criminalize our communities, because people of colour will be the main target of this bill. i invite you to oppose this bill , and also to have a dialogue. thank you. [applause] >> next speaker, please. >> good afternoon. i will speak for myself. i'm a third-generation bay area native, and i'm shocked. i really don't understand it. i was at the last board meeting on monday, and you guys were on track, and i understand that you have input from up above saying she wanted you to do something else. i don't get this. ptsd is not just something that is for veterans. it also hits the civilian population. many of these people you want to approach with helpfulness or carrying them all, have ptsd.

they have been abused and that is why they are not in shelters. they don't want that many people close to them all the time trying to get something from them. we need more humanity. you need to go ahead and help these people, not just round them up and put them away. this is too far overreaching, and it opens the gateway for abuse. that is what we are concerned about. i've heard it mentioned about the reagan era and what happened there. that is over. now we need the department with new humanity. it is not just a humanity issue, nothing is really being accomplished here. this is the rich attacking the poor and the poor need help.

>> good morning, supervisors. i'm a former commissioner for the city mental health board and currently a member to the board of directors, of the mental health association of san francisco. this bill is about chain -- it was an invalid detention. back in 2014, we had a similar debate going on when laura's law was being debated. back then, his the supervisor then came up with some suggestions to improve it, but bringing in a committee of three people to evaluate every case for someone being brought before the law, which they called -- it

helped reduce harm, it helped to humanize it. i see nothing like that in this law. there's a lot of things we can do instead that are more humanizing and help with addressing the core issue of provider caused trauma, which is why the one reasons why people avoid treatment in the first place. we could create a system of true navigation. navigation with transport, meaning we have peers coupled with the nurses, coupled with mental health professionals going after the community to engage people who aren't engaged with services and help them get into services, and they have transport bands that aren't police cars, that aren't ambulances, they are just consumer or medical transport bands to bring people to services. think about how that could reduce harm and solve the problem this is trying to solve. thank you.

>> hello. coalition on homelessness. this is a highly contentious issue and highly contentious for a reason. when we introduce a radical change that moves us from a long-standing agreement, that you only take away civil liberties -- liberties when there is a safety issue, or they are so disabled they can't care for themselves, to an absolutely random 85150 decided on by police, after determining seven times that that individual does not meet the safety standards, yeah, it will be contentious. the state bill requires the city to show that there are services and no one will be displaced. the city has done no such thing. for the most part, these services are not entitlement programs. there's already people queued up for them. there have not -- they have not shown exactly what level of care each needs, and what services have been offered to each time,

and where the vacancies are at the level of care that melanie needs. i will give an example of housing. they are supposed to be often supportive housing. there is no honest way to say no one will be displaced when they prioritize these folks for housing when you have people with 21 plus years of homelessness that are literally at risk of dying tomorrow without housing, yeah, it will be contentious when you displace people like that and make room for someone else. currently sv40 is amending this bill. do the authors get input from the community of addressing their concerns? not at all. do the mayor's office address one single concern with the implantation plan, no, not one. one folks are more interested in personal political winds than addressing the true need of folks and engaging with people and the lived experience, it will be contentious. whatever you are offering melanie is not helping her meet her goals. the system failed her.

you are now shifting the fault of the system onto the shoulders of melanie. let's get real and truly address their needs. thank you. >> hi, and speaking as a member of the gay queer direction, a group that formed in 1983, and as a long-term member of the lgbtq community, i remember the days where queers, young queers, and queers of color get locked up for involuntary treatment at the behest of their family, at the behest of their community, and i'm surprised nobody's talking about the impact on the queer community. people come to this city, and people end up on the streets because they can't afford to live in the city. while on the streets, they become subject to all of the challenges to their mental health that come from living on the street. when they get locked up, they

are still subject to demands for gender conformity and other kind of conformity in order to get discharged. i don't doubt that this will happen with this bill, despite all the well-meaning queers who are employed by the san francisco department of public health. the people who are on our streets need supportive services , not incarceration. there are actually far fewer voluntary community service -- unity services available today than when we formed in 1983, and that is just sad. incarceration isn't humane, and it dehumanizes the incarcerated and their jailers. thank you. >> my name is tori becker, i'm also a member of the gay queer direction. i am a retired psychiatric nurse practitioner, and i worked with substance abuse in people with chronic mental illnesses. i'm totally against this for so many reasons.

