the model. today there is three people living there. it will be much better in meeting the needs of our population, and i would also comment that 50 3% of people who are just as involved in this are out of jail on pretrial release, and i just want to make that comment as well. of the entire group that would be in jail otherwise, at least 50 3% are out on pretrial release, and that's a system that has its own momentum that i imagine we will be wanting to look at at some point as well. thank you very much for having this hearing. i really appreciate it. >> thank you. and then we have a number of folks from the public defender's office.

i don't know if there's anyone in particular who might want to share thoughts and anything we've heard, but particularly opportunities around mental health diversion, around next steps and anything else you want to share on your thoughts. >> i am managing office or in our office. we do have seven other attorneys here from the public defender's office, and that is because we care so deeply about this issue. our clients with severe mental illness are the ones that break our hearts, perhaps the most, and we anguish over how to help them with all the constraints that we face.

our position is that the criminal court system should be the very last resort in addressing what we all agree is a mental health crisis. we feel that way because, in so many cases, we feel that the public health system has not been able to intervene despite so many opportunities before the criminal court involvement begins. we see so many clients who have been in and out of the psychiatric hospital, on 5150, again and again, and every chance feels like a potential missed opportunity. we also see the criminal court system as a last resort because jail is traumatizing for so many people, and especially the most

vulnerable folks with severe mental illness. we are against, if at all possible, harming people in order to help them, which is what we see so many of our clients going -- going through, being harmed in the county jail on a regular basis. we are asking for the city to focus its resources into primary ways, one by substantially increasing the front end treatment and permanent housing opportunity for this population, that means repeatedly making those treatment and permanent housing options available and desirable, meaning that they are safe, they are trauma-informed, every time a city agency contacts a person and it is known that that person, bless

you, they have a major mental illness, that is an opportunity to engage, and we would ask that there be every effort to increase resources in that area so that engagement, that outreach can happen over and over again, and to build in a system of accountability for there's resources so that when those resources are being allocated, the board, the city can see exactly how that money is being spent and what improvements can be made along the way. when people do get into the criminal system, there's got to be a tiered response. most folks who are charged or arrested, cited, booked on misdemeanours, should be immediately diverted out of the

system through programs, existing programs like law enforcement, assisted diversion, neighborhood courts, those minor offences should be diverted at the first possible time before they get to criminal court, and a program that looks like misdemeanour behavioral health court should only be for a very small subset of misdemeanours, and then the low and mid-level families can go to mental health diversion over the very -- under the very broad legal criteria that the legislature has set up in part to address -- to help the courts deal with this, what we heard today in terms of statistics is that about 50% of people who are eligible for behavioral health court are actually being accepted into the court, but only less than about 30% so far of people who are

eligible for mental health diversion are being accepted, and that is the program that doesn't require the agreement of all the parties, there is a reluctance there, and the reluctance is based on the legal outcome, i would suggest that it is viewed not as targeting the mental health problem that is before the court and the reason why the person is in this system and the y. the legislature is set up this way, it is targeted -- it it is viewed as some kind of windfall for the offender, and there is a severe reluctance to have that happen, and then many of those cases are being funnelled into behavioral health court, even though they qualify as mental health diversion, so i think that we have two really stretch ourselves in this mental health diversion program and give it as much of an opportunity to see what it can do as possible.

a little bit over 30 people in eight months, there is just a missed opportunities happening there. >> i think vice chair stefani has something to say. >> what would you attribute that to reluctance to? do you think it's -- is it a public safety -- what do you think the reluctance is on part of the judge she was deciding whether or not to engage in mental health diversion for the defendant? >> i do think that there is a narrow public safety exception, and it is to find in a different penal code section as being a substantial risk that someone is going to commit a very severe additional offence, not just any offence. if we were going to exclude everyone for mental health diversion who has a risk of reoffending, we would have no

one in mental health diversion, because of course, there is a risk. the question is, under the law, do they have a risk of committing a heinous crime, and i don't think that narrow definition is necessarily being adhered to. you also heard the judge talking about the nexus, and what we are seeing, in other words the statute requires there to be a link, a substantial link between the mental illness or mental health disorder and the alleged criminal conduct, and we have seen, on a number of occasions where we do have qualified to mental health experts saying, yes, this is linked to the mental health disorder, but the court is not accepting that, despite the fact that there is not contrary, there's not another mental health expert -- expert disagreeing, so i think there's a philosophical reluctance, like i talked about

