Appear on the june 4th, board of supervisors agenda, unless otherwise stated. Please read items one and two together. Hearing regarding the City Services regarding but not limited to Supportive Housing with Wraparound Services and adequate beds, Mental Health counciling and psychological services, resources and to serve the population. Item number 2 is an ordinance amending the health code to authorize procedures for the appointment of a conservator for someone caring for health and wellbeing due to a serious Mental Illness and Substance Use disorder, and designating the City Attorney to institute the initial proceedings. Thank you so much. We continue this item from last week, i know the Mayors Office has the presentation, i dont know if you want to make any opening remarks, supervisor mandelman . Only to thank the members of committee for taking the time last week and again this week. I know there were some Unanswered Questions from Committee Members last week and im hoping there have been fruitful conversations over the last week. My hope is that we will be able to bring this to committee today thank you. I want to thank the Mayors Office and especially the policy director for sending this followup memo, which was very helpful. I still have some questions, but that is exactly what i was looking for. Thank you so much. Do you want to do a presentation for us, or should be launched directly into questions . Okay, thank you. Good morning. Im with the department of Public Health and Behavioural Health services. I have a short presentation to go over some of whats in the memo and reorient us back to the conversation regarding s. B. 1045 or the housing conservatorship. I also want to echo the appreciation to the supervisors in the community for the robust conversation we had last week. This is an overview of what we will discuss today in our presentation. Again, just to reorient us to the conversation, the landscape in which we are providing Behavioural Health services has drastically changed since the enactment of the act. And in San Francisco, we have a methamphetamine and opioid epidemic. There were individuals with complex Behavioural Health needs that are vulnerable in our communities and are unable to care for themselves. For some individuals, when they are unable to accept volunteer services, they cycle into communities and deteriorate, and in extreme circumstances, this can lead to death. As a reminder, the medical examiner reported last year that for individuals who are experiencing homelessness of the time of their death, 35 died subsequent from overdose, and 50 2 had substances in their system. San francisco has a long history of being innovative and adapting to the needs of our community with programs such as assisted outpatient treatment, and s. B. 1045 is an innovative and narrow tool that would be used to serve vulnerable individuals. In order to be eligible for the housing conservatorship, an individual must meet certain criteria, including being able unable to care for their health and wellbeing, have a current diagnosis of sears middle illness and Substance Use disorder, have frequent and voluntary detentions, that is defined by eight involuntary holds or 5150 in the preceding 12 months, and a. O. T. Has been determined by the court to be insufficient for or the individual does not qualify. When we did a deeper dive, we found that 55 individuals met this criteria, which is not to say the 55 individuals would be conserved under this pilot program, but it is potential for those cases, which represents one point 5 of the population served by Psychiatric Emergency Services, in less than 1 of the services of the population served by Behavioural Health services. For the people who were we are discussing, this is a case example we shared last week. This is there experience. For somebody like Melanie Melanie is a woman in her thirties, diagnosed with schizophrenia and severe methamphetamine addiction. She is under crisis, and her Mental Health systems are a cute she is seen running in the streets, taking her clothes off, and not caring for open wounds. She shes appropriate leap placed on an involuntary hold, and brought to Psychiatric Emergency Services for immediate treatment. Which when she is no longer under the influence of substances, she is no longer acute in terms of her Mental Health systems. She can have meaningful conversation, identify resources , and care for herself. Because of that, she is unable to be legally held. While she is offered volunteer services, she declines these services, saying she is fine, it doesnt need anything. She relaxes in the community, and the cycle continues. For people like melanie, what we know is she is deteriorating every time we see her. S. B. 1045 could be a mechanism to support getting her into care one of the Unanswered Questions that we heard last week is looking at a flow for someone like melanie and how she would enter into a housing conservatorship. We wanted to take an opportunity to discuss that, and also discuss how senate bill 40 might shift how she would enter into a housing conservatorship. Voluntary services are our top priority for anyone, including melanie. She accepted voluntary voluntary services and we would be able to provide her with those services. In this situation, for melanie, at the sixth involuntary hold, if she had not yet been referred to assistant outpatient treatment, she would be referred at that point. She would be outraged and engaged by the assistant outpatient team which includes peer and clinical based services , and we employ a whatever it takes and wherever it takes approach. For unsuccessful engaging melanie involuntary services, a