tv Government Access Programming SFGTV May 17, 2019 10:00pm-11:01pm PDT
presentation. thank you. ok. so, this is just an overview of our presentation for today. we just wanted to orient us to the conversation, discuss how we see bill 1045 fitting into the landscape in san francisco. so, want to start off by saying as was just discussed, we know the landscape has changed, not just in san francisco but california and nationwide. and when the act was passed, what we are doing now and the complex needs of individuals we are serving looks very different. what we know in san francisco, we have a methamphetamine and opioid epidemic. and there are individuals of complex behavioral health needs that are vulnerable and unable to care for themselves in the community. when they are unable to accept
voluntary services, this often leads to cycling in and out of crisis services and deterioration and can lead to dying. estimated 400 individuals who experience homelessness die every year, indicated, 35 individuals have, according to the medical examiner, 35% died subsequent to overdose and 52% of individuals had substances in their system. san francisco has a long history of being innovative and adapting to the needs of our community. and senate wiener saw this deep need and worked to develop the legislation to serve a small group of individuals through the housing conservatorship. so again, i work with behavioral health services. i'm, which is part of the department of public health and provides substance use and mental health disorder, treatment services across a range of treatment modalities.
our goal is to support individuals on their path to recovery and wellness in a least restrictive setting. >> thanks. good morning, chair ronen, supervisors, jill neilson with the department of aging and adult services. mission of my department is to support the well-being, safety and independence of adults with disabilities, older people and veteran. and the offers of the public conservator -- it's a privilege for the department to operate this critical safety net program for the city and i'm really fortunate to have a team of skilled and dedicated clinicians that serve as deputy conservators. great pride in the advocacy, assistance and oversight provide to our clients. individuals who do not usually have any other support system in
their lives. before we dive into a complex topic, i wanted to clarify a couple of terms to make sure we have the same baseline understanding. l.p.s., lanterman petra short, the three legislators who passed the hallmark legislation in 1968, and the l.p.s. act provides the legal framework and structure for mental health conservatorships today. the terms are the same, used interchangebly. office of the public conservator, overseeing it. distinguish from probate conservatorships, those are handled by a different division of the aging and adult services and will not be talking about those conservatorships today.
>> thought it would be helpful to take a step back and discuss a case we see as potentially served through the housing conservatorship, and somebody like melanie, not her name due to privacy reasons, this is the experience for some of the individuals. melanie is in her 30s, has schizophrenia. she's in crisis. seen running in the streets, taking her clothes off and vulnerable. she's placed on a hold. no longer under the influence of substances, mental health is no longer acute, stabilizes, a meaningful conversation, identify resources and able to take care of herself. legally she has to be released. not able to remain at the hospital. we offer her voluntary services, including case management and
residential treatment but she tells us i'm fine, don't worry about it, and unfortunately what ends up happening, she is released and relapses on substances and cycles back into crisis. and this is the experience that we see here on this next slide. for some individuals when they use substances, their mental health symptoms are exacerbated. they engage in harmful behavior or unable to take care of themselves. placed on an involuntary hold, stabilized, no longer meets the criteria to remain at the hospital. offered services, decline services and released to the community and the cycle continues and perpetual cycles for some individuals. and sb1045, it needs to happen at least eight times for us to consider a housing conservatorship. what we do know and see as providers for somebody like melanie, worse over time. each time the cycle continues and repeats, she deteriorates in
the community. and at this time we don't have the tools that we need to help her. so because of this cycling, somebody like melanie is left behind and her functioning is deteriorating and again, she's getting worse but she does not meet the grave disability criteria for the l.p.s. conservatorship we currently have. and i have to say as a provider, these are the cases i take home with me and i worry about. and something like housing conservatorship or sb1045 would be the mechanism i need to support her engaging in care. one of the programs i oversee is assisted outpatient treatment, lord's law, and one of the programs i mentioned earlier that san francisco has a history of implementing. program adopted by the board in 2014 and subsequently enacted in 2015. for individuals who have serious mental illness who are not
engaged in treatment and are on a downward spiritual. what i think is important to note about this is it's really focussed on serious mental illness, not the co-relationship of mental illness and substance use. ultimately, what we can do in these cases, if we are unsuccessful engaging in the services, petition the court to office them into outpatient treatment. however, an individual must meet strict legal criteria to be able, for us to be able to do that. one of the big criteria, two or more inpatient psychiatric hospitalizations or receive mental health help while incarcerated or acts of violence towards themselves or others. for somebody like melanie, she does not qualify for assisted outpatient treatment because she has not been hospitalized on an inpatient unit, she does not meet legal criteria. does not have a history of jail contacts and has not had serious violent behavior.
