been honest with the board of supervisors about the resources that are available and i think we have showed that in every single hearing and it's been really frustrating for us. supervisor walton. >> definitely not asserting we cannot chew gum and walk at the same time but a lot of things are broken before i would jump into something like this because at the end of the day we are taking away folks' civil liberties and we have to remember that. so yeah, there are some major concerns with that. a slide that also talks about judicial process, all clients have been offered voluntary services prior to petitioning the court for sb1045. is there like a certain amount of time? how many times they have been offered service? can you talk me through that a little bit? >> so, the role for the public

conservator to conduct an investigation and part of the investigation interviewing the individual and ask them about their experiences, what services have they been offered. also working with our partners at d.p.h. access to avatar and l.c.r. system to check past hospital records, determine what they have been offered. and certainly if services have not been offered to make that recommendation, that's also in the statute. if we determine voluntary services have not been offered in a meaningful way, we would not petition and we would be providing recommendations back to the department of public health on additional service interventions that need to be offered. >> and the fourth bullet, it's going to seem nitpicky, but goes back to terminology. says client may request a jury trial or rehearing at any time

to appeal conservative's determination. aren't jury trials typically for people who commit felony? >> under d.p.s. statutes, they have the ability to request jury trials. 5 or 6 jury trials every year on average. >> and pending legislation slight, from a practical aspect, it says individual notified after the seventh voluntary hold of a possible future conservator petition. how would that notification take place? >> that was a recent amendment recommended by the senate judiciary committee. and what we are envisioning, the department of public health would notify the individual before the 5150, but no later

than that time a conservatorship petition could be forthcoming? >> how, you tell them -- >> during the 5150 hold. working with the courts with the city attorney to develop written materials and explaining what could be for the -- forthcoming. we'll be sitting down with the city attorney, as well as with the public defender's office. they will play a really critical role in terms of due process protections, and that's really what the notification is about. it's about providing additional due process protections for individuals. in response to your earlier question about jury, trial by jury, i'm not an attorney, so i cannot speak to when jury trials

are implemented. only that we use them in l.p.s., and it's really so that there is an opportunity for peers to weigh in. >> thank you. so, i don't have any more questions. i guess i would just say that, you know, i definitely believe in tackling some hard issues and putting some policies in place that are really going to address the needs of what the concerns we have in community, and the things we need to change. but i also know that we have to be very careful setting ourselves up for failure in the policies that we implement and approve, and sitting through this hearing, sitting through public safety and neighborhood services hearing, through budget hearings, i have not heard anything that tells me that we adequately have the ability to address the most acute needs and put in a conservatorship policy,

typically in alliance with sb1045, and 40 more, but a lot of work we have to do as a city and it's really concerning to me as we continue to have this conversation. i just wanted to say that. >> thank you. supervisor mar. >> ok. thank you. we will be giving an opportunity for public comments shortly. thank you. just asking questions and then we will open it up for public comment. thank you. >> thank you. chair ronen. start by thanking, really thanking you and supervisor mandelman for all of your leadership on these important issues and sort of leading this important public sort of discussion about how we could best address the mental health and drug addiction crisis in our city and how we could better support members of our, in our

community who are really suffering and need support for their welfare and the welfare of the broader community as well, and i think also this discussion, you know, this morning is particularly about whether expansion of conservatorship and sb1045 would be a helpful or the best approach to do that. i know we have a lot of folks here who wish to speak during public comment and looking forward to hearing all the perspectives on the complex issues. i'll keep my comments short. had a few questions, kind of following up on some of the questions and points supervisor walton had raised. so i just had a question about whether, or how many, whether there are people who are currently conserved in jail, and if so, how many, and why? why are they in jail?

that are promoting their safety. >> i would add the wraparound services being clinical services. i can say for outpatient treatment we have had significant significants in jail contacts for individuals who participated in the program. >> thank you. i had one other question or set of questions. it is a question of how has in the implementation plan, how have we shown that no voluntary services will be reduced as a

result of implementation of sb1045? >> i don't know that we highlighted. we are estimating so we would potentially serve two to three individuals max every single month. the individuals population that are described are those within the system. we know who they are, and 55 is the outer limits of the eligible individuals we might reach. that does not mean we would serve 55 at any one time. we think we would move forward with the housing conservatorship two to three times max during any particular month. sb40 is shortening the duration. we would be pulling individuals who are high utilizers and helping them to use services in

