signs it into law, then tomorrow you go to try to get melanie conserved under this law. how do you get melanie to court. [please stand by]

>> she'll go up shares and see a judge to start this process. still shaking her head. we want to agree that enticing individuals who do not accept voluntary services to come to court on a voluntary basis is going to become a challenge. angelica has had experience doing that successfully with a small number of individuals that have gone through the aot court process. we're hopeful that sb-40 which is looking likely to pass at the state level will actually strengthen and really make the process to move somebody towards conservatorship more efficient and it will provide them with an opportunity to meet with their public defender because they'll be in the hospital and they'll be able to provide with due process right there. >> i understand that. either we're not going to pass this law -- i can't make a

decision today based on a law that may or may not pass. that is not before us. i don't know the time line of it. i don't know if it goes into effect automatically. i have a lot of questions about that. i want to assume for a moment if i okay this law today -- because that's what you're asking me to do -- that i want to understand how it works. if it goes into effect before sb-40, i need to know what i am signing on to here. so you've admitted that voluntary services don't work. i lit really don't understand. you and i have had this discussion. i don't understand how we're going to get melanie to court. i want to understand how we're going to get melanie to court. >> it would be an individualized experience with these small number of people we're trying to reach. >> are you going to arrest melanie to take her to court? >> we would not arrest melanie to take her to court. >> she's not going to go to

court because you've engaged with her hundreds of times. she won't do i g do anything. >> you are referencing sb-40. it's looking promising that it will pass. we really feel like the time to implement 10-45 is right now because that will give us the authority we need to work with the courts, to start developing protocols and practices. >> i have a few other questions. >> can i try on this one just for a second? i mean, sb10-45 was the first attempt. as i said in my opening remarks, it's challenging to make any changes to lps law in sacramento. in the process of working its way through the legislature, a number of requirements and provisions were put into the 10-45 that are going to be hard to make work. one of the things that is challenging about this is that there's no -- in sb10-45 there's

no compulsion to get them to the court on their conservatorship. the other thing we know is that there are a ton of enormously capable folks in our local departments who are skirting the law all the time to get -- to try to get people into care. there has been, in aot, success. again, hard to get people to show up, but they have been able to get some folks to show up. now, can they put that person successfully through an aot program based on their voluntary participation? no, but should we give up on this because we're going to need a moment where we sort of beg and work with public defender's office to get those folks in? it's a pilot. we're testing it out to see if it will work. it will be easier with sb40 because it addresses this, but i'm not sure they won't be able

to make it work to get these few folks into court and i don't think we should give up on it just because there is this problem in it. >> this is a major problem. you haven't been able to tell me how you're going to get melanie to court except to say the public defender is going to convince her. a public defender she's never met. there's no one here from the public defender's office to answer my questions about how they're going to do that. i don't know if you're trying to get someone from the public defender over here, but i would really like to talk to the public defender's office because that seems to be your main strategy for getting melanie to court. if someone could call and get someone to answer, i would appreciate that. so i'll let this part go for a minute while we're waiting for the public defender's office, but let's -- let's move on. somehow, we get melanie to

court. she is -- the judge conserves her under 1045. what does the judge order? what are the options for what the judge orders? like where is melanie going to go next? >> we would have already developed a treatment inservice plan that would have been based on our investigation. it would have been based on the evaluation, input from the psychiatrist and the doctors that know her because she's a high user of oa our system. we would have a plan in place. we would present that peninsula noplan andit would include a lef care. we would have a bed ready and available and we would be waiting for the court. >> melanie is a relevant person. real person. what does that look like? what is your suggestion on where she goes? >> as we presented in the presentation, a possible treatment plan would be baker

places, a residential treatment facility. >> baker places. she's schizophrenic and a meth user. she's -- someone got her to go to court even though that's never been successful to get her to do anything before. but somehow she got to court. then she's ordered into a residential program where she could leave at any point? i just don't see it. >> is she making a stop at the healing center on the way? >> we may need -- some of these individual may need to go to a higher level of care initially. it would depend on -- >> the whole point of giving melanie's case is that we know what -- who melanie is. she's a real person. we're not using her real name. you know melanie. so tell me -- >> i do not personally know melanie, i'll let you know.

