in the line of duty. that's 75 people who lost their lives. in that same period, we had more than double that of people who actually took their lives. this is cause of death much like cancer. it is actually in the line of duty death as opposed to something happens after. i believe that about cancer, i also believe that about this. that is a discussion for another time. i want to stress to this commission that this document is not a mandate to do -- to create a stress unit.

that stress unit currently exists. this is a planning document. this is a document that the only mandate here is that the chief look into what it is that would be the definition of a perfect peer support unit. it's a support unit. what does a perfect peer support unit look like what resources would be required for sump a unit and how does that unit break down in functionality on day-to-day basis. members of the other departments other stress units, members of cal chief over the last couple of years recognized this as an issue that is very important emerging issue within their

departments. they have started to tackle this issue as well. some of the materials a were called together to make that resolution or both from legislation that the state currently looking at. but also other existing stress units. some of the element of those stress units are also in here as thing the chief should look at in coming back to a proposal to what the perfect stress unit would look like. i have met more importantly with members who have had addictions and who have contemplated suicide. those are the members that i serve. the ones that we serve. it's undispute pated more than

20% of the membership of the average fire department including ours is suffering from some sort of traumatic stress. there was an article in the morning paper that quoted john christy, the former head of the stress unit here in san francisco retired, he stated during a weekly call, he had weekly call about 20 calls. think about that. that's 20 members of our department who's stress level had reached a point, a typically point where they actually picked up the phone and called the stress unit. this is an issue that over the years has a stigma of this job does, of hey, we are trained to solve problems. we go into people houses like police departments do. we are supposed to be the adult in the room under horrible

circumstances. there's been this expectation over the years, police department and fire departments that we are just supposed to take that. the reality of the situation is that we are all human and that is easier said than done. this resolution does call for staffing resources. i know there's a concern there's budgetary strain this could cause. it does not affect the budget, the current budget. it may affect future budgets based on future decisions that this commission makes as to what should be encompassed in this particular unit. however, as i mentioned before, there are endeavors in life that we cannot afford to pursue and there are endeavors such as these that we cannot afford to

ignore. that being said, i welcome any questions any and all questions from the members of the commission. i want to reiterate this is a planning document. this is not a document that it's a mandate for any budget or for any particular resources to be in the stress unit. i'm confident of one thing. if we -- if i have the support of the majority of the commissioners and we pass this measure, i'm confident of one thing. that is that, we will start down a path of creating a state-of-the-art unit on an issue that there's no more important issue within this department in my opinion. because it deals with human being and human beings we are here to serve. we will be down a path of creating a unit that the rest of this nation will look at as a

model fire departments throughout whe nation and world. we all see the same stuff. as a model of what an ideal stress unit should look like. i think that is an endeavor. it is worth pursuing. i hope to have your support and this resolution and the endeavor that that this takes us down over the next several years until we get to a point where we have a unit that we're all proud of. ta is -- that is our mission here. thank you forly opportunity to say a few thing. i welcome any questions you may have. i hope to have your support on

this resolution. >> president cleaveland: thank you. which commissioner like to begin? commissioner covington. >> commissioner covington: thank you mr. president thank you commissioner veronese. i have just couple of questions regarding moving forward. before i ask those questions, i do want to thank you very much for bringing this to the floor and for doing incredible research and giving us a very detailed of what it is you envision that the chief will consider in terms of looking at

a new model for the department. this is not just a daunting task for the department but it is a daunting task for our society. we are still overwhelmingly male department. men in our society are viewed in a certain light in order to be real men. not showing weakness, not sharing problems and feelings and we're all human being. we all have feelings and reactions to challenging situations that we have to face.whether it's on the job or in our individual lives and

homes. for people who are considered universally to be heroes, that is another barrier to saying i'm having these thoughts. i'm having these urges that i can control somewhat by substance abuse or another way of just coping. having an expanded stress unit, having a peer support services resolution is an acknowledgement that we understand your challenges. not just in fighting fires, not

just on the emergency medical side. but we understand that apparently in these jobs, there's a lot of stuff that nobody else will understand except another person who has the job. so to have that connection with other people in the department after some very good training and coaching, i think it is very good. again, i appreciate the amount of time and effort that you have put into this. that was longer than i anticipated. vice president nakajo. you had comments.

