But 1st; The Heritage Foundation has;
Medicaid Expansion Ignores States Fiscal Crisis
“Together, California and Michigan received nearly one-third of the entire increase in federal funding between fiscal years 2008 and 2009. Even though Michigan represents just 3 percent of the total population of the United States,[6] it received 8 percent of the entire increase in federal funding.[7] California received 24 percent of the entire increase, even though it has only 12 percent of the population.”
Here’s some glaring Contrasts
How do you square SF complying with SB 1953’s mandate (see here) to Retrofit the Existing SFGH with Not retrofitting it but Instead soaking Everyone in America for a brand new $1.527 Billion Dollar Additional Building in the front yard, …… which won’t be ready for occupancy until 2032?
Will SF Then vacate the Existing Buildings in 2033 & raise Billions More from Govt. Healthcare Programs, to Someday actually Retrofit Those Buildings?
At SanFranciscoFireDepartment.com;
"SFFD seizure of control of our city's ambulance services in 1996 is a thinly veiled move to increase its budget at a time when the need for extra fire protection sharply declined. By firing all Health Department staff, acquiring a new fleet of 24 ambulances and deliberately understaffing them, often with just a driver, and by minimally training one of each engine crew for EMS certification, they provided an excuse to dispatch one, two, or more additional trucks on minor medical calls, which now constitutes 92 percent of actual SFFD activity, becoming the defacto primary mission. The former, extremely well run and efficient Health Department ambulance service, was staffed by 35 people who served us without charge. Today our ambulance service is operated at 50 times the cost by those whose goal is the exact opposite of efficiency. It has been repeatedly sued for fatal mishaps. And if you ever require the service you will receive a bill averaging $1500."
"SFFD refuses to permit more than 3% of medical calls to be handled by highly efficient professional private ambulance services. More and more cities (such as San Jose, San Diego, Chicago, Houston) are saving many millions and getting better care and service through these excellent services. And they're being paid by these companies for concession to operate in their cities. And their charges to individuals is lower than fees for an SFFD ambulance. But in SF this savings is being blocked."
And:
http://sanfranciscofiredepartment.com/.
"Prescheduled "emergencies" every hour at: 8, 20, 40, 52 minutes after each hour- to meet with buddies. Sirens routinely used to transit the entire city after breaks (medic units). A quarter million gallons of fuel burned every year, cruising our streets. (enough to go around the entire earth... 40 times). Over 68,000 bogus "runs" in 2006"
"Psychiatric Emergency Services (PES) at San Francisco General Hospital is the only 24-hour psychiatric emergency room serving the City and County of San Francisco. "
, ….. and the same SF Dept. of Public Health responsible for that statement, …. Also Publishes as Dept. Policy that all those Other Hospitals are authorized to perform 72 hr. Psychiatric Evaluations, On Their Premises, on people detained on a 5150 hold through those facilities/hospitals/people gainfully employed upon the premises Of those Hospitals/Facilities being issued 5150 detention cards BY, ….. SF Dept of Public Health CBHS?
Note the Name of the Deputy Director of SF CBHS authorizing 5150 facilities and staff on this Next jpg. He's At this meeting too.
Where were those alleged fictitious SFFD dispatches being alleged to?
Furthermore, at:
http://www.sfgov.org/site/mental_health_page.asp?id=63127.
On June 13th 2007 we find This startling revelation:
(this whole Page is in full below. The Bold Face in the full page is also in Red)
"Dr. Lu: “Well I’m very concerned that right now we’re having a backup, as Dr. Cabaj mentioned. We’re at red alert status. We have no beds upstairs and the emergency services are so full they can’t even take people coming in on the 5150s. And they’re bringing these psychiatric patients on 5150s to medical emergency rooms at Moffitt and California Pacific Medical Center, and St. Francis Hospital. These are facilities that physically do not have a psychiatric emergency capability, nor the staff. These patients are waiting days to be in these facilities right now. So we’re very concerned that with the loss of an entire unit, that this situation is going to melt down."
Here’s CBHS from their 2006 Organization Provider Manual
The original Was at, (and God alone knows where it is now):
http://www.sfdph-mda.com/dph/files/CBHSdocs/OrgProviderManual2006.pdf.
If Anyone in SF knows the system, Their Mental Health Board should, ….. Every, Single, One of them along With all the other Administrators and recipients of an SF Desktop Name Plate.
And Not a Single One of those Mental Health Board members, or Anyone Else in the room, Incorporated so much as ‘What?’ to this statement, ….. Not even Dr. Robert P. ‘Bob’ Cabaj: whose name appears on that CBHS Policy page listing all those 5150 card holding Evaluators’ Facilities.
Next, a “Member of the Public” has Her concerns addressed by Mental Health Board Chair Dr. Rebecca Turner’s;
“seeing no further public comment, public comment for this item is closed.”
Member of the Public: “My name is Alexandra Kutik. …..
….. I am wondering what the connection is between the proposed elimination/de-funding of 28 positions in Mental Health and the allocation of MHSA FY’08 growth funds for additional/annualized/part-time to fulltime CBHS staffing for MHSA implementation. If, in fact, MHSA funds are being used to supplant City costs, this is in direct conflict with the spirit and intention of MHSA. Once again, thank you for the opportunity to present these comments.”
Dr. Turner: “Thank you. Is there any further public comment? Okay, thanks for all of you who presented to us, and seeing no further public comment, public comment for this item is closed.”
Well, Ms. Kutik certainly had Her comment closed, now didn’t she?
(this whole Page is in full below. The Bold Face in the full page is also in Red)
"Dr. Lu: “Well I’m very concerned that right now we’re having a backup, as Dr. Cabaj mentioned. We’re at red alert status. We have no beds upstairs and the emergency services are so full they can’t even take people coming in on the 5150s. And they’re bringing these psychiatric patients on 5150s to medical emergency rooms at Moffitt and California Pacific Medical Center, and St. Francis Hospital. These are facilities that physically do not have a psychiatric emergency capability, nor the staff. These patients are waiting days to be in these facilities right now. So we’re very concerned that with the loss of an entire unit, that this situation is going to melt down."
Here’s CBHS from their 2006 Organization Provider Manual
The original Was at, (and God alone knows where it is now):
http://www.sfdph-mda.com/dph/files/CBHSdocs/OrgProviderManual2006.pdf.
If Anyone in SF knows the system, Their Mental Health Board should, ….. Every, Single, One of them along With all the other Administrators and recipients of an SF Desktop Name Plate.
And Not a Single One of those Mental Health Board members, or Anyone Else in the room, Incorporated so much as ‘What?’ to this statement, ….. Not even Dr. Robert P. ‘Bob’ Cabaj: whose name appears on that CBHS Policy page listing all those 5150 card holding Evaluators’ Facilities.
Next, a “Member of the Public” has Her concerns addressed by Mental Health Board Chair Dr. Rebecca Turner’s;
“seeing no further public comment, public comment for this item is closed.”
Member of the Public: “My name is Alexandra Kutik. …..
….. I am wondering what the connection is between the proposed elimination/de-funding of 28 positions in Mental Health and the allocation of MHSA FY’08 growth funds for additional/annualized/part-time to fulltime CBHS staffing for MHSA implementation. If, in fact, MHSA funds are being used to supplant City costs, this is in direct conflict with the spirit and intention of MHSA. Once again, thank you for the opportunity to present these comments.”
Dr. Turner: “Thank you. Is there any further public comment? Okay, thanks for all of you who presented to us, and seeing no further public comment, public comment for this item is closed.”
Well, Ms. Kutik certainly had Her comment closed, now didn’t she?
Here’s MHB Chair Dr. Rebecca Turner Rebutting Pseudoscience.
http://www.newswise.com/articles/view/525396/.
Here’s a smidgen of Dr. Rebecca Turner’s research.
http://news.ucsf.edu/releases/hormone-involved-in-reproduction-may-have-role-in-the-maintenance-of-relati/.
http://www.newswise.com/articles/view/525396/.
Here’s a smidgen of Dr. Rebecca Turner’s research.
http://news.ucsf.edu/releases/hormone-involved-in-reproduction-may-have-role-in-the-maintenance-of-relati/.
Here’s a page on Dr. Turner’s Oxytocin itself, “The World’s First TRUST Spray” which certainly looks as ‘Mentally Healthy’ as anything Else the ‘Mental Health’ Industry is peddling.
http://oxytocinnasalsprays.com/.
And here, this “Cuddle Chemical” is cuddling with National Depression Screening day.
And here, this “Cuddle Chemical” is cuddling with National Depression Screening day.
http://www.hbcprotocols.com/screeningday/.
So, as you can see, Dr. Rebecca Turner is as Eminently well Qualified to Chair this SF Mental Health Board as anyone might expect.
Three paragraphs later Dr. Turner has preceded Dr. Bob Cabaj’s “we don’t quite comment on that” and “a little uncertain” with her own;
“….. Maybe you can just explain the terminology a little bit.”
“Dr. Cabaj: “Well thank you. Those are excellent comments. Actually, if you notice, the timeframe is the problem. This is a report that’s supposed to be through December 2006; so most of those challenges were met and resolved by now, but we don’t quite comment on that. (???) Next year it would say that. So we were a little uncertain about how to do that, but I think if we can incorporate some of these remarks, that would help.”
If? We can Incorporate? Some? of these Remarks?
That would help?
Are there Comments which Could be made, which if they were Incorporated, wouldn’t, “Help”?
The ‘Mental Health’ Board is Agreeing to Agree that they Want another $2.368 Million from the General Fund to prop up the ONLY 24 hr PES in the City, while “Not Incorporating Remarks” following Dr. Lu’s;
“California Pacific Medical Center, and St. Francis Hospital. These are facilities that physically do not have a psychiatric emergency capability, nor the staff.”
Are there Comments which Could be made, which if they were Incorporated, wouldn’t, “Help”?
The ‘Mental Health’ Board is Agreeing to Agree that they Want another $2.368 Million from the General Fund to prop up the ONLY 24 hr PES in the City, while “Not Incorporating Remarks” following Dr. Lu’s;
“California Pacific Medical Center, and St. Francis Hospital. These are facilities that physically do not have a psychiatric emergency capability, nor the staff.”
And Dr. Turner’s;
“public comment for this item is closed.”
Now, ….. Let’s get this MHSA/Prop 63which we haven’t yet posted on, Up, in passing.
http://www.dmh.ca.gov/prop_63/mhsa/docs/Mental_Health_Services_Act_Full_Text.pdf
“public comment for this item is closed.”
Now, ….. Let’s get this MHSA/Prop 63which we haven’t yet posted on, Up, in passing.
http://www.dmh.ca.gov/prop_63/mhsa/docs/Mental_Health_Services_Act_Full_Text.pdf
Prop MHSA/63 imposed a 1% Tax on Million Dollar Incomes. It was projected to take in $750 Million to ‘Diagnose’ & ‘Treat’ up to 2.9 Million Californians to a Serious ‘Mentally Ill’. At 2.5 Million that’s $300 per head per year. MHSA/Prop 63 also postures about Stigmatization of those 2.5 million, by the remaining 34.5 Million Californians.
$750 Million would provide a whopping $21.74 per head to Stigma Police those 34.5 Million potential Stigmatizers through all 365 days of potential Stigmatizing, with ZERO left over for Diagnosis & Treatment of the prime 2.5 Million Stigma Targets with a Serious “Mentally Ill.”
So what Happened with this thinly disguised Initiative?
$750 Million would provide a whopping $21.74 per head to Stigma Police those 34.5 Million potential Stigmatizers through all 365 days of potential Stigmatizing, with ZERO left over for Diagnosis & Treatment of the prime 2.5 Million Stigma Targets with a Serious “Mentally Ill.”
So what Happened with this thinly disguised Initiative?
Dr. Bob Cabaj’s CBHS has a Directors Report from Sept 10, 2008:
We Quote, bottom of pg 2 &; top of pg 3
5. Mental Health Service Act (MHSA)
MHSA IN THE NEWS
“Rose King, a former member of the drafting committee of the original ballot measure
Proposition 63, has leveled some sharp criticism in the way the Mental Health Services Act
Has been, in her opinion, mishandled by the Department of Mental Health after its first four years following its passage (“Mental Health Act Doomed by Initiative Origin” – The Sacramento Bee, August 11, 2008). She blames the State for sitting on$3.2 Billion in new revenue while only $726 Million have been distributed to the counties due mainly to a “complicated, expensive and unnecessary bureaucracy invented by the DMH.” The other major ailment of the MHSA is “the DMH policy creating a two-tier mental health system, giving priority to funding new programs rather than improving the existing system,” according to Ms. King.”
And Ms. King never saw it coming. $300 per head to involve her Opinion in 37 Million Californian’s lives through Penalizing California’s Job Creating Millionaires.
And (2007-2008) at pg 4 paragraph 2 of;
http://argosysf.tripod.com/SFUSDbroch0708.pdf.
We find Prop 63’s Mission Objective being Redefined, ….. Right, ….. Out of the closet.
MENTAL HEALTH SERVICE ACT
Mental Health Service Act (Prop 63) Stipend Program Internship
….. A key objective of the MHSA is to increase the quantity and quality of trained persons available for employment in the public mental health system and encouraging development of a diverse workforce. Toward this aim, California’s Department of Mental Health has partnered with the California Social Work Education Center (CalSWEC) to establish competitive stipend program for graduate students enrolled in schools of Social Work across the UC system.
That means PAYING More Social Workers like the 2 posing with Mr. Paramedic Tangherlini a STIPEND out of the Public’s Pocket, while they’re going to school in the UC System, in order to ensure a Majority of ‘Gratefulness’ gets Established back into the Ballot Box.
And those $2.368 Million General Fund Dollars are Inexhaustible, Right?
Medicaid Expansion Ignores States Fiscal Crisis
"California Pacific Medical Center, and St. Francis Hospital. These are facilities that physically do not have a psychiatric emergency capability, nor the staff.”
And, just moments Earlier:
We Quote, bottom of pg 2 &; top of pg 3
5. Mental Health Service Act (MHSA)
MHSA IN THE NEWS
“Rose King, a former member of the drafting committee of the original ballot measure
Proposition 63, has leveled some sharp criticism in the way the Mental Health Services Act
Has been, in her opinion, mishandled by the Department of Mental Health after its first four years following its passage (“Mental Health Act Doomed by Initiative Origin” – The Sacramento Bee, August 11, 2008). She blames the State for sitting on$3.2 Billion in new revenue while only $726 Million have been distributed to the counties due mainly to a “complicated, expensive and unnecessary bureaucracy invented by the DMH.” The other major ailment of the MHSA is “the DMH policy creating a two-tier mental health system, giving priority to funding new programs rather than improving the existing system,” according to Ms. King.”
And Ms. King never saw it coming. $300 per head to involve her Opinion in 37 Million Californian’s lives through Penalizing California’s Job Creating Millionaires.
And (2007-2008) at pg 4 paragraph 2 of;
http://argosysf.tripod.com/SFUSDbroch0708.pdf.
We find Prop 63’s Mission Objective being Redefined, ….. Right, ….. Out of the closet.
MENTAL HEALTH SERVICE ACT
Mental Health Service Act (Prop 63) Stipend Program Internship
….. A key objective of the MHSA is to increase the quantity and quality of trained persons available for employment in the public mental health system and encouraging development of a diverse workforce. Toward this aim, California’s Department of Mental Health has partnered with the California Social Work Education Center (CalSWEC) to establish competitive stipend program for graduate students enrolled in schools of Social Work across the UC system.
That means PAYING More Social Workers like the 2 posing with Mr. Paramedic Tangherlini a STIPEND out of the Public’s Pocket, while they’re going to school in the UC System, in order to ensure a Majority of ‘Gratefulness’ gets Established back into the Ballot Box.
And those $2.368 Million General Fund Dollars are Inexhaustible, Right?
Medicaid Expansion Ignores States Fiscal Crisis
"California Pacific Medical Center, and St. Francis Hospital. These are facilities that physically do not have a psychiatric emergency capability, nor the staff.”
And, just moments Earlier:
"Sutter Health announced in April closure of another 28 locked inpatient beds at CPMC"
Dr. Francis G. Lu, June 13, 2007 San Francisco City Hall
California Pacific Medical Center, ...... IS, ..... Sutter Health.
http://www.hospital-data.com/hospitals/ST-FRANCIS-MEMORIAL-HOSPITAL-SAN-FRA884.html
And not even a single “What?” from the Mental Health Board, ….. None of them.
Wiki: on MHB Chair Dr. Rebecca Turner, Ph.D.’s “Cuddle Hormone”
“Increasing trust and reducing fear. In a risky investment game, experimental subjects given nasally administered oxytocin displayed "the highest level of trust" twice as often as the control group. Subjects who were told that they were interacting with a computer showed no such reaction, leading to the conclusion that oxytocin was not merely affecting risk-aversion.[23]
search
Mental Health Board >> Meetings
Mental Health Board
June 13, 2007
ADOPTED MINUTES
Mental Health Board
Wednesday, June 13, 2007
City Hall, Room 278
San Francisco, CA 94102
BOARD MEMBERS PRESENT: Rebecca Turner, Ph.D. (Chair); James L. McGhee
(Vice-Chair); James Shaye Keys (Secretary); Bridgett Brown; LaVaughn Kellum King; Dr. Toye Moses, Ph.D., M.P.H; Tom Purvis; Jagruti Shukla, M.D, M.P.H; Lisa Williams; Virginia Wright.
BOARD MEMBERS ABSENT: Jeanna Eichenbaum, L.C.S.W; John Kevin Hines; Claudia Lebish.
OTHERS PRESENT: Helynna Brooke (MHB Executive Director); Ayana Baltrip-Balagas (MHB Administrator); Francis Lu, MD, SFGH; Emeric Kalman, Member of the Public; Julio Montes De Oca, Conard House; Frank Vallecillo, Sunset Mental Health-MHA-SF; Alex Kutik, Member of the Public; Joyce Rich, Member of the Public; Laura Barber, Member of the Public; Mary R. Higgins, M.R. Higgins & Associates; Kathleen Connolly, Citywide Case Management Forensics; Marven Lightner, Member of the Public; David Keck, CBHS, Member of the Public.
CALL TO ORDER
The meeting was called to order at 6:34 p.m. by Rebecca Turner, Ph.D. (Chair).
ROLL CALL
Ms. Brooke read the roll.
AGENDA CHANGES
Dr. Turner: “We’re going to first vote on action item 3.2, because we have a quorum now and a board member has to leave early. Is there any public comment? Our resolution is to approve the minutes of the Board Meeting of May 9, 2007.”
Item 3.0 ACTION ITEMS
3.1 Public comment relevant to Item 3.0
There was no public comment.
3.2 Resolutions.
3.2.a PROPOSED RESOLUTION: Be it resolved that the minutes of the Mental Health Board meeting of May 9, 2007 be approved as submitted.
Minutes approved unanimously.
Item 1.0 DIRECTORS REPORT
Monthly Director’s Report
June 13, 2007
1. Successful All-Staff Meeting of CBHS Adult/Older-Adult SOC. Over 1000 providers from contract and civil service mental health and substance abuse programs attended the CBHS All Staff Meeting of the Adult/Older Adult System-of-Care on May 9th and 10th at the Bill Graham Civic Auditorium.
The purpose of the All-Staff Meeting was to share with all CBHS providers the vision of addressing behavioral health needs in San Francisco in an integrated, seamless, and comprehensive manner. The challenge that has commanded our attention in recent years involves the provision of services to persons with mental illness and with substance abuse problems in a manner that CBHS contributes significantly towards addressing major health and human service needs in San Francisco, including addressing homelessness, community violence and other community issues. This involves partnership with other services such as primary care, court system, human service and housing agencies. Several of our milestone achievements in the recent period demonstrate that we are heading in this right direction.
Dr. Mitch Katz visited to welcome the participants at the meeting, and to thank all CBHS employees across our system for everyone's important contributions toward the wellness of the community. He emphasized the necessity of providing holistic care to the persons we serve, and that this is best done through integration of mental health, substance abuse and primary care, and the development of community partnerships.
A series of presentations and workshops ensued throughout the day, which further explored the areas discussed above. Dr. Alice Gleghorn and several community providers presented the exciting work occurring in San Francisco due to the infusion of new funds through the Mental Health Services Act. Dr. Tina Yee introduced a panel of consumers who eloquently and movingly shared stories of their recovery journeys. Edwin Batongbacal, Director of Adult/Older-Adult Systems-of-Care provided an overview of the wellness-recovery principles that guide our service-delivery. Over 20 CBHS providers presented in workshops addressing issues of community violence, integration with primary care services, work as a component of recovery, care needs of women, welcoming practices at our programs, addressing homelessness, and self-care in the workplace.