1045 is a blatant public relations stunt, hypocritically couched in concerns for people with psychiatric disability and house list people. in response to big business, the tech industry, condo developers, to try to make it look as though the city is doing something about the quote unquote terrible houseless problem. this is part of the rising tide of fascism and white supremacy in this country. make no mistake about it. it is part of a general shift to the right throughout the country , and this is happening in san francisco, with the liberal guys of caring about people who are on the street. it is shameful, if the city does pass this, rather than build more public housing, more intensive case management services that people can access, then it will be a shameful,

terrible day, and it will be one more step towards fascism. people should really remember that. [please stand by] >> and get higher rents and raise the hotel fees. that's the only thing behind

this thing. you know, it's trying to put a band-aid on the capitalist pig, which is corrupt, decaying, murderous. and, you know, it's not going to do any good. homelessness is a problem all over this country. and it's going to continue to be a problem, as the system decays, as supervisor ronen said, the system is broken, trump, human need and responsibilities. 100-year-old woman, kicked out of her apartment after 60 years. where was the law to protect her? the chinese family in chinatown. [bell ringing] the disabled daughter was kicked out of their house and the mayor of the city could not save them. where was the law to protect them? so you've got to look at where this law, who is generating the money to back this law.

you always got to follow the bucks. thank you. >> good morning. my name is jordan davis. i am speaking for myself. i'm a transgender woman, i live in district 6. and i voted for london breed for mayor and i really oppose this. i have talked about the potential impacts of this new form of conservatorship on transcommunities and my own experience with homelessness last week. i want to tell you that i won't be mad at any member of the committee for what will happen. i'm mad at this entire process, as well as the strong mayor system and how we can -- we can't think about voluntary services first. i heard through the grape vin our bullshit mayor is holding -- over you. i voted for london breed. i gave her so many chances. but with her manipulative behavior, people should not be

conserved. i also regret supporting ravenel mandelman, who is basically made progressives lose their objectivity over this. had this just been breed doing this, the mill particular club may have opposed this, as they opposed anti-homelessness, pro-cop thing. i could have been conserved when i was homelessness. take it from me. the bill fucing sucks. if you know why my mental health is suffering, it's because of this shut railroad -- oppose this. [applause] [bell ringing] >> only one way to take care of this problem, i demonstrated that before, when you were negotiating the navigation center at embarcadero, center.

you could build the complex for $56 million, which is the lowest embarcadero -- rate throughout the city. the map figures, with the supervisor mandelman there and use my technique, versus the technique that he thought was the best and we end up saving $66 million. the people that's out on the street need permanent housing. and a permanent location where they can live and then get the type of services and treatment of professionalism that you're trying to give. and about you claiming that you've got shelter beds or adequate beds, that's nothing but a mack. that's not a bed. people need their own apartment and be stable and a place where they can receive the services that you claim that you're offering. okay. as far as supportive housing is concerned, you can't even

perform equal opportunity housing out of all of the apartment buildings that's coming out of the mayor's office on housing. you're the sole reason why the people out on the streets and suffering, having this mental disability in the first damn place. if they had housing, that they could afford to live in, they wouldn't be out on the street. you talk about -- [bell ringing] mental services. you've got 17 opening for mental psychiatrists within your own system, and you try to step out of your own jurisdiction and tell kaiser hospital about the mental services that they're giving to their patients, and you got 17 openings for psychiatrists, on the same system that payroll as yourselves. and now you're talking about adequate beds, conservatorship. you can't even support the system that you got now. and you're trying to gather up people by the police. [bell ringing] you must be out of your mind. [laughter]

[microphone shut off] >> next speaker. >> all of you made an appointment to see a psychiatrist yourself. [laughter] [applause] >> next speaker, please. >> all right. >> hello. i'm with the association. i'm someone who is homeless, who is formerly homeless and living with mental health challenges. i get it. you guys are like the warriors. 17 points down, the city 17 points down. we know that you don't have the services. we know that you have a lack of bills, you don't have the shelters. we know you don't have all of the things that you need. and so this -- 10:45 looks like a win. it's a false win. in the long run, this will not work and we know it. if you haven't incurred the basic needs and the basic problemsing the more complicated problems become more complicated. people aren't getting what they need. if we aren't getting what we