it is -- >> i'm using your example. >> supervisor ronen, i think you came to the -- to court one day, and so you actually had the opportunity to observe our community independence participation program. >> yes. >> that's a non di a non-contesd program for people who are gravely disabled. >> amazing program. >> we serve a small number of individuals through this program, but it is a non-contested lps could notsive conservatorship. >> i visited and asked everyone there, including you and the judge and the public defender and the district attorney, what is wrong with our system? why is it so broken? what do we need? not a single person said we need to reform our conservatorship laws, not a single person. they said, we don't have enough treatment beds in the system,

and so we don't have places to send people. that's what they said, all of them. in fact, i didn't just visit that court. i visited behavioral health, ps, the lock unit at general, i visited countless programs, the tap program. i've been everywhere throughout the city, and not once did anybody, any of the professionals in any of the places -- and i didn't even know about conservatorship at that point. i had no prejudice one way or another. not a single person told me we needed to reform conservatorship law. everyone said -- and i said, i want to work on this and change anything we need to change. every single person said we do not have enough residential treatment beds in the system. we don't have a place to send them once they complete the programs. that's what they said.

fyi, you brought that up, not me. going back to what i was saying, melanie, i saw you -- you were going to get up to talk about melanie. would baker place be the place we send her, and why should we assume that is going to be successful for melanie if we've worked with her hundreds of times and nothing's ever worked before. it's not a lush facility. it's voluntary services. why is baker place going to work for melanie now if she doesn't want to be there and nothing else has worked before? i do know melanie and i think it's an important question. i can say working with aot and running that program. for some individuals just having the court utilizing the symbolic weight of the court to leverage them into care makes a

difference. we don't know i if that's the ce for melanie or if she's going to go directly into baker place. she might need -- we might need to work to transition to baker places. >> so in melanie's case then, wa locked ward first. >> if her current state a and what i know today, that's likely what she'll need before she goes to a lower level of care. as soon as she's ready and able to transition to that lower level of care, we would ensure that happens. >> okay. so she would likely going to a locked ward. do we have capacity in our locked wards right now? i know last week or at some point last week, i know the 7th ward at general was full

and in fact, that 37 of the 44 people that were there were there awaiting placement at a more appropriate lower level of care. but since none existed, they're staying in the locked ward. do you see where i'm going with this? it's -- we just don't have a system in place, i feel, to do this. i mean, my understanding that we don't have the beds even in the locked facilities, even with the addition of the healing center beds because we cut them in half in 2000 1 2011 and we're not clo getting them back up to where they were at that point. does anyone know how often there are even -- i'm sure kelly will know -- space in our locked facilities? >> so i certainly will turn it over to kelly here who is the expert on that, but before i do,

i just want to say that i appreciate you asking in the way of what it looks like today because it's living and bathing breathing and it does change. it's not just adding beds to the healing center, which is an important part of our system, but it's making sure that we have beds across the system so that patients can flow through them as they're ready to step down. >> right. >> but i'll ask kelly to address your question in terms of current capacity. >> not current capacity but average capacity. >> we try to get a trajectory that's right for a person. some people to wait for san francisco healing center bed might be just a few days. for other people, waiting for it maybe several months. that might be complicated by the fact people have cooccurring

circumstances. people who are high assault history who have been through all of our facilities and have a hard time being accepted back need a higher level care like a state hospital. and these waits are long partly because we don't control the state hospital wait list system. they change the way they do wait lists a few years ago, and it used to be that we had control over the capacity of our beds, and today we do not. other people who have developmental disabled are shared complaints with golden gauge regional center and minding finding a placement fors trickey and hard and waits go long. >> can i go back to what you said in the beginning? you said that an individual that doctors determine need a locked facility today, sometimes have to wait three months for a bed in a locked facility? >> or state hospital. >> but i'm -- i'm not talking about a state hospital. i'm talking about where melanie