The highlight of both days were the recognition ceremonies, during which staff and programs from throughout the system were recognized for the exemplary work they perform on a daily basis. Nominations for recognitions were made by their co-workers, supervisors and the clients they serve.
Overall, the event was a resounding success. Thank you to all who helped organize the event, and to everyone for participating!
2. Mental Health Board Awards Reception. The San Francisco Mental Health Board held its first gala Awards Reception on May 31, 2007 at The Arc of San Francisco. The room was filled and the balcony overflowed with awardees, friends and co-workers to celebrate Exceptional Programs and People. In attendance was Chief Heather Fong, Jeff Adache, Public Defender, Judge Mary Morgan, Judge Ballati, Judge Tsenin, Supervisor Maxwell, Executive Directors of many programs, consumers, and family members. The keynote speaker for the evening was Assemblyman Mervyn Dymally, Chair of the Health Committee for the California State Assembly. Jacqueline Horn, PhD, President of the Board of Psychology and Supervisor Sophie Maxwell made a few remarks. Belva Davis was the Mistress of Ceremony for the evening.
The Mental Health Board selected programs from five areas for these awards.
á Criminal Justice Response to Mental Illness: San Francisco Police Department, Behavioral Health Court, Jail Psychiatric Services
á Foster Care and Mental Illness: Foster Care Mental Health Services, A Home Within, Honoring Emancipated Youth (HEY), Family Mosaic, Robin Love
á Violence Prevention: The SAGE Project, Instituto Familiar de la Raza, Urban Services, YMCA, Girl’s 2000 Hunters Point Family, Mission Community Response Network, Brothers Against Guns, CHALK, Larkin Street Youth Services, United Playaz, Homeless Children’s Network, Supervisor Sophie Maxwell
á Healthy Workplace Awards: Richmond Area Multi-Services, Edgewood Center for Children and Families, Conard House, Iris Center, Huckleberry Youth Programs, Youth Leadership Institute, Oakes Children’s Center, Curry Senior Center, The Volunteer Center
á Community Leadership Award: Mental Health Association of San Francisco
The Mental Health Board was pleased to honor so many great programs and individuals.
3. Appointment by Governor Schwarzenegger. CBHS Director of Cultural Competency and Client Relations, Tina Yee, Ph.D., and CBHS Medical Director of Quality Improvement, Al Gaw, MD, were recently appointed by Governor Arnold Schwarzenegger to the Advisory Committee to the California Department of Mental Health for Developing the California Strategic Plan for Suicide Prevention.
Congratulations Tina and Al!
4. Community Behavioral Health Services (CBHS) Integration.
CBHS has launched a new Integration Information Line at (415) 252-3086. This phone line provides pre-recorded information on upcoming Change Agent Monthly Meetings and Leadership Trainings.
Zialogic will be arriving to conduct a quarterly consultation with CBHS on Monday, July 9th. Zialogic is scheduled to meet with CBHS Exec team and Integration committees. Zialogic will also provide a day long Leadership training with Change Agents on July 20th.
5. Mental Health Services Act (MHSA) Update.
COMMUNITY SERVICES AND SUPPORTS (CSS)
Full Service Partnerships (FSPs) :
207 partners have been authorized to receive full service partnership services as of close of business on June 1, 2007. The chart and table below show the age group of these partners and the agencies where they were referred to: Please check the May 2007 Director's Report on the Community Behavioral Health Services Site to see the graphics. Choose the Director's Reports link on the left side of the page.
http://www.sfdph.org/CBHS/
MHSA – Housing Service Partnerships (HSP) :
Of the twenty two (22) stabilization units available for FSPs, twenty (20) are occupied through June 1, 2007. Three Adult partners have recently moved into permanent housing units.
Six Transitional Age Youth partners are in permanent housing.
General Systems Development:
The total numbers for unduplicated clients will be available for the fourth quarter on July 31, 2007. The total number of unduplicated clients served through the end of the third quarter is 673.
MHSA Implementation Progress Report :
The thirty-day public comment period on this report ended on May 31, 2007, with no comments received. The Mental Health Board will have a public hearing on June 13, 2007, after which the report will be submitted to the State on the deadline date of June 29, 2007.
Fiscal Year 2007-2008 Growth Fund Budget:
The 2007-2008 Growth Fund Budget of $2,292,795 was posted on the DPH web site for public comment on June 1, 2007. A notice was also publicized in the San Francisco Chronicle on June 4, 2007, welcoming all stakeholders to participate in the 30-day public comment process. The growth funds were a result of unexpected additional revenues received above the anticipated 1% income tax revenue projected to be received by the State, from Californians with incomes above $1,000,000.
WORKFORCE EDUCATION AND TRAINING:
The last Workforce Development Education and Training Committee meeting was held on June 7, 2007. The State has delayed publication of the final guidelines until the end of June or early July. The committee will reconvene to review all recommendations, to insure that they are still within the framework of the final guidelines. They will then constitute the basis of our three-year plan, to be submitted to the State for approval.
MENTAL HEALTH ASSOCIATION FOCUS GROUPS
The Mental Health Association of San Francisco will hold two separate focus groups with MHSA funded agencies to learn more about their implementation strategies, challenges and success stories and to foster ongoing collaborative relationships with community based organizations funded by MHSA. The first focus group will be with Hyde Street, one of the adult FSP program, on June 14, 2007 from 3:00 –4:00pm. The second will be conducted at Larkin Street Youth Center, funded to operate a peer based center and transitional residential housing for TAY and deliver supportive services for housing, on June 27, 2007 from 2:30 – 3:30 pm.
MHSA Advisory Committee Meetings:
The Mental Health Services Act Advisory Committee meets bi-monthly from 3-5pm, alternating between advisory meetings and community forums. The schedule of upcoming meetings is as follows:
Thursday, June 28, 2007 Wednesday, August 29, 2007
Advisory Committee Meeting Community Forum
1380 Howard Street Location to be determined
4th floor conference room
Other Upcoming Events:
Safe Workplace Violence Prevention by Mike Arraj – August 31, 2007 (AM and PM sessions), Philip Burton Federal Building. Limited seating available.
To register for these trainings, please contact Norman Aleman, CBHS Training Coordinator at 415-255-3553 or email norman.aleman@sfdph.org
Past issues of the CBHS Monthly Director’s Report are available at:http://www.dph.sf.ca.us/CBHS/default.htm To receive this Monthly Report via e-mail, please e-mail kathleen.minioza@sfdph.org
Dr. Cabaj: “I will do a quick report, since you have the written one in front of you, so we have time to look at the other items on the agenda.
Just to highlight, we had mentioned before that there was an all adult staff meeting. We had about 1100 providers who attended the two-day meetings and it was quite successful—lots of interaction, lots of looking ahead to the future. Dr. Katz came and addressed the group and it was a very successful event. We hope to make it an annual event.
I highlighted in my report, although it was your event, the Mental Health Board’s Awards Reception. It was such an outstanding evening and I wanted people to be aware of it throughout the system, and Dr. Katz was also mentioning this in his report since it was so outstanding. I was very impressed with the audience of judges and policemen, and the Public Defender; and how people who might not ordinarily be in the same room were all there together, and I thought you did an amazing job. It just reflects the strength of the Board as well as the integration of our systems with all the different forces that we work with. So thank you.
We’ve been honored to have two of our staff appointed to the Advisory Group on Suicide Prevention and this includes Dr. Tina Yee, who’s currently our Director of Cultural Competency and Client Relations. I think you also know Dr. Yee is going to be retiring the end of this month, June 30th, and Dr. Albert Gaw, who is our Medical Director of Quality Management. Dr. Gaw retired, but came back to work for us. We are pleased that they will be honored on the state level. As an aside, Dr. Gaw just had a very good article published about Filipino American mental health services and their needs in the current issue of Psychiatric Services; so you might want to research that article. It’s very, very good.
Our integration efforts continue. We’ve created a new hot line for the change agents. That’s the group that is leading the charge and getting people motivated and active in integrating mental health and substance abuse.
Following, we have an update, which is the current information about the Mental Health Services Act’s use of our dollars to date, including the use of the Full Service Partnerships (FSPs) and some of our other system change efforts. I won’t read you all the data because it’s collected here in the report, including a graph, pointing out some of the ways we distribute the patterns of service delivery, as well as the dollars.
The Workforce Development, Education and Training Taskforce has completed its work, and will be finishing their recommendations. Our group is actually in the lead in the State, and we still haven't received the official guidelines about what to do with that additional portion of Mental Health Services Act dollars money.
We’ll be poised to have some ideas, and then we will incorporate what we can from the recommendations of that group with the state guidelines and maximize the ways we can use our dollars. The Mental Health Association has also been helpful, not only in getting the word out on this evening’s hearing, but also bringing together focus groups to help us look at the changes that the Mental Health Services Act has done in the community. They’re focusing on transitional age youth and peer based services. The feedback will be helpful for the state, which has been trying to collect more information.
As you know, we have an ongoing advisory committee, which we created to guide the work of the Mental Health Services Act as it unfolds in the city. June 30th is the Advisory Committee meeting. The meeting on Wednesday, August 29th will be open to the full community. Everyone is welcome to come. We have public comment at every other meeting, and the next one is in August.
Finally, we have an upcoming training on violence prevention in the workplace.”
Dr. Turner: “Thank you. Are there any questions or comments for Dr. Cabaj?”
Dr. Cabaj: “I’ll be happy to comment on what I know about budget.
Dr. Turner: “That would be great.”
Dr. Cabaj: “Right now, the budget for Behavioral Health is not great. As you recall, the Health Commission decided not to advance any cuts or any of the recommendations that had been created by Dr. Katz in consultation with the whole department. It therefore allowed the Mayor to pick and choose what he wished on the list. At least in terms of what’s going to affect Behavioral Health directly, is a reduction in residential and outpatient substance abuse services by $1.8 million, which I think is extremely significant. If this cut happens, it could actually lead to the complete elimination of services for certain age groups and genders. Women’s services in particular might be eliminated and services for youth. So it could be a very difficult situation if that has to be implemented.
It also did not add back lots of the Board of Supervisors add-backs. In other words, it didn't get continued in the baseline. So we’re still sorting out what would not continue to be funded, and what would be. We don’t have all of that information because it keeps changing.
One nice thing is there was some funding backfill, which included some of our SAMSHA dollars. This is good because we get money from the Federal Government, which allows us to do things that would not generate billing because it’s really meant for money and services that you couldn't use in other ways. We support our central access team with that as well as part of our placement and homeless outreach team. The grant never keeps up with the cost of doing business, but this year the Mayor did allow us to backfill the grants, so we won’t have to eliminate any staffing in that area.
There is another issue that is a cut of sorts. It involves creating a community resource by combining the Urgent Care Center with an Acute Diversion Unit (ADU), which is an alternative to the hospitalizations. It was tied to a reduction in the beds at San Francisco General Hospital , so there will be also a discussion about the reduction of inpatient beds. I believe Supervisor Daly has suggested that money come back, as well as some other things that he’s added back, but as we know, that’s still in the balance.
I was reading the newspaper this morning just to see where things are at and you may know even more. If you look carefully at the budget it actually includes eliminating 28 positions in mental health, and that’s not getting much press because it’s usually thought of as administrative. But in fact it would be a problem if those positions are deleted or defunded. It’s a very complicated way to help support the long term care services, which have gotten to be over $5 million a year, and we don’t have the resources for that. So there’s been some tradeoff, and I think the Mayor felt there are too many new positions throughout the City, and therefore recommended deletions.
San Francisco General Hospital is supposed to eliminate 21 positions, Laguna is supposed to eliminate a little less than 2, 1.75, and ours is 28. Now what I’ve been told is that the positions wouldn't be eliminated, just not funded, which means you couldn't fill them, and that would be the equivalent, in my opinion, if you estimated it, of at least one to two full mental health centers. So it could mean that we would be unable to fill vacant positions as they come in. We don’t have the details yet. It might apply both to the clinical services as well as administrative. So that’s what I know as of this afternoon”
Dr. Turner: “I’m really wondering about the impact of all this. It seems so tremendous. When I look at Psychiatric Emergency Services (PES), Edgewood, Westside, all these places, I don't know how up to date my information is. This is from 6/4/07.”
Dr. Cabaj: “The Beilinson Hearing budget list is the official services cut proposal. Because the cuts to substance abuse outpatient services are listed generically, no particular program is highlighted, so therefore every program that gets funding is notified. So not all of those would be eliminated but any or all of them could have reductions in their service delivery package that we fund.
Dr. Turner: “So what’s the impact on the City and the people?”
Dr. Cabaj: “Well there are two things. Again, as the representative under Dr. Katz and the Mayor, I have to say this is the budget but in terms of an analysis, I think obviously a reduction in outpatient substance abuse services and residential services would truly have an impact.
We’ve been one of the few counties that really strongly supported substance abuse services, and we know that they really depend on the general fund. So it’s a very easy target every year. That’s why every year, substance abuse gets listed as potential cuts and every year the Mental Health Board has been very helpful in looking at the funds to support that. There’s also another big problem with the Ryan White money, and it’s not directly under Community Behavioral Health Services, but it’s all now part of our Community Programs; and that’s about a $5.3 million deficit, I believe, which we’re also trying to sustain. The Board of Supervisors is also saying that they would try to help fill in. So when you start looking at all of these major issues, as well as their impact, somebody might think $1.8 million is nothing compared to the $5.3 million that has to be rescued and so on.
So it’s a question of priorities, obviously. But if we had to implement the cuts, I don’t believe it would make sense to reduce all programs by that percentage because that could mean some programs wouldn't have enough operational power with the amount of reduction. So it most likely means we’d have to comb through particular programs and look at reductions. And we’ve eliminated so many programs over the years that we’re actually at that point where most likely a big chunk of adult services, a big chunk of women’s services, a big chunk of youth services might have to be eliminated, and that’s just on the substance abuse side.
There have been lots of thoughts and comments on the inpatient service. The PES is very frequently backed up. Often the emergency room has been going on red alert because they don’t have places to admit people when they come into the emergency room. If there are fewer beds at San Francisco General for psychiatry, I can only imagine that would have an impact”
Dr. Turner: “I just wonder if, you know, with the reduction in PES as well as substance abuse services and some of the programs for youth, if that means we see an increase in homelessness.”
Dr. Cabaj: “Well that would, and especially if some of the residential services that we’re looking at would be cut. That would definitely have an impact. And as I said, it’s nice that they’ve restored money for the homeless outreach team, but unfortunately that might mean there’s more homeless to outreach to with some of the proposed cuts.”
Mr. Purvis: “Dr. Cabaj, within NAMI there’s some real concern about the elimination of inpatient services, even a small cutback. There seems to be an attitude in some places that it’s okay. Inpatient services are not desirable. But we know, we have family members that are in acute states that inpatient is almost the only way to go. So that’s a particular concern for NAMI.”
Dr. Cabaj: “And again, I can explain the only rationale that they had for listing some of the reduction in inpatient services was it was to counterbalance the creation of a community alternative. And everyone certainly wants community alternatives. It would be great if people didn't have to be hospitalized if there was a good option. That’s why the creation of 14 new ADU beds as well as an urgent care center, which the belief is that it would help offset some of the PES impact, was linked together.
The Health Commission itself kept that link and that did get passed along, so the Mayor just picked up on what the Health Commission had actually supported. There’s also the studies that show that about half of the people currently in the inpatient beds at the San Francisco General are actually not acute, meaning they shouldn't be at that level of care. They should be somewhere else. There are also thoughts that we don’t really need that many beds. But one of the problems is they’re there because there aren’t enough community resources for people to leave the hospital. So it all ties together like that.”
Mr. Keys: “Yes, James Keys. I personally would like to welcome the people in the audience this evening. Thank you very much for coming out on this very warm June day. Dr. Cabaj, I don’t have a question in as much as I have a comment and I’d like to put this into the record officially. Along with the psychiatric beds, I believe that there are cuts being made for women and children, but you forgot to mention that minorities figured into that prominently.
Each and every year—and again, this is a statement that I’m making—I have for the last three years gone through this budgetary process. I have sat and I get phone calls into Supervisor Daly’s office from doctors, men, women and patients from San Francisco General crying out that these budget cuts are going to affect their jobs.
They have to take time off with their work from helping and serving those people who come in needing their help to come and beg for money. This demoralizes not only the workers at San Francisco General but it affects the patients, and people that they’re there to serve. I find this to be, in the least, distasteful and I won’t say how I feel really about this, yet now we are going to be seeing the Mayor cut more funds. That’s going to create homelessness or more homeless people out on the streets, to then create a community court where people who are homeless, people who are sleeping on the streets or who may have to do other things on the street can be arrested and taken to jail. I find this absolutely mind-boggling. If there’s anything, Dr. Cabaj, that you can suggest that we can do as a board to fight these cuts, please let us know. Thank you.”
Dr. Cabaj: “Well I think certainly what you observe is a process that’s happened year after year after year, and as many of you attend the hearings at the Health Commission when they do have comments from the public, that’s exactly what happens and people do get very frustrated. And as I said, it’s often disproportionate to the substance abuse side because of the dependency on the General Fund, and obviously it has a major impact on minority communities because there’s a much greater representation of the minority population in those services. So yes, it has that direct effect when you look at it from that point of view. The budget process is not one I created. I understand, but I think advocacy has been obviously helpful.
I believe the Health Commission had its best intentions in mind when they heard the public comment. It was painful, you know, when people would tell their stories. And their message was we believe we’ve created the best health system now. There is absolutely no reason to cut or eliminate. So I believe they did in their minds the right thing but unfortunately the process left too many open ends and I think we saw the consequences.
When people call me about what to do on a one-to-one level, I’ve usually urged them to contact their supervisor and to work with them. So some of the calls you get may have been because of that. But most of our major contractors know that. They know the best thing to do is to call on the supervisors. They certainly have worked – many have said they’ve gone to the Mayor directly but at this point now it’s the give and take. So the Board has to decide on the best action, but I believe any advocacy, any statements of your concerns about the impact that if these things happen of what it would do to the system would, I believe, be heard and certainly would have some power. “
Dr. Shukla: “You mention that part of the motivation in going forward with these cuts were that there were too many positions in mental health. And I was wondering if there was any basis or any inefficiencies that were noted within the mental health system that led him to choose these cuts versus others.”
Dr. Cabaj: “It wasn't so much any one particular department had too many positions. He felt the City had grown too many positions across the board. And I think there was some comment, there were 136 positions that would have been created in the last year, and he wanted it reduced to 104. So it was sort of up to Dr. Katz, I believe, to determine which areas would take that impact. So I’m not exactly sure why mental health was picked. I haven't been able to get a clear picture, other than that we have one of the biggest pools of employees and the primary care clinics weren't targeted because they’re getting new funding from Healthy San Francisco, which used to be called HAP – it has a new name now – Healthy San Francisco.
There’s additional funding as well as from State monies that are supporting that. So I believe they looked at San Francisco General, a tiny little bit of reduction at Laguna, and then the biggest other employer in the Department of Health is Mental Health. And I say Mental Health in particular because our substance abuse side really doesn't have many employees. All of our substance abuse work is contracted out. But many, about half or two-thirds of our mental health services are done by civil service staff.”
Dr. Moses: “Dr. Cabaj, You know, it’s kind of sad to see or to hear you say 28 positions are de-funded. Is there any plan in place as to seek Federal money? Because every time you look around at federal fund, they’re making some money available for substance abuse. Can we go for some of that?”
Dr. Cabaj: ” Well we, actually as a county, pretty much try to maximize all of our funds that we can get from the Federal Government. We’re pretty good about that. But there’s not that much. And if you know the politics, California doesn't rank high often in the current administration for extra money. The Bay Area ranks even lower, and San Francisco ranks even lowest; so whenever there’s anything that might depend on Congress, we don’t get a lot of money.
We do apply for every grant that we can so we’re looking right now at a grant that would expand some services for the impact on children because of methamphetamine use in their families. And we’re hoping that we can get that grant. So things like that; but they’re all, I hate to say, nickel and dime. They’re small increments but we try to maximize everything that we can. The SAMSHA money is really important. We depend on that a lot, but it also goes through cycles where they may run out or they renew it for only a certain period of time, and then may not continue it. If we eliminate positions we also reduce revenue.”
Dr. Moses: “Thank you.”
Mr. McGhee: “I just have one thing to say. I think it would behoove all of the board members to meet with your personal supervisors that appointed you. I’m definitely going to meet with Supervisor Peskin, who appointed me, because 1.8 million dollars, as far as I’m concerned, in the mental health area is almost criminal based on where we are in San Francisco with the amount of patients and people we have and homeless as well as the mental health industry. So I would implore that two things happen: (1) that we institute a letter from the Board opposing the cut. I think we should go on record as the Mental Health Board, and (2) I think that each one of us needs to make an appointment with our respective supervisors so we can meet with them on making sure that $1.8 million does not come out of the budget.”