need now, what do you think s.b. 10:45 will get us what we need. we need what david elliott lewis was really talking about. we need an extreme team to work on these cases, on these people dealing with all of these issues, that have -- i think you said 40, 30 or 40 people. well, we need an extreme team. i think mental health association, along with the rounds, along with all of these other programs, can work on building the team that deals with these cases in a more humane way. locking them up six month is not going to problem the problem. we have to solve the problem at the basic line. we have to love and care and do this the right way. or we're going to lose the game for real. thank you. >> hello. good morning. my name is ray small, i'm an organizer at senior and disability action. i'm actually going to read the testimony from susan missner,

the director of the aclu's disability rights program, because she wasn't able to make it today. i want to be clear that the -- sorry -- start over. thank you for taking my testimony remotely. i want to be clear the expensive case management and the relationship-building that was described earlier, as part of how assisted outpatient treatment is successful, is a key fact here. we know that relationship-building is key. we know that patient and persistent outreach is what it most affective to get people stabilized and off the streets. a harm reduction approach gets people stabilized. we know that. why are we not trying it first? it should be in place for a full year, before we have decided that another approach is needed. our laws require that conservatorship be the least restrictive option. would you not use what are known as effective approaches for voluntary treatment before we use coercive treatment, than we're not using the least restrictive approach.

we should be clear that forced treatment on people is not new and innovative. it is old, regressive and even medieval approach. if san francisco wants to be innovative, it should establish a clear standard for what needs to be tried first to establish the conservatorship is the least restrictive option. thank you. [bell ringing] >> thank you, supervisors, for the opportunity to speak today. my name is dr. o'leary, i'm the chief of psychiatry and clinical professor of psychiatry at u.c.f. school of medicine. i'm here today because a group of extremely vulnerable san francisco residents living homelessly on the streets, in a state of constant crisis, due to mental illness and substance use disorders. they're brought dozens much times a year to the psychiatric emergency room and to jail with illness-related behaviors. unfortunately their mental illness robs them of the capacity and judgment to accept

treatments that would help them. s.b. 10:45 would allow us to provide potentially life-saving treatments to these individuals over their objection. as the hospital psychiatrist, i'm acutely aware of the need to protect patients' rights and committed to doing so. we're lucky to live in san francisco, where we have a talented and dedicated mental health legal team and the public defender's office, who is paid by our city to protect the rights of psychiatric patients. they're really good 59 what they do. i'm confident they'll not allow any person to be mandated to treatment without just cause. to those of you who have advise reservations about 10:45, if your brother or sister or father or mother or daughter or son were in this kind of dire life-threatening situation, would you want us to throw up our hands and say, i'm sorry, there's nothing we can do? i don't think you would. [bell ringing] as the city, we know how to do

better. please enact s.b. 245 to provide help to the extremely vulnerable population. thank you. >> hi, i'm allen cooper. i'm a retired physician, who spent the last five years doing safety net medicine, after i retired from caring for people with alcoholism and mental and liver disease. at the last meeting -- i agree with dr. leery, there is a vulnerable population on the streets. and we should be doing something to try to identify and help them. at the last meeting, i asked if anyone knew how many of the 400 people, who died in the last two years on the street, had had at least 55150. do we have an answer? did anyone bother to look? good data could persuade me to go the other way. but i think you're afraid of the answer. i think you're afraid of the answer because the people who

are dying tend not to be the ones who are most visible, in my experience, working with homeless, they tend to be the ones who are lying in corners quietly. i'd love to hear that answer before you move forward. get data and you can convince us that we're wrong. >> good morning, supervisors. my name is jared atkins andi like to take the opportunity to tell you about my friend christine. christine was a hell of a woman, who was homeless here in san francisco for several decades. she struggled with drug and alcohol addiction and in and out of treatment. some months she was doing great and other months she was clearly barely hanging on. she taught me a lot about the realities of being homeless and about the difficulty of dealing with addiction while living on the street. on the first sunday in november, i got a call from a friend of mine telling me that christine had died of a drug overdose. and i was actually on my way back to the office from doing

visibility with you, super mar, when i got the call. i have no doubt that had christine received the help she needed, even perhaps involuntary, that she'd be alive with us today. please support s.b. 1045, because it has the potential to save people who are unable or unwilling to help themselves. even if one person can be saved with this legislation, it's worth our efforts to do everything that we can to save them. thank you. >> hello, thank you for letting me be here today. my name is ben moreman. i would like to honor the comments of the first doctor, who was up here, but disrespectfully disagree with him, firstly. i came to this city with a state of mental illness that was chronic. i could not get out of bed. i was helped by supportive housing in the city, by an organization that got their money from department of public

health. they do incredible work. they have 1500 clients. they help people with their mental illness, because they house them, because they gave them wraparound services, base they give them counselors. the number of people on the streets here, who i see all the time with mental health challenges, need those kinds of services. they do not need to be put into conservatorship for 14 days, for six months, for a year. with this group, i lived in their housing, with two people with schizophrenia. they were doing all right because they got services. i'm now out. i'm doing well. i volunteer with an organization that does street outreach to youth. and now i'm on the board of an organization that serves 1500 clients. we can get better, but we get better with support services. and with supportive housing. not with coerced treatment into institutions.