would go first. so that, i'm assuming, are either the healing center at st. mary's or the 7th ward at general. right? >> well, we have more than just the healing center as a lock sub acute. we have contracts with behavioral health and they have them throughout the state. we place people at crestwood vallejo and the healing center. we have another one in movado. each of the different programs have different sort of a focus. so we try and match up the person's presenting need and trajectory for wellness with the facilities. >> so okay. i didn't realize they go out of county. >> we have the san francisco behavioral health center and we have rehab as well. >> i didn't realize we're sending people out of county. that's a whole other issue. so we're saying for someone like melanie that there's anywhere -- you said anywhere from a two-day to a three-month wait?

>> i would say for somebody like melanie, it would not necessarily be a long wait simply because melanie's trajectory is straightforward. for her to be accepted would be streamline because of who she is and how she is currently presenting. >> so she would have a space at one of the san francisco based locked facilities? >> yes. >> but that takes away a stays someone else who needs it and has to wait three months. >> the people waiting three months, are they waiting for the healing center? >> they are probably waiting for any lock sub acute bed that's able to accept them. for many people waiting three months, it may be they had a recent assault and so it makes their list shorter because now they can't go back. >> they assaulted someone so they are a harder person to place and melanie is not one of those -- >> exactly. >> she's not hard to place.

>> right. thank you, kelly. under sb-40, it's -- what would happen is that immediately there would be a temporary conservatorship, and melanie would be placed under potentially up to 28 days in a locked facility. is that correct? >> during that time, once the conservator is in place, we would have the authority to move her to an appropriate facility. >> okay. so under sd40, but not under 1045 before getting her before a judge? >> during that time, she would have -- actually, i think captain pang was referring to dr. -- and dr. bland referred to the hearings in the court. she would also have the ability to work with her public defender and there's a probable cause hearing that occurs at sf

general. >> okay. and so -- >> during that time, the conservator's office di is not - we don't have a role in those hearings. my understanding, the treating psychiatrist presents evidence as to why an individual -- it will mirror lps and the treating psychiatrist would need to demonstrate how whoever is on the hold meets the criteria that's set out in sb-40. >> so sorry. the way we get around getting melanie to court, which is a big problem under 1045, is that the treating psychiatrist puts her on a temporary conservatorship under 1045. >> this is under sb-40. >> so to be clear, the idea is to mimic pretty much exactly how it works today under lps. someone, on th seventh 5150, thy

would be eligible. within that 72-hour hold period on the 8th 5150, they would have a probable cause hearing that would make the determination as to whether to grant a 28-day conservatorship. so today, under 1045, that procedure doesn't exist. sb-40 mimics the procedure that is well tested as part of lps. so that's the -- >> gravely disabled procedure? >> so it's a probable cause hearing. so basically, the judge determines based on the criteria established in 1045 whether or not an individual qualifies for that temporary 28-day conservatorship which then allows for the actual court proceeding on the underlying conservatorship to happen within that same period of time. >> okay. what i'll just say about this part and then i'll move on is that i really am worried about

capacity in the system because if sb-40 passes, we're talking about a significant number of people. i know that pes is on divergence 37% of the time or it was in april because it is at capacity. i know that the ward at general was at capacity in april. mostly because we can't transfer people with a lower level of care was we don't have capacity in the rest of the system. this is a comment. i have a lot of concern about capacity in the system. >> they're in the system already to be clear, and then today, one of the reasons the mayor announced that she is investing in the 30 dual diagnosis beds is really to unlock that flow. so this is -- that is the investment that can best target and create space across the entire portfolio. >> i would just say that i do feel like you're offering