Mr. Keys: “Thank you, Vice-Chair McGhee. I believe that your idea of a letter is a great one, yet to make a stronger statement perhaps we should create a resolution.”
Mr. McGhee: “That’s fine. But what I’d like to see, Madam Chair, is for the Board to take an official position, however you feel, whether it’s a letter or a resolution; but I think it’s something that we need to act upon right now. And then I think, Ms. Brooke should help in setting up the meetings with our supervisors as quickly as possible so we can get in to meet with them.”
Ms. Brooke: “A letter we could do without having a board vote. A resolution we couldn't do until July.”
Dr. Cabaj: “One other area I didn't comment on because it’s not directly related to the City budget, but to the State budget. I learned this morning, if you remember the AB2034 money, which we’re all advocating for, it was at a joint committee between the Assembly and the Senate, and this morning, they did agree that it should be funded. Now that still doesn't mean it will, because it’s still up to the Governor. But they did not agree to support the Mentally Ill Offenders grant, which was the additional new money that came for the mentally ill offenders. So if that happened that would be a grant that we did receive. It would run through this fiscal year, we learned, and about half of the amount of money then would stop. But as of June 30th all the AB2034 money would stop and we would have a deficit of $2.3 to 4 million. There’s no backfill at all discussed about the AB2034 money because it’s still so unknown.”
Dr. Turner: “Okay, are there any other Board member comments related to this topic? There was also the handout that we received around the growth funds along with Dr. Cabaj’s report, the plan for the growth funds.?
Dr. Cabaj: “Okay. I have it as a separate attachment. If you recall, we discussed in here that the State did pass a bit more money along to us for clinical services and support; almost $2.2 million. That was on top of the $5.3 million we get. And our plan with that growth fund is what was outlined there.
Basically it’s not doing anything different, it’s just continuing to fully fund all the adult programs and all the violence response programs. I think, last year I said we were going to only fund one adult program and one violence program, but because of the Request For Proposal (RFP) process, three programs, all whom were within a half point of each other got selected. So we said if the State allowed us to use some one-time money, we would support these programs for that year, but there was no promise funding would continue.
This additional money allows all three programs to continue, as well as the added violence response services. And all it does is help some part-time positions become full-time and strengthen the role of peer employees. It’s our plan to basically keep everything that we’ve been doing going. Otherwise we would have actually faced some potential reductions in the number of clients we could see through the Full Service Partnerships. So this allows us to do that, strengthen our violence response network and enhance peer employment in the system.”
Dr. Turner: “Okay, thank you for that Dr. Cabaj. I’m going to open this up to public comment. Is there any public comment relevant to this item? We have three minutes for each person to present and then you’ll hear a little ding from the timer.”
1.1 Public comment relevant to Item 1.0
Dr. Lu: “Board members and Dr. Cabaj, my name is Dr. Francis Lu, last name L-u, and I just want to say that in July, I will be celebrating 30 years of working in the Department of Psychiatry at San Francisco General Hospital with the inpatient services. And I’m also a professor of clinical psychiatry at UCSF. I have a written document to just discuss the budget issues affecting the Department of Psychiatry at San Francisco General, first of all to inform you of what’s happening and secondly, if you so please, to pass a resolution advising the Board of Supervisors to add $2.368 million dollars in general fund dollars in order to accomplish the following two actions. (The document follows.) And I’m just going to summarize here because of time.
One action we’re requesting to be taken, is to prevent staffing cuts in the Department of Psychiatry. This would require $1 million in General Fund dollars, and there are a number of positions that are going to be cut throughout the Department and we hope that you might support adding back funds to prevent these cuts to outpatient services as well as inpatient services. The second action is to prevent the closure of an ethnic minority focus psychiatric inpatient unit of 22 beds at San Francisco General, and $1.368 million dollars in General Fund monies will be needed for that. And that’s documented on the Beilenson hearing document, the second line item. If you look in the box here it does say that $1.368 million is the planned reduction at San Francisco General Hospital. And just to be very clear, this represents one of four units, 25% of the psychiatric beds in the public sector at San Francisco General.
While we support the expansion of community services, we believe it’s both too dangerous and unwise to close an entire 22-bed inpatient unit before these community alternatives have had a chance to demonstrate to what extent they can eliminate the need for locked beds, as well asdivert the planned 30% of patients that normally would come to PES. That was in the Department of Public Health (DPH) plan that was submitted. For example, according to that DPH plan patients that need medical clearance, seclusion restraint or hospitalization would still come to PES and I ask, you know, how will the police and others determine where to send the patients so as to offload 30% of them. Also, we’ve had a drastic reduction in hospital beds in the City from 176 to 71 over the past 16 years, not including San Francisco General. Also in April, Sutter Health announced the closure of their 28 beds next year, and so we are very concerned. And finally, concerning the four ethnic minority focus units, which unit do you cut, the Asian focus, the Lesbian Gay Bisexual Transgender (LGBT) focus, the Black focus? And so I ask for your support in this matter. Thank you.”
Dr Lu's Written Statement
Budget Issues Affecting the Department of Psychiatry at SFGH Document:
TO: San Francisco Mental Health Board
FROM: Leadership of the Department of Psychiatry at San Francisco General Hospital
Robert L. Okin, MD, Chief; Mark Leary, MD, Deputy Chief; Francis Lu, MD
DATE: June 13, 2007
RE: Budget Issues Affecting the Department of Psychiatry at SFGH
We are writing as leadership of the Department of Psychiatry at San Francisco General Hospital (SFGH) to inform the San Francisco Mental Health Board about our deep concern on two separate issues in the Department of Public Health (DPH) budget as they relate to the SFGH Department of Psychiatry. Comprehensive care requires the need for high-quality, community-oriented, culturally competent hospital care for patients when they need 5150 emergency evaluation/treatment in a locked setting that can provide comprehensive medical assessment/treatment. The partnership between our community services and SFGH is critical for the health of our patients. Therefore, we ask that the San Francisco Mental Health Board pass a resolution advising the Board of Supervisors to add $2.368 million in general fund dollars in order to accomplish the following two actions:
1. Prevent staffing cuts in the SFGH Department of Psychiatry ($1 million in general fund dollars). These cuts will affect many programs in the Department. 200 mentally ill outpatients and 125 mentally ill inpatients with complex medical and surgical problems will otherwise not be served because of cuts to psychiatrist and psychologist positions. Hundreds of inpatients will not receive adequate linkages with their families and community providers as they prepare for discharge, because of the cut in inpatient social work. Certain other crucial administrative cuts are scheduled to occur which will damage the Department’s infrastructure and ultimately compromise clinical care to patients. Because of a very severe recruitment and retention crisis of psychiatrists, these cuts were necessary to bring psychiatrist salaries closer to the salaries paid by other organizations such as the community behavioral health services of San Francisco, San Mateo, and Santa Clara counties so as to recruit and retain psychiatrists.
2. Prevent the closure of an ethnic/minority focus psychiatric inpatient unit (22 beds) at SFGH ($1.368 million in general fund dollars). This represents a cut of 25% of the psychiatric beds in the public sector at SFGH. While we support the expansion of community services, we believe that it is both too dangerous and unwise to close an entire locked 22-bed inpatient unitbefore these community alternatives have had a chance to demonstrate to what extent they can eliminate the need for locked hospital beds as well as divert the planned 30% of the patients that normally would come to PES. For example, according to the DPH plan, patients that need medical clearance, seclusion and restraint, and/or hospitalization among other conditions would still come to PES; how will police and others determine where to send patients in emergency 5150 situations? It is presently very difficult to get a patient admitted to a hospital bed because of many reasons including the decline in the number of psychiatric beds in the city from 176 to 71 in the last 16 years (exclusive of SFGH). Furthermore, Sutter Health announced in April closure of another 28 locked inpatient beds at CPMC next year; CPMC is appealing. The loss of 22 locked inpatient beds at SFGH will make it extremely difficult for our mental health system to provide this level of intensive emergency care. Finally, the four SFGH community inpatient psychiatric units also constitute nationally and locally recognized Ethnic/Minority Focus Programs providing culturally competent care for Asian, Black, Latino, women, LGBT, and HIV/AIDS patients. Cutting one of these units will jeopardize the integrity of the Focus Programs to care for these underserved populations who experience profound mental health care disparities. Ethnic/ minority populations will be disproportionately adversely affected since these services do not exist at any other San Francisco hospital.
Mr. Keys: “Excuse me. Dr. Lu, can you stay, please? I have a few questions. Dr. Lu, James Keys. We’ve spoken several times on the phone before. Welcome and thank you for coming out.”
Dr. Lu: “Thank you.”
Mr. Keys: “Dr. Lu, how long have you been in San Francisco General again?”
Dr. Lu: “30 years this July, July 25th.”
Mr. Keys: “Thank you. With these cuts what is going to happen to those people who are not receiving services, in your expert opinion?”
Dr. Lu: “Well I’m very concerned that right now we’re having a backup, as Dr. Cabaj mentioned. We’re at red alert status. We have no beds upstairs and the emergency services are so full they can’t even take people coming in on the 5150s. And they’re bringing these psychiatric patients on 5150s to medical emergency rooms at Moffitt and California Pacific Medical Center, and St. Francis Hospital. These are facilities that physically do not have a psychiatric emergency capability, nor the staff. These patients are waiting days to be in these facilities right now. So we’re very concerned that with the loss of an entire unit, that this situation is going to melt down.
I just wanted to comment, again to i1nform you and also, if possible, ask for your support to try to reverse the situation, which I think would be to restore the funding for the inpatient unit and continue the funding for the community alternative. I don’t see this as an either/or situation. I think this is a place where we can come together.
I also am making all these statements in the context of the dreadful, dreadful cuts that we just heard about; so I don’t mean to, say that we’re the only ones in need. But I just want to make this very clear that we’re talking about 5150 emergency patients that are sometimes in need of a locked setting with expert medical assessments. And when the police pick up someone on the street, are they going to take the person to PES, where you have a medical emergency service next door and medical consultation that are able to do chemistry tests and a CAT scan, and drug screens, or are the police supposed to bring the person to the urgent care center, which may not have all of those services? I don’t have the details, but I think that, again, it’s not an either/or. I think we can try to work on both.”
Mr. Keys: “Excuse me, Dr. Lu. Dr. Cabaj, do you know if there is a backup plan for what’s going to happen to people who are coming in for help or services from San Francisco General from the Mayor’s Office if these cuts happen?”
Dr. Cabaj: “Well the alternative is supposed to be this community center. My understanding is they wouldn't close the beds until the center is up and running. I believe it’s linked that way. And unless the language changed, it also had a reduction in PES staffing too, which also needs to be highlighted, I believe. I don't know if that changed. The proposal changed a lot, but the belief is the new urgent care center with the ADU beds would be the alternative; so people would be brought there.
Now the question has come up how would we train the police, who would work with them? You may be brought in because of the training program that you support, and about how we address who goes where. And it’s a question of who does that screening. And I think the medical issues that Dr. Lu brings up are very important ones to consider.”
Dr. Lu: “Thank you, Dr. Cabaj. I just want to make it very clear in my reading of the DPH plan, it kind of implies that those community alternatives are going to be open first and then the reduction in the beds. But if you read the document carefully, it clearly states that January 2008, the unit is going to close, and then these alternatives are going to come up, and there’s no overlap period at all. There’s no room for error, when we’re already on condition red 30% of the time in March and April. So I think this is a very serious matter and I think this could really blow up in the Mayor’s face, to be very honest, and I must say in the year 2000, when DPH proposed the closure of an inpatient unit at that time, our current Mayor, Gavin Newsom, was very much in favor of supporting the unit. He visited General Hospital. He was one of the first supervisors to support us. So I hope that some consideration will be given to this, and I certainly wanted to inform you of this.”
Mr. Purvis: “I’d just like to add a comment. This is the very issue that I was commenting on before. We know that family members who are part of NAMI have adult children who are in jail or on the streets for lack of appropriate inpatient care in a timely manner. So I’m sure, I know that we’ll be able to support the points that you’re raising.”
Dr. Lu: “Thank you very much.”
Ms. Kellum King: “My name is LaVaughn Kellum King and I’d like to ask you has anyone asked the Mayor to come over and take a tour of the facilities and show him what the devastation is and how it can worsen.”
Dr. Lu: “That’s a very good idea. I think we could certainly make every effort to do so, yes. Thank you very much for that idea. Certainly any support that the Board could give would be much appreciated. Again, thank you very much for the time and consideration.”
Dr. Turner: “Thank you. I want to open this up to further comments from the public.”
Member of the Public: “Hi. My name’s John Cleveland, Sr. And I don't know what the amount of the funding for the Behavioral Health Court system was exactly, but I think that if they can have a place out of jail to go to, maybe some construction job. Some of these buildings need remodeling or some of these old buildings need to be taken down. If the City can hook them up with something like that to where they would have a better life, I think that it would be working more.
The way that it’s not funded now is because they end up back into the system again. You know, they go out so far but it just opens up another door. They have nowhere to lead them anywhere, to construction or to something to that affect that gives them a better life. So if the funding was there or if the City could come up with some wrecking crew or something and put it together at the cost of equipment and then some good construction leaders, maybe they can branch out with people being more productive instead of spending so much time nonproductive in jail. And that’s about all I have to say about the Behavioral Health Court system or maybe a system that can take off with that and be more helpful to the City and maybe the County. Thank you.”
Mr. Keys: “Mr. Cleveland, I just wanted to comment that you have two actually excellent ideas about San Francisco creating a sort of infrastructure of work for people who have little skills or who can be taught some skills to do some basic work that we need done. Construction is one of those things, cleaning the City is another one of those ideas. That’s actually a fantastic idea, and to give a person work is to give a person hope, and give a person an outlook of a good future for themselves. So I wanted to thank you very much for your comments.”
Member of the Public: “Hi, my name is Sheri Erlinson. I’m from the Citywide Case Management Forensic and Forensic Linkage Project. When I came to San Francisco, I was homeless and everything else, you know. And I’ve been in 16 different programs here. I know what they’re all about. The ADUs I’ve been to are very nice programs. I’ve been in San Francisco General Hospital 38 times, and they’ve helped me each time I was there.
Why would they cut this budget down? Because, you know, I’ve even been in jail because they didn't know where to put me. My friends at Citywide Forensic are asking, what are we going to do when they’re going to close General. What are we going to do, you know? And I don't know what to tell them. You know, I’m just a client like they are. They’re just so worried about what happens. What are we going to do next, you know?
There’s going to be a lot of homelessness and then there’s like the pregnancy. I almost had my son in a program. They take care of programs very well and I don’t think they should be closing down General or any of the hospitals, you know. I already know that Davies closed their program now, which I didn't think was right, because I had an ex who used to go to that hospital, and they helped her out very much. I’ve had lots of friends of mine go to these different hospitals. They needed it. And I know they’re overcrowding hospitals and also boarding, ADUs because they’ve got so many people in jail now waiting to get into an ADU. Two to three months waiting. They’re in jail waiting for an ADU for two to three months, and it really just hurts me to see them. Every week someone goes to the judge, and the judge says ‘you can’t go to an ADU because they’re still trying to get the people out of General’. That’s how bad the system is now. What’s going to happen when General completely shuts down to these ADUs? It’s going to be overcrowded and more people are going to go to jail. There’s going to be more people who are homeless. They’re going to be all in the Tenderloin, you know. I’ve been in the Tenderloin. It’s no good. That’s all I have to say.”
Member of the Public: “Good evening. My name is C. W. Johnson. I identify myself as emotionally disabled, which just means I’m manic-depressive and I suffer from schizophrenia. I’m also an advocate in association with the Mental Health Association.
One of the things that I feel, well three of the things that I feel is that we have a lot of homeless because we don’t really have good homeless prevention. I think if we’re going to have money, money should be toward that, toward helping the homeless, most definitely. I’ve been almost evicted a couple times myself for what I consider a disease. Also, I think that this seems not to be talked about or even looked at, is a transitional support for people who are mentally ill. When you have lived on the streets a certain way for two, three, maybe four years, you develop habits and a way of living. And I think that any training around training people how to get their lives back would be a great way to prevent people from becoming homeless.
Third, but not last, I think housing is really a problem. I think – I forgot the name of the program, but they do a really good job of putting emotionally disabled people together. They have these really wonderful houses. Progress Foundation, that’s it. And I think that as we move people, there’s no upward movement. It’s just like you get in this hotel and it’s beautiful and everything but that’s it, as far as you go, you know. And I don’t think life is actually a monopoly. I think you should be able to go as far as your emotional stability should be able to take you, and I think we really need support around those things and I would definitely like to be a part of anything like that if you guys come up with it. So thank you very much for your time.”
Member of the Public: “I’m Kathleen Connolly. I’m the Director of the Citywide Case Management Forensic Program. We’re a program of UCSF. And I just wanted to piggyback on Dr. Lu’s comments about the hospital inpatient beds.
I think it would be a travesty to lose those beds. Our community is already at its limit as far as the ability to get our folks into the hospital for stabilization when they really need it. Our program works with some of the most severely mentally ill folks in the City. I’ve been with the program for ten years and I actually used to work out of psych emergency (PES) and my impression is that probably both options are needed. We need to keep the inpatient unit open and then add this other community type program to relieve some of the pressure from psych emergency. But I don’t think it can be an either/or because I think, that they’re two very different functions.
I think an emergency room has to be trained and run as an emergency room, and the folks that are going there are not people that do not need to be there. The reason they’re overflowing is because every single person needs to be there. We don’t even take people to the hospital when we know that there’s a slight chance that they wouldn't get hospitalized. So they have to really meet a high standard, as it is, and the people that are in the hospital that are on administrative days, they need to be there because there’s no place to send them once they are stable. And we’re lucky if we can even get them in long enough to stabilize them. So I just wanted to really advocate for that, and stress the importance of it as a community case manager working with all these folks. Thanks.”
Mr. Keys: “Ms. Connolly, could you just briefly explain what your organization does?
Ms. Connolly: “We’re an intensive case management program. We’re actually, part one of the FSPs that was funded through the Mental Health Services Act (MHSA) money. We’ve been around for about 20 years, serving mostly high users of both the inpatient psychiatric units and psych emergencies. So we provide intensive case management and wrap around services to folks for as long as they need it.”
Mr. Keys: “How are people referred to your organization?”
Ms. Connolly: “Mostly through the inpatient unit from various community providers. If someone’s in an outpatient clinic and they need a higher level of care, we’ll get referrals that way. My program is the Forensic Program so we get most of our referrals through jail aftercare, so we’re working with folks coming out of jail.”
Mr. Keys: “What would happen if funding were to be reduced or stopped?”
Ms. Connolly: “I think that the City would lose a huge service. We probably have about 500 clients that we serve at our clinic, between three different case management programs.”
Mr. Keys: “So the funding that’s going to be stopped for San Francisco General, how is it going to affect your organization?”
Ms. Connolly: “Well it does trickle down. We’re part of the Department of Psychiatry for UCSF, so when there are cuts that need to be taken, they are spread out amongst, not just the inpatient unit, but they trickle down to the various outpatient programs. There’s Citywide Case Management, there’s Crisis Resolution Team, the ED Case Management Program, and various other smaller programs I think. So yes, we’re in the process of actually having to cut a few positions right now.”
Dr. Turner: “Ms. Connolly, if you have the time, and actually for anybody who represents programs, if you want to just email us a few lines that you think will help us, we will put them into our letter.” I think sometimes the more facts we can have, it’s helpful to us.”
Ms. Connolly: “I’d be happy to do that.”
Member of the Public: “My name is David Keck. I want to shed some light on why I feel I am lucky. The reason I’m lucky is because I have services, I am receiving services. I have housing that’s owned by the City, and I can afford it. I have services provided through St. St. Mary’s Clinic, part of St. Mary’s Hospital. It has a Catholic training school. And all my coverage is included. I mean, I get about a thousand dollars a month in treatment. It’s offset somewhat by Medicare and Medi-Cal.
But I want to also shed some light that I am hearing impaired. I go to the Center of Deafness, UC Center of Deafness at Laurel Campus and there I see a case manager weekly. I see a case manager and a social worker for an hour each. And as I need it, I see a psychiatrist because I had an automobile accident long ago and I had head trauma. So that’s what’s keeping me afloat and I want to offer my services as a volunteer. I want to be utilized in any possible way that I can to structure programs, to be of help for the people that are trying to come up.
I am a peer counselor now but I’m not working, for one reason or another. I’m not sure why, but I used to be the assistant to the coordinator for a program, and we were servicing 25 interns scattered in ten different centers, hospitals, clinics and that sort of thing. And I just put it out now that I’m a volunteer, and I want to be utilized in any way that I possibly can to support what everybody’s trying to do. Thank you.”