but her psychosis is exacerbated by her methamphetamine use, but again, she stabilizes while at the hospital and must be discharged. and again, while we offer here voluntary services she continues to decline these and says i'll be fine. >> l.p.s. act founded on the principle that mental illness is treatable and with care, individuals with serious mental illness can recover, and that's why the procedure is composed of multiple short-term involuntary holds in the state's welfare institutions code. 51 5150 hold, initiated for three criteria, specifically defined as the inability to provide for one's own food, clothing or shelter. most individuals who are held on a 5150 recover in 72-hour window. and they are released. it's only a small fraction of individuals who do not recover,
continue to meet the narrow legal definition and are not released. definition only allows us to assist individuals who are gravely disabled due to serious mental illness or chronic alcoholism. and once at the hospital, individuals receive a clinical evaluation. those who continue to be considered gravely disabled by the treating psychiatric and medical teams can be held up to additional 44 days, but at any point in that timeline they can be released. if the team feels recovery is unlikely, a referral for conservatorship will be generated. a public defender and due process protections, and the public conservator is responsible for carrying out investigation to ensure the conservatorship is the least restrictive intervention. it's important to note that the goal of an l.p.s. conservatorship, like a housing conservatorship, is actually to move an individual to wellness
and recovery and to terminate the conservatorship, and by a variety of treatment interventions and services that will continue long after the conservatorship has ended. whether thinking back to melanie, she's not eligible for l.p.s., but excellent care, hydration, and drugs pass through her system. when she's lucid, how she will obtain her own food, clothing and shelter and legally has to be released. offered voluntary services but will refuse them and when she returns to the streets she will use drugs again and then she's back in the cycle of addiction that angelica was referencing. we cannot compel her to use the services to assist her, we have
no option but to watch her deteriorate and cycle in and out of the hospital. that's why we feel we need to implement the conservatorship program. >> what were the voluntary services offered to melanie? >> later in the presentation we go in-depth offered to her. the same offered to anyone going through a housing conservatorship program. intensive case management, connection to residential treatment. >> all offered to melanie? >> that's correct. >> so intensive case management, residential treatment, and what was the third? >> counseling. >> counseling. >> okay. >> just, if it's possible to, i think we have about ten more slides.
to get through the slides and then have questions. great. >> we feel we have a tremendous opportunity at this moment. housing conservatorship program will be an important new tool to allow us to reach a small group of people. angelica explained how a client like melanie will not qualify for assisted outpatient treatment and how the limitations of l.p.s. in regards to assisting a client like melanie. we can do better for people like her. housing conservatorship program aims to provide a clinically appropriate alternative in the least restrictive setting possible. for individuals incapable of caring for their own health and well-being, and reach individuals like melanie due to co-occurring mental illness and substance use disorder. similar to l.p.s., only provided if it's the least restrictive possible.
