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

>> time has elapsed. >> next speaker, please. thank you. >> good afternoon, supervisors. my name is carolyn kennedy. i live in the dolores park area and chair of our neighbourhood association. for the past few years, i have seen the deteriorating condition of the homeless people in my community. now we have an opportunity to offer an alternative to are most severely mentally ill and homeless people. i have heard and spoken to people who oppose this program and i ask, why oppose a pilot? pilot programs that offer an alternative to the extreme and recurring bout of violence

violent psychosis that these people are experiencing. besides being a pilot of the conservatorship, it ends on a date certain, in the whole program of sunset in january, 2025. finally, there is an appeal for individuals were placed under conservatorship. this to me just make sense for very, very few people. it is a chance to get our worst off mentally hill -- bill to get better. right now they are not getting better. they are taking drugs on our streets. how does this life help them -- help them get healthy? how many psychotic episodes do they need to experience or commit crimes and land in jail? what are we waiting for? are we waiting for the drugs to destroy their brains? we need to try new approaches, better approaches than jailing or appealing. and as our elected leaders, i ask you and your colleagues to implement this very small pilot. you will quickly know if it makes a difference, and it can be adjusted as it goes along.

as san francisco is receiving more money for homeless services , we need you, our safety to find effective strategies that are the worst off. take a small step to test out this program. i hope it works for those who are placed in the program. i have a comment also for my neighbour who could not be here. he says this is a moral imperative. i have someone in my neighborhood, a man who i know would qualify under this program i literally checked the street before i step out my door. if i see him outside, i tried to avoid passing. >> hi there, my name is brad, and i'm speaking in my capacity as an individual. this whole conversation has been really sad for me. my background is in clinical psychology and i've had these 5150 people myself, and in doing

that is one of the most difficult things i have ever had to do. it is my understanding that in the cases that a person would be eligible for conservatorship that they would not only have been 5150 several times, but there would have to be services for those people, so in the case that a person is at a heightened risk of hurting themselves, killing themselves, or another person, it seems to me to make the most sense to pass this and i don't say that thinking that this is a solution, i think i celebrate all of the things that people are saying about drastically improving mental health services, psychiatry is not enough, medicating people is not enough.

housing and robust medical and mental health care for all is essential. i think this is a necessary step to preventing unnecessary death, preventing murder, and preventing people from being imprisoned, and entering jail instead of treatment, not the treatment -- not that treatment is adequate, with the treatment of some times is better than going to jail or hurting themselves or someone else on the street. thank you. >> good afternoon. i'm with san francisco travel association. we are a nonprofit organization that markets san francisco globally. we have over 1300 travel and tourism visit -- business partners. thank you to supervisor mandel meant for your leadership on this legislation. we are concerned, as you are, the most buildable people on our stage not receiving the care they need to keep themselves safe. i'm here to support the local

implantation ordinance to expand our existing conservatorship program to serve individuals suffering from serious mental illness and substance abuse disorder. without adequate tools to intervene, people battling untreated mental illness and drug addiction will deteriorate. housing conservatorship provides an opportunity to bring stability into the lives of those who are unable to make decisions for themselves and put them on a path of healing. when people come to visit san francisco, they are shocked that we let people struggle on our streets. they see this incredible city we have, the cultural institutions, the public spaces, the scenic beauty, and it appears as though we're neglecting those who need help the most. we know this legislation won't only help a small number of people, but we strongly believe that all options should be used to make a lasting, positive, long-term impact on our neighbors most in need. thank you for your time and consideration and thank you for your thoughtful questions and you try to grapple and wrap your head around to this will help and how it will help them. it has been an educational

experience wash in this hearing. thank you so much. >> hello. my brother was diagnosing he was 16. in his early twenties, he ended up in the streets of san francisco. he was on the streets at sixth and market and pulling food at a stranger his hands, grabbing cigarette butts on the street, he was only in his mid-twenties and he was in his late forties. he had housing. he lived in an s.r.o. he also had money because he, s.s.i. at the time. he had family who loved him, and we had no way to help him. i thought the last time i saw him in that condition was the last time i was going to see him