petition would be filed with the court, and if granted, should be ordered to participate in outpatient treatment. If a. O. T. Continues to be unsuccessful in stabilizing her in the community, and it is determined shes a higher level of care, she would be referred to the public conservators office. At the eighth involuntary hold or 5150, she would be informed that the public conservator may submit a petition to the court. At this point, the Public Defenders Office would be informed, and the public conservators office would have an investigation to determine if she meets the criteria for housing conservatorship. This would include a facetoface conversation with melanie, and the development of the service plan, which would be in the least restrictive setting melanie would receive a notice of a petition, and would be supported in meeting with the Public Defenders Office. This would occur through outreach teams, including the Homeless Outreach team and the assisted outpatient treatment team. I can share that in 100 of cases, we were successful in supporting that individual in meeting the public defender in the community. In order to support melanie to attend court, we would have reached out to her before the court date, we would remind her of her court date, and offer her assistance in attending court which could be via taxi, public transportation, or a city vehicle, whichever she is most comfortable with. We would also see her the morning of court to remind her of her court date in some and support her in attending court. At no point, would Law Enforcement used to transport her to court. I just want to reiterate the importance of building that relationship with melanie and i think in assisted outpatient treatment, we have seen that Relationship Building is what has supported us with the individuals attending their court date. At that point, a hearing would occur, or a jury trial. If that is what is requested. If granted, she would be ordered to participate in the treatment plan that the court approves. This is really using the symbolic wait of the court to leverage someone into care. You conservatorship would last no longer than 12 months, but could end sooner if it is determined that she doesnt continue to meet the criteria for conservatorship. Throughout this time, she would receive intensive Wraparound Services, and potential treatment plan for some be like melanie might include an initial placement at the Healing Centre, and then having the opportunity to have uninterrupted care where she is able to stabilize and we can have conversations regarding harm reduction, and engage her in motivational interviewing. Should then be able to transition to a program, followed by a coop, all the while working with an intensive case manager, potentially through citywide, who also provides peerbased services, and ultimately, when she is clinically ready, being placed in permanent Supportive Housing. Before we go on, how will that change can i go through questions about how it would work under the current law . So first of all, the case manager that has been working with melanie already, how many clients does that case manager serve . Through assisted outpatient treatment, the ratio is 110 clients. So melanies case manager has ten clients . Correct. Does that allow the case manager to, you know, spend a lot of time with melanie . Absolutely. So that Team Includes clinicians , and also peerbased services, it is through citywide Case Management, so provides a lot of opportunity to outreach melanie multiple times, sometimes daily, depending on the needs of that individual, and building that relationship where an individual is and the trajectory of their care. The department of Public Health, our a. O. T. Care team supports that work and the individual through our services, so if more intensive services are needed, we Work Together to be able to provide those. So melanie has already been referred to a. O. T. Correct. Okay. And she is homeless. Correct. So the case manager has been able to find her and knows where she sleeps on a regular basis. Despite that daily interaction, she refuses to accept any voluntary services at all . Correct. Okay. , so if we look at this, i will also look at the memo that was submitted to me ahead of time. So once it is determined that a housing conservatorship is going to be pursued on behalf, or for melanie, so you say that the public defender is going to be the one to inform melanie of this . Because you have, in step nine, the public defender meets with melanie. Correct. So how is that going to happen . And is the public defender here . I believe she is on her way. I spoke to her prior to the hearing. I do not see her yet. Okay. Because i was assured that the public defender would be here. That is who i have a ton of questions for today. I know she was in a car on her way before we started, so she should be here momentarily. Okay. Maybe that is her. No such luck. So the public defender, with the help of a. O. T. Team in the case manager, and the hot team, find melanie, and i really want to talk about the public defender and talk about what that conversation looks like, and how that relationship goes forward, but here it says that i will wait until she gets here before i have that conversation, what it says, if melanie does not agree to come to court, she will be compelled by Law Enforcement to attend. So i believe it said she will not be compelled by Law Enforcement, just to clarify. Okay. Thank you i read that wrong. The only way we are going to get melanie to go to court is through the help of the public defender and the hot team. And or the assisted outpatient treatment, which we do on a regular basis. And this