legal and ethical obligation that our office must follow. one of the most significant differences between the housing conservatorship program and l.p.s. is the eligibility criteria. it's not grave disability as for l.p.s. here it's founded on multiple factors, and all of these factors must be met. they include the inability to air for one's own health and well-being, serious mental illness, substance use disorder, documented frequent 5150 holds, specifically eight in 12 months. and all petitions to the court have to show every other less restrictive alternative first. that the individual could not be treated through the outpatient treatment program and other community-based services were attempted but were not effective. >> take a second to look at the
population and doing a dive into our data who we think would be eligible and served through sb1045. 55 individuals are currently eligible. as indicated, not to say 55 individuals would be placed on a conservatorship program but an option that we can consider for them. all of these individuals have a current diagnosis of serious mental illness and substance use disorder and have eight or more involuntary holds or 5150 in the last 12 months. of note, on average, the individuals have 16.5 visits. 96% of the individuals also had a visit to an emergency department. 98% have experienced homelessness on average 8.9 years. 91% have significant medical needs, and that's just to say that again this is a population that we see deteriorating in the
community that not only have complex behavioral health needs but medical needs that let to the deterioration. 75% have been connected to mental health services in the last year, and these individuals and providers are outreaching them and attempting to engage them. 35% have had a visit to an acute diversion unit. what we do know for the individuals, unable to remain in care. and that the need for something like sb1045 is pronounced in our community. i want to take a second to pause and talk about the different numbers discussed since the time sb1045 was initially introduced. when it was first introduced, anticipated that it would serve up to 200 individuals but through the legislative process and criteria put into the bill, ended up being more like the 55 individuals we are discussing today. as we worked toward
implementation. language around assisted outpatient treatment that unintentionally narrowed the population to around five individuals. jill will be speaking about senate bill 40, back to the 40 individuals but ultimately what it requires us to do is consider assisted outpatient treatment as a least restrictive setting but not preclude from moving forward with conservatorship if that's the most appropriate. so, i wanted to show and highlight how we imagine sb1045 fitting into our system of care. as we discussed multiple times, an individual has to have eight or more involuntary holds to be considered for the conservatorship. at the point of contact with a hospital setting on an involuntary hold, offered voluntary services. we are ready to connect them to the services. if they do not accept the
voluntary service, they could be referred to assisted outpatient treatment. that has whatever it takes and wherever it takes approach to outreach and engage the individual, attempt to offer them voluntary services, if they accept, we would immediately connect them to. not only on the team assisted outpatient treatment have clinicians, but peer navigators to support that work as well. if they continue to decline the voluntary services and unsuccessful, we could petition the court for a court order. at that point, the court could determine if a.o.t. is insufficient or inappropriate for the individual, and then the case would be conferred to the conservator's office as indicated. and again, i want to highlight through the process and voluntary services at the forefront, and having the tools
needed as a mechanism to support individuals and accessing care. >> key part is the connection to housing and part of an initial court petition, the p.c. will be required to demonstrate clinically appropriate housing placement is available. and likely that over the span of an individual's total recovery period that each individual will have multiple placements, likely a combination of licensed care facilities, and community-based options. the hope is move each individual into permanent supportive housing once that individual is ready to live at that level. every individual ready for supportive housing will get a unit and if not, commitment of the program for the higher level of care. highlight some of the key provisions.
three counties for the five-year pilot. local legislative body must opt in, why we are here today. additionally, the bill requires any county that opts in to form a working group. this working group composed of advocacy organizations, labor, and representatives of city departments. carry out a critical oversight and advisory role with the housing conservatorship implementation. they will provide valuable input as to the, to help craft the evaluation of the program that needs to be carried out and that than locally here in san francisco to the board as well as at the state in sacramento. >> as an individual is considered for housing conservatorship, they will have access to full due process protections. one of the most critical aspects of the process will occur initially during the investigation phase and that
will be handled by the office of the public conservator. determine that voluntary services have been offered prior to any involuntary measures. procedurally, it will mirror l.p.s. procedures. individuals will be represented by the public defender and have the ability to request a jury trial from the outset and appeal the conservatorship at any time. as she mentioned previously, a bill pending in sacramento that is aimed at cleaning up aspects of 1045, so it better aligns with the bill's original intent. no expansion of the eligible population is anticipated as a result of sb40. notably the bill shortens the duration of the conservatorship from 12 mostly sunny to six months and requires the p.c. provides status updates to the court every 60 days to justify