ever because he was quite agitated and a bit violent. was shortly after our last visit , he ended up in the criminal justice system. today, because of that intervention, he was compelled to accept treatment for his substance abuse, but he was also -- he also had access to treatment for his schizophrenia, and it turned out that the treatment was actually up in the vallejo area. i don't know if he was arrested here in san francisco, or he if he was arrested up there, but it was because of that confinement that his life turned completely around. today my brother leads a full, active, and healthy life. he has a stable, long-term relationship, he has a stable job, and has been able to support himself ever since. my brother's recovery was not a miracle, it was accomplished by hard work, his hard work, and hard work of dedicated professionals, the police, psychiatrist, social workers who assisted him, and who treated him, and yes who can find him long enough for him to reclaim

his health and his life. i think them from the depth of my heart, and i thank you as you move this legislation forward. thank you. >> thank you. >> good afternoon, chair and supervisors. my name is kevin carroll and i'm with that hotel council of san francisco. we are a nonprofit trade association it works on behalf of our industry. i'm here to speak in support of this ordinance and support of the bill. i want to thank supervisor mandelman for your leadership on sponsoring this and we realize it is a very difficult issue and we are seeing people struggle on our streets every day. it is clear a crisis is playing out on our streets in this ordinance will help those individuals most in need, and most in need, and it is not humane to allow people to die on our streets. and for us, this situation where someone is not able to take care of themselves and you're putting forward a planned way of helping someone who needs that help is something we want to support. we believe this ordinance will

provide the tools needed to help those most in need and allow them to get the help that they deserve and they need. the council urges you to move this forward and we support this ordinance. thank you very much. >> thank you. next speaker. >> hello. my name is dianne and i'm a medical student from ucsf. i'm here today to speak in opposition of the bill. to clarify, i'm not here to say that the current conservatorship process has no room for improvement, however, i'm deeply concerned that the changes being made to this medical process is being done through legislation that has not been drafted in consultation with the people with the most expertise, whether through professional experience or those lived experience, and i would argue people with lived experience are the most important stakeholders in this conversation. i think a big question is what evidence of this treatment are we hoping to provide through

involuntary treatment? from our research, we found -- first off, i disagree that there is mounting evidence in support of involuntary treatment. from our research, we have found that the research in this area is highly inconclusive. a systematic review published in 2015 in the international journal and drug policy found that 33% of the study reported no significant impact of compulsory treatment compared with control. twenty-two% saw ambiguous results, 22% saw negative impacts, and only 22% were reported positive impacts on criminal recidivism and drug use they concluded the evidence as a whole does not suggest improved outcomes for compulsory treatment, and quote, given the potential for human rights abuses within compulsory treatment settings, not compulsory treatment legalities should be prioritized by policymakers. a systematic review published by the review in 2017 which was the

gold standard for systematic review evaluated two trials in the united states that compared court ordered outpatient commitment and voluntary committee treatment and found out participants in any form of compulsory community treatment were no less likely to be readmitted than participants and control groups. specifically they found you needed to do -- >> thank you for your testimony. next speaker, please. >> please leave the box -- leave it in the box and i'll pick it up b hello, my name is india, i'm also a medical student. i would like to echo everything dianne said and added a little bit of perspective. i have been working intimately with people who use drugs in new york and boston for a number of years and in the context of harm reduction and the medical space -- magical spaces that harm reduction creates. i would employ the supervisors to really take a look at harm reduction principles as a way to

lead with compassion in this issue. many people know that harm reduction is an evidence-based approach to reducing the harms associated with drug use and behind the many -- beyond that many strategies and initiatives that we think of when we think of harm reduction, at the forefront of it is the idea of honouring the rights, the agency , and the humanity of people who use drugs and it believes in working collaboratively with these individuals in order to give them the tools for them to live the healthiest and safest life they can possibly achieve. i believe that conservatorship is not one of these evidence-based tools that you could provide tell them of the healthiest and safest life they could possibly live. it is important that we think about the people that we are going to be targeting, like this bill bill. i see that it has been made

