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.

>> 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