>> vice president nakajo: thank you very much mr. president. commissioner veronese, i appreciate this resolution. i think in terms of your statements and in terms of the reasons why you want to promote and advance this resolution. i don't have a problem in terms of many of the things that you said. the majority of the things you mentioned, i don't have a problem with them. i'm concerned about the details that are part of this resolution. this resolution from my workings, it didn't have a number on it. there's seven pages on here. i didn't know how much you want to go into it. for myself, i have a questions

on every page. i have some detailed question on every page. i know this is a planning document but i did not know if you likely to make a reference to those questions at this particular time or basically i didn't know highway long o -- hw long or how far you want to go in terms of this resolution if you are moving towards discussion, questions or ultimately are you looking for an acceptance of this resolution. i'm not quite sure we can pull that off this evening. this is the commission talking. do you want me to make references to my questions? >> commissioner veronese: i would point this out to start. i know there are some questions about the resolution.

unfortunately, the process by which we are mandated to go through is that i cannot sit with each of these commissioners and so so the public knows and to go over this resolution and make changes outside of the view of the public. that's not how this is done. there are rules against me doing that. i can, however, do it with one of you. if i do it with two of you, i'm breaching the brown act and the other rules. unfortunately, this is the way we have to do it. i do want to preface this. it's an important point you did reference. this is a planning document. this is asking the chief to come back to us with what a

state-of-the-art unit looks like. what we are saying here, chief, come back to us in this time that we have allotted here and tell us what the ratio and it's in 1.7, which is probably the most important paragraph here, tell us what the minimum projected number of peer support members will be. she can decide one peer support member for every 1400 members of the department. it's more and it goes on and on as you can see. i can go through some of the on the elements. what is the projected number of peer support managers. we're creating which is -- we're creating a network of people who have the training and the idea is to capture these stressors

early. the people we are addressing currently in the stress unit are the people we should have helped earlier. this is really telling the chief, a through i of this particular paragraph, come back to us and tell us what your thoughts are on each of those elements. by the way, if there's more and if we're missing something because you done more research than i would have done, tell us what that is. tell us what the ideal stress unit is. it is not a mandate other than that give us the information so we can use that information or you can use that information to

create a unit. i'm happy. answer any questions that you have. i believe this will be the correct form to do that. >> this is officially the second agendized item on this resolution. we agendized this once time before. as i chaired that meeting, definition of the first reading. to be honest with you commissioner when i looked at that document, this document is overwhelming. there's a lot of stuff in this document. i don't want anyone out there in the audience or anyone in the department to think that we're not supportive of this. that's really important any questions that come up of concern or a budget maybe reflected by someone that's in

in department this commission may not be supportive of that. they need to think we need to get that out the way to talk about it. it goes without saying in terms what is it they support within that. for me it's a working document. you talked about a planning document. part of that planning document is i know there's a stress unit. we have two staffers in that. i know i been on this commission for a number of years. looking at this particular resolution, it almost makes me feel like i need to have an updated presentation exactly what that stress unit is doing. i like to see some numbers in

terms that as well. commissioner, we're just commissioners on here that's not saying we don't have expertise, your interpretation and my interpretation in terms what we're talking about maybe little bit different or broader or more narrower. we have a unit, we have two personnel unit. i ooze -- i like to be little pitt mor -- bit more concrete wt we're talking about. what kind of cases and how many numbers. i know we've had presentations

to that. i don't have a problem changing the name. 1.3, even peer support member as you identify it, peer support member what that means. it's a new definition or reinforced definition in terms of 1.5 as a reference to a clinical psychologist. chief of department is there designated for purpose of resolution as peer support clinical director. i can follow that. for me in terms of a medical director or anything close to

this, i have to examine what we have at this present time. which is one full time medical staff person. there's a lot of definitions as to differentiation of that. to be honest with you, you made a statement in terms that may have minimal budget impact. it sound like there might be potential budget impact in term of this position. that's just one position. again, as we move off and we look into it, i'm looking for the first time in term of

definitions. peer support manager, peer support member, peer support clinical director. i don't have a problem with that. i need to hear some definition of how this mechanism is going to occur. to me, it sounds like a creation of a new unit even though we have a unit. i know that's not what you're thinking. i don't think. what i'm coming from it's examination what we have existing. is there elements of this proposal that you have that we can add to that. 1.7 within 180 days of adopting this resolution, we have some flexibility. the chief of the department will deliver to the commission for consideration and new general order consolidating general order.

just as a suggestion. there's another one, line b that talks about one peer support

february fo--member for every 5. is it 50 or is it 500, more than that, how does this training occur. i know that members of the department will be given an option if you're interested in this peer membership, you will sign up. as you get signed up, i'm assuming there's a training component to that. to the public, i don't want to

shorten how much work put into this commissioner. i know you've done references and you've done research. from our dialogue, some of this is not new. i'm not sure how that works out. next page that i marked, page four, i circled the area of the minimum mental health benefits.