the continued need for conservatorship. and also clarifies that a.o.t. must be attempted first and all who qualify for a.o.t. will get referred to the program before a petition for housing conservatorship is committed to the court. >> in looking at services that would be offered to this population, i think it's important to note that the individuals that are currently eligible for sb1045 represent less than 1% of the total population we serve in behavioral health services but are the most acute. and again, for some a.o.t. is not sufficient and conservatorship is the last and final tool to work with them. offer similar to assisted outpatient treatment, wrap around comprehensive clinical and pure based services to support recovery and wellness and prioritize community-based treatment and always considering
the less restrictive option. as jill again already mentioned, not only an ethical responsibility for us as providers to do so but a local obligation and requirement to the court to do that as well. this is just to highlight some of our work. we serve over 25,000 individuals a year and are the largest provider of behavioral health services in san francisco. our services range from prevention and early intervention to outpatient and residential treatment, and crisis and acute services. what's important to note about this, the level of care is dependent on the individual's needs, and they may be in different levels of care throughout their time being served by the department, depending on what their needs are at any given time. again, this is just to note the number of individuals that we serve. psychiatric emergency services
is a crisis stablization unit. and they provide immediate evaluation and treatment of individuals. fiscal year 17-18, they provided services to unduplicated count of 3,674 individuals, which again in looking at the population who would be served through sb1045, that population is roughly 1.5% of the total population served at p.e.s. >> very much like l.p.s. conservatorships, housing conservatorships carried out with other entities, department of homelessness and supportive housing and courts. and some come from zuckerberg and other psychiatric hospitals
in the city and would do so under the new model. all tri aged through the program, psychiatric treatment program and other under conservatorship licensed care setting where they may be residing but provided by behavioral health services and community-based contractors. services that are provided are tailored to meet the needs of the individual, and this slide lists a range of services individuals may receive depending on their care plan, and it takes a multi-departmental partnership to provide the necessary services. they will all be provided with a strength-based approach and focus on empowering individuals. role of the p.c. to oversee the care plan in its entirety and make sure legal obligations are met. we have to ensure all services
follow the least restrictive mandate, that really guides our work. other critical services will be intensive case management, provided by c.b.o., such as city-wide, medical care from community-based clinics, perhaps like tom wadell. vocational support offered, and family services agency. comprehensive and holistic care, recovery in the least restrictive clinically appropriate setting. and services long after the termination of the conservatorship. this slide is intended to illustrate a pathway for services. it shows each individual likely offered multiple housing as they work toward recovery. to help individuals stabilize to a level of independence to allow placement in permanent supportive housing. self-care or acceptance of supportive services will be a
significant marker in making that determination. access to permanent supportive housing is the long-term solution for this small group of people that will be served through the program and housing program will facilitate our ability to get them the services that they need and to move them to that point. if we look back at the case example from the origins of the presentation, i wanted to describe a possible tailored service plan for a client like melanie. by the time the court has authorized a conservatorship, clinicians from my office would have conducted outreach with her and trying to engage her to actively participate in her own treatment plan and i think that one strength we have with the housing conservatorship program is the offer of permanent supportive housing. and hopefully that will help to really engage individuals in their treatment. the primary services will be provided through the licensed
care setting where melanie likely would reside in the initial phases of her recovery. very likely reside in a treatment setting like baker place, at least initially. precise placement identified by the transitions team in d.p.h., and over the duration of her stay, the transitions team would be conducting regular visits to ensure the quality of the treatment she received. and also connected to individual counseling and peer support, navigation, intensive case management. provided by city-wide, for example, and those relationships again are critically important because those are individuals who will continue to work with her once the conservatorship has terminated. so access to psychiatric and medical treatment through d.p.s. clinics, as well as money management, an important tool. department of aging and adult
services, we operate a representative pay program and would manage her social security income in collaboration with her case manager. if she decides returning to work is a goal for herself, we would connect her to vocational services. public conservator has the responsibility for overseeing the treatment plan in its entirety, and providing her with advocacy along the way. sb1045 will provide health care and housing to get back on track with their lives. our goal here is really to break the persistent cycle of streets, hospitals and jails. hopefully she'll be able to stabilize and recover and a permanent supportive housing unit waiting for her. >> wanted to talk about some recent investments made into the system, would benefit individuals such as melanie and the population for sb1045. what's important is to note that
there is a priority for individuals to be placed in permanent supportive housing and the department of homelessness and supportive housing as you know is working very closely to get as many units on board quickly that would serve individuals such as melanie. the healing center is having 14 new beds added so a total of 54 beds. new substance use recovery beds, 72 new beds added. mayor is committed to $1 million to stabilize residential care facilities, and i'm happy to announce on behalf of the mayor's office today that 30 new residential treatment beds are being added into our system of care, which is the largest investment in residential treatment beds in our last generation. additionally, $6 million have been added to increase street medicine teams. a.o.t. is in the process of expanding our team as well, so we have additional clinicians to work and engage individuals