is where i just dont believe that this is a practical, workable plan, because you said you have a case manager that is working with melanie daily, and yet she was refused to participate in any of these services, so she doesnt want to participate in services, and knows she will be involuntarily conserved if she goes to court, i just failed to see how melanie is going to go to court. I am frustrated that the public defender is not here, because that is who i have the majority of questions for on this. I guess maybe we should continue with your presentation while were waiting and circle back to that. Okay. I would like to take a second to talk about how as be 40 would adjust this process. Senate bill 40 would reduce the length of the conservatorship from 12 months to six months, and the individual would be notified at the seventh involuntary hold of a possible future conservatorship, rather then the eighth, and at this point, an individual could be placed on a temporary conservatorship which could last up to 28 days. Again, i think that this is important because it gives us that time to stabilize an individual, and in some cases, you conservatorship may not need to proceed, but they could be stabilized in that 28 day period and transitioned to voluntary services. Will that individual be held in the locked award at s. F. General . It would depend on the individuals needs. It could be at the hospital, where they could be placed somewhere like the Healing Centre for that time period. Okay. But it would be a lock towards. Correct, in most situations. This also mirrors the treatment language, but the conservators office would have to provide a report to the court every 60 days to show the court that the individual continues to meet criteria for conservatorship, and what the treatment plan is for them, and if they better be served in a less restrictive setting, which is a legal and ethical responsibility for us. It also clarifies the intent of the language around the treatment for a. O. T. To be considered as the least restrictive option, but to not preclude us from moving forward if somebody does not meet the criteria. So this process will look very similar, but theres a couple of things that i would like to highlight around number 2, and this is specific to the assisted outpatient treatment language. If somebody meets the criteria for assisted outpatient treatment, and is determined to be sufficient, a Court Petition could move forward for that program. An individual it could be determined that outpatient treatment is not appropriate, or they do not meet the legal criteria, at which point it could be referred to the public conservator for consideration. Finally, assisted outpatient treatment and individuals could meet the legal requirements for that, but it is determined is insufficient to meet their needs , and so as not to delay services, they could be referred to the public conservators office. At the seventh 5150, an individual would receive notice about the possibility of a conservatorship. At the eighth involuntary hold, the Public Defenders Office would be notified, and the individual be placed on a temporary conservatorship which could last up to 28 days, and they would be a hearing in the hospital. The conservatorship lasts for six months, or could end sooner if it is determined if they meet the criteria. To be the same a treatment plan that we saw mirrored in s. B. 1045. That concludes our slides. I dont see cara yet, but im happy to follow up with her to see what her expected time of arrival is if that would be helpful. I will open this up for public comment, and then we will talk to the public defender when she gets here. So i will call the speaker cards that i have. If you can line up to my left, youre right when i call your name. Bridget brown, spencer hudson, tiny, michael lyon, teresa palmer, and anybody else would like to speak, feel free to line up. Anyone can come up and be the first speaker. Thank you. Hi, my name is bridget brown, i work for independent Living Resource Centre here in San Francisco, and i consider myself a Mental Health advocate, also, i consider myself a client with a Mental Health background. I would like to say that i could have been melanie, that could have been me. I was at a club one night and somebody put oxycontin in my drink and i ended up in the hospital. It turned out i had oxycontin in my system, and i was one of those revolving door people that they have been talking about throughout this whole s. B. 1045 issue, and i had to go to court, they wanted to conserve me, and luckily, with the blessings that i have on me, i didnt end up in a locked facility. I just want to let you know, that could have been me. It could affect people with things beyond their control and things happen to them, okay . That is all i wanted to say. Thank you. Michael lyon, Public Health justice collective. If you believe that this plant is racist, and it is, if you believe it is unfairly targeting homeless, and it does, if you believe that it puts cops in the drivers seat about who gets detained, and it does, and if you believe that the city has woefully is woefully lacking mean voluntary services, which it does, you need to stop this plan now. You need to resist the temptation to wait and see what happens with s. B. 40, because it greases the skids to detaining homeless, it removes the requirement that clients be offered a. O. T. , a removes the requirement that the city can actually supply these services, so you need to stop it now. Dont wait. Thank you, next speaker, please. Tiny, we have a Homeless People solution to homelessness that we are building right now in east oakland. I keep trying to get conscious