Dr. Turner: “Thank you. We need to get this letter out as soon as possible; so anybody who is going to write anything to us, speed is of the essence. I think we’ll probably get it out Friday morning.”
Member of the Public: “My name is Alexandra Kutik. I was dismayed and concerned to hear about proposed reduction of inpatient beds at S.F. General Hospital based upon the expectation that community-based services would fill in the gap. Have we not learned from the mistakes of public policy dating back to the 1950s and 1960s when de-institution-alization with a similar expectation resulted in the streets along with jails and prison populations serving in place of those non-existent community resources? Promises made then remain broken. It is unconscionable that we would ignore this history lesson and make this same promise again, particularly when we already know that resources are not available.
I am wondering what the connection is between the proposed elimination/de-funding of 28 positions in Mental Health and the allocation of MHSA FY’08 growth funds for additional/annualized/part-time to fulltime CBHS staffing for MHSA implementation. If, in fact, MHSA funds are being used to supplant City costs, this is in direct conflict with the spirit and intention of MHSA. Once again, thank you for the opportunity to present these comments.”
Dr. Turner: “Thank you. Is there any further public comment? Okay, thanks for all of you who presented to us, and seeing no further public comment, public comment for this item is closed.”
Item 2.0 PUBLIC HEARING ON THE ANNUAL UPDATE TO THE MENTAL HEALTH SERVICES ACT PLAN (MHSA)
We’ll move at this point to the hearing on the annual update for the Mental Health Services Act. We all received this in our packets and hopefully members of the audience have it, but if not, there are copies in the back that Ms. Brooke has supplied.
2.1 Presentation
I’ll start off with a few things I noticed in the report. First of all, I just wanted to say I’d like us to add that hearings were held at each of these meetings and these hearings tended to be quite long in terms of getting public comment. They moved up to two hours, and Mental Health Board members who were on the taskforce facilitated those hearings; so I think that would be important for us to add in terms of our process.
This is a comment, and then I have a question. Maybe you can help me with this—in Part A, I guess on page 7, we talked about implementation challenges. And before I noticed the heading, and I was reading I was saying oh, no, we’ve said all these things we’ve done wrong. And then I realized that’s what we’re supposed to put in the report—the challenges. But I would think it would be important to, at least for our own selves internally, if not in this report, to explain how we’re going to avoid having these kinds of problems, you in the future.
There were things like the plan was approved, but positions couldn't be posted. Some of these things we can’t do anything about; but as of December 2006, none of the clinical positions were hired. That’s on page 7 in the middle, and I was wondering about the employee turnover, and the fact that we were short-handed to handle contract renewals. We might do a better job of just explaining how we are managing these things, not only for the presentation to the State, but also for our own internal work on ourselves.
The staggered funding of MHSA was a challenge for our financial accounting unit. I guess now we’re doing better with that. Sometimes this is the jargon that is used, but when we talk about full service partnerships, we’re talking about various organizations that are our partners; but yet we also use the word “partners” for clients. So I’m wondering, are we talking about people or organizations? Maybe you can just explain the terminology a little bit.”
Dr. Cabaj: “Well thank you. Those are excellent comments. Actually, if you notice, the timeframe is the problem. This is a report that’s supposed to be through December 2006; so most of those challenges were met and resolved by now, but we don’t quite comment on that. Next year it would say that. So we were a little uncertain about how to do that, but I think if we can incorporate some of these remarks, that would help.
The State was very adamant about creating that term ‘full service partnership.’ We had already been using terms like single-point of responsibility. The program we just heard about, Citywide, is that. The ACT program uses another name, ‘assertive community treatments,’ and we felt that there were plenty of terms that were already out there, but the State wanted to come up with a new term; so they came up with ‘full service partnership.’
Usually partnering does mean contract agencies or sister organizations like the police or the courts. So, I’ll have to reread this but I thought they would weave together. When they use partnership, it usually meant to the clients because of their needs, and full service partnership implied everybody working together to help that client, doing whatever is needed. It didn't imply who was doing it, necessarily. The partners are who do the work, so we’ll see if we can make that clear.
The reason we even have the term CSS, Clinical Services and Supports, is because the State did not want to use the term “system of care”, which we’ve been using for many years. They thought to transform the system, you had to come up with a new term so that’s what they did.”
Dr. Turner: “It was a little hard to read without tables. Maybe you aren’t supposed to put tables in. I know the State has all these formulae about how you have to present these things. But it would have been a lot easier to read it if I had those tables. Here’s the number of proposals on page 3 that we got, and then it starts explaining on page 4 who got them and for what, and does that account for all of them? It is unclear. A table, I think would be really helpful for people to understand.”
Dr. Cabaj: “I’ll see if we can do it. Again, Maria O’Malley was one of the major coordinators of the Update. I actually encourage all of my staff to read it, because I thought it was a well-written report even if there were some questions on content here and there. But it’s one of the rare times where it was actually enjoyable to read, I thought.”
Dr. Turner: “It is actually well written.”
Dr. Shukla: “I had a question about outcomes and again, your point’s well taken about how this is actually dated December 2006, and that may be a little bit early; but I think there was a public comment that was very well taken about programs being cut at the same time that services are expanded. And I think that the only way to really justify doing that is if you are supplanting existing programs with better programs or fuller programs, or programs that can actually show that they produce better outcomes. And I think a really important piece of this in the next phase will be to actually demonstrate that all of these new services are actually improving the state of health of these patients. Especially with all the cuts, I think that’s vital.”
Dr. Cabaj: “Excellent.”
Dr. Turner: “I think the sad thing is that even if this is helpful, you’ve got all this other data related to the cuts, which may show harm, and then it’s kind of hard to know what’s helping and, it gets over-shadowed.”
Dr. Cabaj: “I’ve been paying attention to that question of supplantation and there’s so many interpretations of it. I tried to use this term to address the 28 position deletions. But there are two interpretations: that it only applies to State funding, the State General Fund, and although I’ve heard it interpreted for the County it would be pertaining to the ‘04/’05 level, and I’ve been told that we still would not be below the ‘04/’05 level because of cost of living and other increases to the whole system and other growths. So it’s a technicality, but I think it’s tough. The outcomes are a key part of this, and it’s too soon to assess the outcomes, because they’ve just started. So the outcomes will be one of the key parts, and we will be following them not only for the clinical services but as the new monies come along for prevention, early intervention training and so on. That’s going to be a key issue.”
Dr. Shukla: “Is there a general sense of how well these programs are doing?”
Dr. Cabaj: “We feel confident because we’ve had the working model of a program like Citywide and our AB2034 programs. So basically the Full Service Partnerships are just like that model, except we are able to fund more services for clients. And those models have been very successful, as you know, reducing hospitalization, reducing time in jail, increasing work activity, and increasing housing. We have no reason to doubt that those same things will happen with the FSPs. But again, it all depends on the funding. So it’s too soon really to know the impact of these programs. But I can’t believe it would be any different.”
Dr. Turner: “Any other Board members want to make comments or ask questions about the Update? Another point is that Board members here are doing program reviews for each one of the programs that was funded. We selected them specifically for that reason.”
Mr. McGhee: “I just have a question. You know, in reference to the reduction, Dr. Cabaj, I think with the 160 programs we fund or something like that, how is that $1.8 million going to affect some of those organizations that are doing a pretty good job?”
Dr. Cabaj: “The $1.8 million you’re talking about? As I mentioned, Dr. Katz and the Mayor did not specify any particular programs. That’s why every one is listed. So if that cut went through, which we really hope your advocacy and other input might prevent, but if it came through, we’d have to determine whether we do a formula of a certain percentage to all programs. But I worry again about the ability of a program to function if you go below a certain level, or target a particular program. But, in the past we’ve always honored programs for children, minorities, and for women. And if we try to keep with those same priorities, we actually would still bump up against having to cut some services into those areas. So I am worried about how we would roll that out.”
Dr. Turner: “Any other Board Members want to comment? Let me open this for public comment related to our presentation on the updated report. Are there any members of the public who would like to make a comment? There is a three-minute time limit.”
2.3 Public comment relevant to Item 2.0
Member of the Public: “Hi, my name is Sheri Erlinson. When I first came to San Francisco nine years ago, I didn't have food or housing. I made poor decisions because I didn't have the right psychiatrist or the right meds. I’ve been hospitalized. I got referred to Citywide by SOMA because I’ve been hospitalized too many times in another state. I have not been hospitalized since January – February 2005 because I’ve become stable on my meds.
I pled to a crime that I did not commit in 2004 so I could get out of jail. I got in trouble for violating my probation many times from 2004 to 2006. In May, I got arrested and sent to jail for two months, then I got into Behavioral Health Court (BHC) where I met Monica, my caseworker. I like Behavioral Health Court because they allow me to work on recovery and not as punishment. I can think about myself as a success and not just another criminal.
My goals right now are to become my own payee, to deal with my fears, to have my own housing, and to own a horse therapy ranch for people with mental illnesses. Citywide helps prepare me to do these things. I have been sober for one year, and I have accomplished more goals in my treatment plan this year than the year before. Thank you.”
Ms. Kutik: “Throughout most of the report, MHSA-funded FSPs and other agencies are not identified by name. This seems like a curious omission, particularly for readers who are members of the public.
II. Efforts to Address Disparities
B. Outreach (page 17)
I participated in the “consumer and community orientation of the RFP review process.” I served on one of the review panels and was the only consumer/community member, despite the fact that two others had signed up and were scheduled to participate. Given my experience, I wonder whether there is a discrepancy between “one-third of various panels were composed of consumers and/or community members” and the actual number who participated in the review process.
I. Program Services – Implementation
B. Key Transformational Activities (page 8)
C. Implementation of Full Service Partnerships (page 9)
One of the “five fundamental elements” of MHSA to which SF remains committed is “wellness/recovery/resiliency focus.” While these sections acknowledge the sea change required of both CBHS and contracted providers – from a medical model treatment philosophy (client impairment) to a recovery model (client goals and functions) – the conclusion is that “additional training on the recovery model … is a priority.” I would suggest that this is not simply a priority, but an essential and necessary element of SF’s plan that should have been part of implementation prior to the implementation of FSPs.
III. Stakeholder Involvement (pages 19-21)
IV. Public Review and Hearing (page 21)
The recruitment and participation of consumers and families in the MHSA planning were successful and exemplary. Given the lack of written public responses to the report during the 30-day period ended 5/30/2007 and the lack of attendees at this public hearing, it seems that current outreach efforts for the implementation phase are inadequate and in need of expanded action.
I attended a recent community forum of the MHSA Advisory Committee. I requested that CBHS put me on the distribution list for both future Committee meetings/community forums and job opening flyers for employment of consumers and family members. To date I have received no information as a result of either request.”
Dr. Turner: Thank you. Will you please send us your comments in writing? We will include them in our letter.”
Ms. Kutik: “I can provide them before the deadline.”
Dr. Turner: “Thank you. Is there any other public comment on the update?”
Member of the Public: “My name is Laura Barber. On page 6 on violence and trauma recovery, as the lady stated earlier, they didn't mention the name of the agencies who received the money for violence and trauma. I would like to know, can anyone supply me with the agencies that received the money? They said one agency in the Mission District received money, and then one in the Western Addition, and one in the Bay View neighborhood; but there is no name who received the funds, no agency name. Can that be given out?”
Dr. Turner: “The Instituto Familiar de la Raza, and Urban Services, YMCA. Those two were for violence and trauma recovery agencies, receiving $120,000 each.”
Dr. Turner: “We often don’t answer questions but the information was sitting right here on the table. Okay, any other further public comment? Seeing none, public comment is closed.
2.2 Board discussion of Possible Board responses to the presentation
Dr. Turner: “I inadvertently went to public comment before we talked about Item 2.2 so we’ll go to that now, before moving forward, and that is Board discussion of possible responses to this topic.
Let me ask a question instead of a response. This report will get some revisions before it will be submitted to the State with comments and that will all go together; When does that get submitted?”
Dr. Cabaj: “I believe it has to be to the State by June 30th”
Mr. McGhee: “So actually this can be revised. This is not the final report.”
Dr. Cabaj: “I have to revisit the technical side. This is one of those weird ones where there is supposed to be public comment that could or could not be incorporated. It might be just the addendums. And then the public hearing, which is this, which we also would usually attach as comments. But I will clarify this, because if we can go back and revise it with some of the things that were suggested earlier, I would definitely want to do that. If not, we may incorporate them as comments to the report. But one way or the other we’ll make sure these things are noted.”
Dr. Turner: “It seems to me that a really high percentage of the proposals that came in got funded. That is interesting in relation to Ms. Kutik’s comment about the difference between the public hearings where there were so many people who came out and we heard about so much need everywhere in the City; and now there’s not so much response.
I guess what happened is that these areas of focus got selected and so the RFPs just focused on them. So the people who are in those areas where we prioritized are probably happy, but other folks in other areas of the City, who were are not happy but they’re not here, and that’s your point.”
Dr. Cabaj: “Yes. And also I think, as you’ve seen in other processes, there’s always a lot of excitement about how to spend money and how to prioritize the funds. Watching it unfold is sometimes not as interesting; or people watch it from a distance. But usually when you have a voice on how you actually will shape a program and design how money goes, you’ll get many more people interested. So if we get significant new funding, I’m sure we’ll have more public response as we try to add or expand programs. But I appreciate those who are here tonight. I think the Mental Health Association was helpful too in getting the word out on tonight’s hearing.”
Dr. Turner: “Well the difference too is that we’re having the meeting here, and that’s not convenient for everybody. We went around to every neighborhood in the City during the RFP process.”
Dr. Cabaj: “Yes. The Community Advisory Board is rotating throughout the City, so we can make sure that at least people can come more conveniently if it’s possible.”
Dr. Turner: “So then public comment is being obtained from all of these community meetings.”
Dr. Cabaj: “Yes.”
Dr. Turner: “And it is being compiled?”
Dr. Cabaj: “Documented, right.”
Dr. Turner. “Good.”
Dr. Shukla: “That doesn't have to do with this report though.”
Dr. Cabaj: “No, it doesn't have to do with this report. It’s not even a State requirement to hold these community meetings, but we wanted to because I would not want a system unfolding without public review and support, and especially as we are moving towards that recovery model and community-based services, the community’s got to be involved.”
Mr. McGhee: “Dr. Cabaj, would you be able to get us, the Board, a final draft before we have to submit it on June 30th?”
Dr. Cabaj: “Yes, I will find out tomorrow what the technicality is and you will get copies of everything before it’s sent.”
Dr. Shukla: “Before the State makes a decision regarding the second round of funding, what additional information are we required to provide, or do we plan to submit to them in addition to this document?”
Dr. Cabaj: “Well the current plan is for three years; so there’s no more funding in store, unless we had a radical, huge influx of money, which isn’t going to happen, in which we could maybe fund some of the programs we couldn't fund previously. If you recall, some of you who were on that taskforce, and we funded about four categories in each of the groups that were listed, but there were clearly other things that were listed that we couldn't fund. So one thought is if we had extra money, we could just go revisit the plan and look at funding additional new services that were already approved in the plan, but not fundable; or we could expand current services. But any new dollars, like for prevention and so on, we’re waiting for the State to tell us what the role of public comment is or not. That’s why we did convene already the subgroup or taskforce on the education and training.
They’re considering now a four-year plan. They decided to incorporate one year into the process because it took them a long time to respond and so on. Then most of the money will go back to the County to determine how to use it, and at that point we’ll probably have to have a whole new process. I don't know if that clarifies the process.
What theoretically is supposed to happen, and again, the State keeps changing the rules even as we talk, but after ’09, ‘09/10, I believe, all the money will be put into one lump some for the County, meaning the money that was teased out for education, for prevention, for clinical services; then it’s up to the County to come up with an integrated plan, not having these separate plans.
What’s been frustrating for most counties is why do we have to have five separate plans? Why do we need an education plan? It really all fits together. A public comment was made and others said we can’t do many of these things without training. It’d be great if we can incorporate the prevention, early intervention now. We all really were demanding that the State please give us the money now because we’d like to incorporate it into the original plan. But in the State’s wisdom or decision-making process, they are keeping it out separate. Then within two or three years, it will all be put back together, and then it will be up to the counties to do sort it out. At that time, we’ll definitely want another public process.”
Dr. Sukla: “I think my question was just trying to address at this point, if the funding amount will not be changing then. The question may not be how the money will change in terms of who receives the money, but rather how well again that money is being used and how the programs are up and running, at least at this time.”
Dr. Cabaj: “Right. That’s why we’ll be following the outcome information and start appropriating that into our reviews, as well as reports that you would get; and I think it’ll be a major factor in deciding on future uses of additional dollars.”
Dr. Turner: “Okay, any other Board responses?”
Mr. Purvis: “I just have one question. I don't know if this even fits right here but is there anything new on the possibility of getting additional Proposition 63 funds? We’ve been talking for a year or more about possibly getting funds that other counties have not fully allocated.”
Dr. Cabaj: “If you’ll recall, I mentioned, we sent a letter under Dr. Katz’s name and the Mayor’s support to ask for $26 million more for additional full service partnerships and we’ve not heard anything back from the State. That was about three months ago. Except we heard a little comment that implied that they did get the letter. That’s all I know.”
Dr. Turner: “If there’s no further Board comment I will move to our reports.
Dr. Cabaj: “I want to thank you for your great comments and support. I’m glad we had comments from the public. We will move forward, and I’m glad when I can be here as long as I was tonight. I’ve got to get ready to get back to Sacramento so thank you very much.”
Dr. Turner: “Ms. Helynna Brooke will now give her brief report.”
Item 4.0 REPORTS
4.1 Report from the Executive Director of the Mental Health Board
Ms. Brooke: “I’m Helynna Brooke, Executive Director of the Mental Health Board, and I first want to report that our program reviews are up and running. James McGhee completed a review of Community Vocational Enterprises, and James Keys completed a review of Larkin Youth Services; and we have reviews set up for the Family Mosaic Project and Instituto Familiar de la Raza, and one with the Mental Health Association. We are in the process of setting up ones with Walden House and the Family Service Agency, along with one for Citywide. We will continue to move through the rest of the MHSA programs so that the Board can get a real intimate idea of what’s happening. One of the reasons the Board does these reviews is to really understand what clients need and what they’re receiving so we can be much stronger advocates.
The second thing I want to call your attention to is a play called “The Spot.” The next showings are Thursday and Friday at the St. Boniface Church in the Tenderloin. It’s on Golden Gate. There’s a flyer in the back.
It is a play about recovery, and about being in the jail system unfairly, and I highly recommend it. Geoffrey Grier is the director, and he is in recovery himself. You are asked to pay by donation, and they even have snacks; so I encourage you to go. Curtin goes up at 8 o’clock Thursday and Friday.
Finally, the Board collaborates with the Police Department for the Police Crisis Intervention Training that we developed. We will have our 22nd training next week. Over 600 officers have been trained, and at every training, we hear about yellow alerts and red alerts at San Francisco General and where am I supposed to take people.”
4.2 Report of the Chair of the Board and the Executive Committee:
Dr. Turner: “Thank you. Just a few things. A reminder that June 19th, Tuesday, is the hearing on the proposed reduction in health services; so that’s a time to make more comments. The meeting starts at 3:30 p.m.
We just recently, on May 31st, had an awards reception and it was wonderful; and I’ve thanked all of our Board members who participated so much and provided so much leadership in this event. We had about a hundred people there. And one of the things that came from it, I just wanted to read because I thought it was a very, very important letter.
A letter came to both James McGhee, Vice-Chair, and me from Judge David Ballati, and he’s the judge that we wrote to make sure that Behavioral Health Court stayed intact and funded and ongoing in its same spot; and that happened. And so he wrote to us: ‘On behalf of the Superior Court of California, County of San Francisco, I wish to thank the Mental Health Board for selecting our court’s Behavioral Health Court as a recipient of the Criminal Justice Response to Mental Illness Award. I attended the awards ceremony and was honored to see that the Behavioral Health Court was one of many distinguished and deserving individual agencies and programs selected for special recognition. I can assure you’ – this is why I’m saying this on the record – ‘I can assure you that the San Francisco Superior Court will continue to work with the criminal justice partners in crafting innovative practices and programs for people with mental health issues who become involved in the criminal justice system.’ Anyway, a few other things, and he signs David Ballati, Presiding Judge. And that’s a very, very important statement, and it’s the kind of advocacy on the part of the public and this Board I think that can make things like that stay alive. And they don’t if we don’t really fight for them. So that was really good. One of the nice outcomes, was getting something like that in writing.
The other thing that we’ve done recently is to do a showing of the film, “The Bridge” moderated by Board Member Kevin Hines. Kevin’s not here tonight. He facilitated a discussion about the film “The Bridge” because he is an advocate for a barrier on the Golden Gate Bridge. He was part of the film. And there was a fantastic showing—all in all, a few hundred people. And I think a lot of us faced seeing the film, those of us who hadn't seen it, with some trepidation because it’s not exactly an upper. However, the film was so well done, I think we ended up agreeing with Kevin that it was actually a very important film with an important message, and I hope we do more things like that with other Mental Health Boards. This screening was done in conjunction with the Marin Mental Health Board.”