involuntary services as well as increase intensive case management capacity. and $3.2 million added to intensive case management, mobile harm reduction counseling, transition out of crisis services, and social workers and psychiatric services to support discharge planning. i want to turn it over to simon who will also talk about his experience in cases and a case example that would be served as well through sb1045. >> good morning, chair ronen and the members of the board of supervisors. my name is simon pang, part of e.m.s.six, a unit that responds
to frequent 911 users, shepherding people to detox, treatment, health and mental health care and supportive housing. senate bill 1045 written to save the lives of a small number of people who are dependent on 911 for their daily survival. individuals that have such severe substance use disorder and mental disorganization that they cannot perform basic acts of daily living. individuals that have continuously refused shelter, treatment, and housing. these few individuals will use until they are incapacitated, stumble out of an emergency room as soon as they can walk or rolled out of an e.r. in a wheelchair and use some more. it is a vicious circle of misery. i'll give four examples. a man i'll call john died in an
e.r. >> sorry, if you can -- there will be an opportunity for public comment and we don't allow audible noises while someone is speaking, so please, if you want to react and show your reaction, if you can give us thumb's down or supportive fingers, but we will give you time to speak during public comment. >> a man i'll call john died in an e.r. having been found with hypothermia by paramedics. he was a user, and sometimes willfully in continent. more than 100 emergency responses the year before he died. for acute emergencies or because a bystander saw a legless person covered in excrement who could not get back to his wheelchair. every time he had a bowel movement a nurse would have to clean him. he would leave hospitals with
insulin and wound care supplies. and throw them away. in the year that he died, e.m.s.six engaged him 48 times to offer shelter, substance use treatment, or to help him get documents because without an i.d. you can't get housing. but this is hard to do when someone is under the influence, hospitalized, or soiled with excrement. when he was clean and sober, he would refuse to participate. john was not able to be conserved under current law and he did not qualify for assisted outpatient treatment. another meth user, frank, sits in his wheelchair and excrement all day. he has an abscess on his back side that has tunnelled down to the bone. sometimes he will try to get out of his wheelchair to defecate in
the open. they find him covered in feces, wound exposed, unable to pull up his pants or get back into his wheelchair. and the last two years he has activated 911 122 times. my team, e.m.s. six, met with him 99 times, offering him shelter, navigation center bed, assistance activating benefits, referrals to treatment programs, he refused it all. time and again i have been dumbfounded, having been told he was allowed to leave a hospital because he could not be kept against his will. richard, another meth user, used 911 208 times in one year. he rides the bus all night, usually soiled in excrement and asked people to call 911 because
he thinks he's having a life-threatening event and he's scared. he'll stay in the e.r. for an hour or two, then he'll just walk out. hours later he activates 911 again. this happened four times in one day. richard was provided with a free room with in-home supportive services and a case manager. he never used the room. yet medical and mental health doctors let him leave they're hospitals because they believe he has a plan what he says, i'm going to see my doctor at her office. i get food there. and i'm going to the beach to meet some friends. but he never goes to see his doctor, unless escorted there, and there are no friends. another individual hospitalized for a life-threatening condition
21 times since january of this year. yet he insisted on leaving so he could use meth and heroin. we were told doctors could not keep him against his will. he has been released and readmitted the very same day. admitted january 2nd, released january 2nd. admitted january 3rd, released january 7th. admitted again on january 7th, released january 8th, admitted january 9th. you get the picture. he died a few days ago. had he been conserved and gotten sober, might he have chosen a different path? while it is true that there are not sufficient quality services for all the people without homes in san francisco, for the population affected by sb1045, every service and resource has already been offered but they are continuously refused.
we need a tool that can provide temporary respite so that free of substances a person's mind may clear. their body may heal. given the possibility of rediscovering the desire for a better life. thank you. >> thank you, simon pang. i have a couple questions, i don't know if anybody has questions. or if you want to run questions. >> ok. do you want to start, or you want to start, since this is your hearing. >> i'm fine letting sunny walton start. >> supervisor walton. >> thank you chair ronen, and thank you for this report from d.p.h. and from testimonial from the fire department. this is a serious issue, of course, and there are a lot of questions that come from me about conservatorship and i've
been talking to supervisor mandelman, the mayor's office, really trying to understand exactly the benefits of if we were to support sb1045 and current toreship and there are a lot of struggles for me as we continue to have this conversation. so, i have, i guess, some statements and some questions, particularly starting with, we had a mental health hearing and public safety neighborhood services. we have also had some reports from department of public health and i guess my first question is, because i've consistently heard from the department of public health that we don't have enough beds to adequately address the needs of people seeking voluntary services, am i right that is still the case?