a more effective and efficient manner. >> with intensive case management to increase capacity we would insure we are adding services needed to support this population. >> how much would it cost to provide services for a individual under sb1045 including the guaranteed support of housing that comes at the end? >> i am sorry. i do not have access to that information. certainly we would be happy to follow up and we could pull that information together for you. >> i would add that we are happy to follow up regarding that information. these are individuals known to our system cycling through crisis services. they are already costing the system of care existing dollars to support them. >> it is my understanding state law requires we have sufficient

funding for this. i guess the question is if the funding has been set aside for this for implementation including the permanent support of housing that comes at the end? >> i was going to say that i don't think we don't see a separate population to be served. they would be served through the existing system so there is not unique funding. with the expansions of services we know are needed throughout the system they would flow through and be eligible for the services regardless. >> thank you. >> supervisor mandelman? >> thank you. i want to drill down on a couple issues and talk more about them. there is a question of capacity in the system, and i don't know if the director is still around. there he is. i will bring you back up.

i apologize. your goal so you don't have enough housing units for all of the people who are homeless? >> that's correct. >> so you would ask us presumably to find revenue and build and buy a lot of housing units to house people who are stuck at various places in the system or not even in the system at all? you don't have to give us policy direction it might make your job easier. given the scarce resources, you have spent a lot of time over the last couple years trying to set up a system that allocates scarce resources, presumably according to need. is that correct? >> that's correct. >> you are doing your best and you may not have arrived there yet, but you are trying to figure out who has the most acute and severe needs to get those people off the street and

into care fastest. >> that's correct also. >> do you have any doubt at all the population we are talking about, sb1045 population would be at the very top of that acuity need list? >> no, no doubt at all. >> so if your systems are working correctly and you are trying to get the systems to work correctly. there may need to be further conversations to make it work better for those in drug treatment right now. the small number of 1045 people not in drug treatment currently because they aren't able to access it would be at the top of the list and you believe should be at the top of the list and not necessarily displacing other people at the top of the list? >> that's correct. >> okay. thank you. i am done with you for the moment. i want to talk a little bit

about 5150. there may be people to address this. there is concern about what i have heard that this legislation is going to promote more 5150s and more encounters traumatizing encounters between police and folks on the street. i don't believe that is the case, but i want to know what is in place to make it unlikely that that happens or if that does happen that it will become a bar to that person being conserved? how are we going to know? one question is whether people currently arriving at psychiatric emergency services are being inappropriately brought thereunder 5150. doctor bland. >> good morning. >> you were at psychiatric emergency services until about a month ago or maybe two months ago?

>> there about. thank you for the question. i want to make sure i understand the context the concern about the over use of 5150 and the second question about people coming to pes. >> what happens if some police officer treats somehow reads in the paper sb1045 is implemented locally and decides to go and start 5150ing people not appropriate in hopes of getting them in housing conserto have ship. >> -- conservatorship. what would happen if that were going on? >> that is a important question. we are trying to help the people that are most affected and having been in pes as a physician and psychiatrist and seeing these individuals cycling through services, i have been increasingly concerns about the

limits and constraints of the system to meet their needs. the welfare institution codes for the act has several checks and balances in place in that individuals can be placed on the 5150 when they -- 5150. someone observed behavior concerning it to be dangerous or behavior that suggests the person is not able to make use of food, clothing or shelter. when a person is placed on 5150, it is important to understand that is simply a petition for evaluation. that person must be taken to the nearest emergency or evaluation facility as designated by the county. many cases in psychiatric emergency services. at that point we have an obligation to provide timely assessment of the individuals.

psychiatric emergency services is the only place to be seen by a psychiatrist when a crisis 24 hours a day seven days a week. we take great joy and pride in providing that service to the citizens of san francisco. when they identify someone meeting those criteria. at this point where they arrive our goal is to understand the validity of the concerns. we have to spend time doing evaluation of the person directly was well as looking for collateral information or resources to confirm the concerns expressed in the community. it is an ongoing process, often not easy to collect that information at various points. it comes to the team of the physician whether or not the person will continue to need to be detained much longer. i will say the last part of the checks and balances around the

lps is individuals who place someone on the involuntary psychiatric hold without adequate criteria can be subject to criminal and civi line for te action. >> while you are up here. i wonder if you could talk a little more about the potential benefits of involuntary periods of sobriety for someone struggling with methamphetamine addiction particularly 1045. frequently experiencing meth induced psychosis. there is argument about whether compelled treatment can work and we hut up studies treatment may have possibility. short of that, what 1045 would allow us to do is just even before compelled treatment would