4.3 Planning Committee Task Force Report:
Mr. Purvis: “I just wanted to say at this point that I was very sorry that I had to miss the actual awards ceremony. If people saw me coming in tonight, you see how difficult it is, and I knew that would be an event where meet and greet would be important. Tonight I can just come here and sit. But all the feedback I’ve had is that it was a very wonderful, successful event.”
Dr. Turner: “Well thanks for all your planning help, Mr. Purvis.”
Mr. McGhee: “I really don’t have that much more to say. As a matter of fact, some of you in the audience actually attended our first annual award reception. I’ve thanked the Planning Committee and the Board, as our Chair has, for all the work that they did to make that a very successful event. I will say one of the reasons that we, as a Board wanted to do that, is because we feel that people who are providers in the community don’t always get the recognition for the hard work that they do, and they sure don’t get the compensation for it. So we felt that, it was a priority of ours as a Mental Health Board to reach out and award those organizations.
There was a competitive process. We sent out probably over 160 questionnaires, and there was a methodology of going through them, talking about what each organization did. And we’re very happy that people responded like they did. And we just want to say that we’re taking this month off, but starting July we’re going to be in our planning stage for next year because our goal was to continue to make it bigger and better, and continue to get that outreach to the community at large. And I’m not talking about the community so much in mental health, but those who are outside the mental health community, that need to be aware of the needs of the mental health community. So I just want to say thank you very much, and I want to thank those who came, and we’ll look forward to seeing a lot of you next year.”
Dr. Turner: “Okay, next is Item 4.4, report by members of the Board on any activities recently on behalf of the Board. Does anyone have a report?
4.4 Report by Members of the Board on Their Activities on Behalf of the Board.
Mr. Keys: “Yes, James Keys. I completed my program review of Larkin Street Youth Services. Also next week I believe on June the 20th, I believe that’s a Wednesday, at 12 noon on the City Hall steps we’re going to have a press conference for the budget, where we’re going to talk about the cuts and the budget that was proposed by this administration, and what the Board of Supervisors can do to help not make that a reality. We would really appreciate having people come and support us next Wednesday, June the 20th at 12 noon at City Hall. We’re going to be fighting for the General, Hospital psychiatric beds. We’re going to be fighting for the $1 million cut that was made for psychiatric beds. We will be then going up into the Board of Supervisors Budget and Finance Committee meeting, and doing public comment.”
Ms. Brooke: “I just want to announce that I believe June 21st at 11:00 a.m., is when the Mental Health budget will be heard in the Board of Supervisors. This is another chance to have your voices heard. Just move into City Hall for next week and advocate.”
Dr. Turner: “Okay. We are at Item 4.5 New Business: Suggestions for future agenda items that will be referred over to the Executive Committee. We are not allowed to discuss them now but we’re allowed to name them.”
4.5 New Business
Mr. Keys: “I would like to see the letter that Vice-Chair McGhee suggested.”
Dr. Turner: “Okay, that’s going to be real immediate, and we’ll send it to all Board members on email and people can give feedback, comment, and edit suggestions. So people who are going to send us material, if you can do it by the end of the day tomorrow it would be great. I think we can put all of our concerns into one letter and address them clearly. It might be a little long letter but that’s okay.”
Dr. Moses: “For the Executive Committee consideration, I’d like to see if we can invite Jeff Adachi, Public Defender, to come and talk about the wonderful program he has in expunging criminal records.”
Dr. Turner: “Okay, thank you. We’ve got that noted for the record. Any additional things for us to consider? Okay, is there any public comment relevant to this item where we talked about new business? And then there’s going to be another opportunity for public comment about anything before we close.“
4.6 Public Comment to Item 4.0
Member of the Public: Hi, my name is Sheri Erlinson. I am going to be encouraging at Citywide all the patients who do not want PES to close the hospitals and stuff. I will hold a petition and bring it down to you guys and then next Wednesday or Thursday, whenever the public meeting is. I will bring a group of Citywide people.”
Member of the Public: “My name is David Keck. I’m interested in helping out. I’m new at all this, and I heard yesterday or recently that petitions, where you get signatures, is effective. And my question is what do you find, as a Board, to be the most effective means, a single letter, a letter accompanied by 500 signatures, 100 signatures? What does it take or what would you recommend?”
Mr. Keys: “A letter followed by a petition with a statement at the top of the petition stating what your intentions are. On the petition it should have a name, address, telephone number and signature. They should, you know, generally be voting members of San Francisco, but it doesn't actually have to be. You do want to send a copy to each and every member of the Board of Supervisors, and to the Mayor’s Office and, if you can, you always want to get each and every one of those people to march to City Hall and make a demonstration. And you also want to alert the media to that very same march. So you get as much public attention as you can. At that point, people have to sit up and listen.”
Mr. Keck: “Yes, I will do just that; and my only comment is I used to be on a board and president, and I ended up being a president of a home improvement association representing 17,000 people, and in 13 months after we first spoke of it we swam in the city’s first swimming pool. Things like that. It got done and that made my life very rewarding for the time that we all spent. So I will learn from your comments.”
Dr. Turner: “I thought you said you were new at this. Sounds like you have a lot of experience.”
Mr. Keck: “Well I have a history, let me put it that way. I’m new to this Board’s activities. Basically, my life ended in 1985. I woke up one day and I couldn't remember how to tie my shoes, and I’m recovering from that. And so starting in 2006, I became a peer support intern with CBHS. and at this point in time I’m going to try to allocate about 20 hours a week in volunteer.”
5.0 Public Comment
Ms. Erlinson: “You’re going to see my face a lot, often. I am proud to say that there were three of us from Behavioral Health Court that have completed training in NAMI. We were three that went over to Marin County. We went to the orientation for NAMI and we now give speeches and let people know about families that have people that have mental illnesses, and two of us are going to the Sheriff’s Department next Tuesday to tell them what it’s like to have a mental illness. It’s called, ‘In Our Own Voices. ’ So we’re very proud to have three of us graduate, and hopefully there will be more funding to have people like us graduate from the Behavioral Health Court to go to like places like NAMI and stuff. It’s a new program called “In Our Own Voices”.
Mr. Keys: “Congratulations.”
Ms. Kellum King: “I’d like to say congratulations to you. My son went through that program also.”
Ms. Erlinson: “Thank you.”
Mr. Purvis: “It is a very good program. All the feedback I’ve had within NAMI would indicate it’s going very well. As she said, it’s a brand new program.”
Dr. Turner: “So if you see Judge Ballati, say thank you. Okay, is there any other public comment at this time? Okay, seeing none, public comment is closed. Is there a motion to adjourn?
Dr. Moses: “So moved.”
Mr. Purvis: “Seconded.”
Dr. Turner: “All right. The meeting is adjourned.”
Ms. Brooke: If anybody wants to email any comments I’m going to bring my card down, and you can email me.”
Adjournment
Meeting adjourned at 8:30 p.m.
contact us | accessibility policy | disclaimer | privacy policy
Copyright © 1999-2007 City & County of San Francisco. All rights reserved.
Legal Disclaimer: Since we’re making one Hell of a Lot Less Money off this – as in Nothing – than Dr. Lu & C&C of SF are, our republishing of this copyrighted material constitutes Fair Use under Title 17 U.S.C. Section 107. It is designed to promote open discussion, public debate, democracy, yada, yada, yada, …...
If you liked This one, you might also like:
San Francisco: #1 Psychiatric Borg Cube
J&J Lose: Jury awards $257.7 Million To Louisiana
S. 3900: Sen. Coburn's Medicare Fraud Buster: Part II
“In the past, one of the biggest impediments to fighting waste, fraud and abuse in Medicare and Medicaid is when politicians intervene on the behalf of constituents, who are abusive service providers and equipment suppliers.”
Senator Tom Coburn
Dr. Francis G. Lu, June 13, 2007 San Francisco City Hall
California Pacific Medical Center, ...... IS, ..... Sutter Health.
http://www.hospital-data.com/hospitals/ST-FRANCIS-MEMORIAL-HOSPITAL-SAN-FRA884.html
And not even a single “What?” from the Mental Health Board, ….. None of them.
Wiki: on MHB Chair Dr. Rebecca Turner, Ph.D.’s “Cuddle Hormone”
“Increasing trust and reducing fear. In a risky investment game, experimental subjects given nasally administered oxytocin displayed "the highest level of trust" twice as often as the control group. Subjects who were told that they were interacting with a computer showed no such reaction, leading to the conclusion that oxytocin was not merely affecting risk-aversion.[23]
search
Mental Health Board >> Meetings
Mental Health Board
June 13, 2007
ADOPTED MINUTES
Mental Health Board
Wednesday, June 13, 2007
City Hall, Room 278
San Francisco, CA 94102
BOARD MEMBERS PRESENT: Rebecca Turner, Ph.D. (Chair); James L. McGhee
(Vice-Chair); James Shaye Keys (Secretary); Bridgett Brown; LaVaughn Kellum King; Dr. Toye Moses, Ph.D., M.P.H; Tom Purvis; Jagruti Shukla, M.D, M.P.H; Lisa Williams; Virginia Wright.
BOARD MEMBERS ABSENT: Jeanna Eichenbaum, L.C.S.W; John Kevin Hines; Claudia Lebish.
OTHERS PRESENT: Helynna Brooke (MHB Executive Director); Ayana Baltrip-Balagas (MHB Administrator); Francis Lu, MD, SFGH; Emeric Kalman, Member of the Public; Julio Montes De Oca, Conard House; Frank Vallecillo, Sunset Mental Health-MHA-SF; Alex Kutik, Member of the Public; Joyce Rich, Member of the Public; Laura Barber, Member of the Public; Mary R. Higgins, M.R. Higgins & Associates; Kathleen Connolly, Citywide Case Management Forensics; Marven Lightner, Member of the Public; David Keck, CBHS, Member of the Public.
CALL TO ORDER
The meeting was called to order at 6:34 p.m. by Rebecca Turner, Ph.D. (Chair).
ROLL CALL
Ms. Brooke read the roll.
AGENDA CHANGES
Dr. Turner: “We’re going to first vote on action item 3.2, because we have a quorum now and a board member has to leave early. Is there any public comment? Our resolution is to approve the minutes of the Board Meeting of May 9, 2007.”
Item 3.0 ACTION ITEMS
3.1 Public comment relevant to Item 3.0
There was no public comment.
3.2 Resolutions.
3.2.a PROPOSED RESOLUTION: Be it resolved that the minutes of the Mental Health Board meeting of May 9, 2007 be approved as submitted.
Minutes approved unanimously.
Item 1.0 DIRECTORS REPORT
Monthly Director’s Report
June 13, 2007
1. Successful All-Staff Meeting of CBHS Adult/Older-Adult SOC. Over 1000 providers from contract and civil service mental health and substance abuse programs attended the CBHS All Staff Meeting of the Adult/Older Adult System-of-Care on May 9th and 10th at the Bill Graham Civic Auditorium.
The purpose of the All-Staff Meeting was to share with all CBHS providers the vision of addressing behavioral health needs in San Francisco in an integrated, seamless, and comprehensive manner. The challenge that has commanded our attention in recent years involves the provision of services to persons with mental illness and with substance abuse problems in a manner that CBHS contributes significantly towards addressing major health and human service needs in San Francisco, including addressing homelessness, community violence and other community issues. This involves partnership with other services such as primary care, court system, human service and housing agencies. Several of our milestone achievements in the recent period demonstrate that we are heading in this right direction.
Dr. Mitch Katz visited to welcome the participants at the meeting, and to thank all CBHS employees across our system for everyone's important contributions toward the wellness of the community. He emphasized the necessity of providing holistic care to the persons we serve, and that this is best done through integration of mental health, substance abuse and primary care, and the development of community partnerships.
A series of presentations and workshops ensued throughout the day, which further explored the areas discussed above. Dr. Alice Gleghorn and several community providers presented the exciting work occurring in San Francisco due to the infusion of new funds through the Mental Health Services Act. Dr. Tina Yee introduced a panel of consumers who eloquently and movingly shared stories of their recovery journeys. Edwin Batongbacal, Director of Adult/Older-Adult Systems-of-Care provided an overview of the wellness-recovery principles that guide our service-delivery. Over 20 CBHS providers presented in workshops addressing issues of community violence, integration with primary care services, work as a component of recovery, care needs of women, welcoming practices at our programs, addressing homelessness, and self-care in the workplace.
The highlight of both days were the recognition ceremonies, during which staff and programs from throughout the system were recognized for the exemplary work they perform on a daily basis. Nominations for recognitions were made by their co-workers, supervisors and the clients they serve.
Overall, the event was a resounding success. Thank you to all who helped organize the event, and to everyone for participating!
2. Mental Health Board Awards Reception. The San Francisco Mental Health Board held its first gala Awards Reception on May 31, 2007 at The Arc of San Francisco. The room was filled and the balcony overflowed with awardees, friends and co-workers to celebrate Exceptional Programs and People. In attendance was Chief Heather Fong, Jeff Adache, Public Defender, Judge Mary Morgan, Judge Ballati, Judge Tsenin, Supervisor Maxwell, Executive Directors of many programs, consumers, and family members. The keynote speaker for the evening was Assemblyman Mervyn Dymally, Chair of the Health Committee for the California State Assembly. Jacqueline Horn, PhD, President of the Board of Psychology and Supervisor Sophie Maxwell made a few remarks. Belva Davis was the Mistress of Ceremony for the evening.
The Mental Health Board selected programs from five areas for these awards.
á Criminal Justice Response to Mental Illness: San Francisco Police Department, Behavioral Health Court, Jail Psychiatric Services
á Foster Care and Mental Illness: Foster Care Mental Health Services, A Home Within, Honoring Emancipated Youth (HEY), Family Mosaic, Robin Love
á Violence Prevention: The SAGE Project, Instituto Familiar de la Raza, Urban Services, YMCA, Girl’s 2000 Hunters Point Family, Mission Community Response Network, Brothers Against Guns, CHALK, Larkin Street Youth Services, United Playaz, Homeless Children’s Network, Supervisor Sophie Maxwell
á Healthy Workplace Awards: Richmond Area Multi-Services, Edgewood Center for Children and Families, Conard House, Iris Center, Huckleberry Youth Programs, Youth Leadership Institute, Oakes Children’s Center, Curry Senior Center, The Volunteer Center
á Community Leadership Award: Mental Health Association of San Francisco
The Mental Health Board was pleased to honor so many great programs and individuals.
3. Appointment by Governor Schwarzenegger. CBHS Director of Cultural Competency and Client Relations, Tina Yee, Ph.D., and CBHS Medical Director of Quality Improvement, Al Gaw, MD, were recently appointed by Governor Arnold Schwarzenegger to the Advisory Committee to the California Department of Mental Health for Developing the California Strategic Plan for Suicide Prevention.
Congratulations Tina and Al!
4. Community Behavioral Health Services (CBHS) Integration.
CBHS has launched a new Integration Information Line at (415) 252-3086. This phone line provides pre-recorded information on upcoming Change Agent Monthly Meetings and Leadership Trainings.
Zialogic will be arriving to conduct a quarterly consultation with CBHS on Monday, July 9th. Zialogic is scheduled to meet with CBHS Exec team and Integration committees. Zialogic will also provide a day long Leadership training with Change Agents on July 20th.
5. Mental Health Services Act (MHSA) Update.
COMMUNITY SERVICES AND SUPPORTS (CSS)
Full Service Partnerships (FSPs) :
207 partners have been authorized to receive full service partnership services as of close of business on June 1, 2007. The chart and table below show the age group of these partners and the agencies where they were referred to: Please check the May 2007 Director's Report on the Community Behavioral Health Services Site to see the graphics. Choose the Director's Reports link on the left side of the page.
http://www.sfdph.org/CBHS/
MHSA – Housing Service Partnerships (HSP) :
Of the twenty two (22) stabilization units available for FSPs, twenty (20) are occupied through June 1, 2007. Three Adult partners have recently moved into permanent housing units.
Six Transitional Age Youth partners are in permanent housing.
General Systems Development:
The total numbers for unduplicated clients will be available for the fourth quarter on July 31, 2007. The total number of unduplicated clients served through the end of the third quarter is 673.
MHSA Implementation Progress Report :
The thirty-day public comment period on this report ended on May 31, 2007, with no comments received. The Mental Health Board will have a public hearing on June 13, 2007, after which the report will be submitted to the State on the deadline date of June 29, 2007.
Fiscal Year 2007-2008 Growth Fund Budget:
The 2007-2008 Growth Fund Budget of $2,292,795 was posted on the DPH web site for public comment on June 1, 2007. A notice was also publicized in the San Francisco Chronicle on June 4, 2007, welcoming all stakeholders to participate in the 30-day public comment process. The growth funds were a result of unexpected additional revenues received above the anticipated 1% income tax revenue projected to be received by the State, from Californians with incomes above $1,000,000.
WORKFORCE EDUCATION AND TRAINING:
The last Workforce Development Education and Training Committee meeting was held on June 7, 2007. The State has delayed publication of the final guidelines until the end of June or early July. The committee will reconvene to review all recommendations, to insure that they are still within the framework of the final guidelines. They will then constitute the basis of our three-year plan, to be submitted to the State for approval.
MENTAL HEALTH ASSOCIATION FOCUS GROUPS
The Mental Health Association of San Francisco will hold two separate focus groups with MHSA funded agencies to learn more about their implementation strategies, challenges and success stories and to foster ongoing collaborative relationships with community based organizations funded by MHSA. The first focus group will be with Hyde Street, one of the adult FSP program, on June 14, 2007 from 3:00 –4:00pm. The second will be conducted at Larkin Street Youth Center, funded to operate a peer based center and transitional residential housing for TAY and deliver supportive services for housing, on June 27, 2007 from 2:30 – 3:30 pm.
MHSA Advisory Committee Meetings:
The Mental Health Services Act Advisory Committee meets bi-monthly from 3-5pm, alternating between advisory meetings and community forums. The schedule of upcoming meetings is as follows:
Thursday, June 28, 2007 Wednesday, August 29, 2007
Advisory Committee Meeting Community Forum
1380 Howard Street Location to be determined
4th floor conference room
Other Upcoming Events:
Safe Workplace Violence Prevention by Mike Arraj – August 31, 2007 (AM and PM sessions), Philip Burton Federal Building. Limited seating available.
To register for these trainings, please contact Norman Aleman, CBHS Training Coordinator at 415-255-3553 or email norman.aleman@sfdph.org
Past issues of the CBHS Monthly Director’s Report are available at:http://www.dph.sf.ca.us/CBHS/default.htm To receive this Monthly Report via e-mail, please e-mail kathleen.minioza@sfdph.org
Dr. Cabaj: “I will do a quick report, since you have the written one in front of you, so we have time to look at the other items on the agenda.
Just to highlight, we had mentioned before that there was an all adult staff meeting. We had about 1100 providers who attended the two-day meetings and it was quite successful—lots of interaction, lots of looking ahead to the future. Dr. Katz came and addressed the group and it was a very successful event. We hope to make it an annual event.
I highlighted in my report, although it was your event, the Mental Health Board’s Awards Reception. It was such an outstanding evening and I wanted people to be aware of it throughout the system, and Dr. Katz was also mentioning this in his report since it was so outstanding. I was very impressed with the audience of judges and policemen, and the Public Defender; and how people who might not ordinarily be in the same room were all there together, and I thought you did an amazing job. It just reflects the strength of the Board as well as the integration of our systems with all the different forces that we work with. So thank you.
We’ve been honored to have two of our staff appointed to the Advisory Group on Suicide Prevention and this includes Dr. Tina Yee, who’s currently our Director of Cultural Competency and Client Relations. I think you also know Dr. Yee is going to be retiring the end of this month, June 30th, and Dr. Albert Gaw, who is our Medical Director of Quality Management. Dr. Gaw retired, but came back to work for us. We are pleased that they will be honored on the state level. As an aside, Dr. Gaw just had a very good article published about Filipino American mental health services and their needs in the current issue of Psychiatric Services; so you might want to research that article. It’s very, very good.
Our integration efforts continue. We’ve created a new hot line for the change agents. That’s the group that is leading the charge and getting people motivated and active in integrating mental health and substance abuse.
Following, we have an update, which is the current information about the Mental Health Services Act’s use of our dollars to date, including the use of the Full Service Partnerships (FSPs) and some of our other system change efforts. I won’t read you all the data because it’s collected here in the report, including a graph, pointing out some of the ways we distribute the patterns of service delivery, as well as the dollars.
