally ill. organic issues. so we ask our officers to treat everybody the same, so they don't, oh, my god, what do i have here? so they focus on that more than anything else. and then if we believe that the

person is in drug crisis, you see that with the person taking the clothes off, the skin is getting red and hot, so now know he has something on. so we ask for ems to respond right away. we know it's going to turn into a medical emergency. they're in narcotics that are causing the body to go to a high temperature, which is not typical of a person suffering from mental health and organic issues. that's some of the stuff we teach our officers. but we use the template, we treat everybody the same as far as behavior. >> council member madrid: going back to my other questions, are

those officers wearing body armor as well to protect the officers as well as civilians? >> if they're wearing body armor? everybody has to have the body cameras on. so those officers will have body cameras. so there is a policy that the police department has in place for the body camera wearing. everybody from the top to the bottom is supposed to wear a body camera. >> council member madrid: and last question was, do you train them hands-on, like going on the street, or it's up to them to

train themselves when they're outside? >> we do live trainings where we train the officer through scenario components. so my unit, the people in charge of the training, i have two sergeants in crge of it. we utilize the negotiators, we have 36 of them in san francisco, so the role players are negotiators that deal with peop clensis all the time. they can tell you and behavehe way they see other people behave in them. so it's very realistic. we use rubber weapons. they're very realistic. and we goes hands-on, on situations. one of the scenarios i can describe to you to explain what i'm talking about, a lady that is suicidal, have posted facebook comments about killing herself, we responded to the

house. i don't know what is wrong with my daughter. so the officers have to figure it out and ask the right questions of the mom, if they do, they will find out she has a gun registered to her, she has been fired from a job, or gone through a breakup. they have to gather all the information before we can contact her. if they don't do that, they're going to come to a big surprise because they're going to try to talk to her and they have a firearm laying near the table where she is at. and they were not able to see that until they make entry in the room. so in that instance, the right situation for the officers, if they don't have information and make entry to the room, once they see the firearm, it's for them to retreat. yobeoumadrid: thank thank you. >> co-chair blacksten: i need to -- i understand that sally

has a question. >> council member mcdonald: i was going to ask you about the percentage, but how are the people selected for the training and what is the response of the rank-and-file officers? do ty appria i >> sure. in past years, i will type a memo, send it out to the command staff and they will ask their officers to attenthe training. now, we changed that. so now what we've done now is opening a learning portal to the academy. and we are utilizing the training sergeants in each district. and because everybody has to go to the training, the training sergeants will contact the officers and ask for volunteers if they want to attend the training. and then they will assign people if they have no volunteers. but everybody has to go to the training. good news, people are looking

forward to going to the training. what i see the change is now, people are signing up in advance to attend the training. so it has changed. i'm being honest with you, at the beginning, we've been doing de-escalation forever. the police department has had a program since 2001 on de-escalation. which is called a different thing. it was called crisis intervention training. we trained 900 officers. in 2010, that training was stopped for a while. and then we had two high-profile shootings and people asked questions, what kind of training are we doing for the officers? we weren't doing any at the time, so we created a new program, the one that i just spoke about. >> co-chair blacksten: that's great. all right. so how many people total have gone through the training in the last few years?

>> so as of right now, i have 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, d anything cannpe to you. that's w 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 orlunt 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 mhealth 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'llet 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. >> thayou, counci 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 binning of the honeymoon, we'll see how long it lasts, but we allel feood 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 tonow 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 settingom se 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 comm >> 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, mirig 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 forhose 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 rking group t 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 programs 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 ci 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. 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 se 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. 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. 'llweear, 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 sho 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. d thas verimportant. 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 aand jls 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 osf

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 thigrax, wt 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 lks 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 cha 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 ver 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 f the general population. including anti-social cognitns. 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. ar 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 andopf foatlks 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 mor 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 dividual because we're not addressing something significant that lies at the core of why there is a poor employment history. same with all eig 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 sysof . 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 oing to see as much success if t

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