i'm not quite sure interpretation of trade policy. what i understand trade policy, i need more info from the membership, trade policy is pretty -- the word is precious. that's not the right word. trade policy is important to our members. just making a statement from observation. members utilize trade policy quite frequently for various situations. i think you using that as part of that. i'm not sure. that's kind of the thing that i was looking at as i move down, there are some elements in my notes section 7 that talks about peer support month. i'm okay with that.

section 3.1 talk about discovery and confidentiality and proceedings. commissioner, i got a little confused on that. in the sense of maybe for myself, i didn't know how that worked out. i needed to have little bit more definition. i didn't know if i needed to see the attorney's opinion on that in terms of discipline.

i would be able to operate better if i know what we're doing presently with our peer group. what i'm saying in some ways do we have enough functionality within our peer group structure now that we might be able to integrate some of this and how

we do that with a budget request. that's about it. i apologize veronese in terms of jumping around. i'm look for an opportunity to write it more concretely or communicate with you or commissions as we move on. i don't know if the president wants to establish special meeting in terms of this. with that i'll stop. >> commissioner veronese: , i appreciate your efforts and our willingness to fully understand this document to go into it. i expected you to come back with a lot of questions. i think what's missing here -- let me start by saying, i went over this document line by line with the chief of the department. the chief of department made

several changes including the paragraph where you had cited you weren't sure about the 180 days. i had it 90 days in there. the chief had requested some additional time. this is a document that the department has fully reviewed. more importantly, what i want this commission to understand as what exactly this resolution does. there are a thousand issues that are going to up in the formation of peer support unit. i appreciate that you have concern for that. this document does not resolve any of those issues. i'm not supportive, not because i'm rigid because i'm intolerant of a process ma is circular.

i'm in support of creating a task force to study this issue of creating a task force of studying it issue. that's what i just heard. this is not creating the peer of the stress unit. please, this is exactly what this does. this tells the chief, tell us what a ves unit look -- stress unit looks like. do this research and answer these questions to the best of your knowledge. tell us what that looks like. come back to us and say, hey commission, i really studied this issue. i foe it's important -- i know

it's important to you. i've dug into this issue now. i think from all the experts a i have talked to, that by way of example, because it's mentioned in here, i believe a i think we >> supervisor fewer: at least three instead of two peer support managers in the department in the the year 2019 and ramp that up to four by the time we get up to 20. i'm putting words in the chief's house after toes of research. -- months of research. that will impact future budget. i believe a the ratio of active members of the department to peer support februaries, should be one for every -- it could be

500. a will impact training and so the budge should consider training. by the way, we've already started that training. three months ago we started a training with the grant funding from last year. i believe that the minimum training certification based on the research i've done if the last six toes, should be x. commission i also believe a the minimum training certification for each peer support member should be x. fast how it's going -- we should be going after these grants that exist. fast why the definitions in the beginning are important. they don't really mean anything other than to describe what's

going on later on if this document. i believe a the elements of the state of the art peer support unit should include this protestant call -- protestant pi

think we don't need referencing now, paragraph 14 where it talk about clinical director. the chief can say, commissioners i don't believe we need full time clinical director. we got two gentlemen that serve our department.

we're not a small department. we're a big department. i'm of the opinion that we could be that department. we could be that new york fire department that gets those grants. those homeland security grants. we can be that department that gets those. nobody is doing this now like we

would be doing this. when i said that this is a planning document, it is exactly that. it is a planning document. it's not a document that mandates a particular act other than asking the chief which is our authority to come back and tell us what the perfect unit look like. frankly we should be doing this with the marine unit. this commission did this with this chief before my time in regards to personnel. we went to the chief. we said, what's the perfect personnel hiring look like. you guys came up with a plan before me. what is the perfect plan look like for buying new equipment? you guys came up with a six to seven-year plan. chief do this research. use some of the resources that

you have. this is an important issue. that's all this does. let me see if there's questions about -- what are the minimum mental health benefits improved -- approved by the department. this is what we currently approved. answering the questions that you have. we think in order to be state-of-the-art unit this is what we should do. we should recognize ptsd as an injury. which i don't think any department does. it's covered by workman's compensation for example. my point is, the chief would tell us what sheties thi she ths

look like. if this is important to us, we should be putting together a six or seven-year plan. maybe it will cost us a million dollars or 10 or 50. who knows. you dealing with benefits. maybe it will require some state legislation. this puts this planning in action. other departments are not doing that. this is taking a look at the issue from 30,000 feet, telling the members i care because i know you guys care. i'm not saying you don't. we're going to put the planning time in to actually get this done. that's all this does. if there's something in this proposal that you think steps over a line, you tell me now and i will move to strike it. i don't think there is.