i urge you to vote against this bill and come up with better services for our city's residents. [bell ringing] thank you so much. >> great. good morning, supervisors. excuse me. thank you so much for considering this issue so carefully and really hearing the community. i'm jessica lane, i'm executive director of senior and disability action. a few things i want to say today. one is to clarify a point raised earlier by department of public health about the inability to care for one's self-railroad, being one of the criteria. i think that's mislead, it has been the criteria under l.p.s. conservatorships and part of the opposition to s.b. 1045 is taking that out. what it say in s.b. 1045 is the inability to care for one's self is as evidenced by multiple

5150. ping many of us would agree that having multiple 5150s does not actually mean that you are unable to care for yourself and make decisions for yourself. second, is really important that we go over, you should not have to be conserved to get services. the city has not shown services are available. we have countless examples of people with lived experience, not abling to the services they want and need. i have heard that social workers are already talking about how do we get people conserved, just so they can get services and housing. this cannot be how our system and how our city works. yes, people are dying on the streets, because we're not offering them services. that's what we need to do. we're talking about really adding trauma, every time someone goes through a 5150, trauma when they're conserved, trauma locked into a treatment, trauma when they lose the ability to make decisions for themselves. [bell ringing] and why do people -- why do people sometimes benefit from

it? you know, there was a drug policy alliance conference just last week about, called beyond coerce. and they talked about people are resilient and people will get what they can out of situations they are in. when you force people into services, those are services and sometimes people will benefit. that does not mean that that is the way we should be doing it or that's the best thing for people. [bell ringing] i understand that supervisor mandelman -- >> speaking time has elapsed. >> i'd urge you to -- a reminder this is about civil rights. that always needs to be part of the conversation. >> thank you. next speaker. >> good afternoon, supervisors. my name is bradley weedmeyer. i'm a member of a home care organization called provider network. and here speaking against senate

bill 1045 and senate bill 40. i think that there's just way too much that's arbitrary in the figuring of this -- the eight 5150s, all of the suggestions that this just 50 people. we have absolutely no idea. obviously one cannot have a health -- mental health program by just addressing one part and the most severe part of our mental health crisis. obviously -- i live on gary and shannon alley. so i deal with people who are in distress every day. and seeing them. and i know we need to do something. but just doing the politically attractive thing of getting hard

on mental health expressions in the public realm is not the way to do it. and i think that we need to expand the mental health services of the city, so that people don't get to this point. what happens to melanie when they comes out of conservatorship? she's going to be homeless again. [bell ringing] i think it makes no sense to just do the -- a politically dramatic thing, that looks like we can check off the most needed, when these people are not getting the services before they reach the state. the city needs to have an entire mental health review and address these issues, so that we can be the city that we need to be. it's a shame that we are one of the last places that got rid of the -- [bell ringing] >> thank you. i'm going to call two other cards. if you haven't yet spoken, amber and katherine. and anybody else who would like to speak. >> i want to speak later.

>> my name is -- conservatorship. it deprives the civil liberties of the mental illness. if they cannot go to the hospital, these are people. [indiscernible] and follow up. [indiscernible] we don't need isolation. thank you very much. >> hi, there. my name is ronny. and i'm a medical student at u.c.f. i think that s.b. 1045 is really the wrong approach to address this really severe gap in care

that we all agree on. and since the last hearing, over last week, i've really been trying even more to understand the supporting side. because we do see psychiatrists that, and people in the medical world and psychiatrists that support the bill. i've been trying to grapple with what is it that is missing here in understanding, like why are we seeing this so differently. and, you know, what i thought is you will see a lot of -- and i ended up talking to people with multiple perspectives at my school. and you do see several psychiatrists that are supportive of this bill, but you also see several that really agree that it's not a good idea. and what i'm seeing is that it's really an agreement on the concept, in that we have this gap of care and maybe this is going to be one tool we can use to address it. what you're missing is that this bill and the way it is written has such severe potential for abuse and misuse by the system, and i will flat out say straight