allow compelled sobriety, i believe. that is one of the reasons why it is attractive to me. as a doctor, can you talk a little bit about your thoughts on involuntary treatment, sobriety, that kind of stuff. >> thank you. i think it is important to understand that referring individuals for an evaluation and treatment in the hospitals is not equivalent of incarceration. this is treatment. we are there to help people get better. many individuals do actually recover. addiction is a chronic brain disease. it is fundamentally changing personality emotions and behaviors and interferes with ability to make decisions. there are elements of the process typically people are in denial. they feel loss of control to limit ability to recognize how serious the problem has become

for them. in substance abuse treatment we have had varying opinions around a client-centered approach to treating addiction, and what is clear is that contrary to popular belief there is a mounting amount of evidence that suggests involuntary compelling treatment can be helpful for individuals suffering with substance abuse disorders. i think that there are opinions and philosophies and then there is data. that is what i want to come back to. what does the data tell us? there is data for mandated patients that challenges that individuals must be ready or motivated to change before they are able to change. the key factor in the treatment is length of time an individual

is able to be retained in treatment. it is important that the person is able to reach sobriety to begin to be able to change. compulsory measures reduce the treatment dropout as with other serious mental illnesses involuntary hospitalization may be necessary to stabilize, assess and come up with appropriate plan for an individual. similar to outcomes for coerced treatment for users of other drugs, moderate outcomes are also seen for methamphetamine users who are reporting they have felt compelled or pressured to treatment. for the most part the outcomes have very much similar to individuals that would have sought treatment voluntarily. the strongest predictor of success for an individual in

addiction services under compulsory mechanisms or voluntarily is the number of months that person spends in treatment. the longer in treatment the more likely they are to be successful. >> than thank you, doctor bland. that is it to moore questions. -- that is it for my questions. we are deeply concerned about our behavior health system in san francisco. a couple things give me hope. one is that -- three things. while our system is not ideal, i think it is probably better and doing more and trying harder than any other system in california. i think i am on a daily basis impressed by the efforts made by people like anton bland and the folks through the systems and conservator office trying to do

heroic things and kelly in a system that is not ideal, but people are trying so hard to make it work and going above and beyond. what gives me hope. we have a mayor and board of supervisors committed to new investments. this sheet every sept investments is high -- sheet every sent investments. in opposed the 14 new healing center beds. those are critical. some of the folk opposing the implementation opposed the 72 new substance abuse recovery beds. those are critical and give me hope. the 30 new residential treatment beds are the first new mental health or dual diagnose beds in the city since 2008. it is the most significant investment in that type of treatment facility or those kinds of beds in a generation.

the fact that we have pioneered the humming bird navigation center, i want a hummingbirds in my district. i am eager to see more capacity. this is potentially an exciting time for san francisco to show the rest of the state and country how to do this right. i have a lot of hope and gratitude for the people who are doing the work. thank you. >> thank you. i have a number of questions, but absolutely i want to echo supervisor mandelman and the gratitude to all of you who do the work on the city side and in the public. this is some of the hardest work that anyone does out there, and to dedicate your life to this type of work, you are heros and we just appreciate you immensely. i completely agree with supervisor mandelman on that

point. i have a number of questions. we will get to public comment right after i ask these questions. stay tuned and thank you for being patient everyone. i am wondering, i noticed -- let me back up. if someone could come up maybe jail and walk me through -- maybe jill and walk me through what this would look like what a -- how this would work. let's take melanie. melanie has not accepted voluntary services 5150 for 10 times. this law goes into effect, and the next time she is 5150, where will she go? >> are you asking me to provide

a pathway for her, assuming sb40 passes at the state level? >> i will talk about sb40 later. i am concerned we are having this discussion with sb40 pending. i am assuming that 1045, you know, that this legislation passes and then i am assuming whether it is the police. under sb1045 we would be engaging angelica's team and other folks from the sf hotted team would be engaging with melanie. a client like her is homeless on the streets, trying to engage her in voluntary treatment which she has refused. at that point aot would make a referral to our office and practically speaking, when we receive referrals for lps we are evaluating whether an individual

might be eligible for aot. assuming that the referral that we are able to meet the statutory requirements under sb1045, we would conduct our own investigation, which as i explained before would include looking at clinical records, it would involve interviewing her directly, interviewing service providers that worked with her. we would also be trying to determine if there are any family members or other support, informal support to pull into the care plan. >> is melanie homeless? >> yes. >> melanie is living on the streets and schizophrenic and taking meth. let's take out the aot part for the moment. but she is eligible for 1045. who is going to go find melanie