the belief that this is somehow two offender -- 20 offender centred, our clients, and not looking at the other interest in the criminal system which are substantial, of course, with the reason for mental health diversion is the idea that the mental health disorder is what is causing the conduct, and so if we address that, then the other considerations that are inherent in this system will follow, they will be taking care of if we treat the source of the criminal conduct. >> do you think a lack of resources contributes at all to the reluctance. >> i don't think it is a lack of resources that is preventing people from being accepted into mental health diversion. the mental health resources goes to the wait times, which are just as bad, if not worse than

mental health diversion then inmate -- behavioral health, and the wait times in all avenues, the jail behavioral health services did not get any additional staff until just recently, but still they didn't get any staff to deal with the in custody referral. they did not get any additional staff, so they only have the staff they have, in their evaluations take time, and that is a wait period, and then finding the program is another way to period, and getting the program interview and then the acceptance, and then the actual availability of the bed, and there's also a real reluctance on the part of the partners to when that bed is not available, and it will not be available for some time, to look at an interim outpatient supportive housing option, and maybe a lack of

available resources as well to make those placements while a residential placement is being sought. >> isn't availability one of the factors judges are supposed to think about and granting or not granting mental health diversion >> the court has to find that there is an appropriate plan, not that -- if the resources were never going to be available , then of course, they would be no point, but they don't have to find that there's currently available resources. >> so you don't think -- >> it just has to be a realistic plan for treatment. >> do you think -- do you think that is weighing on the court shall chart reluctance to do diversion? >> i have not heard that stated as a basis. and then, i just want to make a few comments about behavioral health court.

as i said, our belief is that when the mental health diversion criteria is not met, then only those folks should be considered for behavioral health court, the first stop should be mental health diversion. for behavioral health court is an amazing program and has helped a lot of people. it is not -- there is no panacea here, and it is not behavioral health court, the reason for that is multi fold, one is that treatment is tethered to legal outcomes as you heard. treatment is a privilege if you agree to the legal outcome that the district attorney wants, and if you don't agree to that outcome, in some cases, we have a case right now where there is a bed available for a client of ours, and it is very possible

that that bed will come and go because we cannot yet reach an agreement on a legal outcome, and there is a lot of reluctance to allow the person to go to that placement in the meantime. usually, almost always, you must have the agreement, and it doesn't matter if the bed is available or not, and so it can be quite coercive in some ways in that fashion, another important problem is that many times you will spend less time in jail if you opt out of behavioral health court, and that means you are not getting the treatment that the behavioral health court offers. that should never be, it should never be that someone with major mental illness is going to get a better treatment, a better legal

outcome without treatment because they don't want to wait in jail. and we are not talking about a little bit of time difference, we're talking about months and months in the first instance, and for some folks, as you heard , people cycle in and out of jail behavioral health courts because they have setbacks or perceived setbacks, and then they spend months awaiting again we have people in behavioral health court to have done hundreds and hundreds, a year his worth of custody crime waiting, stabilizing, and then waiting, stabilizing and then waiting, it is not a small difference, and you asked a really important question about why is the difference between the people who might be eligible for behavioral health court, that population is so much bigger than those who are actually referred to. it is that problem. it is because we, as the advocates, the representatives

for these people know this is not even worth your time. you're not going to spend this much time in jail on your case, and we shouldn't even look at behavioral health court. it is too punitive, too onerous, and then there's trauma. we can't advise our clients towards trauma, and then the last thing i want to mention is we have a housing that is dependent on criminal involvement, a criminal system involvement, so that people literally can't afford to get out of the system because they will lose their housing, i'm not sure how that reality came to be , what it should not been the case that someone who is doing great in the criminal court system and two has done everything the court wants them to do can't move on and get out of the system because they are going to lose their housing if they're not on probation. it is the probation problem

essentially. behavioral health court is a probation court. everyone in behavioral is not on probation. again, i will just end with how i started the front end treatment and permanent housing is what we are hoping the focus can be on, and accountability for wear those resources are going and how they're being used >> thank you. >> questions? okay. if we have no comments or questions, we will take any public comment that there might be, i have some things to save a public comment including that you have two minutes, and we ask that you state your first and last name for the record, and somebody left their phone.