folks in office, but also politicians to listen to that. I want to thank you, supervisor walton, because you brought up the real issue, which is these kinds of laws will directly impact more poor people, what specifically, people of colour, black people, the remaining residents of San Francisco of colour who are holding on by a thread because there is no or room for poor people, or workingclass people to be in this city, so we end up on the street. We end up in our cars. As most folk no, i was houseless , and my mom with my mom throughout my childhood. I dont speak as an other, im not a social worker, im not an advocate, im a poverty scholar, i have lived through this. Many times, when the police would engage with us, there would be this threat of arrest, because my mom was mentally disabled, and she would get upset, but thats what people do when they are sleeping on the street, they get upset. They get distressed, and that would be perceived as a 5150 threat, or a 5150 hold. This arbitrary amount of eight 5150 is complete b. S. I want to finish by saying that first of all, housing can be built with the amount of money that this is going to take, number 1, number 2, we have a surplus in San Francisco. Number 3, you continue to build navigation centres, which is temporarily holding our houseless bodies, a number 3, all of you know this is wrong, but it is being billed as an answer to solve a problem that really needs to be solved by building more poor people housing, and services, Mental Health services thank you. Thank you. Next speaker, please. My name is tony, i was become behalf of myself. I dont like the facade, i dont like the pretending that the city cares in doing this. We know what this is about. We know it is about not wanting to see certain people on our streets, and at the same time, we dont have supports for these people who are oh, we cant offend the business people, right . We cant offend them. We have a 16 billiondollar budget in San Francisco. It is more than some countries. 16 billion, and this is the best that we can do . I have been here 54 years, i have seen a lot, i am born and raised here. We know people like me, that doesnt even matter. I can come here and say im a sixth generation San Francisco, it doesnt mean a god damn thing this is the best that we can do, 16 billiondollar budget, and keep beating people down that are already beaten down, kick them down, kick them even more, it seems to me that the city enjoys, or takes joy in beating down the ones that are most down , take all their dignity and kick them even more. I am ashamed of San Francisco, i am ashamed of this city. Good morning, my name is spencer hudson. I am not a physician, but i have worked in the Clinical Department for nearly 30 years. I understand the importance of basing medical decisions on convincing data, and welldesigned, and executed studies, not on anecdotes or supposition. Last week, this Committee Heard a number of to my testimonials about people with Mental Illness who had been helped by conservatorship. We also heard about some people who may be helped by the new scheme of s. B. 1045. I do not, in any way, want to challenge or minimize anyone cheaply s deeply personal account of successful treatment and recovery. But the stories are just that, stories. While case histories are in important part of understanding Mental Illness and addiction, they are only hypothesis generating. They are not evidence. In fact, there is scant scientific or medical evidence that shows treatment of people with addictions have any longterm lasting clinical benefits for the patient. There is emerging evidence that forced treatment has no longterm benefit, and may well be harmful. Last week, supervisor mandelman went away from the idea of forced treatment and said he believed that s. B. 1045 would allow forced abstinence, there is no evidence whatsoever that forced abstinence has any effect on patients whatsoever. In fact, the United Nations have stated that forced attention or forced abstinence is ineffective and violent. So how did we get here . The authors of s. B. 1045 and this ordinance are no champions of homelessness people. 1045 is supported by a number of business membership organizations such as the chamber of commerce and hotel association. It is supported by the vigilantes who call themselves it is supported by the nextdoor nimbys such as the Eureka ValleyNeighborhood Association and the middle of mission association. Thank you. Thank you, next speaker. Hi, my name is teresa palmer, im a physician and a geriatrician. I have a 102yearold mother who has major Mental Illness, and i have been through hell with her, and one of the big problems i see with s. B. 45 is she will lose the trust of the community that you need to serve, and supervisor mandelman, i thank you have a good heart, but you are wrong, and this is going to be used by forces beyond your control for cynical, political reasons to make people think that this will effect the problem with homelessness, and people who are annoying on the streets. We dont have enough case managers now. The public conservator is overwhelms. As a nursing home dr. And a dr. Of conserved people, you tried to get someone on the phone, you cant. The public conservator is not available after hours. Youve got in the department of Mental Health, and behavioural services, you have a 20 absence of needed employees, even at the low level of funding that now exists of psychiatrists and case managers. All of the nonprofits that you have planned to contract to in this are having trouble retaining. This is a digression from what we need to do, which is increased funding for voluntary services, and it is a