clear to me that individuals who would be targeted by this bill are not here and are not being considered and are not sitting at the table. they can make these decisions alongside the supervisors. i think that is incredibly important and again, compulsory treatment is not evidence-based. and there are many other ways that we can provide evidence-based care to the population without traumatizing them and perpetuating the distrust in our system that currently exists. thank you so much for your time. i really do hope you will approve this bill. >> thank you. next speaker. >> good afternoon supervisors, my name is, and i am a senior activist in san francisco. i first of all would like to thank supervisor madwoman -- supervisor mandel men for courage and tenacity to make life better for the mentally ill i certainly agree that we should

be supporting to the greatest extent possible, voluntary services. we should take into account that some individuals, however, who are the most mentally ill, will frequently not accept services no matter how persuasive or talented the mental health outreach worker. i might have been on the other side of this issue had my sister not become ill with bipolar disease when we are both in our twenties. now 50 years later, she has been recently released from a six week stay in a psychiatric hospital in maryland. she found herself there after being asked to leave homeless shelters, the library, kicking police officers, who were arresting her and throwing plastic bottles or restaurant staff after not paying a bill. she went off her meds over a year ago and slowly deteriorated she then lost all her i.d. and had no idea where her s.i. checks were and since she had

close her checking account and a bank whose name she had forgotten. i see psychotic individuals on the streets of san francisco. i think of my sister and realized like her that civil liberties have been usurped by the severe mental illness. your freedom of choice is such that they cannot take care of themselves and are in danger of dying, being assaulted or possibly harming others, which is unusual, but it happens. the families of such people live in constant fear of getting a phone call regarding their psychotic loved ones' demise and some horrible way. i would just ask you, this is a pilot project. is not -- let's see -- let's build on that. >> good afternoon, supervisors. i am a medical student and we represent a collection of medical students and attending at use e.f.f. -- e.c.s. avenue. we are in opposition to the bill for a number of reasons.

one of which, it bypasses psychiatric and medical evaluation of conservatorship by departing from the harm to others and the standard to consideration based only on a number of the 5150 population. for a consideration conservatorship that is so complex and nuanced, it is -- it is pretty ridiculous that a tally mark is the only arbitrary choice, when it is may not necessarily in collaboration with providers who are actually caring for these people. unit addition, healing is most effective when done in the context of the original harm. by taking the individual out of the community, and from the space -- and then bringing them back to a space where they eventually have to return to, we do so by adjusting to life posttreatment, and increase the likelihood they will return to san francisco with great -- greater connections to their community, and community support is integral to long-term healing

>> if a court ordered they must wait for a patient. patients must wait anywhere at the extent of six months to 2.5 years for the process to go through. we like to see more conclusive data from people who spoke earlier about these wait times. and sometimes it will end in them failing to find adequate placement. the waiting period includes all of the following. the financial cost on the health system of caring for a patient who otherwise would not be there , the unavailability of a bed for another patient who needs it, patient loss of function over time, and this is really important. the hospital is not designed for such a long term stay. we have seen this patient

severely compensated over the waiting period. they are less separated from the supports and less active and mobile under not moving around as much. they're helped candid -- health can deteriorate further they can develop severe depression. the lengthy stay and wait time could contribute to vision burnout as there is an increased patient load and they have to manage secured frustration of patients who have been hospitalized and who may not have received care otherwise staying in bed. >> i would like to add that this will further perpetuate the disparities of manti -- mentally ill teachings. this is another tool for police officers to use against black people and people of colour. this will not be able to help. these people need this and i just wanted to say that. >> folks have told compelling personal stories about why they think conservatorship is important for patients and we want to echo that we don't oppose conservatorship blindly. we do not propose any amendments

to the current law and we just think that the way that this bill specifically immense conservatorship is problematic. it opens up a space for abuse even the director of mental health services early in which she was trying to share that it wouldn't open up space for abuse stated that a 5150 is a request for an evaluation and can be placed by an officer. we know from history and modern-day that when there is room for abuse against populations, it happens. we just want to state again that the point that s.f. does not have adequate services to comply with this law which requires us to have services has gone unaddressed, and finally, it is ironic to me that the department continues to reiterate that once this bill is passed, they will establish a working group with advocacy organizations for important input and oversight when they are currently ignoring all the advocacy and service organizations in this room who are currently saying no to the bill and it makes a sceptical

that this program will be subject to oversight and input. it seems in line with the overall theme of getting people in the way because we think we know what is best for them. [applause] >> my name is alan cooper. i am an emeritus professor at stanford and those kids are great. i work with some of them at the homeless clinic and it gives me hope for the future. i have had the opportunity with many, if not all of you. the question is, will this save lives? i think supervisor ronen asked what i was going to ask, is of those who died in the last two years? how many one had this? how many had these.