contradictory assertions quite often, and i saw it in your report as well. you're saying they're in the system and using the services, but then you're saying they won't use the services. so it is an inte an ininherent contradiction. they're using ems services. i don't dispute that. they're not using the services that lots of people voluntarily want to use and can't use because there's not enough in the system. so that is a major, major concern of mine as well. just a few more questions before i open it up to public comment. now, most people admit this is about meth users, that 1045 was designed specifically for meth users. i know that supervisor men

treated a task force and it's met one time. i'm wondering why we're creating an intervention for meth users, why we're not letting this task force do a very important job, which i really appreciate it and maybe this is a question for supervisor mandelman of coming up with interventions that might work with this population before jumping to this intervention. >> whicwell. >> well, we have a crisis. there is an emergency. i've done an tour of our system and talked to folks in our public health system and providers with our community based nonprofit partners, and it felt to me i was having one-on-one with them, that it would be useful to have them in a room talking to each other

about ways to streamline processes, work together, ensure they're the right hand-off when people are leaving psychiatric emergency services, that there was a lot that could be done. this is a task force that's going to meet four or five times over the next couple of months. it's not going to be a permanent part of our infrastructure, but i'm hoping that it will be useful in coming up with better ways for the system to work. i don't think that has any necessary bearing on whether this particular intervention, this creation of this additional type of conservatorship is a good idea or bad idea. >> okay. i have a few -- just a couple more quick questions. i want to understand a little bit more on what's been offered to people that they have refused. this comes from two experiences. my own experience that i talked about with alice where she

refused to accept any services we got a housing placement for her with the help of barbara garcia. she didn't want to come inside. we got her inside using a volunteer in my office, ann, became friends with her and started taking her under her wing. she visited her every day. she developed trust with her. she knew her favorite foods. she knew her whole family history. she knew what motivated her, et cetera, et cetera. and so after getting to know and developing trust between annn ad alice over a month, alice agreed to come inside. we got alice inside, and she was

diagnosed with breast cancer that was stage 4 because she hadn't gotten medical treatment. she died about a month later. right? what worked with alice wasn't the conservatorship. what worked is someone taking the time to care about alice, taking the time to get to know alice, and taking the time to understand what makes alice tick and convince her to come inside. that was a huge learning experience to me about people who are very, very, very, ill like the people we're talking about here which are a relatively small number of people. that worked. now i want to tell a story of another individual. this was actually told to me by a social worker at st. mary's who works with conserved individuals. this individual was someone that everyone knew, spent time on van

ness from pacific heights to the chinatown area. he's a melt user. he's someone who drove everyone crazy. you will a the neighbors complained about him constantly. there was a twitter feed about him. there was a blog of frustrated neighbors. probably because the city and the supervisors and the dph and the police and the department of homelessness were so -- got so many complaints about this individual, once again, in an attempt, a case manager, including a former director of behavioral health took this person under their wing and got to know him and convinced him, without a conservatorship to come inside and get into treatment and get into services. when we're talking about such a few amount of individuals that

are so sick, i'm wondering, have we really ever tried what we tried with this individual who drove the neighbors crazy in pacific heights and what ann tried with alice to get them inside, or have we said, high,,, very sick person, you can get treatment and case management, et cetera, and then they just refuse. i want to understand the flavor of what we've offered these individuals. >> supervisor, i really appreciate that because i think the importance of the relationship is incredibly important, and it's exactly what we do in assisted outpatient in building those relationships and trust. you know, i could talk to you about melanie's case in particular, but i want to share

in my experience with assisted outpatient treatment that we engage individuals for a minimum of 30 days before we consider filing a court petition and, again, we have clinical and peer navigators. it's that whatever it takes and whatever it takes approach and meeting people where they're comfortable, finding out the foods or coffee they like and really building that personal relationship for them. a lot of ways, that's really successful. then there are individuals where despite that were still unsuccessful. although that is a really important part of our system, it's something that we know is important, that we have increasing dollars dedicated to peer-based services to accomplish that and navigate peer specialists to do that. for somebody like melanie, i can share that she has been engaged -- not only offered case management everybody social socd for a period of time. that attempt to build that