rabbit hole. I urge you not to go down it, i urge you to kill this. This is what san diego and l. A. Did. Kill this measure. It is going to be a cynical, political move, and more people will be afraid next speaker. Hello. My name is michaela taylor. Please speak into the microphone. I am living person suffering from ptsd ptsd and multiple disabilities and in and out of Psychiatric Services for most of my life. Putting people in the state of florida, we have a different type of facilities that is for us, and they dont take our rights away, but the group homes support us when we are not able to survive in society. They dont have the police come out for us or send an ambulance out. If you put a Mental Health person in a car for a Mental Health issue, they are going to think they did something wrong when you are trying to help them that is the wrong thing to do. I feel like they should have more help than making them feel like they are not part of your society, meaning, i am part of the Mental HealthOutreach Centre that is here now, and i feel like if they had more funding where they can hire more staff throughout the state, then they could be able to help and reach out to people like us, and do more for us, and for those who need more assistance. There should be longterm work into a group home. Thank you all, god bless. Thank you so much. Next speaker. Good morning. My name is adam and i am a resident of San Francisco. I grew up in San Francisco, but i recently returned. I have been here, back forefront years ago. Im speaking as an individual, and i am in favour of supervisor mandelmans legislation for several reasons. The first is, i have had personal Family Experience with someone who is conserved, it helped them and made them into a much better person in my family. It helped my family personally. That was some years ago, so i cant journal eyes to everybody, and i dont intend to, but my main point is, San Francisco has said you are committed to helping the most vulnerable, and these people who this legislation would affect are the most vulnerable, and the fact that we cant help everybody is an outgrowth of the most vulnerable strategy. You start for the people who needed the most, and these are the people who need it the most. I want to relate to you and experience i had on the 38 bus over the weekend on saturday, coming west on yuri. As the bus was approaching 11 th worth street, there was a woman walking in the street. The driver was frantically honking at her, she ambled around and got on the curb, and the bus stopped, and the woman, who people recognized, and i think i recognize her, too, as someone who has been a person with erratic behaviour. She got on the bus, the bus proceeded a few minutes later, and a woman came up, i was in the front of the bus, and said, this woman in the back is smoking something, and it is not marijuana, and it is not tobacco the bus driver stopped the bus and address the situation. He said, i know her, i saw her one time at the bus stop, she was buck naked, and another person said yes, i saw her a few weeks ago, she was put under a 5150 and she was doing well, until she got out. Thank you. Next speaker. Hi, my name is marisol, and i just wanted to tell a story about one day i was feeling depressed, and so i didnt have a therapist, so i went to the hospital just to ask to talk to a therapist so i wouldnt become suicidal, they decided to put me in the hospital, i was angry about that because i just wanted to talk to a therapist and they wouldnt listen to me, so it took me two weeks to get out because they wouldnt cooperate with them because i was angry, so i can only imagine how people will feel if they are forced into what i consider incarceration because you cant leave, and so that is all i wanted to say. Hi, sometimes i wonder if i should say what i really think, but i just wanted to say thank you, supervisor walton, for assuming a human position to this, rather than it rather then being a politician. We really need that to understand that it is not about a political move, it is about humans and that should be the priority. I wanted to say, just make sure we have a hearing on Mental Health, and guess what, we didnt have the services then, and by a miracle, now we have the services . That is ridiculous. In a country not the country, this is supposed to be a very progressive city, but i dont really see it. I think that we have become numb to our poor people in the streets, we have become numb to our low income people in San Francisco. We have become numb about the social issues that we are facing in the city. Please consider that just on mae services, we probably dont have it. Thank you. Hi, my name is kathryn and i may mission resident. I have a doctorate of Public Health from u. C. Berkeley, and we are speaking on behalf of the Public Health justice network. We opposed s. B. 1045 and urge you to do the same. Instead invest in public and Mental Health supports including voluntary services. We are particularly concerned with three specific areas of negative Public Health impacts of s. B. 1045. The first is immediate harm of those put into conservatorship, including disruption of social networks, loss of property, and increased operations with police , which increases the likelihood of being exposed to violence. While sweeping people under the rug may placate rich corporations, it is not do anything to help her heal the people of San Francisco or put us on a path to address the rampant inequality in our city, and the lack of housing, jobs and services. A more effective solution is having the corporations actually pay their fair share of taxes. The second concern is the attack on Civil Liberties, which