i have trained at san francisco general and the standard was we work on the tough circumstances and we get better care for these hospitals. when you sentiment out of the hospital or an emergency room, great fear is you are making the mistake and they are going to come to harm or die. i don't think when a patient just says i'm ready to go they accept that. these doctors are too good. they are here, they care too much. the real solution to this, i think, is in intensive outpatient case management. it was distressing to hear that 24 -- 20% of the slots are vacant. you need to raise their pay, you need to double their number, and you need to make a real effort to implement this program.

get on the street and help those people, and that will bring them home, and you've given us great examples. thank you. >> thank you. >> next speaker. >> hello supervisors, i'm a mental health advocate in san francisco and also a mental health client. i would like to say yes when the police do 5150, they do handcuff you because i have been a victim of the handcuffs and i also would like to say, i have been that person who has gone and been that revolving door going back and forth, been to mental health court to keep myself out of mental health court. from being transferred to -- luckily for me i can speak out for myself. there are a lot of people who can't speak up for themselves who have been shipped out of san francisco, and i just want you to know that i don't think this conservatorship -- because all it is doing is taking away the rights of people like me and others who don't have a voice

here today speak for themselves, and i want you to know that i believe something needs to be done, but i don't think conservatorship -- what is it? s.p. 1045 will cut it. thank you. >> next speaker, please. >> good afternoon, supervisors. and with the policy alliance and i'm happy to be a member of supervisor madeleine's mandelman methamphetamine task force. i know that we shared goals around ensuring that our system of care can meet the needs of everyone here in san francisco. i also want to make a bug for the conference that we are holding on thursday around coerced care. it will be a three conference at u.c. hastings all day on

thursday. we would love to see you there. we are trying to add some of the insights and research. i was going to read the same findings from the systematic review of compulsory treatment, but somebody else, one of the students got to it first. thank you for that. we are hearing a number of anecdotal stories about successes coming from coerced or compulsory treatment. i just front to remind you that there are lots of anecdotal stories on the other side as well of people's whose trauma has been increased, who have had their path to recovery made more difficult because of incarceration, because of institutional violence, administrative violence, and words of the unsafe being spayed , and we need to be cautious about ways in which we are increasing the trauma of turning and going through these services and finally, i'm a little frustrated that i need to

say this, but people who use drugs are human beings, and people who use drugs feel and reason, they may not be responding to the same things that any of us outsiders feel are important, but they are using reason, and they're doing the best they can with the resources that they have available to them, and in some cases, where they are is because they are feeling even deeper then the rest of us. >> hi, and rachel rodriguez, i am a social worker in san francisco over the past 16 years , and i wanted to speak on behalf of dozens of my colleagues who have signed a letter. i will read part of it today. i have submitted the whole letter to the rules committee and the board of supervisors. before i do that, supervisor ronen, you mentioned earlier about agreeing that it needs to change to include more substance -- substance use disorders than just alcohol the -- alcoholism. and i want to highlight that that is what s.b. 1045 is.

that is what it is offering for us now. to put substance use disorders beside serious mental onus and alcoholism under the law. we had that opportunity and san francisco is the right city in the right time to do it. the renter does the letter reads , as mental health professionals who work with individuals of serious mental illness and substance use disorders, we want to implement this bill. it is not a solution to the homelessness crisis. that is proxy, nor will it address the needs of the larger population suffering from untreated mental illness on our streets, but it isn't urgently needed tool that will help providers like us deliver care to a small population of people for which our tools do not work. as mental health professionals, we agree that systemwide reform is needed, that we as a city must provide treatment on demand and shelter to all who needed, however, this is not an excuse to the deny the treatment, service or supportive housing that will be provided to these individuals whose disabling conditions prevent them from seeking their own care.