relationship outside of placements that she's been at, which we would talk about that also. she's also been somebody who we've worked with through assisted outpatient treatment. we've had the opportunity and the flexibility to engage her in that way. but unfortunately, despite those efforts and building those relationships, we're still unable to engage her in voluntary services. >> okay. okay. thank you. i appreciate that. two more questions, and i swear i will end and open this up to public comment. maybe this is a question for director krasinski. i was just wondering, i know that there are about -- the statistic i've heard and -- tell me if i'm right -- is about 150 homeless people die on the

street every year. is that correct. >> it's higher than that. it's closer to 200. >> closer to 200. okay. and of those 200 people, how many of them would fit the criteria under under 1045. >> i don't have that data. dph gathers that data. i'm not sure they would know with the data they've collected. >> okay. the reason that i'm making this point is because we have a crisis. we've a major crisis in san francisco. if 200 homeless people are dying in the streets and they can't get voluntary placements because we don't have enough in the system, i don't know if we can say that some people are more grave than others given that there are 200 people dying in the streets every year. so the fact that we don't have enough capacity in the system, i'm not trying to be difficult at all because i want these people to get help as much as

you do, supervisor mannedle man and as much as you do mayor breed and all of our city staff. i just -- i have to know that someone else that's critically ill isn't going to get bumped or taken off the list, and if 200 people are dying in the streets, that's something that is deeply, deeply concerning to me. anyway, that, i think, is just a very, very important point. thank you so much. >> thank you. >> okay. and with that, there might be more questions at the end, but i'm going to open this up to public comment. if any member of the public would like to speak, please do so. you can line up over here. i will call -- i will call some names. sasha bitner, george bachi, sidney wright, kevin o 'shae.

feel free to line up. >> ever.every speaker will haveo minutes. mr. wright, did yo can you stars off? >> i'm going to be her interpreter. >> i'm speaking ohi. i'm -- can you hear me? she says hi, i'm sasha bitner and i'm speaking on behalf of

senior disability action. she says, i'm in opposition to sb 1045. she says, and implementation in san francisco. she's opposed for a couple reasons. one is because it's a civil rights issue and you can't take away someone's civil rights

without a very, very good reason. she's afraid that it will go down a slippery slope. she says it's unclear as to how it will be implemented and if it will be effective and they're lacking basic information. she says finally, she doesn't

think police officers should be making these decisions and determining whether they're eligible for conservatorship in the 5150 context. she says there's so many issues with police officers. we don't need them more involved than they already are. thank you very much, and now you get to hear from me. i'm representing independent living resource center, san francisco, as the community

organizer there. we are proud members of the voluntary services first coalition led by senior disability action and the coalition on homelessness. you'll hear today from many of our colleagues in the voluntary services coalition, and we stand in strong opposition to the implementation of the bill as when we echo many of the concerns brought up by supervisors on the committee and we appreciate your very thoughtful deliberation on this issue. as sasha said, we're concerned that it may change the interi action between folks with -- that would fall under this and police officers given that they now have this involvement and

the power to 5150 folks. also, it's just a basic self cil rights issue that one shouldn't take away basic civil rights from folks and make independent decisions instead of focusing on this very narrow population. we feel that we should be expanding voluntary services and give more choice to folks. thank you. [ applause ] >> thank you so much. >> thank you to my colleagues for letting me go ahead of them. my name is claudia. i'm with the disability rights program. i'm here to speak in opposition

to the proposal. i want to make three points. first, i want to say that people referenced earlier today the closure of the state psychiatric hospitals. i want to make clear that the closure of the state psychiatric hospitals decades ago did not lead to or cause our current homeless population. those are different populations. the state hospitals housed a different population similar to our nursing home population today. it's sort of a trope that the closure of the hospitals caused our situation today. that's not accurate. our situation today is caused in large part by drastic cuts to the federal government support for housing, the fact that ssi has not increased at all with inflation and regional and global trends around income and ennuyee quality. that's my first point. secondly, i think we offer