out, the medical institution has done harm to patients in the past. we've made wrong decisions. we make wrong decisions all the time. and what you're seeing in the community here and the perspectives here is foresight. foresight in this bill, the way it is proposed, that could lead to such bad abuse, giving more power to law enforcement and to other forces taking the decision out of the medical provider. [bell ringing] and other ways that we make these decisions. so i just want to reiterate that. next, i also spoke with someone from hot, the homeless outreach team. and there's also mixed perspectives in that team. but what you find again and again is people are agreeing that, you know, this is probably not the best option. this is not the best way we could be addressing this issue, that we all agree is an issue. no one wants to leave people out on the streets. [bell ringing] no one is saying that. [microphone shut off] >> speakerrer time -- speaker,

time has elapsed. [applause] >> hello, my name is phoebe. i didn't actually come here for this hearing. i came here for something else. but after listening, i really feel that if i don't say something, i would be wrong. i sat on the reenvision the jail committee for an entire year. this bill is so fascist and so beyond anything that we were trying to do at the reenvision the jail committee, i can't even believe something like this was actually put on the table and is even being considered. to remove the civil rights from people, when we have a police department that is outrageously egregious, kills people without -- i mean, we have a terrible police department. i'm not even going to defend it. and to put hands, the hands of people at risk, who are fragile in those hands, oh, that's

outrageous. and i completely oppose it. and we did not sit on that committee for one year to end up with this as a solution. or a remedy. [applause] >> good morning, supervisors. my name is high carol. i live in district 8 and have for seven years. i used to work in tech and began volunteering and meeting people on the streets through project open hand, project homeless connect. now faithful fools. i spent a year with concern providing crisis de-escalation, alternatives to 911 on the streets. i -- collaborated with the hot team, hor are the hardest to handle, whether with memory loss or addiction or other issues. i have yet to meet one person whom, like i know better than i do. there's just -- i haven't met that person yet. we each are doing the best that we can with where we are.

and i went to that conference last week at u.c. hastings on coercive treatment. i heard speaker after speaker saying i was hospitalized with a child, i was hospitalized for a year. i somehow made it through. i realized i couldn't fight from within the system, i had to get out of that system to come back. we already have conservatorships and we've had lawyers come and talk to us about all of the different ways and the poor conservatorships that people are protected. and how you get into one and it just boggles my mind that we're considering 5150s. if you set a metric, that's what you're going to work towards. so we're going to try to get as many 5150s as we can, to try to get people into the system to try to get them help. [bell ringing] we really need money for community-based mental health alternatives, money for things like concern or just any other alternative to just funneling more money into the police to

try to police our ways out of a human rights and health crisis. and a crisis of will and compassion. thank you. >> my is robin buckins. i didn't come here for this hearing. i won't stand up here and pretend i know the ins and outs. i wanted to speak to this, because i have a family history of mental illness. my mother is schizophrenic. and, as a result of that and the lack of mental health, you know, laws and whatever, we haven't seen her. she disappeared. i haven't seen my mother since i've been 25 years old and i'm 58 years old. we don't know where she is, okay. and i take care of her sister now, who is schizophrenic. and because i take care of her, and i can't get any help for her, i understand that this is a very, very difficult situation. i'm kind of torn.

but one of the things i do not like, this cannot be put in the hands of a police to make the decision. okay. it has to come from psychiatrists or whatever. because i do know that those who are mentally ill -- but at some point part of their illness don't end up back on the street. okay. what they need really is to have some type of housing, where there are case managers on site, where there are people that are monitoring them in and out. otherwise it's just like recidivism, is that the right word, in and out, in and out. it could be 72 hours the way they do it now. [bell ringing] or your program suggests six months, back and forth, back and forth. i just see this as a band-aid to look good about getting the homeless people -- the fake white liberals don't want in their neighborhood. [applause] >> is there any other member of

the public who would like to speak? seeing none, public comment is closed. [taps gavel] i know the public defender arrived and so i'm wondering if we could call him up to the front . >> good morning, supervisors. my name is kara chen. i am a deputy public defender. i manage the mental health unit. >> thank you so much for being here. so both at the last hearing and today, despite the fact that there's case managers that perhaps have daily interactions with the individuals at s.b. 1045 is attempting to serve, that the individual refuses services. and when i ask, well then now if