weakens our democracy. Strong democracies, where there is a baseline of human civil rights, are healthier places for all of us. S. B. 1045 moves a framework for treating Mental Health concerns further under the purview and discretion of police, which is counter to Public Health research and recommendations. The american Public Health association passed a resolution that shows that people who face Mental Health issues are already more likely to be exposed to police violence, and San Franciscos own Health Commission passed a resolution with evidence for approaches to these issues as health issues. Hi, my name is amber, im also part of the Public Health justice collective. Building on what she just said, San Franciscos own Health Commission, as you all know, recently passed a resolution with sound evidence for approaches to these issues of health issues, rather than disproportionately harming people by relying on police and prisons, or developing systems that are more prisonlike. It is a dangerous precedent when we should be investing in other solutions. The third Public Health concern we want to bring up as how to proposed this this proposed legislation in the limitation of it others people. The bay areas at the forefront of research on the negative impacts, including health impacts, at this proposed legislation in its implementation would put us on the forefront of dehumanizing people. By other ring, we mean the process by which we use messages and laws to create a mythology that some of residents are different, less than human, not deserving of basic freedom and human rights. This process is how the greatest atrocities of humanity has succeeded. The rhetorical process of doing this is the same, and the Public Health implications are severe. We should be ashamed of this from a moral standpoint and from a Public Health standpoint, we know that this telling people, in many different ways that they dont belong, also harms their health, and the health of our greater society. We cannot and will not have Health Healthy communities and a healthy San Francisco when we are so readily willing to discard part of our community. We therefore oppose the imitation of s. B. 1045 and urge you to do the same. Thank you very much. [applause] good morning, supervisors. My name is joyce, i am with senior disability action, but i was also the very first promoter for justice, peace, and care creation for the dominican order , the order of creatures. Our judeochristian tradition speaks about genesis 126 and it says, god created things and said it was all good. That applies to all people. God created all things good. People might be sick, and so s. B. 1045, i oppose it because you will be taking away the worth and dignity of a person who was created in the image and likeness of god, and taking away their liberties, and also there is solutions, like i am proudly i am a house person through home match. You can go to jails and open up more Supportive Housing. And then like last week, supervisor walton said, your race might be attacked, and supervisor ronen said, oh, people can change their mind. That is pope francis message. I used to teach severely handicapped people. The teaching was, if one way doesnt work, try another way. The Mental Health people said, there is actually a way to do it there is three people going out with Homeless People. P. Advocates, people with a psychology background, but there is an answer. We are San Francisco. The city of st. Francis remembered, st. Francis and hug hugged and kissed, so we should two. Next speaker, please. Hi, my name is lester bruins and i live in the santa cruz district. I am here because i learned a long time ago from the Union Movement that an injury to one is an injury to all. I think it is about time we start putting people who are poor and disabled and unable to put them in the forefront of our lives, put them in houses, and put them in places where they can determine their lives, and not to take their rights away by creating a conservatorship, and take their money away the same way, i appreciate the efforts that people are concerned, but i harken back to a statement by hl mencken regarding things that we do, and this legislation is, to paraphrase him, is for every problem, there is a simple and easy solution. Neat, plausible, and wrong. I think it is about time we sit down, put some committees together and get on the right foot and do the right thing. Thank you. Good morning, supervisors. My name is maria and im a board member of senior disability and action. I stand today in opposition about s. B. 1045 and s. B. 40. Rest recently, i visited my family in los angeles and i was so happy to learn that my 14 yearold greatnephew and my 6yearold greatniece were receiving therapeutic housing. Prevention is ever so valuable. Another one of my great nephews is a very energetic 4yearold, and one morning i wanted to engage with him, so i asked him, have you ever tried meditation . He quickly responded, what meditation . And said, no, i am talking about mended medication. It is something you can do to help you feel calm and relaxed. He utters, how . So i then led him into some deep breathing exercises, and he played along for about 20 seconds. Then he very assertively stated, this meditation isnt working. We have failed to present of preventive services. We cannot fail again by line the civil rights of those in need of services to be stepped on, especially when they are not available. I want to say that this is not the same, but on a personal level, i can count the number of doctors to get me to agree to gastric bypass surgery. Im sure it was for my own good. Obesity is associated with serious illnesses, but