reliable intervention services. what we don't reliably voluntarily offer is a bridge into long-term supports such as a path to step down beds or to long-term permanent supported housing. we have a bridge to nowhere, and that's going to cause people not to be engaged with services. my third point is that the state law as well as the americans ams with disabilities act says conservatorship should be required when it's the least restrictive alternative. the approach would be to provide patient persistent outreach to people, dedicated case managers with fewer than ten people on their caseload, a connection to voluntary real long-term care services and housing after crisis intervention. >> stop being hard on your

administration because you are the damn problem. for the past decade, you've got nerve to talk about conservatorship. yeah. too many people telling you what to do. you've got a lot of nerve stepping outside your own jurisdiction and going to kaiser hospital and trying to tell them about the mental services they're giving to people with mental disabilities. when you have 17 openings for professional psychiatrists with ph.ds to give services to the people that you act like you're trying to help. how are you going to step outside of your own jurisdiction and try to tell kaiser hospital and have their executives to come up here and sit up here for hours while each and every one of you get unlimited amount of time to speak. the executives come up here and we get two god damn minutes to speak. you have a lot of nerve. you're the god damn problem. you need to be in conservatorship. you talk about housing?

you don't even provide housing for the income bracket of the people who are on your god damn seat in the first god damn place. you're the god damn problem. you need to put conservatorship in the hands of the federal district court judge to give equal opportunity and housing for the people that you act like you want to help. your top class professional bullshit. talking about you helping people. you need to be -- and i'm going to tell you something else. when you fill 17 positions that's open, i want each every and one of you board of supervisors and the mayor, too, to make an appointment to see the psychiatrist because you've got a problem with your god damn self. you might need to start taking some medication. you're giving multi millions and trillions of dollars to twitter and other high tech companies tax-free money talking about you giving them a break when that money should be spent on the people you act like you're

trying to help. what do you have to say about that? [ applause ] >> good afternoon. thank you. my name is sidney wright. thank you for the opportunity to speak in support of implementation of health conservatorship in san francisco under sb-1045. i'm a practicing psychiatrist in san francisco. i'm president of northern california psychiatric society which represents 1,100 psychiatrists in this area. sb-1045 offered a structured, humane pathway to help individuals previously beyond the reach of appropriate and ongoing medical and mental health interventions. the individuals who would be helped with the implementation of sb1045 suffer from untreated mental health disorders.

they are not disorders for choice for the individuals involved. these are human beings who's neuro biology has been hijacked by diseases such as schizophrenia and bipolar disorder with substance addiction, substance use disorders. the individual in social consequences of untreated mental illness are astounding. individuals with schizophrenia on average die 20 years earlier than their same age individuals in the general population. lack of routine medical care for these individuals results in striking rates of high blood pressure, heart failure, emphysema, all significantly related to tobacco smoking. individuals with bipolar disorder are 25 to 60 times more likely to attempt suicide with nearly 20% completing suicide. again, i believe it's imperative to recognize that individuals who would be subject to conservatorship under sb1045 do not choose to have their illnesses and social

consequences of their illness. instead, they are the result of their severe and neuro biological illnesses. sb1045 is straightforward and clear as a path to life saving care. >> thank you so much. and before we hear from the next speaker, supervisor walton -- >> thank you, share ronen. i want to apologize to everyone. i have to attend a doctor's appointment. do not worry, i am the epitome of health. with that said, for me, there are a lot of unanswered questions so i do want to just say for the record that it would be my vote that we continue this to a later time to have more discussion about this ordinance or legislation. thank you so much and i apologize again for having to leave. >> thank you, supervisor walton. good luck. thank you. >> good morning. almost good afternoon, i should say. thank you for giving me the