>> supervisor, i think what we discussed is important in terms of adding, something as a landscape has changed in san francisco for who we are serving, we also have to respond to that and adjust our system to meet those needs. so adding the beds is an important part to us addressing the needs and what's important to note about this population is that because they are cycling in and out of crisis services, they are a priority for us and we are able to meet their needs immediately if they would accept those services, that we have beds available and place them in them if they are to accept them but not the case for this population. >> what's troubling as well, our entire homeless population is a priority. we have had major concerns and major issues with homelessness for a long time, and so as we talk about prioritizing, i'm not confident that all of a sudden
we can adequately address the needs of a specific portion of the homeless population. all of us, all of my colleagues, everyone in the audience, your department is extremely focussed on addressing homelessness. and so that's very concerning to me to hearsay that all of a sudden we can wave a wand and address another population. also the way we do 5150 here in san francisco i know it's determined by law enforcement, and we have been working very hard to decrease negative interactions between public and law enforcement and is there a way to change the policy for determining 5150 and making it completely medical? what's the conversation around that? >> so, i would just highlight, supervisor, that while law
enforcement are able to place somebody on an involuntary hold that it's not exclusively law enforcement that does that. providers are able to do that and receive training to be able to do that. so, it's not just law enforcement making that determination. i also think having a facility like psychiatric emergency services provides us with the opportunity to provide that immediate evaluation to see that is clinically indicated to be on an involuntary hold. >> as someone who definitely has, addiction runs in my family and we know that, and with supported by data, the majority of folks who do well and are able to stay in recovery are folks who voluntarily choose to go into recovery. and so with that said, what are your thoughts about that? because if we are talking 40 people and look at the data, we
know that typically people who are forced into a situation to try to seek recovery don't typically do well. what's the conversation and thoughts around that? >> so, i think while voluntary services are always a priority and something that is very important to us as the department and as a system, that there is mounting evidence compelling somebody into treatment under certain circumstances for some individuals they do benefit from it. and they don't necessarily fare worse than individuals who accept voluntary services, although that is the priority and goal for all of us. >> real quick, what's the measuring stick for be worse. >> sure. i am share articles that we have looked at, that individuals do equally well if they are
compelled into treatment. also important to note for the services that we are discussing that would be offered to an individual is that these services are not forcing substance use disorder treatment, but there is the expertise for individuals who are providing those services that they are able to work with individuals by engaging motivational interviewing and other tools to support individuals on that path to recovery related to their substance use. >> and when we say equally well, the data demonstrate the duration or how long? it's one thing to be put into a service involving things to do well for a certain period of time. are we tracking the long-term implications versus someone put involuntary recovery versus someone wlo choose it and was able to stay in recovery. is that data tracked in that? >> longitudinal data? >> i appreciate that question. i would have to look into it in more detail and circle back to
you about that. the assisted outpatient treatment program, we do look at the extended data and for the program thus far that we have had long-term impact of individuals continuing to accept voluntary services after the court process. >> and then as a person of color, always a major concern any time we put any system in place of incarceration or taking away someone's ability to be free, typically disproportionately affects black people and people of color. i know you can't give me a guarantee that won't happen, but what's been the conversation around that? because that is one of the things most disheartening, concerning, troubling for me and one of the biggest reasons why i'm not excited about this. >> i think it's incredibly important to discuss and don't want to minimize that or take
that away from the conversation at all. and like you said, while i'm not able to provide guarantees, i want to know that we are not talking about incarceration here, that that is important to discuss but a separate conversation from this. the other thing that i would note, having the working group is important so that we do continue to have those conversations. i'll note similar concerns arose when we looked at implementing assisted outpatient treatment and say from personal experience it's not something we have seen in practice but something that should always be at the forefront of conversations in our continued reports with the working group as well as with the board of supervisors. >> what's the definition of incarceration? >> i think in terms of incarceration, what i would look at in terms of what we are talking about, somebody who is booked into a county jail or facility related to criminal charges, whereas this we are looking at a civil court
process. >> so, i would push back and say that anybody in the custody experience where they can't get out, where their freedom is taken away, is probably considered incarceration. that would be -- that would be my thought right there. but, and so with that said again, you know, typically people of color are disprobl disproportionately affected and the negative outcomes of people with color. as we ask that, because even unthe current system of involuntary services being chosen, how is one transported to involuntary services? >> just to clarify in terms of being placed on involuntary hold, for the community -- >> that could be the case. say you are out and given the option to walk in the street,
give an option of going to services or going to jail, how is one typically transported to either service? >> so, i can share for something like our law enforcement assisted diversion program, another innovative program that we have where individuals are offered services at the earliest point of contact with law enforcement, certainly times when law enforcement may transport them to those services but we have built in providers who have vehicles to be able to pick an individual up and take them to services. >> when people are transported to involuntary services, they are not handcuffed and taken to voluntary services as well? >> so, i certainly can't speak on behalf of the police department. go ahead. >> i would like to answer that question. there have been a number of occasions when somebody that was conserved, i had a social worker call me up, and ask if we could escort them in a taxi to the next destination.