this individual is refusing any sort of services, refusing housing, how are you going to get them to court, if this process requires that they be in court. and they say that the public defender is going to play the role of urging the person to come to court. now i'm an attorney and i know that the ethical obligations we have as attorneys is to support the will of our clients. so if the individual doesn't want to engage in services, and yet they're going to rely on you to get this individual to come to court, i'm wondering if you could explain how that seemingly contradictory set of situations, given your ethical duties to, you know, as an attorney, et cetera, are going to work. >> first of all, we are mandated by the statute to represent

clients, who are placed on -- in voluntary holds. in this particular case, s.b. 1545 is a very unusual, legal process. the person is being petitioned to be placed on the housing conservatorship, from the community. so if it's not our role, as the public defenders to drag the client to court, even though they don't want to be part of the process, that's not our role. our role is hypothetically speaking, i am a responding party. when the city attorney files the petition, then we -- then they file with the court, we receive a copy of it and we try to -- through the petition, we try to discern the location of the client, for example, this client will be at this location. normally that will be where the client is residing or camping. we will contact the public conservator to make sure the client is at that location.

then we will go out to the community to meet with the client and hopefully they will talk to me. in the past, we have done similar outreach through assisted outpatient treatment program petition. so usually it takes more than one occasion to talk to -- to reach them. and if they don't want to talk to us, we'll leave them with our contact information and say, please, this is your court date. we would encourage you to come to court, because an a.o.t., the court can make a decision in the client's abstentionia. >> we're talking under 1045. >> yes. if they're not in court, they cannot make a decision. so the only thing i can do is to leave my contact information, let them know the next location court date, the location of the

court and invite them to come to court. that's what i can do. now if the client says it sounds good, i want some services. and i may want to come to court, then i say do you need any assistance to get you to court. and then i will contact the case manager and the conservator and let them know the client would like to come to court, please provide transportation. that's the extent of our involvement. >> but, i mean, what would your -- what would the conversation look like with the client? i mean, this is a client who has been 5150 eight times and who has been, according to the appropriates of 1045, been offered every service under the sun and has refused to accept it. and so there's been a process initiated where, against their will, go to conserve this person, force them into services. the person they're rely on to get them to court, to force them into services they don't want is you. that's what they're saying. >> so i'm an attorney.

i don't-- i don't like to specu. i haven't done a 1045 petition yet. >> but they're sitting right there. they are saying they're going to rely on you to urge the individual to come to court? this is an individual who doesn't want services. >> so reaching into my experience, when i outreached the a.o.t. client, which i have substantial experience. >> yes. >> it will be multiple outreach. it will be very short and they're going to tell me -- >> here's the problem. a.o.t. is a voluntary service, right. and so >> it's not voluntary. once the grant court is granted, it's mandatory. the petition -- the respondents are asked to participate. they could say no. >> right. yes. so it's different than conservatorship, where you are being ordered by the court to do something against your will. it works differently from a.o.t. with a.o.t., you can tell your

client, if you don't come to court, they're going, in your absence, without your voice being heard, going to order you into certain services. >> yes. >> you can't do that with 1045. >> no. >> i understand the only experience we have is a.o.t. to like, even understand how this might work. when i'm telling you if it doesn't make any sense to me. how are we going to force an individual, who has not accepted any voluntary services to come to court, so that they can be forced into services. and how is the city going to rely on the public defender's office, whose job is to represent the interests of the individual and what they want to do it. it doesn't make any sense. and and i'm hearing a clear answer from you, other than under a.o.t. repeated context. what would you say to your client? i mean, you have to be honest with your client. and you're going to tell your

client, you know, they can't conserve you unless you go to court. you don't want to be conserved, you don't want any services. but they're asking me to ask you to go to court. it makes absolutely no sense whatsoever. >> i would have to advise them more or less with what you just say, is that in order for them to conserve you, you need to be part of the -- the participant of the process. if you do not come, then the petition will be on hold indefinitely. >> okay. so we all admit this makes no sense whatsoever, because a client, who has denied services there for years, with their intensive case management who has daily interactions with them, is not going to then voluntarily appear in a court, where the judge could order them to receive services against their will. makes no sense whatsoever. but having accepted that that makes no sense whatsoever. second question to me.

