one of those evidence proof treatment is incarceration treatment. there was an office inspection in general report and eventually matt case became supervisor for it. i have been involved in other places. treatment in custody doesn't work. flash incarceration does not work. as far as the treatment that do work for alcoholism, alcoholism is a chronic disease like diabetes. hypertension and emphysema. when we look at outcomes for chronic disease, a landmark study for the journal medical association in 1999, showed that results for treatments were no worse or better than any other chronic disease model. so treatment of alcoholism and addiction works. as far as new treatments for alcoholism, when it comes to substance abuse treatment, typically with any chronic disease it takes time and effort. let me give you a picture two of extremes. one extreme is the first of the month with $200 in your pocket and you are in tenderloin and the other extreme is the stationery outcome with handcuffs. so the illustration here is that somewhere between these two extreme

what is it about forced treatment and the consequences for an allowing refusing treatment. we have a panel who have a knowledge of this subject in some cases because of their professional endeavors and in some cases because of personal experiences and in some cases, both. let me introduce them. karen chen is an attorney manager for the san francisco public defenders office, kathy, whose son battled mental illness, can is a subject treatment expert for the medical center. danny is the associate director for the serial neeb breet program for the city of san diego. and san francisco chief of police. gary is a psychiatrist and laura's law advocate and eduardo vega the mental health association of san francisco. let me start by opposing a question to karen chen from the public defenders office. karen, can you -- how about if you start by giving us an overview of how the city handles this conflict between treatment and civil liberties. >> an involuntary hold starts in san francisco when a peace officer or a clinician makes the determination that the person is due to a mental diso

and i often know that when i went to treatment from the age of 15 to 17, i was in treatment a numberof four times. when i left treatment, there was no recovery support services available. there was no recovery high school. there was no alternative peer group. you know, i think i met with the substance abuse counselor only a handful of times at my high school. and so, i really think there needs to be a more integrated approach to how we are delivering these services to youth and young adults. vanna, talk to us about what your agency does in terms of pulling in the families and the youth when they're running into trouble. the institute for health and recovery incorporates family treatment and family services and case management into all of our programs, whether we're working with young adults or families or women or individuals. so, that's a very important component because we know that that's where our young people thrive, is within their families, if their families are supportive and educated on the same information that we're providing to the parents. for example, our treatment mode

once they are in treatment, they continue to receive treatment voluntarily. but sometimes some individuals need a little bit of extra help. that's how i see -- actually one thing that, i think it's also important to distinguish between making diagnosis, i think the diagnosis of schizophrenia or bypass bipolar is very clearly state. the fact that one has an illness or not is not in the criteria. >> we have an audience. >> thank you. [ applause ] >> we have an audience question for eduardo vega. for the severely mentally ill, involuntary measures and current use are chaotic and traumatic. we talked about the current system, on the other hand laura's law provides community service with know forced meds. why would you be against it? >> why has laura's law be implemented in one small rural county. i think part of the answer is we do have good community services and support in san francisco and we have the best in the country and funded through the mental health services act. do they solve all the problems? absolutely not. do we need more? absolutely. to bring an a

that they can enter treatment, and after treatment they can have recovery support services that arevailable to them and that fit their needs, whether they're in college or not in college, whether they're in high school, or they need to go to a recovery school. and i really think that approach can also include the family and the community to really strengthen the-or to increase the-recovery capital for the youth and young adult. and jim, in terms of the association of recovery schools, what component do you have that really tries to engage the young people that are participating in these programs to design their own peer support system? well, actually ars was somewhat significant in regards to ypr's development, and so we are proud of that. i think that to a certain extent, different schools have different protocols, and so each academic environment is going to address their own needs in certain ways. from an organizational perspective, really, we try to advocate for these kids at the academic level, and so that advocacy then turns into a support system that may look different on the

maybe she likes that treatment. i just want to be clear: nobody likes it but, as with a lot of terrible dynamics, they're hard to break right away. if they were easy, those of us in the health care business would be out of business. it takes people time, and we need to recognize that and not make women feel bad if they go back to a violent situation a couple of times before they finally free themselves. very good point. and, dr. clark, let me go back to the whole notion of what samhsa is doing currently. one of our strategic initiatives is on trauma and justice. you want to talk a little bit about that? well, we have eight strategic initiatives at samhsa. one of them is indeed trauma and justice, making it clear that we believe that we have to deal with trauma as an integral part of the behavioral health strategy to assist people in need of services. so the strategic initiative lead is lar quong dr. lar quong, appointed to that role by pamela hyde, the administrator of the substance abuse and mental health services

and so treatment became the ways in which we deal with pollution. narrator: to protect public health, starting in the 1950s and '60s, there was a push to put in wastewater treatment plants across the united states. today, with evolving technologies, the waste travels through multiple stages of treatment, removing tons of solids... settling out microscopic particles, and introducing bacteria that consume and decompose the toxic material. in some plants, the water is further disinfected through the use of ultraviolet light or ozonation. these plants cost millions of dollars to construct, operate, and maintain. in population centers like los angeles, the scope of the task is staggering. the hyperion wastewater treatment plant serves four million people. it processes 350 million gallons of sewage and removes 500 tons of solids daily. after treatment at hyperion, what was once raw sewage is clean enough to release into santa monica bay. other cities and towns release treated wastewater, or effluent, into local rivers, lakes, and streams. as it flows down

and then our treatment peer mentors is our latest program. we have a clubhouse model, where we have substance abuse treatment for adolescents, and we provide support services

you know, the other issue that you mentioned, that you tried to get them treatment. well, we know for a fact that only about, i would say, 10.8 percent of the people who really need treatment of the 20.6 million that are affected-and this is the entire population, 12 and older, that have a problem. so, how do you begin to weed out with those families to try and get them help? there's actually a program, a national campaign, called the 1 in 5 campaign, which states that one in five youth have an issue, and of those five, one of them gets treatment. that's sort of the rule of thumb that we go by. so, there are a lot of different things that we try to do in our community because we're aware that nationwide, it's a problem with resources, providing access to effective treatment is a huge problem across the country. so, when we come back, i want to continue with that train of thought because i think that will be very helpful for our audience. we'll be right back. [music] we want everybody in the community to understand signs and symptoms of mental illness and of addiction