i also know society prefers time has expired. [applause] i would like to thank the previous speaker because i would probably be hyperventilating if i did not practice deep breathing for a couple of seconds. My name is joshua ram. I would like to speak briefly in cautious support of senate bill 1045. I appreciate all the comments we have heard today, and im sure everyone in this room has their heart in the right place. I am speaking because i have someone very close to me whose mother struggles with schizoaffective disorder and has also struggled struggled with meth addiction, and there are people in the city who we can see, and people we know in the city, with some of us maybe close to, who are either going to be in conservatorship or dead those are the options for some people. Not for a lot of people, but sometimes voluntary services can be a great thing, but there are some people who they are not involuntarily conserved, they will die on the street, i think it is important to give supervisor mandelman his day in court. I think he is he has a very personal experience, obviously, and i hope we have i think we have a vigourous debate here and theyre like to commend Public Health for the work and supervisors as well. That is my comments. Thank you very much. I am one of the editors in the haightashbury literary journal. The literary journal was started by a former heroin addict and other people here were also former heroin addicts. I also received many submissions of people who are schizophrenic who have compulsive disorders, and im against the way this bill is because even though people i know have problems, they all have specific things that were important for them. Parts of the city that meant a lot to them, and also, when people say they had a relative that was in conservatorship, at least a relative was there who they knew, and was interested in them and would come and see them also, one of the people i know who is schizophrenic went to the centre in minneapolis or minnesota and i think it is a good model that can help people. There are a lot of creative programs. You might want to look into it. I wonder how, or why melanie doesnt want to use voluntary services. She was forced to be conserved and how she would feel. Would she have to be restrained . What would they do to keep her in a place . Those are my concerns. Good morning. And the president of the lot tuna of the latina club. I am here to oppose s. B. 1045. I havent had my coffee yet. I want to applaud supervisor walton for your leadership in addressing the inequity component of this bill, and how it will further criminalize our communities. Extensive research has shown that what our Community Needs is stable housing and voluntary treatment, so i appreciate supervisor mandelmans intend to solve the situation, but i think it needs further conversation and dialogue with the homeless community, and the community in general to find a more equitable solution to this, along with more investment in affordable housing. The root of the because here is the lack of affordability, and i myself live in a rent controlled apartment, and it is really hard i have a masters degree, but im still struggling to live in the city. What i want for my community is more investment and more dialogue, please reach out to experts that fully understand the needs of homelessness. We dont want to further 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. Im a thirdgeneration bay area native, and im shocked. I really dont 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 dont 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 dont 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. Ive 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. Im 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 lauras 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. Theres 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 arent engaged with services and help them get into services, and they have transport bands that arent police cars, that arent 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 longstanding agreement, that you only take away Civil Liberties liberties when there is a safety issue, or they are so disabled they cant 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. Theres 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 Mayors 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. Lets 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 longterm 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 im surprised nobodys talking about the impact on the queer community. People come to this city, and people end up on the streets because they cant 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 dont doubt that this will happen with this bill, despite all the wellmeaning 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 ServiceUnity Services available today than when we formed in 1983, and that is just sad. Incarceration isnt humane, and it dehumanizes the incarcerated and their jailers. Thank you. My name is tori becker, im 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. Im 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. Thats the only thing behind this thing. You know, its trying to put a bandaid on the capitalist pig, which is corrupt, decaying, murderous. And, you know, its not going to do any good. Homelessness is a problem all over this country. And its going to continue to be a problem, as the system decays, as supervisor ronen said, the system is broken, trump, human need and responsibilities. 100yearold 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 youve got to look at where this law, who is generating the money to back this