we should not sacrifice the lives of people in crisis in the name of a perfect system. every day we work with our clients to help them make healthy decisions for themselves engaging them in voluntary services, in some cases, our clients choose treatment, except services, and go on to make positive changes in their lives. we applaud those who do. want the same chance of success for all of our clients, including those for whom their severe mental illness and addictions have eroded their capacity to seek care voluntarily and who may not recognize their own illness, and they still need care urgently. we see the urgent need for the city to expand. >> hello, good afternoon. i am an organizer with senior and disability action. we represent hundreds of san franciscans who are opposed to the implementation of s.b. 1045. in the disability rights community, we have a slogan that says nothing about us without us

and this has been about us, without us from the first day at the state level. scott weiner did not consult with any groups about writing the law and at the local level, the consultation with community group and drafting the mayor's plan was totally insufficient. we hear again and again from people who are in favour of this that it is not compassionate to let people die on the street. our response to that is, of course, it is not compassionate to let people die on the street. it is also not compassionate to cut $40 million in community mental health services since 2008, and to leave people with no choices, or -- arrested eight or more times in the year, then discharging them with no services, then taking their rights away and forcing them into treatment. as others have mentioned here, there's a consensus that forced treatment does not work for drug use, that gives people ptsd and also make some more likely to overdose and avoid treatment in the future. i would just like to urge you to

listen to people with disabilities, listen to drug users, people who are formerly homeless because we already know what works to solve these problems. thank you. >> hello, my name is gerald rutledge, and i had a mental illness crisis in 2010, and things which helped me to live a good life since that time have been having housing, having a network of friends, and having access to mental health services

, now -- not the best for my limited income. they do help. and finally, to be able to make my own choices about my own life i have been going through difficult period in my life and i still deal with that difficulty in my life. i thank you, and i am against the implementation of 1045. thank you. [laughter]. >> deer rules committee, i just -- my name is jordan davis, and

i wear a lot of hats. i just want to say i am really opposed to the local implementation of s.b. 1045 because it sax, but i also want to talk about how this -- what would happen to the community. forty 9% transgender his of san franciscans have been homeless. forty 1% nationwide have considered suicide, and one in four trans women have been victims of police violence. these numbers are higher for trans women of colour. why am i talking about this stuff? because trans people are going to be targeted disproportionately under this bill, and do you know what could happen to the community if this passes? if that -- without housing services, we could be sent to locked facilities or an area in modesto where we are denied hormones, forced to see trans phobic therapist and forced to leave -- live as our birth gender. incarceration by any other name

would smell just as bad. is a formerly homeless transgendered women, we need community, not -- not coercion. and we are seeing white game in like madwoman -- mandelman and weiner liang us. i want to say, i probably swore eight times right now, so that is the number of times that someone would have to be detained under 5150 and be concerned under this legislation just to show how absurd it is. just stop this. it is stupid and it needs to stop. thank you. next speaker, please.

>> those described by this it is meeting 1045 will only effectively be dealt with on locked units from the descriptions i heard today, and from the one psychiatrist who spoke and described the problems with meth as organ changing, brain changing problems coming from that, it sounds like what you are proposing is not a short-term solution, but a long-term lockup for people and in san francisco, if we implement this, our answer to people on the street with the severe problems would be to call the police, call them again, call them again, call them again , and it puts the police in

the position of being the ultimate, in the ultimate role of mental health evaluators. seven 51 fifties, seven times someone has been picked up, and seven times it has been determined -- are we losing a quorum? >> it has returned. [laughter] >> seven times it has been determined that that person did not require conservatorship, and yet number 8 is the door that opens up the magic of conservatorship. i think if you really want to do something helpful, it would be to look at -- i'm sorry, look at the shelter system. people turn down shelters and they are criticized for that.