>> all right, you know how i come to, and i heard a lot of feelings, and i don't mind hurting them. first of all, there's twaddle ways of dealing drugs. if you deal drugs out on the street like people who deal drugs in our communities, or you can go to school and get a masters degree and become a dr., and pedal drugs by rating the scripture, they have a system up there where they walk around with a cart full of drugs, and they yell out and they stick their hands through the jelle sale bars and you are passing out drugs like people passing out candy to little kids that are trick-or-treating on halloween night. you're talking about how you want to help and rehabilitate the inmates, and you're keeping them strong out, we have all those drugs going on.

you need to run a statistic and ask what type of drugs that you are passing out up there at 850 bryant street and get a number to verify how you're keeping people out on drugs. you have inmates that talk and said, i like coming to jail because we get to drugs in jail and it is better than my outside drug connection on the outside, and about this 80 2% success rate, people graduating from the program, those are high and -- high income addicts. and then you talk about you have a success rate, you have 912 people that applied, and you only accept 204. that means approximately 708 people are being rejected, and you are looking for the correct word to use to call those people , it is called the most vulnerable drug addicts that need to the treatment, and as far as your nexus is concerned,

you're talking about mental capacity and a crime that is committed, you're not including the element of drugs which is causing that problem in the first place. you need to get your statistics on and put them in jail. [indiscernible] >> thank you. next speaker. >> good afternoon, pleasure to be here. my name is maria, and i'm the deputy public defender that staffs behavioral health court and i have been a public defender for 15 years, and have worked with this population for that long, and i think that the varying opinions cut today come from the fact that this is not a one-size-fits-all problem. we have people with mental health problems who commits low-level crimes, high-level crimes, who commit specific

crimes and nonspecific intent crimes, and i've seen stages where intervention could have happened, and it didn't. i would say, at the first level stage, there is a huge population of clients and citizens that have mental health that can be decriminalized, and i can say that as a defence attorney because i know that there are specific crimes that, you know, people get arrested for, and we are going to trial, and at trial, after being in custody for two or three years, they cannot prove it. they just wasted two years of jail and resources that could have been spent in other places, including behavioral health court, so in terms -- i agree with the district attorney that there are stages -- stages in terms of lowering that jail population, and we need to look at that.

for the majority of cases, the legislature has created this mental health diversion on the pluses are this, it is simple, we don't have to go on about it. they're not on probation so they get a preplea disposition where they get help, and they get a clean record, and they can get reintegrated into society, it is that simple. you saw the graduation, the pride on their faces, that is how mental health diversion will be, i think that with regards to being -- [indiscernible] >> what would make behavioral health court works better? >> thank you. if we had uniform forensic training for all of the participants, the judges, the district attorneys, the healthcare providers, and if we had the appropriate forensic treatment options for each and every single one of them, and by

forensic, i mean comes into contact with jail. you brought up a really wonderful point, supervisor mandelman, the most difficult cases that we have are the what the ones with the clients are sitting in the jail the longest because there is no bed for a pregnant woman who has schizophrenia, there is no bed for an arsonist or 290 registrant, there is no bed for a client with a low i.q., and those are the people, that is the population that we need to serve the most, so what ends up happening, supervisor, we end up cobbling together whatever we have to give them, and sometimes it is not enough and then they don't graduate, so you see those limits -- numbers plummet, of the other reason why you see those numbers plummet, and it breaks my heart, these wait times, and i think the judge indicated that it wasn't six weeks, it is 137 days from the time the 47 is referred until placement, which is four months

for them to get placement, four months just on that one go around, what is ending up happening, sadly with the behavioral health clients is that they are maxing out on their maximum term of commitment , and even though they want to stay and get help, you can't keep them in jail, you can't warehouse them forever. the needs to be a place we can house them while they're waiting for treatment. they are super important, and they have their place for really serious crimes that are on an escalated level, so those are my opinions from somebody who gets to work with this population and it is not a one-size-fits-all, it is today we are talking about bhc and this is what we need, and for mental health diversion, we need this, and some clients have spent years in jail only to get their places dismissed at trial. those clients should have come into contact with law enforcement officers who had training and diverted them to a prearrest diversion program

which is a great idea. i wouldn't be surprised if the district attorney were on board for that. i know they have a very expensive mind. i appreciate your time. it was a pleasure and delight seeing everybody. >> thank you. next speaker. >> hello, my name is charlie, i'm a social worker at citywide but i'm speaking out as a representative, but as -- from my own experience, and i think i really appreciate your question about where is one place money could go to make things better, and when we are placing clients in behavioral health court to have severe mental health issues , they start out at grove street house which is one of the most destructive residential treatment programs, because so many of them are put on the list to be placed, there was a long waiting list, we have many other ninety-day programs for less acute clients, we have decent availability the substance acute -- substance abuse treatment, but there is a backlog at a backlog coming from the hospital for that placement. if we could get a second house in the model, i think it would