and that's how we did it. >> and i'm asking these questions, you know, not as a got you, and as someone who has visited, and had conversations with law enforcement, with our health providers and i do know of instances where even people who choose to voluntary choose service because at the point of contact it is with law enforcement that they are actually transported in handcuffs because that is the -- that is police department policy that if they transport someone they are taken in handcuffs. and would love to see when we have someone who voluntarily chooses service, to be the one to transport in all cases. not specific to sb1045, but this is -- i'm just having a conversation right now about who is happening, because as we talk
about conservatorship, one would have to be confident everything we say is going to take place is even possible before i could even think about supporting something like this, and we are not even close to that in a lot of aspects. i want to go quick and i'm not going to take too much time, but i want to go to -- on one of the slides connection to housing, don't have page numbers, but it says any individual who has gone through the conservatorship will be guaranteed clinically appropriate housing placements along the way. and i want to know how we are going to achieve that. because we are not achieving it now. >> good morning, supervisors, department of homelessness and supportive housing and supervisor walton, thank you for recognizing that there are thousands and thousands of people on the streets all of whom need assistance.
we need more housing, we need more shelter, need more of everything, that's painfully clear. however, i think we also need to focus on getting better at how we use the resources that we have. and i think one of the ways that we are doing that is through coordinated entry in which we are assessing individuals based on acuity and length of homelessness, so they are getting access to permanent supportive housing, the individuals who are the greatest risk of dying or getting very ill on the streets and we'll use a similar process to coordinate entry to work with individuals in the 1045 program. assessed, i don't think i need to assume, i think the current work that we are doing will show that individuals who are this ill will be at the very top of our housing queue and put into appropriate treatment placed on
high needs, generally in a room that's got its own kitchen and its own bathroom, fully adaptable or accessible and services on-site. >> follow up, go ahead. >> what you just stated and guaranteed don't equal the same thing. you talk about a process hopefully that we could -- but guaranteed is different than what you just said. >> we have over 1,000 units opening up on any given year. people are placed into the units are being placed due to, after being assessed. so, following an assessment in which the highest acuity individuals are being prioritized for housing, so these individuals will be guaranteed placement to housing. we cannot necessarily do it in
the moment, but in 90 days we should be able to place what i would imagine would be a very, relatively low number of individuals on any given year into a permanent supportive housing site without having to break fidelity at all from the system of coordinated entry. >> to reiterate, state law requires, requirement at the end of the process that they are provided with supportive housing unit if they are ready. if they are not ready for a permanent supportive housing units, they are guaranteed another housing placement at the proper level of care. fundamental as spent of this bill. >> supervisor walton, can i just chime in here? 12 days ago at the may 1st hearing, kelly said 44% of people who finish residential treatment program are released back to the street or to
shelter. so, following up, this is a major concern of mine as well with supervisor walton, it's not just all homeless people on the street where clearly there is not enough housing. it's people with severe mental illness and substance abuse that don't get housing. 44% of the time when they leave residential treatment and that's the specific concern. can you respond to that? >> without seeing any of the data that miss hirmoto is referring to or knowing what clients are exiting, it's hard for me to respond. but what we should be doing, ensuring those individuals are being assessed in the coordinated entry system because they likely are also, you know, high acuity individuals. and coordinated entry system has only been up and running about four months now, so we are still working out a whole variety of -- >> i understand that, director,
you were not at this hearing so maybe you didn't see this. this was 12 days ago, and the director of transition told us that 44% of the people leaving residential treatment are released back to the streets or a shelter. that is -- you are the director of the department of homelessness. and that's an extraordinary figure. and that's why people like supervisor walton and i have concerns that we are not ready to implement this law. >> not to cut over, director, with all due respect, 1045 population are not exiting treatment because they are never going into treatment. so those folks are more acute than the people making it through and a shockingly large number of whom are not getting placed and so that's -- but i -- i mean, i would like to know. >> wait, wait, i'll give you your chance, supervisor mandelman, but what i'm -- but