>> thank you. next speaker, please. >> hello, my name is bettye trainor. i agree with everything karen has said. i want to add one more thing. i want to thank supervisor madwoman -- mandelman for establishing the mental health task force. that is a solution, to have people coming together who are in the system, either as clients or as workers, as nonprofit people with the city. they will come up with a solution. we don't need something like involuntary 1045. thank you. >> next speaker. next speaker. >> hi, my name is cw. i'm with the mental health association of san francisco, and i am formerly homeless and dealing with mental health challenges as well as physical challenges. also, i am with the sda. here's just a few things i need

to say that i have come to you about several of these things, and i just want to give an overview of what i say. we have a housing crisis, and seniors and disabled have become a -- are becoming homeless for longer. we have a lack of beds for people with severe mental health challenges, we have a lack of service for people with severe drug use, we know that when police or the point of entry, escalations with mental health and crisis can go up. how does this bill improve all of these issues? until those questions are answered, we cannot move forward with s.b. 1045. i oppose this because we have not figured it out and i oppose it because at the end of the day , i know it is hard, and i know it is a hard decision, but we cannot approve this. we need to find a better solution. thank you. >> thank you. next speaker, please.

>> hello i'm -- we stand in opposition to any expansion of conservatorship. thank you. >> thank you. next speaker. >> hi, i am with stop crime and in support of conservatorship. i personally working health care , my husband does, my son does, my family and friends all work in the healthcare service. we all agree that the outstanding number of folks on the streets with mental health addictions. we first moved to get the folks off the street, within the two triage them. we need to assess them with the addictions, the drugs, alcohol, and those in need of psychiatric assistance. we need to provide these individuals with resources and the departments they need for their issues. the lack of moving forward is inhumane. let us remind you, you are all elected officials to provide and protect the public health and safety for all. thank you.

>> thank you. is there any other member of the public who wishes to speak on this item? >> hi, i have a son who is autistic and also has bouts of mental illness and i just like to say that even if you are the richest person in the state, you won't find a mental healthcare system, we just don't have a mental health care healthcare system. there needs to be longer-term hospitals that actually provide the services that people need and that's what i want to say. you actually have to have a system first. >> thank you so much. any other member of the public would like to speak? >> i thank you are doing a disservice to the community by and large, and i think -- you

need to find a better way to do this process, but i don't see it happening. >> thank you. is there any other member of the public would like to speak? seeing none, public comment is closed. before i call other supervisors, i have one quick question from the mayor's office. do we know when the next hearing on s.b. 40 will be held? or the next step with that law? >> it is making its way through the senate, and it has not yet moved out of the senate. it will then move to the assembly side, and so we are anticipating it coming and going through the process and being done in about three months. there is a provision currently in the bill that would allow for it to go into effect immediately if not, we don't know if that will happen, if that provision will stay in the urgency clause.

if not, if it goes through and passes now, it will not go to session until january 1st of next year. >> thank you. supervisor mandelman? >> again, i want to thank you, chair ronen, and supervisor mark for sticking with us, and of course, to the folks who turned out and spoke, you know, i thank you began by saying, you know, noting this is imperfect legislation, and you really wish that what we were dealing with was a different kind of fix, and the challenge for us here in san francisco as local legislators is that we can't write state legislation, so we have to deal with what is given to us, the tools that come down to us. they are often imperfect, but i think even with its imperfections, s.b. 1045, which i trust is as good as senator weiner could make it for san francisco, is worth moving

forward with. i think we do have an urgent crisis and should be seizing every tool. i think s.b. 40 may be an improvement on 1045. there are things i like about it more, and there things that i like about it less. the fundamental question about whether to move forward with a tool like this is the same for s.b. 1045 as it is for s.b. 40. the -- the opposition to 1045 that showed up today will show up with equal payments, fervour, and certainty and implementation of s.b. 40. it says a terrible message to the state presses say that we are not interested in moving forward with 1045. i think it undermines s.b. 40 for us to do that, and i think it sends a terrible message to our constituents who are desperate or us to get a handle on this challenge and the county that spends more per capita on mental health and substance use than any other county that we actually solve this problem, and move forward. again, neither s.b. 1045 or sv40