so somehow the client still decides to go to court, and -- they don't want to be conserved, so you're defending, you know, your client's rights, what would that defense look like? whether it's before a judge or a jury. can you walk me through, because you have to challenge i'm assuming eight 5150s. so what would a challenge to eight 5150s look like? >> it would be kind of like a murder trial, because i have to go through each 5150 to make sure it's justified. because that is the element to sustain the petition. and i would not be doing my job if i don't thoroughly litigate each 5150. >> so what does it take to challenge each 5150? does the officer -- the officer or whoever else initiated the 5150 have to be present in court to testify? >> because there's a case law of people versus sanchez, it has --

people cannot testify. here's the statement. so the witness, related to the specific incident, has to come to court. so either the peace officer, who initiated the 5150, or the provider, who initiated the 5150, or the nursing staff or medical staff that initiated the 5150 at p.e.s. they have to be subpoenaed into a court for each one. >> incredible amount of resources. okay. so in my opinion, and i think i have just proven the point. 1045 is unworkable. it doesn't make any sense whatsoever. but let's talk about -- let's talk about s.b. 40, because that is a different process. so without the client's present, i guess attending physician will initiate a temporary conservatorship. and the individual -- let's say

the individual is brought to p.e.s. on their eighth 5150. they'll be taken to a locked ward at either general or the st. mary's healing center and they'll be locked up. so that, you know, they don't -- they're already there against their will. so will the process of you defending that client's right be -- it would be similar, though, where you would challenge eight -- each of the eight 5150s? >> it will be similar. and the only difference is that the client -- we know where the client is. >> right. right. and the client has -- >> i'm not responsible for bring them. >> yeah. you're not the one trying to push them to go to court. okay. thank you. those are my questions. any of my other colleagues have questions for miss chen? no. and thank you so much. >> thank you. >> if i could call upangelica again. so when you said that -- in

melanie's case, who is a real person, so we can actually know what happened with melanie. in melanie's case, why -- what were the reasons she gave for not accepting services? >> so in melanie's case, i think i had mentioned that our last hearing that we had worked with her through assisted outpatient treatment. and she really told us that she just didn't want services, that she was fine and didn't need them. that's something we heard on a repeated basis. and what services was she offered in particular? was she offered housing? >> so she was offered intensive case management and through assisted outpatient treatment, we have a stabilization room to support her, which she declined. acute diversion units, residential treatment. >> but not housing? >> through the stabilization housing, but not permanent housing. y , she was not offered permanent housing? >> i should add, she wasn't willing to accept our support to go through the assessment process for that. >> okay.

and so she was offered intensive case management, but she was already in intensive case management? >> she had a history of intensive case management, that she had declined and terminated services with. and through outpatient treatment, we offered her reen engagement -- reengagement with appear different provider. >> okay. okay. any questions for angelica? no. thank you. any other comments or questions? i have some closing comments. supervisor walton. >> one, i just want to again say that i appreciate everyone for coming out. i think this is hearing number three. and we have always had several concerns about s.b. 1045. i'm just going to just speak directly about one concern, because you'll be hearinger more from me as we move forward on this. there's just one thing that i do

want to talk about in this committee today. this is something i haven't received an adequate response to. and i don't think one actually exists. but we can't look at all of the steps that we have taken on police reform and the 272 recommendations of the department of justice, about how to improve policing practices here in san francisco, and about better policies to keep communities safe and work towards achieving those goals and outcomes and then in turn support further possibilities of negative police contact. that impact is being downplayed in s.b. 1045. i have heard nothing about mitigating the possibility of black people and people of color being disproportionately affected by s.b. 1045. i just want to go on record stating that today. i have several concerns and other things. but in the interest of time, in the fact -- interest of fact we've had this conversation,

nothing new in terms of my issues and concerns, i'm going to leave my comments at that. >> thank you. supervisor mar. >> thank you, chair ronen. i just wanted to first acknowledge all of the thoughtful and i believe well-intentioned work on this proposal by supervisor mandelman, mayor breed, d.p.h. and d.o.s.s. also wanted to thank all of the diverse community members who shared their perspectives on these really important and complex issues. i think just from listening to all of the -- well, the presentations and all of the comments and i have gotten a lot and we've all gotten a lot of comments directly into our offices, you know, i believe we're clearly all in agreement that much bolder actions are needed to address the urgent mental health and drug addictions in our city. i also believe we're in agreement that voluntary services first needs to be the

approach to this -- to addressing these challenges. you know, i think the proposal that we're considering is really an attempt to address the needs of a small number of community members, who to whom voluntary services hasn't been an effective approach. and i think my position on this -- this issue this week is the same as last week, in that i'm not really able to support the proposal, because there's still too many unanswered questions, particularly like i have questions around the s.b. 40, the status of s.b. 40. and whether that's just going to change the state guidelines and framework for what we're going to attempt here in san francisco. but more importantly, you know, there's just been a lack of enough information to ensure that voluntary services, you know, are really -- are going to