The Workforce Development, Education and Training Taskforce has completed its work, and will be finishing their recommendations. Our group is actually in the lead in the State, and we still haven't received the official guidelines about what to do with that additional portion of Mental Health Services Act dollars money.
We’ll be poised to have some ideas, and then we will incorporate what we can from the recommendations of that group with the state guidelines and maximize the ways we can use our dollars. The Mental Health Association has also been helpful, not only in getting the word out on this evening’s hearing, but also bringing together focus groups to help us look at the changes that the Mental Health Services Act has done in the community. They’re focusing on transitional age youth and peer based services. The feedback will be helpful for the state, which has been trying to collect more information.
As you know, we have an ongoing advisory committee, which we created to guide the work of the Mental Health Services Act as it unfolds in the city. June 30th is the Advisory Committee meeting. The meeting on Wednesday, August 29th will be open to the full community. Everyone is welcome to come. We have public comment at every other meeting, and the next one is in August.
Finally, we have an upcoming training on violence prevention in the workplace.”
Dr. Turner: “Thank you. Are there any questions or comments for Dr. Cabaj?”
Dr. Cabaj: “I’ll be happy to comment on what I know about budget.
Dr. Turner: “That would be great.”
Dr. Cabaj: “Right now, the budget for Behavioral Health is not great. As you recall, the Health Commission decided not to advance any cuts or any of the recommendations that had been created by Dr. Katz in consultation with the whole department. It therefore allowed the Mayor to pick and choose what he wished on the list. At least in terms of what’s going to affect Behavioral Health directly, is a reduction in residential and outpatient substance abuse services by $1.8 million, which I think is extremely significant. If this cut happens, it could actually lead to the complete elimination of services for certain age groups and genders. Women’s services in particular might be eliminated and services for youth. So it could be a very difficult situation if that has to be implemented.
It also did not add back lots of the Board of Supervisors add-backs. In other words, it didn't get continued in the baseline. So we’re still sorting out what would not continue to be funded, and what would be. We don’t have all of that information because it keeps changing.
One nice thing is there was some funding backfill, which included some of our SAMSHA dollars. This is good because we get money from the Federal Government, which allows us to do things that would not generate billing because it’s really meant for money and services that you couldn't use in other ways. We support our central access team with that as well as part of our placement and homeless outreach team. The grant never keeps up with the cost of doing business, but this year the Mayor did allow us to backfill the grants, so we won’t have to eliminate any staffing in that area.
There is another issue that is a cut of sorts. It involves creating a community resource by combining the Urgent Care Center with an Acute Diversion Unit (ADU), which is an alternative to the hospitalizations. It was tied to a reduction in the beds at San Francisco General Hospital , so there will be also a discussion about the reduction of inpatient beds. I believe Supervisor Daly has suggested that money come back, as well as some other things that he’s added back, but as we know, that’s still in the balance.
I was reading the newspaper this morning just to see where things are at and you may know even more. If you look carefully at the budget it actually includes eliminating 28 positions in mental health, and that’s not getting much press because it’s usually thought of as administrative. But in fact it would be a problem if those positions are deleted or defunded. It’s a very complicated way to help support the long term care services, which have gotten to be over $5 million a year, and we don’t have the resources for that. So there’s been some tradeoff, and I think the Mayor felt there are too many new positions throughout the City, and therefore recommended deletions.
San Francisco General Hospital is supposed to eliminate 21 positions, Laguna is supposed to eliminate a little less than 2, 1.75, and ours is 28. Now what I’ve been told is that the positions wouldn't be eliminated, just not funded, which means you couldn't fill them, and that would be the equivalent, in my opinion, if you estimated it, of at least one to two full mental health centers. So it could mean that we would be unable to fill vacant positions as they come in. We don’t have the details yet. It might apply both to the clinical services as well as administrative. So that’s what I know as of this afternoon”
Dr. Turner: “I’m really wondering about the impact of all this. It seems so tremendous. When I look at Psychiatric Emergency Services (PES), Edgewood, Westside, all these places, I don't know how up to date my information is. This is from 6/4/07.”
Dr. Cabaj: “The Beilinson Hearing budget list is the official services cut proposal. Because the cuts to substance abuse outpatient services are listed generically, no particular program is highlighted, so therefore every program that gets funding is notified. So not all of those would be eliminated but any or all of them could have reductions in their service delivery package that we fund.
Dr. Turner: “So what’s the impact on the City and the people?”
Dr. Cabaj: “Well there are two things. Again, as the representative under Dr. Katz and the Mayor, I have to say this is the budget but in terms of an analysis, I think obviously a reduction in outpatient substance abuse services and residential services would truly have an impact.
We’ve been one of the few counties that really strongly supported substance abuse services, and we know that they really depend on the general fund. So it’s a very easy target every year. That’s why every year, substance abuse gets listed as potential cuts and every year the Mental Health Board has been very helpful in looking at the funds to support that. There’s also another big problem with the Ryan White money, and it’s not directly under Community Behavioral Health Services, but it’s all now part of our Community Programs; and that’s about a $5.3 million deficit, I believe, which we’re also trying to sustain. The Board of Supervisors is also saying that they would try to help fill in. So when you start looking at all of these major issues, as well as their impact, somebody might think $1.8 million is nothing compared to the $5.3 million that has to be rescued and so on.
So it’s a question of priorities, obviously. But if we had to implement the cuts, I don’t believe it would make sense to reduce all programs by that percentage because that could mean some programs wouldn't have enough operational power with the amount of reduction. So it most likely means we’d have to comb through particular programs and look at reductions. And we’ve eliminated so many programs over the years that we’re actually at that point where most likely a big chunk of adult services, a big chunk of women’s services, a big chunk of youth services might have to be eliminated, and that’s just on the substance abuse side.
There have been lots of thoughts and comments on the inpatient service. The PES is very frequently backed up. Often the emergency room has been going on red alert because they don’t have places to admit people when they come into the emergency room. If there are fewer beds at San Francisco General for psychiatry, I can only imagine that would have an impact”
Dr. Turner: “I just wonder if, you know, with the reduction in PES as well as substance abuse services and some of the programs for youth, if that means we see an increase in homelessness.”
Dr. Cabaj: “Well that would, and especially if some of the residential services that we’re looking at would be cut. That would definitely have an impact. And as I said, it’s nice that they’ve restored money for the homeless outreach team, but unfortunately that might mean there’s more homeless to outreach to with some of the proposed cuts.”
Mr. Purvis: “Dr. Cabaj, within NAMI there’s some real concern about the elimination of inpatient services, even a small cutback. There seems to be an attitude in some places that it’s okay. Inpatient services are not desirable. But we know, we have family members that are in acute states that inpatient is almost the only way to go. So that’s a particular concern for NAMI.”
Dr. Cabaj: “And again, I can explain the only rationale that they had for listing some of the reduction in inpatient services was it was to counterbalance the creation of a community alternative. And everyone certainly wants community alternatives. It would be great if people didn't have to be hospitalized if there was a good option. That’s why the creation of 14 new ADU beds as well as an urgent care center, which the belief is that it would help offset some of the PES impact, was linked together.
The Health Commission itself kept that link and that did get passed along, so the Mayor just picked up on what the Health Commission had actually supported. There’s also the studies that show that about half of the people currently in the inpatient beds at the San Francisco General are actually not acute, meaning they shouldn't be at that level of care. They should be somewhere else. There are also thoughts that we don’t really need that many beds. But one of the problems is they’re there because there aren’t enough community resources for people to leave the hospital. So it all ties together like that.”
Mr. Keys: “Yes, James Keys. I personally would like to welcome the people in the audience this evening. Thank you very much for coming out on this very warm June day. Dr. Cabaj, I don’t have a question in as much as I have a comment and I’d like to put this into the record officially. Along with the psychiatric beds, I believe that there are cuts being made for women and children, but you forgot to mention that minorities figured into that prominently.
Each and every year—and again, this is a statement that I’m making—I have for the last three years gone through this budgetary process. I have sat and I get phone calls into Supervisor Daly’s office from doctors, men, women and patients from San Francisco General crying out that these budget cuts are going to affect their jobs.
They have to take time off with their work from helping and serving those people who come in needing their help to come and beg for money. This demoralizes not only the workers at San Francisco General but it affects the patients, and people that they’re there to serve. I find this to be, in the least, distasteful and I won’t say how I feel really about this, yet now we are going to be seeing the Mayor cut more funds. That’s going to create homelessness or more homeless people out on the streets, to then create a community court where people who are homeless, people who are sleeping on the streets or who may have to do other things on the street can be arrested and taken to jail. I find this absolutely mind-boggling. If there’s anything, Dr. Cabaj, that you can suggest that we can do as a board to fight these cuts, please let us know. Thank you.”
Dr. Cabaj: “Well I think certainly what you observe is a process that’s happened year after year after year, and as many of you attend the hearings at the Health Commission when they do have comments from the public, that’s exactly what happens and people do get very frustrated. And as I said, it’s often disproportionate to the substance abuse side because of the dependency on the General Fund, and obviously it has a major impact on minority communities because there’s a much greater representation of the minority population in those services. So yes, it has that direct effect when you look at it from that point of view. The budget process is not one I created. I understand, but I think advocacy has been obviously helpful.
I believe the Health Commission had its best intentions in mind when they heard the public comment. It was painful, you know, when people would tell their stories. And their message was we believe we’ve created the best health system now. There is absolutely no reason to cut or eliminate. So I believe they did in their minds the right thing but unfortunately the process left too many open ends and I think we saw the consequences.
When people call me about what to do on a one-to-one level, I’ve usually urged them to contact their supervisor and to work with them. So some of the calls you get may have been because of that. But most of our major contractors know that. They know the best thing to do is to call on the supervisors. They certainly have worked – many have said they’ve gone to the Mayor directly but at this point now it’s the give and take. So the Board has to decide on the best action, but I believe any advocacy, any statements of your concerns about the impact that if these things happen of what it would do to the system would, I believe, be heard and certainly would have some power. “
Dr. Shukla: “You mention that part of the motivation in going forward with these cuts were that there were too many positions in mental health. And I was wondering if there was any basis or any inefficiencies that were noted within the mental health system that led him to choose these cuts versus others.”
Dr. Cabaj: “It wasn't so much any one particular department had too many positions. He felt the City had grown too many positions across the board. And I think there was some comment, there were 136 positions that would have been created in the last year, and he wanted it reduced to 104. So it was sort of up to Dr. Katz, I believe, to determine which areas would take that impact. So I’m not exactly sure why mental health was picked. I haven't been able to get a clear picture, other than that we have one of the biggest pools of employees and the primary care clinics weren't targeted because they’re getting new funding from Healthy San Francisco, which used to be called HAP – it has a new name now – Healthy San Francisco.
There’s additional funding as well as from State monies that are supporting that. So I believe they looked at San Francisco General, a tiny little bit of reduction at Laguna, and then the biggest other employer in the Department of Health is Mental Health. And I say Mental Health in particular because our substance abuse side really doesn't have many employees. All of our substance abuse work is contracted out. But many, about half or two-thirds of our mental health services are done by civil service staff.”
Dr. Moses: “Dr. Cabaj, You know, it’s kind of sad to see or to hear you say 28 positions are de-funded. Is there any plan in place as to seek Federal money? Because every time you look around at federal fund, they’re making some money available for substance abuse. Can we go for some of that?”
Dr. Cabaj: ” Well we, actually as a county, pretty much try to maximize all of our funds that we can get from the Federal Government. We’re pretty good about that. But there’s not that much. And if you know the politics, California doesn't rank high often in the current administration for extra money. The Bay Area ranks even lower, and San Francisco ranks even lowest; so whenever there’s anything that might depend on Congress, we don’t get a lot of money.
We do apply for every grant that we can so we’re looking right now at a grant that would expand some services for the impact on children because of methamphetamine use in their families. And we’re hoping that we can get that grant. So things like that; but they’re all, I hate to say, nickel and dime. They’re small increments but we try to maximize everything that we can. The SAMSHA money is really important. We depend on that a lot, but it also goes through cycles where they may run out or they renew it for only a certain period of time, and then may not continue it. If we eliminate positions we also reduce revenue.”
Dr. Moses: “Thank you.”
Mr. McGhee: “I just have one thing to say. I think it would behoove all of the board members to meet with your personal supervisors that appointed you. I’m definitely going to meet with Supervisor Peskin, who appointed me, because 1.8 million dollars, as far as I’m concerned, in the mental health area is almost criminal based on where we are in San Francisco with the amount of patients and people we have and homeless as well as the mental health industry. So I would implore that two things happen: (1) that we institute a letter from the Board opposing the cut. I think we should go on record as the Mental Health Board, and (2) I think that each one of us needs to make an appointment with our respective supervisors so we can meet with them on making sure that $1.8 million does not come out of the budget.”
Mr. Keys: “Thank you, Vice-Chair McGhee. I believe that your idea of a letter is a great one, yet to make a stronger statement perhaps we should create a resolution.”
Mr. McGhee: “That’s fine. But what I’d like to see, Madam Chair, is for the Board to take an official position, however you feel, whether it’s a letter or a resolution; but I think it’s something that we need to act upon right now. And then I think, Ms. Brooke should help in setting up the meetings with our supervisors as quickly as possible so we can get in to meet with them.”
Ms. Brooke: “A letter we could do without having a board vote. A resolution we couldn't do until July.”
Dr. Cabaj: “One other area I didn't comment on because it’s not directly related to the City budget, but to the State budget. I learned this morning, if you remember the AB2034 money, which we’re all advocating for, it was at a joint committee between the Assembly and the Senate, and this morning, they did agree that it should be funded. Now that still doesn't mean it will, because it’s still up to the Governor. But they did not agree to support the Mentally Ill Offenders grant, which was the additional new money that came for the mentally ill offenders. So if that happened that would be a grant that we did receive. It would run through this fiscal year, we learned, and about half of the amount of money then would stop. But as of June 30th all the AB2034 money would stop and we would have a deficit of $2.3 to 4 million. There’s no backfill at all discussed about the AB2034 money because it’s still so unknown.”
Dr. Turner: “Okay, are there any other Board member comments related to this topic? There was also the handout that we received around the growth funds along with Dr. Cabaj’s report, the plan for the growth funds.?
Dr. Cabaj: “Okay. I have it as a separate attachment. If you recall, we discussed in here that the State did pass a bit more money along to us for clinical services and support; almost $2.2 million. That was on top of the $5.3 million we get. And our plan with that growth fund is what was outlined there.
Basically it’s not doing anything different, it’s just continuing to fully fund all the adult programs and all the violence response programs. I think, last year I said we were going to only fund one adult program and one violence program, but because of the Request For Proposal (RFP) process, three programs, all whom were within a half point of each other got selected. So we said if the State allowed us to use some one-time money, we would support these programs for that year, but there was no promise funding would continue.
This additional money allows all three programs to continue, as well as the added violence response services. And all it does is help some part-time positions become full-time and strengthen the role of peer employees. It’s our plan to basically keep everything that we’ve been doing going. Otherwise we would have actually faced some potential reductions in the number of clients we could see through the Full Service Partnerships. So this allows us to do that, strengthen our violence response network and enhance peer employment in the system.”
Dr. Turner: “Okay, thank you for that Dr. Cabaj. I’m going to open this up to public comment. Is there any public comment relevant to this item? We have three minutes for each person to present and then you’ll hear a little ding from the timer.”
1.1 Public comment relevant to Item 1.0
Dr. Lu: “Board members and Dr. Cabaj, my name is Dr. Francis Lu, last name L-u, and I just want to say that in July, I will be celebrating 30 years of working in the Department of Psychiatry at San Francisco General Hospital with the inpatient services. And I’m also a professor of clinical psychiatry at UCSF. I have a written document to just discuss the budget issues affecting the Department of Psychiatry at San Francisco General, first of all to inform you of what’s happening and secondly, if you so please, to pass a resolution advising the Board of Supervisors to add $2.368 million dollars in general fund dollars in order to accomplish the following two actions. (The document follows.) And I’m just going to summarize here because of time.
One action we’re requesting to be taken, is to prevent staffing cuts in the Department of Psychiatry. This would require $1 million in General Fund dollars, and there are a number of positions that are going to be cut throughout the Department and we hope that you might support adding back funds to prevent these cuts to outpatient services as well as inpatient services. The second action is to prevent the closure of an ethnic minority focus psychiatric inpatient unit of 22 beds at San Francisco General, and $1.368 million dollars in General Fund monies will be needed for that. And that’s documented on the Beilenson hearing document, the second line item. If you look in the box here it does say that $1.368 million is the planned reduction at San Francisco General Hospital. And just to be very clear, this represents one of four units, 25% of the psychiatric beds in the public sector at San Francisco General.
While we support the expansion of community services, we believe it’s both too dangerous and unwise to close an entire 22-bed inpatient unit before these community alternatives have had a chance to demonstrate to what extent they can eliminate the need for locked beds, as well asdivert the planned 30% of patients that normally would come to PES. That was in the Department of Public Health (DPH) plan that was submitted. For example, according to that DPH plan patients that need medical clearance, seclusion restraint or hospitalization would still come to PES and I ask, you know, how will the police and others determine where to send the patients so as to offload 30% of them. Also, we’ve had a drastic reduction in hospital beds in the City from 176 to 71 over the past 16 years, not including San Francisco General. Also in April, Sutter Health announced the closure of their 28 beds next year, and so we are very concerned. And finally, concerning the four ethnic minority focus units, which unit do you cut, the Asian focus, the Lesbian Gay Bisexual Transgender (LGBT) focus, the Black focus? And so I ask for your support in this matter. Thank you.”
Dr Lu's Written Statement
Budget Issues Affecting the Department of Psychiatry at SFGH Document:
TO: San Francisco Mental Health Board
FROM: Leadership of the Department of Psychiatry at San Francisco General Hospital
Robert L. Okin, MD, Chief; Mark Leary, MD, Deputy Chief; Francis Lu, MD
DATE: June 13, 2007
RE: Budget Issues Affecting the Department of Psychiatry at SFGH
We are writing as leadership of the Department of Psychiatry at San Francisco General Hospital (SFGH) to inform the San Francisco Mental Health Board about our deep concern on two separate issues in the Department of Public Health (DPH) budget as they relate to the SFGH Department of Psychiatry. Comprehensive care requires the need for high-quality, community-oriented, culturally competent hospital care for patients when they need 5150 emergency evaluation/treatment in a locked setting that can provide comprehensive medical assessment/treatment. The partnership between our community services and SFGH is critical for the health of our patients. Therefore, we ask that the San Francisco Mental Health Board pass a resolution advising the Board of Supervisors to add $2.368 million in general fund dollars in order to accomplish the following two actions:
1. Prevent staffing cuts in the SFGH Department of Psychiatry ($1 million in general fund dollars). These cuts will affect many programs in the Department. 200 mentally ill outpatients and 125 mentally ill inpatients with complex medical and surgical problems will otherwise not be served because of cuts to psychiatrist and psychologist positions. Hundreds of inpatients will not receive adequate linkages with their families and community providers as they prepare for discharge, because of the cut in inpatient social work. Certain other crucial administrative cuts are scheduled to occur which will damage the Department’s infrastructure and ultimately compromise clinical care to patients. Because of a very severe recruitment and retention crisis of psychiatrists, these cuts were necessary to bring psychiatrist salaries closer to the salaries paid by other organizations such as the community behavioral health services of San Francisco, San Mateo, and Santa Clara counties so as to recruit and retain psychiatrists.
2. Prevent the closure of an ethnic/minority focus psychiatric inpatient unit (22 beds) at SFGH ($1.368 million in general fund dollars). This represents a cut of 25% of the psychiatric beds in the public sector at SFGH. While we support the expansion of community services, we believe that it is both too dangerous and unwise to close an entire locked 22-bed inpatient unitbefore these community alternatives have had a chance to demonstrate to what extent they can eliminate the need for locked hospital beds as well as divert the planned 30% of the patients that normally would come to PES. For example, according to the DPH plan, patients that need medical clearance, seclusion and restraint, and/or hospitalization among other conditions would still come to PES; how will police and others determine where to send patients in emergency 5150 situations? It is presently very difficult to get a patient admitted to a hospital bed because of many reasons including the decline in the number of psychiatric beds in the city from 176 to 71 in the last 16 years (exclusive of SFGH). Furthermore, Sutter Health announced in April closure of another 28 locked inpatient beds at CPMC next year; CPMC is appealing. The loss of 22 locked inpatient beds at SFGH will make it extremely difficult for our mental health system to provide this level of intensive emergency care. Finally, the four SFGH community inpatient psychiatric units also constitute nationally and locally recognized Ethnic/Minority Focus Programs providing culturally competent care for Asian, Black, Latino, women, LGBT, and HIV/AIDS patients. Cutting one of these units will jeopardize the integrity of the Focus Programs to care for these underserved populations who experience profound mental health care disparities. Ethnic/ minority populations will be disproportionately adversely affected since these services do not exist at any other San Francisco hospital.