will solve the entirety of the problem, but i think it moves us in the right direction, and i think we have to take these opportunities as they are given to us by the state, so i look forward to working with you on expanding resources. i think it would be a terrible mistake not to move forward as quickly as we can with s.b. 1045 >> thank you. supervisor mark? -- supervisor mark? >> i want to thank you for all your leadership and your work for all of these complex issues, and thank all of our department -- department to have been working on this, as well as the mayor. as somebody who has loved ones and close friends that have really struggled with serious mental illness, this issue, you know, is really personal to me, as well, and i think you've made a good case for, you know, careful and thoughtful expansion of conservatorship here in san francisco. it is really targeted at

community members that aren't really being served by the current system adequately. i do want to say that i'm not going to be able to support this moving forward here today because i feel like there's still too many unanswered questions about how this could fit into a more comprehensive strategy to address in -- be addressed more comprehensively and address the needs of our behavioural health system and so many of our community members in need. i know there is other discussions here on the board, and also with the mayor's office about broader efforts and more comprehensive efforts. i would like to see this consideration of s.b. 1045 implementation as part of a more comprehensive strategy, i don't know, would be good for me to make a motion? >> sure, you can make a motion.

>> i would move that we continue this item to the call of the chair. >> okay. just a couple things, i want to thank supervisor madeleine -- madeleine for your work on this issue. it is a pass and that we share and we have been working on this issue substantially and as i said at the beginning, we may disagree on strategy, but we are completely united in wanting to help the sickest people on our streets. there's no question about that. i do have some unanswered questions that continue, but i believe, maybe we could get those answered within the next week. i was just wanting to ask one quick question about whether or not we know if there has been attempts in the last five to ten

years to amend lps conservatorship. there has been none, okay. when is the last time that the conservatorship, there was an attempt to amend it? >> so there have been attempts to move forward, changes to lps, but none of them have made it through the process. >> when was that last attempt tried? >> there were several bills last year that were actually moving forward at the same time that 1045 past. and i believe it was the only bill that made it out. >> to amend the discussion? >> correct. >> and to amend it specifically in amending the way substance use or broadening. >> you know, i would need to figure that out. >> we can do some research and provide bills that are moving

forward right now, as well as bills that move forward last year. >> okay. >> i will say that i think everybody who has looked at the law knows that we need -- it is not just one fix, and i think that what we have -- >> not everybody, though. there's lots, and lots of opposition. >> so last, 1045 was being considered and there was an attempt that was sponsored by elliott -- l.a. county to amended to include the population generally that we are talking about today. >> okay. that is really good to know. so instead of amending this to the call of the chair, because i do, you know, think that there should be a vote on this, if it is okay with you, supervisor mar , i would suggest that we continue this item for one week so that we have some time to get some more of these unanswered questions that we weren't able

to get answered today, so that -- again, i can only speak for myself here, but i believe there are -- i believe we need conservatorship and that there are times when people must be forced into treatment, and i believe that there are problems with conservatorship, and i wish that we were amending those are that that could pass the legislature. i just want to make that crystal-clear, and i'm only speaking for myself in that case , but i think that if we continue this item for a week and have a chance to talk, for me, the biggest issue that i didn't get satisfying answers to today, and that i want to talk to the department in between now and then and next week is practically, how this will be implemented if sv40 doesn't pass , and practically, how it

will be implemented if it does pass, and there were some real gaps today in walking me through that, so hopefully there will be an opportunity to have that conversation between now and then. so i do want to amend, sorry, i guess it is to the may 20th meeting. >> sure. i would amend my motion that we continue this item to the may 20 th rules committee meeting. >> i just need to clarify. is this both the hearing and the ordinance? >> yes. >> without objection, that motion passes. >> these matters will be continued to the may 20th meeting. >> thank you. is there any other my items? >> that completes the agenda for today.

we spoke with people regardless of what they are. that is when you see change. that is a lead vannin advantage. so law enforcement

assistance diversion to work with individuals with nonviolent related of offenses to offer an alternative to an arrest and the county jail. >> we are seeing reduction in drug-related crimes in the pilot area. >> they have done the program for quite a while. they are successful in reducing the going to the county jail. >> this was a state grant that we applied for. the department is the main administrator. it requires we work with multiple agencies. we have a community that includes the da, rapid transit police and san francisco sheriff's department and law enforcement agencies, public defender's office and adult probation to work together to

look at the population that ends up in criminal justice and how they will not end up in jail. >> having partners in the nonprofit world and the public defender are critical to the success. we are beginning to succeed because we have that cooperation. >> agencies with very little connection are brought together at the same table. >> collaboration is good for the department. it gets us all working in the same direction. these are complex issues we are dealing with. >> when you have systems as complicated as police and health and proation and jails and nonprofits it requires people to come to work together so everybody has to put their egos at the door. we have done it very, very well.