consider those in your suggestions to us. in my research, these are the thing that other departments are looking at. i believe i took the language of this straight out of the peer support privilege document that exist. there may be one or two changes to it. i can see how, are you creating by this resolution that doesn't exist. the department has peer support privilege. the police department has one. if there are any changes to it, it's minor changes to make it more look like the police department. all peer support privilege says, if you say something to your peer support manager, that cannot be used against you in

disciplinary hearings. i believe that currently already exist. it it doesn't and you want to consider the peer support privilege as a separate item, i'm happy to do that. i'll strike the whole thing now. i think it is my core belief that this resolution has been before this commission for almost three months now. when it was originally introduced. little over two months ago. there has been time to consider it. i know it's a lot of information. it really isn't anything more than telling the chief to find the perfect solution. bring it back to us so we can do budgetary planning around it in the coming years.

>> president cleaveland: none of us disagrees with your intent and importance of having a restructured peer support service unit for the department. this a very complicated and detailed resolution. it's almost comes across as a mandate in many ways which is problematic. i don't know if we have looked at have you considered what the city already provide city employees. they have a mental health network through the current contract which allows for visits with psychologists or psychiatrists or any issues that they may have. when firefighters are exposed to

unsettling situations, they have what's called critical incident response team a already serve destresses and detoxes the individual from that impact. lot of stuff already been done. this resolution, i agree with vice president nakajo. changing the name to problem. if you tip the resolution whereas, up to the point where you get into details, sections one, i think if you said something -- if you just lift it, we need to establish a peer support unit and that we should consider some of the following recommendations versus saying you must include these. it would give the chief lot more

they shouldn't be mandated. i think that's problematic. i have so many questions. idea of having a medical doctor as the peer support clinical director, why they have to be a medical doctor? why can't they be a clinical psychologist. why does this person have to report to the commission? what's the purpose of that?

[please stand by]

it's a long document but asks the chief to consider the following. i appreciate the fact that may be tying the chief's hands. it didn't come up, there was one word, chief, we did change when you and i had a discussion when we went over this line-by-line.

the only deliverable in this document is this report within 180-days of what state-of-the-art looks like. >> would you be amenable to moving the 180 days to the end of the fiscal year. >> i would be, it was 90 before. yes, if you need more time because this is a daunting task, of course. >> it's not the only thing the chief is doing. >> i understand that. >> it's going to take a lot of time and research to put together an expanded peer-support unit and understand the cost involved and the training requirements and all of the things you mentioned here, which are all good. but it's going to take some time. we need to look at what other departments around the country are doing, if anything, so we could have a better understanding what's out there.

why recreate the wheel if the wheel is already out there somewhere. >> that's what this does, this tells the chief to do that work, to look to see what other departments are doing so she could present it to us. i think the mandate, and this is my fault because i wrote this, but the deliverable is unclear here. just judging by the questions i'm receiving and it's because of the language i put in this document. it's a planning document. it's to have the chief come back and tell us, considering these things, what that unit looks like. this is not meant for this -- this process was not meant for me to, and i'm not qualified to do that. to tell you what a state-of-the-art unit looks like. to tell you if we need a physician or not. to tell the chief, frankly, that's the resources to get that information. but there's no one person in this room qualified to do what this document is asking.

so it requires the resources of people who know what they are talking about on this particular issue in all of the different areas. to go into a document that would come back to the commission at some point, whether it's 180 days, i think you said the end of the fiscal year, which is june next year. that's a long time. but it basically tells the chief to report back to us to consider these things. but if they are not important to what a state-of-the-art unit is, they don't need to include it. it's not our point -- not my job, frankly, to go out and tell you what a state-of-the-art unit looks like. i'm not qualified for that, or that we need a doctor. or that we need five managers for every member. that's not what this is about. or what other departments are doing, frankly. or what workers comp benefits or all these thousands of other issues.

all of that is way above my pay grade. but the department has the resources to find that information, i don't. so that's all this document does. i think if you wanted to simplify this document for purposes of making progress, because i can understand how section 2 and 3 can be daunting. they are actually just reiterating what are general orders, so we can strike those two sections. the commissioners don't have to worry about section 2 or 3 because all of that currently exists. section 2 just says what is the peer support, that's the training portion of this. what does the training look like. we can strike section 3 because the chief will consider the training in the other item. change the word "including" to "considering".