Mr. Keys: “Excuse me. Dr. Lu, can you stay, please? I have a few questions. Dr. Lu, James Keys. We’ve spoken several times on the phone before. Welcome and thank you for coming out.”
Dr. Lu: “Thank you.”
Mr. Keys: “Dr. Lu, how long have you been in San Francisco General again?”
Dr. Lu: “30 years this July, July 25th.”
Mr. Keys: “Thank you. With these cuts what is going to happen to those people who are not receiving services, in your expert opinion?”
Dr. Lu: “Well I’m very concerned that right now we’re having a backup, as Dr. Cabaj mentioned. We’re at red alert status. We have no beds upstairs and the emergency services are so full they can’t even take people coming in on the 5150s. And they’re bringing these psychiatric patients on 5150s to medical emergency rooms at Moffitt and California Pacific Medical Center, and St. Francis Hospital. These are facilities that physically do not have a psychiatric emergency capability, nor the staff. These patients are waiting days to be in these facilities right now. So we’re very concerned that with the loss of an entire unit, that this situation is going to melt down.
I just wanted to comment, again to i1nform you and also, if possible, ask for your support to try to reverse the situation, which I think would be to restore the funding for the inpatient unit and continue the funding for the community alternative. I don’t see this as an either/or situation. I think this is a place where we can come together.
I also am making all these statements in the context of the dreadful, dreadful cuts that we just heard about; so I don’t mean to, say that we’re the only ones in need. But I just want to make this very clear that we’re talking about 5150 emergency patients that are sometimes in need of a locked setting with expert medical assessments. And when the police pick up someone on the street, are they going to take the person to PES, where you have a medical emergency service next door and medical consultation that are able to do chemistry tests and a CAT scan, and drug screens, or are the police supposed to bring the person to the urgent care center, which may not have all of those services? I don’t have the details, but I think that, again, it’s not an either/or. I think we can try to work on both.”
Mr. Keys: “Excuse me, Dr. Lu. Dr. Cabaj, do you know if there is a backup plan for what’s going to happen to people who are coming in for help or services from San Francisco General from the Mayor’s Office if these cuts happen?”
Dr. Cabaj: “Well the alternative is supposed to be this community center. My understanding is they wouldn't close the beds until the center is up and running. I believe it’s linked that way. And unless the language changed, it also had a reduction in PES staffing too, which also needs to be highlighted, I believe. I don't know if that changed. The proposal changed a lot, but the belief is the new urgent care center with the ADU beds would be the alternative; so people would be brought there.
Now the question has come up how would we train the police, who would work with them? You may be brought in because of the training program that you support, and about how we address who goes where. And it’s a question of who does that screening. And I think the medical issues that Dr. Lu brings up are very important ones to consider.”
Dr. Lu: “Thank you, Dr. Cabaj. I just want to make it very clear in my reading of the DPH plan, it kind of implies that those community alternatives are going to be open first and then the reduction in the beds. But if you read the document carefully, it clearly states that January 2008, the unit is going to close, and then these alternatives are going to come up, and there’s no overlap period at all. There’s no room for error, when we’re already on condition red 30% of the time in March and April. So I think this is a very serious matter and I think this could really blow up in the Mayor’s face, to be very honest, and I must say in the year 2000, when DPH proposed the closure of an inpatient unit at that time, our current Mayor, Gavin Newsom, was very much in favor of supporting the unit. He visited General Hospital. He was one of the first supervisors to support us. So I hope that some consideration will be given to this, and I certainly wanted to inform you of this.”
Mr. Purvis: “I’d just like to add a comment. This is the very issue that I was commenting on before. We know that family members who are part of NAMI have adult children who are in jail or on the streets for lack of appropriate inpatient care in a timely manner. So I’m sure, I know that we’ll be able to support the points that you’re raising.”
Dr. Lu: “Thank you very much.”
Ms. Kellum King: “My name is LaVaughn Kellum King and I’d like to ask you has anyone asked the Mayor to come over and take a tour of the facilities and show him what the devastation is and how it can worsen.”
Dr. Lu: “That’s a very good idea. I think we could certainly make every effort to do so, yes. Thank you very much for that idea. Certainly any support that the Board could give would be much appreciated. Again, thank you very much for the time and consideration.”
Dr. Turner: “Thank you. I want to open this up to further comments from the public.”
Member of the Public: “Hi. My name’s John Cleveland, Sr. And I don't know what the amount of the funding for the Behavioral Health Court system was exactly, but I think that if they can have a place out of jail to go to, maybe some construction job. Some of these buildings need remodeling or some of these old buildings need to be taken down. If the City can hook them up with something like that to where they would have a better life, I think that it would be working more.
The way that it’s not funded now is because they end up back into the system again. You know, they go out so far but it just opens up another door. They have nowhere to lead them anywhere, to construction or to something to that affect that gives them a better life. So if the funding was there or if the City could come up with some wrecking crew or something and put it together at the cost of equipment and then some good construction leaders, maybe they can branch out with people being more productive instead of spending so much time nonproductive in jail. And that’s about all I have to say about the Behavioral Health Court system or maybe a system that can take off with that and be more helpful to the City and maybe the County. Thank you.”
Mr. Keys: “Mr. Cleveland, I just wanted to comment that you have two actually excellent ideas about San Francisco creating a sort of infrastructure of work for people who have little skills or who can be taught some skills to do some basic work that we need done. Construction is one of those things, cleaning the City is another one of those ideas. That’s actually a fantastic idea, and to give a person work is to give a person hope, and give a person an outlook of a good future for themselves. So I wanted to thank you very much for your comments.”
Member of the Public: “Hi, my name is Sheri Erlinson. I’m from the Citywide Case Management Forensic and Forensic Linkage Project. When I came to San Francisco, I was homeless and everything else, you know. And I’ve been in 16 different programs here. I know what they’re all about. The ADUs I’ve been to are very nice programs. I’ve been in San Francisco General Hospital 38 times, and they’ve helped me each time I was there.
Why would they cut this budget down? Because, you know, I’ve even been in jail because they didn't know where to put me. My friends at Citywide Forensic are asking, what are we going to do when they’re going to close General. What are we going to do, you know? And I don't know what to tell them. You know, I’m just a client like they are. They’re just so worried about what happens. What are we going to do next, you know?
There’s going to be a lot of homelessness and then there’s like the pregnancy. I almost had my son in a program. They take care of programs very well and I don’t think they should be closing down General or any of the hospitals, you know. I already know that Davies closed their program now, which I didn't think was right, because I had an ex who used to go to that hospital, and they helped her out very much. I’ve had lots of friends of mine go to these different hospitals. They needed it. And I know they’re overcrowding hospitals and also boarding, ADUs because they’ve got so many people in jail now waiting to get into an ADU. Two to three months waiting. They’re in jail waiting for an ADU for two to three months, and it really just hurts me to see them. Every week someone goes to the judge, and the judge says ‘you can’t go to an ADU because they’re still trying to get the people out of General’. That’s how bad the system is now. What’s going to happen when General completely shuts down to these ADUs? It’s going to be overcrowded and more people are going to go to jail. There’s going to be more people who are homeless. They’re going to be all in the Tenderloin, you know. I’ve been in the Tenderloin. It’s no good. That’s all I have to say.”
Member of the Public: “Good evening. My name is C. W. Johnson. I identify myself as emotionally disabled, which just means I’m manic-depressive and I suffer from schizophrenia. I’m also an advocate in association with the Mental Health Association.
One of the things that I feel, well three of the things that I feel is that we have a lot of homeless because we don’t really have good homeless prevention. I think if we’re going to have money, money should be toward that, toward helping the homeless, most definitely. I’ve been almost evicted a couple times myself for what I consider a disease. Also, I think that this seems not to be talked about or even looked at, is a transitional support for people who are mentally ill. When you have lived on the streets a certain way for two, three, maybe four years, you develop habits and a way of living. And I think that any training around training people how to get their lives back would be a great way to prevent people from becoming homeless.
Third, but not last, I think housing is really a problem. I think – I forgot the name of the program, but they do a really good job of putting emotionally disabled people together. They have these really wonderful houses. Progress Foundation, that’s it. And I think that as we move people, there’s no upward movement. It’s just like you get in this hotel and it’s beautiful and everything but that’s it, as far as you go, you know. And I don’t think life is actually a monopoly. I think you should be able to go as far as your emotional stability should be able to take you, and I think we really need support around those things and I would definitely like to be a part of anything like that if you guys come up with it. So thank you very much for your time.”
Member of the Public: “I’m Kathleen Connolly. I’m the Director of the Citywide Case Management Forensic Program. We’re a program of UCSF. And I just wanted to piggyback on Dr. Lu’s comments about the hospital inpatient beds.
I think it would be a travesty to lose those beds. Our community is already at its limit as far as the ability to get our folks into the hospital for stabilization when they really need it. Our program works with some of the most severely mentally ill folks in the City. I’ve been with the program for ten years and I actually used to work out of psych emergency (PES) and my impression is that probably both options are needed. We need to keep the inpatient unit open and then add this other community type program to relieve some of the pressure from psych emergency. But I don’t think it can be an either/or because I think, that they’re two very different functions.
I think an emergency room has to be trained and run as an emergency room, and the folks that are going there are not people that do not need to be there. The reason they’re overflowing is because every single person needs to be there. We don’t even take people to the hospital when we know that there’s a slight chance that they wouldn't get hospitalized. So they have to really meet a high standard, as it is, and the people that are in the hospital that are on administrative days, they need to be there because there’s no place to send them once they are stable. And we’re lucky if we can even get them in long enough to stabilize them. So I just wanted to really advocate for that, and stress the importance of it as a community case manager working with all these folks. Thanks.”
Mr. Keys: “Ms. Connolly, could you just briefly explain what your organization does?
Ms. Connolly: “We’re an intensive case management program. We’re actually, part one of the FSPs that was funded through the Mental Health Services Act (MHSA) money. We’ve been around for about 20 years, serving mostly high users of both the inpatient psychiatric units and psych emergencies. So we provide intensive case management and wrap around services to folks for as long as they need it.”
Mr. Keys: “How are people referred to your organization?”
Ms. Connolly: “Mostly through the inpatient unit from various community providers. If someone’s in an outpatient clinic and they need a higher level of care, we’ll get referrals that way. My program is the Forensic Program so we get most of our referrals through jail aftercare, so we’re working with folks coming out of jail.”
Mr. Keys: “What would happen if funding were to be reduced or stopped?”
Ms. Connolly: “I think that the City would lose a huge service. We probably have about 500 clients that we serve at our clinic, between three different case management programs.”
Mr. Keys: “So the funding that’s going to be stopped for San Francisco General, how is it going to affect your organization?”
Ms. Connolly: “Well it does trickle down. We’re part of the Department of Psychiatry for UCSF, so when there are cuts that need to be taken, they are spread out amongst, not just the inpatient unit, but they trickle down to the various outpatient programs. There’s Citywide Case Management, there’s Crisis Resolution Team, the ED Case Management Program, and various other smaller programs I think. So yes, we’re in the process of actually having to cut a few positions right now.”
Dr. Turner: “Ms. Connolly, if you have the time, and actually for anybody who represents programs, if you want to just email us a few lines that you think will help us, we will put them into our letter.” I think sometimes the more facts we can have, it’s helpful to us.”
Ms. Connolly: “I’d be happy to do that.”
Member of the Public: “My name is David Keck. I want to shed some light on why I feel I am lucky. The reason I’m lucky is because I have services, I am receiving services. I have housing that’s owned by the City, and I can afford it. I have services provided through St. St. Mary’s Clinic, part of St. Mary’s Hospital. It has a Catholic training school. And all my coverage is included. I mean, I get about a thousand dollars a month in treatment. It’s offset somewhat by Medicare and Medi-Cal.
But I want to also shed some light that I am hearing impaired. I go to the Center of Deafness, UC Center of Deafness at Laurel Campus and there I see a case manager weekly. I see a case manager and a social worker for an hour each. And as I need it, I see a psychiatrist because I had an automobile accident long ago and I had head trauma. So that’s what’s keeping me afloat and I want to offer my services as a volunteer. I want to be utilized in any possible way that I can to structure programs, to be of help for the people that are trying to come up.
I am a peer counselor now but I’m not working, for one reason or another. I’m not sure why, but I used to be the assistant to the coordinator for a program, and we were servicing 25 interns scattered in ten different centers, hospitals, clinics and that sort of thing. And I just put it out now that I’m a volunteer, and I want to be utilized in any way that I possibly can to support what everybody’s trying to do. Thank you.”
Dr. Turner: “Thank you. We need to get this letter out as soon as possible; so anybody who is going to write anything to us, speed is of the essence. I think we’ll probably get it out Friday morning.”
Member of the Public: “My name is Alexandra Kutik. I was dismayed and concerned to hear about proposed reduction of inpatient beds at S.F. General Hospital based upon the expectation that community-based services would fill in the gap. Have we not learned from the mistakes of public policy dating back to the 1950s and 1960s when de-institution-alization with a similar expectation resulted in the streets along with jails and prison populations serving in place of those non-existent community resources? Promises made then remain broken. It is unconscionable that we would ignore this history lesson and make this same promise again, particularly when we already know that resources are not available.
I am wondering what the connection is between the proposed elimination/de-funding of 28 positions in Mental Health and the allocation of MHSA FY’08 growth funds for additional/annualized/part-time to fulltime CBHS staffing for MHSA implementation. If, in fact, MHSA funds are being used to supplant City costs, this is in direct conflict with the spirit and intention of MHSA. Once again, thank you for the opportunity to present these comments.”
Dr. Turner: “Thank you. Is there any further public comment? Okay, thanks for all of you who presented to us, and seeing no further public comment, public comment for this item is closed.”
Item 2.0 PUBLIC HEARING ON THE ANNUAL UPDATE TO THE MENTAL HEALTH SERVICES ACT PLAN (MHSA)
We’ll move at this point to the hearing on the annual update for the Mental Health Services Act. We all received this in our packets and hopefully members of the audience have it, but if not, there are copies in the back that Ms. Brooke has supplied.
2.1 Presentation
I’ll start off with a few things I noticed in the report. First of all, I just wanted to say I’d like us to add that hearings were held at each of these meetings and these hearings tended to be quite long in terms of getting public comment. They moved up to two hours, and Mental Health Board members who were on the taskforce facilitated those hearings; so I think that would be important for us to add in terms of our process.
This is a comment, and then I have a question. Maybe you can help me with this—in Part A, I guess on page 7, we talked about implementation challenges. And before I noticed the heading, and I was reading I was saying oh, no, we’ve said all these things we’ve done wrong. And then I realized that’s what we’re supposed to put in the report—the challenges. But I would think it would be important to, at least for our own selves internally, if not in this report, to explain how we’re going to avoid having these kinds of problems, you in the future.
There were things like the plan was approved, but positions couldn't be posted. Some of these things we can’t do anything about; but as of December 2006, none of the clinical positions were hired. That’s on page 7 in the middle, and I was wondering about the employee turnover, and the fact that we were short-handed to handle contract renewals. We might do a better job of just explaining how we are managing these things, not only for the presentation to the State, but also for our own internal work on ourselves.
The staggered funding of MHSA was a challenge for our financial accounting unit. I guess now we’re doing better with that. Sometimes this is the jargon that is used, but when we talk about full service partnerships, we’re talking about various organizations that are our partners; but yet we also use the word “partners” for clients. So I’m wondering, are we talking about people or organizations? Maybe you can just explain the terminology a little bit.”
Dr. Cabaj: “Well thank you. Those are excellent comments. Actually, if you notice, the timeframe is the problem. This is a report that’s supposed to be through December 2006; so most of those challenges were met and resolved by now, but we don’t quite comment on that. Next year it would say that. So we were a little uncertain about how to do that, but I think if we can incorporate some of these remarks, that would help.
The State was very adamant about creating that term ‘full service partnership.’ We had already been using terms like single-point of responsibility. The program we just heard about, Citywide, is that. The ACT program uses another name, ‘assertive community treatments,’ and we felt that there were plenty of terms that were already out there, but the State wanted to come up with a new term; so they came up with ‘full service partnership.’
Usually partnering does mean contract agencies or sister organizations like the police or the courts. So, I’ll have to reread this but I thought they would weave together. When they use partnership, it usually meant to the clients because of their needs, and full service partnership implied everybody working together to help that client, doing whatever is needed. It didn't imply who was doing it, necessarily. The partners are who do the work, so we’ll see if we can make that clear.
The reason we even have the term CSS, Clinical Services and Supports, is because the State did not want to use the term “system of care”, which we’ve been using for many years. They thought to transform the system, you had to come up with a new term so that’s what they did.”
Dr. Turner: “It was a little hard to read without tables. Maybe you aren’t supposed to put tables in. I know the State has all these formulae about how you have to present these things. But it would have been a lot easier to read it if I had those tables. Here’s the number of proposals on page 3 that we got, and then it starts explaining on page 4 who got them and for what, and does that account for all of them? It is unclear. A table, I think would be really helpful for people to understand.”
Dr. Cabaj: “I’ll see if we can do it. Again, Maria O’Malley was one of the major coordinators of the Update. I actually encourage all of my staff to read it, because I thought it was a well-written report even if there were some questions on content here and there. But it’s one of the rare times where it was actually enjoyable to read, I thought.”
Dr. Turner: “It is actually well written.”
Dr. Shukla: “I had a question about outcomes and again, your point’s well taken about how this is actually dated December 2006, and that may be a little bit early; but I think there was a public comment that was very well taken about programs being cut at the same time that services are expanded. And I think that the only way to really justify doing that is if you are supplanting existing programs with better programs or fuller programs, or programs that can actually show that they produce better outcomes. And I think a really important piece of this in the next phase will be to actually demonstrate that all of these new services are actually improving the state of health of these patients. Especially with all the cuts, I think that’s vital.”
Dr. Cabaj: “Excellent.”
Dr. Turner: “I think the sad thing is that even if this is helpful, you’ve got all this other data related to the cuts, which may show harm, and then it’s kind of hard to know what’s helping and, it gets over-shadowed.”
Dr. Cabaj: “I’ve been paying attention to that question of supplantation and there’s so many interpretations of it. I tried to use this term to address the 28 position deletions. But there are two interpretations: that it only applies to State funding, the State General Fund, and although I’ve heard it interpreted for the County it would be pertaining to the ‘04/’05 level, and I’ve been told that we still would not be below the ‘04/’05 level because of cost of living and other increases to the whole system and other growths. So it’s a technicality, but I think it’s tough. The outcomes are a key part of this, and it’s too soon to assess the outcomes, because they’ve just started. So the outcomes will be one of the key parts, and we will be following them not only for the clinical services but as the new monies come along for prevention, early intervention training and so on. That’s going to be a key issue.”
Dr. Shukla: “Is there a general sense of how well these programs are doing?”
Dr. Cabaj: “We feel confident because we’ve had the working model of a program like Citywide and our AB2034 programs. So basically the Full Service Partnerships are just like that model, except we are able to fund more services for clients. And those models have been very successful, as you know, reducing hospitalization, reducing time in jail, increasing work activity, and increasing housing. We have no reason to doubt that those same things will happen with the FSPs. But again, it all depends on the funding. So it’s too soon really to know the impact of these programs. But I can’t believe it would be any different.”
Dr. Turner: “Any other Board members want to make comments or ask questions about the Update? Another point is that Board members here are doing program reviews for each one of the programs that was funded. We selected them specifically for that reason.”
Mr. McGhee: “I just have a question. You know, in reference to the reduction, Dr. Cabaj, I think with the 160 programs we fund or something like that, how is that $1.8 million going to affect some of those organizations that are doing a pretty good job?”
Dr. Cabaj: “The $1.8 million you’re talking about? As I mentioned, Dr. Katz and the Mayor did not specify any particular programs. That’s why every one is listed. So if that cut went through, which we really hope your advocacy and other input might prevent, but if it came through, we’d have to determine whether we do a formula of a certain percentage to all programs. But I worry again about the ability of a program to function if you go below a certain level, or target a particular program. But, in the past we’ve always honored programs for children, minorities, and for women. And if we try to keep with those same priorities, we actually would still bump up against having to cut some services into those areas. So I am worried about how we would roll that out.”
Dr. Turner: “Any other Board Members want to comment? Let me open this for public comment related to our presentation on the updated report. Are there any members of the public who would like to make a comment? There is a three-minute time limit.”
2.3 Public comment relevant to Item 2.0
Member of the Public: “Hi, my name is Sheri Erlinson. When I first came to San Francisco nine years ago, I didn't have food or housing. I made poor decisions because I didn't have the right psychiatrist or the right meds. I’ve been hospitalized. I got referred to Citywide by SOMA because I’ve been hospitalized too many times in another state. I have not been hospitalized since January – February 2005 because I’ve become stable on my meds.