opportunity to address the board. my name is george. i'm a physician, a psychiatrist. i practiced here on mission and 20th for three decades. i'm also for many years on the board of a neighborhood health center and we run the facility for the city. i have also had experience running a 5150 service when i was a director at the hospital. but today, i'm here representing the northern california committee on psychiatric resources. a couple points i want to make. the individuals we're discussing today generally suffer from a neuro cognitive disorder characterized by distorted thoughts, beliefs, feelings, and dilution al distortion about their conditions. these physical already already and i rity tate physical and psychological changes are already seen in other illnesses such as alzheimer's. when you think of some of these patients, you should think of the problems that you have with your elderly alzheimer'ss

relatives. this is a physical disorder in the brain we're dealing with. there's an important characteristic that often presents in brain deterioration. it's the individual's inability to recognize a manifestation of their illness and that's critical when you're trying to offer voluntary services. these symptoms which push patients on to the street today, we view as protected in the name of compassion. they don't recognize that they're ill, so it's hard to be compassionate with somebody who doesn't recognize they're ill. today, there are more seriously mentally ill people in the penal system. this tells us in practice as a society, we've had chosen to use a prosecutor to deprive the them for a civil right rather than use a conservatorship situation. we've chosen to punish rather than provide care. either way, sooner or later, the

mental ill lose their rights. care or jail, that's what you're providing to them. >> good afternoon. i am not a doctor. i'm a private citizen. for 60 years, my family owned a paint store on market street and 16th street. in the late '80s, a man who i came to know as barry sat in our entryway and babbled throughout the day. he was mentally ill and homeless. his rantings became so loud and disturbing we installed a gate. then i moved around the corner to the back of our building and he camped there for over two decades. that is when i got to know him. every so often, he would disappear and when he came back, he would tell me that he had been at either san francisco

general or laguna honda hospital because of his increasing poor health both physically and mentally. he refused to go to a shelter. in 2013, i arrived for work one morning and i checked the back of our building. there was a police car, an ambulance, a van from the san francisco coroner's office, and a body bag on the sidewalk. i knew it was barry. he had died during the night, alone. he obviously needed help because he couldn't manage for himself both physically and mentally. i know something about conservatorships. i have a 23-year-old niece who is severely disabled. when she was 18, my brother became her legal conservator. if he hadn't done that, the state of california would expect my niece to decide where she wanted to live and what treatment she wanted. she is completely incapable of doing that. everyone does not have loving family members who can watch

over them. nobody deserves to die on the street like barry did because nobody was watching. i urge you to vote for these conservator ships. thank you. >> i'm frame and i'm with stop crime san francisco. i'm not here for stop crime san francisco. i'm here for jesse albert. i support this legislation because jesse albert at age 25 hanged himself with a rope until dead. he who is my closest brother had cycled in and out of mental facilities, the street, and jail for several years. i want to thank supervisor mendle man for bringing this legislation to the fore. i believe this is compassionate program that will save lives. it's well crafted and it can only go into effect and part of

state law if the support of housing and mental health services are available. i'll wait until the supervisors are ready. thank you. these are real people who shouldn't have to go to jail to be treated. there's scientific data that backs compulsory treatment over several months. as senator as stated, we have a large program in california. it's called jail. we need a different path. supervisor ronen questioned whether this is workable. i think one of the best parts is that it requires an evaluation of the program's effectiveness. you have a working group that will have a disabled rights advocates as members and it will look and give you data. the sunset clause ends after 2023. i understand there's some valid questions that we heard from

supervisor ronen and mar and walton much don't let the enemy be the perfect the good. this is going to be a pilot program. please pass this legislation. thank you. >> hi. my name is den ice dorian. talking about by own person life will help someone. i hope it will. i was homeless 45 years. i'm still homeless. at age 18, i was diagnosed with severe depression. i was depressed before i was 18 after i had a tonsillectomy. it was caused by a bacteria caused by micro plasma also known as atypical pneumonia i was infected with. that doctor isn't allowed to practice medicine anymore. after the surgery, my personality changed immediately. i went from being gifted to wanting to hide in i cardboard