that should resolve all of the issues, hopefully, the commissioners have -- >> strike 2? >> we can strike 2. because that information, training is going to be considered anyway. i think it's in one of these sub-sections. it is, it's in section c and d. if we strike section 2 and 3, i imagine once we create a peer support unit, those are going to be included anyway. they currently exist as general orders currently. so that's not a big deal. why don't we also do this, because this will also further clarify. we can change sections 1.2, 1.3, 1.4, 1.5 and make them part of the preamble and not mandates. if they read like mandates,

they aren't intended to. they are just definitions. all the way to 1.6. 1.7 would be the only deliverable. and we can change 180 days to whatever reasonable amount of time the chief believes this could be done. we will strike 2 and 3. and we will make the language of section 1.7 more clear, that we are requesting the chief to come back to us. in fact, actually, why don't we do this, instead of making it a consolidation of the general orders, because those general orders already exist. what we will say, if the chief will come back to the commission for consideration, a planning department that defines a peer support unit specifically considering the following.

>> repeat that? >> the only deliverable in this document will be within x amount of days of the adoption of this resolution, the chief of the department shall deliver to the commission, for its consideration, a planning -- something of this effect, a planning document. describing a state-of-the-art peer-support unit, consistent with this resolution and setting forth minimum standards of the peer support unit considering the following. and that's when it gets into a and a-i. >> commissioner veronese, i like this, i would like it to be brought back, cleaned up, shortened so we can vote on it.

i don't think we are ready to vote tonight. at least i'm not ready to vote tonight on this resolution. >> i'll do that. >> i would like to see it cleaned up, shortened, made more of a set of considerations and not mandates and then let's look at it at the next meeting. is that agreeable? >> yes, i will do that consistent with the understanding of -- >> we will take some action at the next meeting. >> i would like to hear from the chief of the department, please. thank you. >> let me finish with commissioner veronese. finish your thought. >> i believe commissioner hardeman has been sitting silently and patiently as well. >> i'm not in any hurry. >> i think it's important to have the chief speak first.

give us your input. >> sure, i'm happy to take any specific questions. it's been a long day, i might be able to be more concise if i get specific questions. commissioner veronese, thank you very much for putting this forward. i've been a long-time supporter of the stress unit and i've worked with a number of members including captain griffin, we have two new members, nazareta and mahoney. certainly i would like their input, as well as griffin, i know retired member christy, endeavoring to look at building on what we have, i really think is a great model. i do. i know there are a number of departments, i know commissioner veronese, you mentioned long beach, they are very progressive. but there are departments that don't have full time members that are firefighters and/or medics that are truly peer

members. they have other alternatives. but i think with a model program, could it be built and improved? absolutely. that's what i think the spirit of the resolution is. having said that, i would endeavor to get some of the people that are doing the work to weigh in. particularly our two new members, as they are sort of the future of the department and they have time left in the department they aren't going to be retiring any time soon, to really engage them, as well as some of our subject matter experts that have previous time there. what i would envision would be forming a work group. the stress unit, peer support unit does work closely and report to deputy chief over homeland security. chief cochrane under the direction of the deputy chief, chief nicholson. so six months, i know,

basically sort of a negotiation with commissioner aliota veronese was ambitious. six months is tight. not to let it tread off your presentation might make more sense to make it as comprehensive as possible as we reach out to other departments and so forth. it's certainly a project i look forward to working on and seeing if we can improve. i'm sure we can. but we have a good model. i do like the idea and i know you brought it up, president cleaveland, it's important that not everyone, i will use myself as an example, i have regular contact with members of the stress unit. i have nothing but total respect for the work they do. personally, if i'm, and this is just me, and everyone deals with their stress in different ways.

personally, if i'm having struggles, whether work-related, home-related, whatever-related, me, the person i am, i choose not to talk to someone within the department, because i'm a very private person and i totally trust confidentiality and so forth, but for me, having sort of a third party and having that anonymity, maybe going to a mental health network, where no one really knows who i am, maybe they do, but they aren't as closely tied in, to have layers built in, because everyone processes things differently, or is more willing to share. that peer support is amazing helpful for some and the only person will you go to. for others, maybe it's too close. to have realization that people process their stress in different ways, but the bottom line is, to your point, having the resources available when the person needs it and wants to reach out. i think we have done a better