I pled to a crime that I did not commit in 2004 so I could get out of jail. I got in trouble for violating my probation many times from 2004 to 2006. In May, I got arrested and sent to jail for two months, then I got into Behavioral Health Court (BHC) where I met Monica, my caseworker. I like Behavioral Health Court because they allow me to work on recovery and not as punishment. I can think about myself as a success and not just another criminal.
My goals right now are to become my own payee, to deal with my fears, to have my own housing, and to own a horse therapy ranch for people with mental illnesses. Citywide helps prepare me to do these things. I have been sober for one year, and I have accomplished more goals in my treatment plan this year than the year before. Thank you.”
Ms. Kutik: “Throughout most of the report, MHSA-funded FSPs and other agencies are not identified by name. This seems like a curious omission, particularly for readers who are members of the public.
II. Efforts to Address Disparities
B. Outreach (page 17)
I participated in the “consumer and community orientation of the RFP review process.” I served on one of the review panels and was the only consumer/community member, despite the fact that two others had signed up and were scheduled to participate. Given my experience, I wonder whether there is a discrepancy between “one-third of various panels were composed of consumers and/or community members” and the actual number who participated in the review process.
I. Program Services – Implementation
B. Key Transformational Activities (page 8)
C. Implementation of Full Service Partnerships (page 9)
One of the “five fundamental elements” of MHSA to which SF remains committed is “wellness/recovery/resiliency focus.” While these sections acknowledge the sea change required of both CBHS and contracted providers – from a medical model treatment philosophy (client impairment) to a recovery model (client goals and functions) – the conclusion is that “additional training on the recovery model … is a priority.” I would suggest that this is not simply a priority, but an essential and necessary element of SF’s plan that should have been part of implementation prior to the implementation of FSPs.
III. Stakeholder Involvement (pages 19-21)
IV. Public Review and Hearing (page 21)
The recruitment and participation of consumers and families in the MHSA planning were successful and exemplary. Given the lack of written public responses to the report during the 30-day period ended 5/30/2007 and the lack of attendees at this public hearing, it seems that current outreach efforts for the implementation phase are inadequate and in need of expanded action.
I attended a recent community forum of the MHSA Advisory Committee. I requested that CBHS put me on the distribution list for both future Committee meetings/community forums and job opening flyers for employment of consumers and family members. To date I have received no information as a result of either request.”
Dr. Turner: Thank you. Will you please send us your comments in writing? We will include them in our letter.”
Ms. Kutik: “I can provide them before the deadline.”
Dr. Turner: “Thank you. Is there any other public comment on the update?”
Member of the Public: “My name is Laura Barber. On page 6 on violence and trauma recovery, as the lady stated earlier, they didn't mention the name of the agencies who received the money for violence and trauma. I would like to know, can anyone supply me with the agencies that received the money? They said one agency in the Mission District received money, and then one in the Western Addition, and one in the Bay View neighborhood; but there is no name who received the funds, no agency name. Can that be given out?”
Dr. Turner: “The Instituto Familiar de la Raza, and Urban Services, YMCA. Those two were for violence and trauma recovery agencies, receiving $120,000 each.”
Dr. Turner: “We often don’t answer questions but the information was sitting right here on the table. Okay, any other further public comment? Seeing none, public comment is closed.
2.2 Board discussion of Possible Board responses to the presentation
Dr. Turner: “I inadvertently went to public comment before we talked about Item 2.2 so we’ll go to that now, before moving forward, and that is Board discussion of possible responses to this topic.
Let me ask a question instead of a response. This report will get some revisions before it will be submitted to the State with comments and that will all go together; When does that get submitted?”
Dr. Cabaj: “I believe it has to be to the State by June 30th”
Mr. McGhee: “So actually this can be revised. This is not the final report.”
Dr. Cabaj: “I have to revisit the technical side. This is one of those weird ones where there is supposed to be public comment that could or could not be incorporated. It might be just the addendums. And then the public hearing, which is this, which we also would usually attach as comments. But I will clarify this, because if we can go back and revise it with some of the things that were suggested earlier, I would definitely want to do that. If not, we may incorporate them as comments to the report. But one way or the other we’ll make sure these things are noted.”
Dr. Turner: “It seems to me that a really high percentage of the proposals that came in got funded. That is interesting in relation to Ms. Kutik’s comment about the difference between the public hearings where there were so many people who came out and we heard about so much need everywhere in the City; and now there’s not so much response.
I guess what happened is that these areas of focus got selected and so the RFPs just focused on them. So the people who are in those areas where we prioritized are probably happy, but other folks in other areas of the City, who were are not happy but they’re not here, and that’s your point.”
Dr. Cabaj: “Yes. And also I think, as you’ve seen in other processes, there’s always a lot of excitement about how to spend money and how to prioritize the funds. Watching it unfold is sometimes not as interesting; or people watch it from a distance. But usually when you have a voice on how you actually will shape a program and design how money goes, you’ll get many more people interested. So if we get significant new funding, I’m sure we’ll have more public response as we try to add or expand programs. But I appreciate those who are here tonight. I think the Mental Health Association was helpful too in getting the word out on tonight’s hearing.”
Dr. Turner: “Well the difference too is that we’re having the meeting here, and that’s not convenient for everybody. We went around to every neighborhood in the City during the RFP process.”
Dr. Cabaj: “Yes. The Community Advisory Board is rotating throughout the City, so we can make sure that at least people can come more conveniently if it’s possible.”
Dr. Turner: “So then public comment is being obtained from all of these community meetings.”
Dr. Cabaj: “Yes.”
Dr. Turner: “And it is being compiled?”
Dr. Cabaj: “Documented, right.”
Dr. Turner. “Good.”
Dr. Shukla: “That doesn't have to do with this report though.”
Dr. Cabaj: “No, it doesn't have to do with this report. It’s not even a State requirement to hold these community meetings, but we wanted to because I would not want a system unfolding without public review and support, and especially as we are moving towards that recovery model and community-based services, the community’s got to be involved.”
Mr. McGhee: “Dr. Cabaj, would you be able to get us, the Board, a final draft before we have to submit it on June 30th?”
Dr. Cabaj: “Yes, I will find out tomorrow what the technicality is and you will get copies of everything before it’s sent.”
Dr. Shukla: “Before the State makes a decision regarding the second round of funding, what additional information are we required to provide, or do we plan to submit to them in addition to this document?”
Dr. Cabaj: “Well the current plan is for three years; so there’s no more funding in store, unless we had a radical, huge influx of money, which isn’t going to happen, in which we could maybe fund some of the programs we couldn't fund previously. If you recall, some of you who were on that taskforce, and we funded about four categories in each of the groups that were listed, but there were clearly other things that were listed that we couldn't fund. So one thought is if we had extra money, we could just go revisit the plan and look at funding additional new services that were already approved in the plan, but not fundable; or we could expand current services. But any new dollars, like for prevention and so on, we’re waiting for the State to tell us what the role of public comment is or not. That’s why we did convene already the subgroup or taskforce on the education and training.
They’re considering now a four-year plan. They decided to incorporate one year into the process because it took them a long time to respond and so on. Then most of the money will go back to the County to determine how to use it, and at that point we’ll probably have to have a whole new process. I don't know if that clarifies the process.
What theoretically is supposed to happen, and again, the State keeps changing the rules even as we talk, but after ’09, ‘09/10, I believe, all the money will be put into one lump some for the County, meaning the money that was teased out for education, for prevention, for clinical services; then it’s up to the County to come up with an integrated plan, not having these separate plans.
What’s been frustrating for most counties is why do we have to have five separate plans? Why do we need an education plan? It really all fits together. A public comment was made and others said we can’t do many of these things without training. It’d be great if we can incorporate the prevention, early intervention now. We all really were demanding that the State please give us the money now because we’d like to incorporate it into the original plan. But in the State’s wisdom or decision-making process, they are keeping it out separate. Then within two or three years, it will all be put back together, and then it will be up to the counties to do sort it out. At that time, we’ll definitely want another public process.”
Dr. Sukla: “I think my question was just trying to address at this point, if the funding amount will not be changing then. The question may not be how the money will change in terms of who receives the money, but rather how well again that money is being used and how the programs are up and running, at least at this time.”
Dr. Cabaj: “Right. That’s why we’ll be following the outcome information and start appropriating that into our reviews, as well as reports that you would get; and I think it’ll be a major factor in deciding on future uses of additional dollars.”
Dr. Turner: “Okay, any other Board responses?”
Mr. Purvis: “I just have one question. I don't know if this even fits right here but is there anything new on the possibility of getting additional Proposition 63 funds? We’ve been talking for a year or more about possibly getting funds that other counties have not fully allocated.”
Dr. Cabaj: “If you’ll recall, I mentioned, we sent a letter under Dr. Katz’s name and the Mayor’s support to ask for $26 million more for additional full service partnerships and we’ve not heard anything back from the State. That was about three months ago. Except we heard a little comment that implied that they did get the letter. That’s all I know.”
Dr. Turner: “If there’s no further Board comment I will move to our reports.
Dr. Cabaj: “I want to thank you for your great comments and support. I’m glad we had comments from the public. We will move forward, and I’m glad when I can be here as long as I was tonight. I’ve got to get ready to get back to Sacramento so thank you very much.”
Dr. Turner: “Ms. Helynna Brooke will now give her brief report.”
Item 4.0 REPORTS
4.1 Report from the Executive Director of the Mental Health Board
Ms. Brooke: “I’m Helynna Brooke, Executive Director of the Mental Health Board, and I first want to report that our program reviews are up and running. James McGhee completed a review of Community Vocational Enterprises, and James Keys completed a review of Larkin Youth Services; and we have reviews set up for the Family Mosaic Project and Instituto Familiar de la Raza, and one with the Mental Health Association. We are in the process of setting up ones with Walden House and the Family Service Agency, along with one for Citywide. We will continue to move through the rest of the MHSA programs so that the Board can get a real intimate idea of what’s happening. One of the reasons the Board does these reviews is to really understand what clients need and what they’re receiving so we can be much stronger advocates.
The second thing I want to call your attention to is a play called “The Spot.” The next showings are Thursday and Friday at the St. Boniface Church in the Tenderloin. It’s on Golden Gate. There’s a flyer in the back.
It is a play about recovery, and about being in the jail system unfairly, and I highly recommend it. Geoffrey Grier is the director, and he is in recovery himself. You are asked to pay by donation, and they even have snacks; so I encourage you to go. Curtin goes up at 8 o’clock Thursday and Friday.
Finally, the Board collaborates with the Police Department for the Police Crisis Intervention Training that we developed. We will have our 22nd training next week. Over 600 officers have been trained, and at every training, we hear about yellow alerts and red alerts at San Francisco General and where am I supposed to take people.”
4.2 Report of the Chair of the Board and the Executive Committee:
Dr. Turner: “Thank you. Just a few things. A reminder that June 19th, Tuesday, is the hearing on the proposed reduction in health services; so that’s a time to make more comments. The meeting starts at 3:30 p.m.
We just recently, on May 31st, had an awards reception and it was wonderful; and I’ve thanked all of our Board members who participated so much and provided so much leadership in this event. We had about a hundred people there. And one of the things that came from it, I just wanted to read because I thought it was a very, very important letter.
A letter came to both James McGhee, Vice-Chair, and me from Judge David Ballati, and he’s the judge that we wrote to make sure that Behavioral Health Court stayed intact and funded and ongoing in its same spot; and that happened. And so he wrote to us: ‘On behalf of the Superior Court of California, County of San Francisco, I wish to thank the Mental Health Board for selecting our court’s Behavioral Health Court as a recipient of the Criminal Justice Response to Mental Illness Award. I attended the awards ceremony and was honored to see that the Behavioral Health Court was one of many distinguished and deserving individual agencies and programs selected for special recognition. I can assure you’ – this is why I’m saying this on the record – ‘I can assure you that the San Francisco Superior Court will continue to work with the criminal justice partners in crafting innovative practices and programs for people with mental health issues who become involved in the criminal justice system.’ Anyway, a few other things, and he signs David Ballati, Presiding Judge. And that’s a very, very important statement, and it’s the kind of advocacy on the part of the public and this Board I think that can make things like that stay alive. And they don’t if we don’t really fight for them. So that was really good. One of the nice outcomes, was getting something like that in writing.
The other thing that we’ve done recently is to do a showing of the film, “The Bridge” moderated by Board Member Kevin Hines. Kevin’s not here tonight. He facilitated a discussion about the film “The Bridge” because he is an advocate for a barrier on the Golden Gate Bridge. He was part of the film. And there was a fantastic showing—all in all, a few hundred people. And I think a lot of us faced seeing the film, those of us who hadn't seen it, with some trepidation because it’s not exactly an upper. However, the film was so well done, I think we ended up agreeing with Kevin that it was actually a very important film with an important message, and I hope we do more things like that with other Mental Health Boards. This screening was done in conjunction with the Marin Mental Health Board.”
4.3 Planning Committee Task Force Report:
Mr. Purvis: “I just wanted to say at this point that I was very sorry that I had to miss the actual awards ceremony. If people saw me coming in tonight, you see how difficult it is, and I knew that would be an event where meet and greet would be important. Tonight I can just come here and sit. But all the feedback I’ve had is that it was a very wonderful, successful event.”
Dr. Turner: “Well thanks for all your planning help, Mr. Purvis.”
Mr. McGhee: “I really don’t have that much more to say. As a matter of fact, some of you in the audience actually attended our first annual award reception. I’ve thanked the Planning Committee and the Board, as our Chair has, for all the work that they did to make that a very successful event. I will say one of the reasons that we, as a Board wanted to do that, is because we feel that people who are providers in the community don’t always get the recognition for the hard work that they do, and they sure don’t get the compensation for it. So we felt that, it was a priority of ours as a Mental Health Board to reach out and award those organizations.
There was a competitive process. We sent out probably over 160 questionnaires, and there was a methodology of going through them, talking about what each organization did. And we’re very happy that people responded like they did. And we just want to say that we’re taking this month off, but starting July we’re going to be in our planning stage for next year because our goal was to continue to make it bigger and better, and continue to get that outreach to the community at large. And I’m not talking about the community so much in mental health, but those who are outside the mental health community, that need to be aware of the needs of the mental health community. So I just want to say thank you very much, and I want to thank those who came, and we’ll look forward to seeing a lot of you next year.”
Dr. Turner: “Okay, next is Item 4.4, report by members of the Board on any activities recently on behalf of the Board. Does anyone have a report?
4.4 Report by Members of the Board on Their Activities on Behalf of the Board.
Mr. Keys: “Yes, James Keys. I completed my program review of Larkin Street Youth Services. Also next week I believe on June the 20th, I believe that’s a Wednesday, at 12 noon on the City Hall steps we’re going to have a press conference for the budget, where we’re going to talk about the cuts and the budget that was proposed by this administration, and what the Board of Supervisors can do to help not make that a reality. We would really appreciate having people come and support us next Wednesday, June the 20th at 12 noon at City Hall. We’re going to be fighting for the General, Hospital psychiatric beds. We’re going to be fighting for the $1 million cut that was made for psychiatric beds. We will be then going up into the Board of Supervisors Budget and Finance Committee meeting, and doing public comment.”
Ms. Brooke: “I just want to announce that I believe June 21st at 11:00 a.m., is when the Mental Health budget will be heard in the Board of Supervisors. This is another chance to have your voices heard. Just move into City Hall for next week and advocate.”
Dr. Turner: “Okay. We are at Item 4.5 New Business: Suggestions for future agenda items that will be referred over to the Executive Committee. We are not allowed to discuss them now but we’re allowed to name them.”
4.5 New Business
Mr. Keys: “I would like to see the letter that Vice-Chair McGhee suggested.”
Dr. Turner: “Okay, that’s going to be real immediate, and we’ll send it to all Board members on email and people can give feedback, comment, and edit suggestions. So people who are going to send us material, if you can do it by the end of the day tomorrow it would be great. I think we can put all of our concerns into one letter and address them clearly. It might be a little long letter but that’s okay.”
Dr. Moses: “For the Executive Committee consideration, I’d like to see if we can invite Jeff Adachi, Public Defender, to come and talk about the wonderful program he has in expunging criminal records.”
Dr. Turner: “Okay, thank you. We’ve got that noted for the record. Any additional things for us to consider? Okay, is there any public comment relevant to this item where we talked about new business? And then there’s going to be another opportunity for public comment about anything before we close.“
4.6 Public Comment to Item 4.0
Member of the Public: Hi, my name is Sheri Erlinson. I am going to be encouraging at Citywide all the patients who do not want PES to close the hospitals and stuff. I will hold a petition and bring it down to you guys and then next Wednesday or Thursday, whenever the public meeting is. I will bring a group of Citywide people.”
Member of the Public: “My name is David Keck. I’m interested in helping out. I’m new at all this, and I heard yesterday or recently that petitions, where you get signatures, is effective. And my question is what do you find, as a Board, to be the most effective means, a single letter, a letter accompanied by 500 signatures, 100 signatures? What does it take or what would you recommend?”
Mr. Keys: “A letter followed by a petition with a statement at the top of the petition stating what your intentions are. On the petition it should have a name, address, telephone number and signature. They should, you know, generally be voting members of San Francisco, but it doesn't actually have to be. You do want to send a copy to each and every member of the Board of Supervisors, and to the Mayor’s Office and, if you can, you always want to get each and every one of those people to march to City Hall and make a demonstration. And you also want to alert the media to that very same march. So you get as much public attention as you can. At that point, people have to sit up and listen.”
Mr. Keck: “Yes, I will do just that; and my only comment is I used to be on a board and president, and I ended up being a president of a home improvement association representing 17,000 people, and in 13 months after we first spoke of it we swam in the city’s first swimming pool. Things like that. It got done and that made my life very rewarding for the time that we all spent. So I will learn from your comments.”
Dr. Turner: “I thought you said you were new at this. Sounds like you have a lot of experience.”
Mr. Keck: “Well I have a history, let me put it that way. I’m new to this Board’s activities. Basically, my life ended in 1985. I woke up one day and I couldn't remember how to tie my shoes, and I’m recovering from that. And so starting in 2006, I became a peer support intern with CBHS. and at this point in time I’m going to try to allocate about 20 hours a week in volunteer.”
5.0 Public Comment
Ms. Erlinson: “You’re going to see my face a lot, often. I am proud to say that there were three of us from Behavioral Health Court that have completed training in NAMI. We were three that went over to Marin County. We went to the orientation for NAMI and we now give speeches and let people know about families that have people that have mental illnesses, and two of us are going to the Sheriff’s Department next Tuesday to tell them what it’s like to have a mental illness. It’s called, ‘In Our Own Voices. ’ So we’re very proud to have three of us graduate, and hopefully there will be more funding to have people like us graduate from the Behavioral Health Court to go to like places like NAMI and stuff. It’s a new program called “In Our Own Voices”.
Mr. Keys: “Congratulations.”
Ms. Kellum King: “I’d like to say congratulations to you. My son went through that program also.”
Ms. Erlinson: “Thank you.”
Mr. Purvis: “It is a very good program. All the feedback I’ve had within NAMI would indicate it’s going very well. As she said, it’s a brand new program.”
Dr. Turner: “So if you see Judge Ballati, say thank you. Okay, is there any other public comment at this time? Okay, seeing none, public comment is closed. Is there a motion to adjourn?
Dr. Moses: “So moved.”
Mr. Purvis: “Seconded.”
Dr. Turner: “All right. The meeting is adjourned.”
Ms. Brooke: If anybody wants to email any comments I’m going to bring my card down, and you can email me.”
Adjournment
Meeting adjourned at 8:30 p.m.
contact us | accessibility policy | disclaimer | privacy policy
Copyright © 1999-2007 City & County of San Francisco. All rights reserved.
Legal Disclaimer: Since we’re making one Hell of a Lot Less Money off this – as in Nothing – than Dr. Lu & C&C of SF are, our republishing of this copyrighted material constitutes Fair Use under Title 17 U.S.C. Section 107. It is designed to promote open discussion, public debate, democracy, yada, yada, yada, …...
If you liked This one, you might also like:
San Francisco: #1 Psychiatric Borg Cube
J&J Lose: Jury awards $257.7 Million To Louisiana
S. 3900: Sen. Coburn's Medicare Fraud Buster: Part II
“In the past, one of the biggest impediments to fighting waste, fraud and abuse in Medicare and Medicaid is when politicians intervene on the behalf of constituents, who are abusive service providers and equipment suppliers.”
Senator Tom Coburn
2 comments:
My hero
$200 Million Dollars in just 1 year to sell Mind Control, and the Best they can do on election day is Nancy Pelosi.
Kind'a sums it up rather neatly, doesn't it?
Post a Comment