box and cry all the time. i got 5150 once. i learned not to cry outside. by age 29, i was on social security disability even though i tried to hold jobs. i had a flatbed truck and moving furniture because i didn't have to get along with anybody. so ticks spread horrible illnesses. mine wasn't from a tick, but i got bitten by a tick later. those antibiotics actually got me over the micro plasma which caused cognitive difficulties. so now some -- justed a few -- ticks spread bacteria, some causing difficulty breathing, heart failure, paralysis, loss of memory, anger issues, doctors ignoring us, cognitive issues, depression, suicide, homicide. there are ticks in all by two parks in san francisco, and i know six people with symptoms of tick bites.

i know it causes death, mental illness, and people are not being tested. they only test you for uti, not at glide or nahc or st. francis, san francisco general. they don't test you alt ucsf anywhere. you cannot get tested for a tick bite in san francisco unless you know the doctors that i know. >> supervisors, my name is mark. i'm here in support of sb-1045. i make these comments as president of the eureka valley neighborhood association. the longest serving neighborhood association in the city established in 1881. over the last decade, our neighborhood has been inundated with the issues and outcomes bit glowing population living on our streets. business owners are left to deal with the symptoms and effects of a system that cannot or will not address the needs of our

addicted and mentally ill populations. they are worsening the quality of life and tearing apart the fabric of our community. time and again, the matter is the subject of conversation. membership often speaks about the growing concerns of the property and personal safety. many have stated that the unpray debilitiable and threatening behavior they experience when walking on our streets is too much and is a major determinant to wanting to leave the neighborhood. i hear dozens of stories from store owners who decided to close up stop, residents moving out, would be visitors who decide to stay away. our storefront vacancy rates are the highest in the city and increase. all too often, citing the increasing extreme behavior and assault on our businesses, their patrons and operations of those suffering from extreme mental illness and drug a loss. abuse. there comes a time when we are obliged to help them. those suffering from addiction

and mental illnesses are in the greatest of need. it is inhumane to leave them on the street increasing the risk to harm. we support sb-1045 as an incremental step toward getting help to the most in need and we implore each supervisor to find their moral fortitude and political strength to vote in support of it. thank you. >> please, next speaker. >> today, supervisors, i want to thank you for your attention to this problem. my name is michael majors, i'm here for sda. no one here is arguing that there's not a great need here for some sort of mental evaluation, but this bill is not it. it'it's two steps back instead f one forward. the point being that 50% of the people who end up on the street in homelessness because of the

financial situation here in san francisco, we'r were not crazy e they got there. they were driven crazy by going on the street. just getting them off the street will decrease the problem by itself. you're talking about the worst of the worst cases here, these people here. and that's a minority of the whole problem that we're facing here. as you pointed out yourself, at least i heard that in your text. i do appreciate your attention. basically, i'm opposed to the fellow that just spoke because i see this as just a bunch of confusing numbers and we need more than that for the homeless. we need some -- you talk about humanity. it's humane to widen the net so there's less support and you bring in more people that we already don't have the resources to properly handle. so no, i'm completely opposed to whawhat he just said and i ask u

to assert that you keep the fortitude of your own convictions from what i heard. thank you. >> thank you. next speaker. >> hello. i'm joan. i represent the homeless kids in the hayden ash bury district. i want to make a point. there's that story, if the camel's head is in the tent, pretty soon the whole camel is in the tent. i'm worried about the $227,000 that it costs to house these people under these conservatorships. that's what i saw online. that's about how much it costs as far as i know to house people in prisons. that's how much prison industries are making for every person they can lock up n , in a lot of these cases. i'm not sure if that's all of them. the point is, someone's making money. somebody's going to make money in they pass this law. what is the real goal?

we have the highest incarceration rate in the world, i believe. that's not right. [ please stand by. switching