and what is going to happen? >> what we are envisions is that we would work through some of our existing programs for example sf hot team where they are doing considerable street outreach. >> let me walk you through. i want to understand how this works. the hot team finding emily. what do they do? >> specifically you are asking how to motivate an individual to come to court? >> okay maybe that is what i'm asking. i want to walk through what this is going to look like. >> are you going to propose? >> we would have to provide

melanie with notification we would be petitioning for conservatorship. >> before melanie is conserved she has to questio to go to cou. she doesn't want services and hasn't engaged with you before. how will we get her to court in. >> a critical player is public defender. he would meet with her before the hearing. >> if we know that in order to conserve her involuntarily that she has to go to court and she doesn't want to go to court, the public defender is going to convince his or her client to do something he or she does not want to do? i do not understand how this works. you are going to ask? is there anyone from the public defender's office here? >> i am in aot.

angelica has experience with the public defender's office and street outreach. >> the public defender plays a crucial role and there is not one person from the public defender's office here? that is shocking. can we get someone from the public defender's office here? as you said several times throughout the hearing. they play a very important role. i am surprised we don't have a representative from the office. you are saying the public defender is going to convince melanie to go to court to face a judge to be involuntarily conserved even though she doesn't want any voluntary treatment? >> our experience without patient treatment because we engage with individuals in the community and support them, if they want to attend court we

will escort them to court. >> what if they don't want to? that is the point. they don't want the services. that is where i have the questions. i don't understand how the law will work. if they don't want services, then how -- the only thing i heard we are going to use the public defender to convince the client to go to court? i don't understand how that will work. >> i was describing the process up until the conservatorship. are you asking how to provide the services when the conservator ship is authorized? >> no how do we get one who doesn't want services to go to court to face the judge to be conserved. >> i would add as a provider who does this work and my experience is that when we filed the petition with the court and working with the public defender's office we meet people where they are comfortable. the public defender will meet

them in the community to understand the individual's desires to represent them. >> we have engaged -- i would love to hear from you, simon. >> i am not an expert. this is my experiences in these matters. step one. how do we meet someone? we have a member that meets with the homeless. they are activating 911. we meet them in the hospital, ask what they are connected to. do you have a case manager, social worker, an id? we try to get them to meet us. when discharged from the hospital or pes we meet them or buy them a sandwich. we say let's go to the dmv and get this done. where are you staying? we will get you shelter tonight. the point is i don't want shelter. we will get a navigation center

bed. i don't want that. they might take it but they are kicked out of the navigation center bed a couple days later for failure to show up. that is what i mean by refusing. >> that is my while point. i am trying to understand if the while point is we can't engage this person. >> i will get there. >> sorry to interrupt. >> now we reach the point where we go on nonemergency basis to outreach on the street. we recognize this person at this moment is gravely disabled. they cannot care for themselves. then we can call the police. in my experience the police have not been the best people to evaluate someone. i will call mobile crisis or street medicine. there are two psychiatrists and they will evaluate that person and put that person on a hold.

then they will go to one of the emergency rooms in the hospital or pes. preferably pes. they will evaluate them for eight to 10 to 12 hours, clear, be able to site a plan, be released. they go back to the street. they repeat. that is the first 5150. we are working with all of the city agencies. we contact the department of public health. we will say this person is really in crisis. the department of public health will say you are right this person has had this many holds. they will send somebody out. i don't know if you want to mention names who work for the department of public health. they would come out. next time they are at the hospital i will call to say this person is at the hospital again. this is the sixth 5150 in the

last number of months. they will talk to that person and say you are in crisis we are trying to get to the residential treatment plan and you don't want to go. i have to tell you that eventually this might lead to a temporary restriction of your freedom. this has gone too far. this is the people i talked about in my testimony. this is who we are talking about. now on that eighth time they go to pes and maybe then pes is going to realize this is the eighth time. all of the boxes have been checked off. we will hold this person. at the general hospital at a hold. there is a room in building 5, sixth floor where there is a judge presiding overall these cases in a weekly basis.

they have an assigned public defender. i have been there for these individuals. one they are at the hospital detained, i guess that someone calls up the public defender to say this person is on the docket. please go see him, there is going to be a hearing. >> if i hear you correctly while the person is on the 5150 hold, they will be taken upstairs to the sixth floor to the judge to start the conservatorship process? >> eventually. >> i was not clear whether you were asking about preconservatorship process, how we are moving someone towards conservatorship? >> sb40 will change. >> that has not passed yet. it is not the law. if you are asking us to pass this without sb40, can you tell

me if we pass this law today, the whole board passes it, mayor 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