>> the model of care where police, district attorney, public defenders are community-based organizations are all involved to worked towards the common goal. nobody wants to see drug users in jail. they want them to get the correct treatment they need. >> we are piloting lead in san francisco. close to civic center along market street, union plaza, powell street and in the mission, 16th and mission. >> our goal in san francisco and in seattle is to work with individuals who are cycling in and out of criminal justice and are falling through the cracks and using this as intervention to address that population and the racial disparity we see.

we want to focus on the mission in tender loan district. >> it goes to the partners that hired case managers to deal directly with the clients. case managers with referrals from the police or city agencies connect with the person to determine what their needs are and how we can best meet those needs. >> i have nobody, no friends, no resources, i am flat-out on my own. i witnessed women getting beat, men getting beat. transgenders getting beat up. i saw people shot, stabbed. >> these are people that have had many visits to the county jail in san francisco or other institutions. we are trying to connect them with the resources they need in the community to break out of that cycle.

>> all of the referrals are coming from the law enforcement agency. >> officers observe an offense. say you are using. it is found out you are in possession of drugs, that constituted a lead eligible defense. >> the officer would talk to the individual about participating in the program instead of being booked into the county jail. >> are you ever heard of the leads program. >> yes. >> are you part of the leads program? do you have a case worker? >> yes, i have a case manager. >> when they have a contact with a possible lead referral, they give us a call. ideally we can meet them at the scene where the ticket is being issued. >> primarily what you are talking to are people under the influence of drugs but they will all be nonviolent. if they were violent they wouldn't qualify for lead. >> you think i am going to get

arrested or maybe i will go to jail for something i just did because of the substance abuse issues i am dealing with. >> they would contact with the outreach worker. >> then glide shows up, you are not going to jail. we can take you. let's meet you where you are without telling you exactly what that is going to look like, let us help you and help you help yourself. >> bring them to the community assessment and services center run by adult probation to have assessment with the department of public health staff to assess the treatment needs. it provides meals, groups, there are things happening that make it an open space they can access. they go through detailed assessment about their needs and how we can meet those needs.

>> someone who would have entered the jail system or would have been arrested and book order the charge is diverted to social services. then from there instead of them going through that system, which hasn't shown itself to be an effective way to deal with people suffering from suable stance abuse issues they can be connected with case management. they can offer services based on their needs as individuals. >> one of the key things is our approach is client centered. hall reduction is based around helping the client and meeting them where they are at in terms of what steps are you ready to take? >> we are not asking individuals to do anything specific at any point in time. it is a program based on whatever it takes and wherever it takes. we are going to them and working with them where they feel most

comfortable in the community. >> it opens doors and they get access they wouldn't have had otherwise. >> supports them on their goals. we are not assigning goals working to come up with a plan what success looks like to them. >> because i have been in the field a lot i can offer different choices and let them decide which one they want to go down and help them on that path. >> it is all on you. we are here to guide you. we are not trying to force you to do what you want to do or change your mind. it is you telling us how you want us to help you. >> it means a lot to the clients to know there is someone creative in the way we can assist them. >> they pick up the phone. it was a blessing to have them when i was on the streets. no matter what situation, what pay phone, cell phone, somebody else's phone by calling them

they always answered. >> in office-based setting somebody at the reception desk and the clinician will not work for this population of drug users on the street. this has been helpful to see the outcome. >> we will pick you up, take you to the appointment, get you food on the way and make sure your needs are taken care of so you are not out in the cold. >> first to push me so i will not be afraid to ask for help with the lead team. >> can we get you to use less and less so you can function and have a normal life, job, place to stay, be a functioning part of the community. it is all part of the home reduction model. you are using less and you are allowed to be a