be available or have been available to the individuals that are being -- would be served by the pilot program. and more importantly to the broader -- broader range of community members that really need those services. you know, i appreciate the presentation last week and hearing about the recent investments, you know, that the mayor has made or is proposing in expanding, you know, the residential treatment beds and other services and supports. but it's not -- i think it's pretty clear that's not enough to meet the needs of the really urgent and great needs in our communities. so i know there's ongoing discussions i think with the mayor's office and the supervisors and the departments about really expanding and figuring out ways to have a more comprehensive strategy to address the mental health and drug addiction challenges in our

city. and i think that's really -- at least for me, that's really important. and in order to see how this expanded conservatorship proposal could fit into a broader strategy, not just be one kind of small step that we take. thank you. >> thank you. supervisor mandelman, you don't want to say anything? okay. this has been a very important discussion. and the issue of our broken system or lack thereof of a system in san francisco, around behavioral health and substance use, has really been brought to light by this discussion. and and i think that's been a very important part of this process. and what we've learned is that 200 people, homeless individuals, die in our streets every single year. and that 44% of individuals that

leave residential treatment programs, on a voluntary basis, are released right back into the streets, where they almost inevitably decline and are circled back into the system again and again and again. now i agree with supervisor mandelman and the mayor that there are some people that are so sick and are so gravely ill, that they need to be conserved. and that there is a process right now that l.p.s. conservatorship, that works for some, and doesn't work for others, because, for example, substance use isn't a criteria under which someone can be found to be gravely disabled or a harm to themselves. i wish we could change that conservatorship, that to me is a no-brainer. rivals had many experiences, not

with the population directly of people, of meth users that s.b. 1045 is meant to deal with, but with other gravely mentally ill people, who are living on the streets, who we have not been able to conserve under l.p.s. conservatorship, because the criteria for harm to self or gravely disabled is so defined in the absolute moment instead of over time, where it's clear that the person is dying in the streets. but i would have to agree with one of physicians who spoke and said, that the illest people are often the ones that are hidden, that don't make a lot of noise in the community. don't generate a lot of complaints by residents. and are not getting the help that they so desperately need.

i think that i have shown and proven that 1045 is just a really poorly written law. it is unworkable as it is currently drafted. it doesn't make any sense internally. s.b. 40, on the other hand, at least you can see how it would work in practice. but that law -- i'm not saying i agree with it, but at least it's coherent in how it would work, if it were passed. whereas s.b. 1045 is unworkable. it hasn't passed, we don't know if it's going to pass. and that's really not what is before us today. i can't support 1045. not only doesn't make sense, but it doesn't put the priority where we need right now, which is to great a workable system, that's getting people the services that they need.

i am not sure what kind of intensive case management is happening. but i believe that -- i know that the word on the street is we don't have a system that works. you could be homeless for 30 years and have to wait another ten before you get into housing. you can ask for residential treatment program and you don't get it. you go into p.e.s. and they just enacted a vertical treatment system to keep you in a chair, while you're there, so that you get uncomfortable and leave as soon as possible, because the system is overwhelmed. and they want you out of there as quickly as they can get you to leave. we do not have a functioning behavioral health and substance use system, despite the fact that all programs are either operated by the city or city funded. they don't communicate with one another, they don't work

together. there's not a system perform care where people move from one service to another with the case management -- case manager overseeing the system and proactively involving. houghwout these services can we force or prioritize, because what we're doing is prioritizing a very few individuals amongst the many that are dying on our streets. and forcing them into services that they don't want, without a system in place to support them along the way. it doesn't make sense to me. but that's -- that's what we have before us today. i'm looking at my member -- my colleagues that are members of the committee to ask what you would luke to -- like to do. i'm happy to move this forward to the full board for a vote. i'm happy to do that without recommendation or i'm happy to do it with recommendation to oppose. i could go either way. >> can we close and file this hearing, first?

>> sure. >> if we could file item number 1 without objection, the hearing is filed. [gavel]y , that means it's not on the agenda next week? >> that's right. [laughter] >> i would make a motion to move this forward without recommendation and let the full board weigh in and have a conversation at the full board about it, s.b. 1045. >> is that okay with you, supervisor mar? >> without objection, this item moves forward to the full board without recommendation. [gavel]. [applause] can you please call item number 3. >> that is a bad