improve discharge times for both the jail and the hospital. we don't stop working with people if they opt out to behavioral health court or if they don't graduate, sometimes that lack of graduation number, i thank you said it was 32%. it feels like a failure, but i wanted to share about one client i worked with who had spent four years in behavioral health court and was remanded ten times because the treatment plan, he wasn't able to work it, but over the course of those ups and downs, we have built a strong relationship, and on his last day in custody when he served out his time, we asked, if you are done with bhc, will you still see charlie? he said, yeah, he is all i've got, that was in may of 2015, and since then, the client got permanent housing after being homeless for about 27 years and

hasn't been back to jail, which is his personal record, he continues to come and see me every single day. even though not all clients graduate, i think positive things can come from it. >> thank you. next speaker. >> thank you for having us today to express our city's values in terms of how it relates to criminal justice and where we are putting our money. my name is daniel and i'm a health educator, i'm here today as a city resident and also a member of the public health justice collective, a group of about 300 public work -- public works workers had to public work lead with projectors prevention and we strongly urged this city to do the same and look beyond jail based treatment and consider investment and treatment services, some of it a lot of the speakers have mentioned today. and youth programs, education, employment, housing, to all the things that support strong and healthy communities. people experiencing mental

illness should be able to access treatment and support services and community before any contact with police or jails. instead, locking more people up, people with mental illness, we need to take concrete and extended measures in the city to address health needs. this means following through with the plan to close 850 bryant. this does not mean opening in mental health justice center to quote the supervisor and her opposition to the proposed mental health jail in l.a., that at the jail is a jail is a jail. money for incarceration is money we can't put towards housing and mental health treatments. we need approaches that heal and prevent illness and support community members. we also commence the health commission to passing the incarceration is a public health resolution last month. it makes clear that the jail expansion in any form will negatively impact people already disproportionately criminalized and overrepresented in our jails

, including people with mental illness, black residents in san francisco, people struggling with substance abuse, homeless residents and transitional aged youth. and in closing, and investing in on jail based solutions to help services and particularly mental health services, you have the opportunity to shift the trajectory of san francisco and improve many lives. thank you. >> thank you. next speaker. >> they his for having me. my name is alexis and i work as a substance researcher i am a harm reduction expert and representing the public health justice collective. it should not be illegal for individuals receiving mental health treatment, which disproportionately means no lower incomes for people of color in san francisco. i have not been -- has not been demonstrated around the country.

it leads to increased insight or acceptance of a necessity for long-term involvement in treatment. we just various treatment of the population of the onset of mental illness, when systems can have the most impact on long-term outcomes for the health of the individuals. this prevents people from going to jail in the first place. saves millions of dollars in healthcare costs, and lost revenue for individuals and their inability to participate in the workforce. we need to decriminalize the quality of life charges. 30% mental health users. sleeping in housing encampments has resulted in homeless jail population and we have not seen the expected decline in the numbers despite implementation of reform.

>> 40% released from psych emergency have had referrals for every person getting intense case management, there were two others that need it. there's long way for people who qualify for community-based mental health treatment while they're in jail because they can't get it. so what do we need. >> we need more neighborhood drop-in centres for people to talk about their problems before they back overwhelmed by it at the onset of their disease. we really need intensive case management in the neighborhoods that meets with clients daily

and we need real supportive housing for people with mental health problems. i think we've seen again and again today that imprisonment should not be a rerequisite for receiving mental health services. >> next speaker. >> i want to also say that this hearing has been really tremendous and helpful and i know that you wanted us to focus on mental health incarceration. with i think we hopefully convinced you to look borde bror and we can't several the mental

health issues in our community amongst the homeless or jail population unless we look at mental health in a different way. and i think today, i just want to thank everybody for spending friday here because i know you're going to go home and do other work and your kid will yell at you

>> supervisor mandelman: and actually gets folks the care they need without engagement in the criminal justice system. i would like to continue this to the call of the chair to come back in six months and hear what's been gleaned from the preliminary needs assessment. it won't be in time for the budget, but it will be in time to think about future budgets, so i'm going to move that we will continue this to the call of the chair, and we will take that without objection. [gavel]. >> supervisor mandelman: thanks so much, everybody. i know this was a tremendous amount of work for a lot of people. i know supervisors get ideas in their head, let's have a

hearing. but i want to thank you, all of you, for the work you do, every single day. mr. clerk, do we have anymore items? >> clerk: that completes the agenda. >> supervisor mandelman: well, then we are adjourned. [gavel]

>> to my left as a deputy city attorney who would provide the board with any legal advice. i am julie rosenberg, the executive director. we will also be joined by representatives from the city departments that have cases before the board this evening. we expect scott sanchez, acting