the point here is not, you know, it's hard to -- it's hard to compare acuity, right? are those people more acute or cause more problems in the neighborhood or, like we have so many acute people on our streets and every one of them deserves and should receive the best quality care and should receive housing and intensive case management and all of these services. my concern is that 44% of people that we are spending an enormous amount of resources on and time, they are saying i want to get better, we don't have enough services in the system so when they are released to the street we know what happens 100% of the time, go back to declining, go back to using drugs, cycle in and out of p.e.s. and so the question is not whether they are more acute or less acute and i don't think we can make that determination. >> i think more acute matters
and i think you can make the determination. >> i'm trying to make my point. i'm not sure that you can, and i would -- maybe there's a doctor that can answer. we don't know who we are talking about, how do we know who is the most acute person. what i'm saying, the system -- we don't have a system that's working. when there is 44% of people who voluntarily are accepting treatment, go through an entire residential program and released back into the streets, then we have -- we have a problem and this is not the answer. we should be -- we should be creating a system that works for everyone. sorry, i want to give it back to supervisor walton, i didn't mean to steal your thunder, i wanted to add that stat that we heard 12 days ago from the department of public health to this discussion. sorry.
back to supervisor walton. >> thank you. >> you want a response or -- >> sure, i'm sorry. >> that's ok. i do not disagree, supervisor, that there are significant improvements that need to be made in the mental health system, why mayor breed and dr. colfax hired dr. bland to effect some of the changes and excited to work with am and i agree we need to do a better job of ensuring people with high acuity are getting access to services and not creating the revolving doors. i don't agree that we can't -- we shouldn't try to fix, just because there is one problem does not mean we shouldn't try to fix another, what i'm trying to say. we are not talking about a large number of individuals who will be affected by sb1045, and i have seen too many people dying on the streets and i would say the vast, vast majority, the vast majority of people we engage with accept services,
they want housing. that is absolutely true and i don't want to, you know, my concern -- i don't want to make it about like the homeless population or about people who are struggling with mental health or substance abuse issues. the vast majority of them are perfectly capable and should make their own decisions about the treatment or housing, but a small group of people are dying on the streets i have personally witnessed turn down offers, not only case management and shelter but in the hospital that we could do a better job serving and even if it's just one person that does not have to die on the streets i think it's worth moving forward with the pilot. lots of things need to be fixed but we can also fix the other problem of a small number of people cycling in and out of the system suffering. >> i would add on behalf of the mayor, housing is the number one priority and made significant investment, and we are making
new investment, including the housing bond, and look forward to your partnership on that, chair ronen. at the end of the day as mentioned, absent intervention these people will die. assertion we should wait and fix the entire system, we all agree needs to be fixed and more housing and resources for everyone across the board, including folks with mental health issues, we cannot wait for these people. we cannot let them die, it's not the appropriate thing to do. >> i understand and i have a lot mr questions about, a lot more things. i interrupted supervisor walton so i want to give it back to him. but the law itself requires that we have enough capacity in our system to that other people are not bumped, and i don't think we are honest about that in this discussion, which is not's your point is not true and i don't agree with that point and we'll discuss it more after i give my colleagues a chance to talk, but the law itself requires it and i don't think we are being honest.
i don't think the department has been honest with the board of supervisors about the resources that are available and i think we have showed that in every single hearing and it's been really frustrating for us. supervisor walton. >> definitely not asserting we cannot chew gum and walk at the same time but a lot of things are broken before i would jump into something like this because at the end of the day we are taking away folks' civil liberties and we have to remember that. so yeah, there are some major concerns with that. a slide that also talks about judicial process, all clients have been offered voluntary services prior to petitioning the court for sb1045. is there like a certain amount of time? how many times they have been offered service? can you talk me through that a little bit? >> so, the role for the public