Here’s Psychiatry/Political Medicine raiding America’s SSI and SSDI systems from Robert Whitaker’s recent book:
And since Money grows on trees in DC, can we Please scrape up 535 copies of it for Congress?
The Disability Numbers
There are no good studies yet on the percentage of “early onset” bipolar patients when they reach adulthood, end up on the SSI and SSDI disability rolls. However, the astonishing jump in the number of “severely mentally ill” children receiving SSI speaks volumes about the havoc that is being wreaked. There were 16,200 Psychiatrically disabled youth under 18 years old on the SSI rolls in 1987, and they comprised less than 6 percent of the total number of disabled children. Twenty years later, there were 561,569 disabled mentally ill children on the SSI rolls, and they comprised 50 percent of the total. This epidemic is even hitting preschool children. The prescribing of psychotropic drugs to two-year-olds and three-year-olds began to become more commonplace about a decade ago, and sure enough, the number of severely mentally ill children under 6 years of age receiving SSI has tripled since then, rising from 22,453 in 2000 to 65,928 in 2007 (98)Moreover, the SSI numbers only begin to hint at the scope of the harm being done. Everywhere there is evidence of a worsening of the mental health of children and teenagers. From 1995 to 1999, psychiatric-related Emergency Room visits by children increased 59 percent. (99)The deteriorating mental health of the nation’s children, declared U.S. Surgeon General David Satcher in 2001, constituted a “health crisis.” (100) Next, colleges were suddenly wondering why so many of their students were suffering manic episodes or behaving in disturbed ways; a 2007 survey discovered that one in six college students had deliberately “cut or burned self” in the prior year. (101) All of this led the U.S. Government Accountability Office to investigate what was going on, and it reported in 2008 that one in every fifteen young adults, eighteen to twenty-six years old, is now “seriously mentally ill”. There are 680,000 in that age group with bipolar disorder and another 800,000 ill with major depression, and, the GAO noted, this was in fact an undercount of the problem, as it didn’t include young adults who were homeless, incarcerated, or institutionalized.That is where we stand as a nation today. Twenty years ago our society began regularly prescribing psychiatric drugs to children and adolescents, and now one out of every fifteen Americans enters adulthood with a “serious mental illness.” That is proof of the most tragic sort that our drug based paradigm of care is doing a great deal more harm than good. The medicating of children and youth became commonplace only a short time ago, and already it has put millions onto a path of lifelong illness.98: Social Security Administration, annual statistical reports on the SSI program, 1996-2008, Social Security Bulletin, Annual Statistical Supplement, 1988-199299: Pediatric Academic Societies, Pediatric Psychiatric admissions on the rise,” May 16, 2000 press release100: D. Satcher, Report of Surgeon General’s Conference on Children’s Mental Health (U.S. Department of Health and Human Services 2001).101: B. Whitford: “Depression, eating disorders and other mental illnesses are on the rise, Newsweek, August 27, 2008
And the response of the parties sitting atop this Disability, Disease, and Death Dispensing Pyramid Scam Is?
You’ll find the word “beds” in this next SF Mental Health Board Meeting from Sept 12, 2007 57 times. 57 times is how obsessed these people are with obtaining OTHER PEOPLE'S MONEY to pay for their psychiatric beds. You'll also notice that like everywhere Else in the Mental Health Industry, there's not a single mention of anyone being Cured.
San Franciso's bed counting is the direct outcome of the Psychiatric Drug fueled Epidemic Robert Whitaker's book delineates. The more drugs sold, the more beds needed. Get rid of the drugs, and what will you have?
A greatly reduced excuse for all of those beds and squabbling over everyone Else’s money to provide them. Or better Still, get rid of the Federal Dept of Education’s uniform Yoke of Indoctrination producing all of those Academic Socialist, Tenure Hunting, Drug/Bed/Disability Creators peddling Failed Political Philosophies just to have dissertations agreeable to their already tenured Academic Socialist Dissertation Graders in order to obtain their college degree/Government funded work license.
You may want to scroll quickly through this meeting's endless 6th grade syntax rather than hazard death by petulance, but This is where your public money Mental Health dollars are being burned up: endless equivocations regarding the modality and legality of How they dispose of Your money and how to justify wasting even More of it without getting collared.
And remember we're talking about Psychiatric Ground Zero here: a thicker infestation per population density than virtually any City in America. This is as good as it gets for "Mental Health".
(emphasis and intrusions into the text are our's)
Mental health Board
Wednesday, September 12, 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; John Kevin Hines; Claudia Lebish; LaVaughn Kellum King; 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.
OTHERS PRESENT: Helynna Brooke (MHB Executive Director); Ayana Baltrip-Balagas (MHB Administrator); Bob Cabaj, M.D., Director, CBHS; Pam Fischer, NAMI; Steve Fields, Progress Foundation; John Nickens, M. D., Progress Foundation; Erin Williams; Progress Foundation.
CALL TO ORDER
The meeting was called to order at 6:32 p.m. by Rebecca Turner, Ph.D. (Chair).
Ms. Brooke read the roll.
Item 1.0 DIRECTORS REPORT
Dr. Turner: Item one on the agenda tonight is the Director s Report and we have Dr. Bob Cabaj, Director of Community Behavioral Health Services (CBHS) to give his report.
Dr. Cabaj: It s been a while with the break in the summer to be able to come back here and review the budget year. You should have a written report in front of you, and again, I ll just walk through some of the highlights.
The first news item was actually updated 30 minutes ago. There was a big delay in the budget. The Assembly and the Senate had worked out a huge compromise and they ultimately agreed to keep AB 2034. The Governor, supposedly said he would keep AB2034, but when he signed the budget, he blue penciled AB 2034 and cut it. So there was a major uproar, as you can imagine, and a lot of us started working behind the scenes. There is going to be again another set of protests, but they thought it s best to try to find some fiscal solution.
The Governor had basically said AB 2034 is a good program, but too bad. He didn't quite say it that way but that s what the message was. And he said we could use other funding sources, even the Mental Health Services Act (MHSA), and then we had been told that it would be illegal to use MHSA funds. ....
"Kirsten Deichert, a Department of Mental Health spokeswoman, said the money released Wednesday was not intended to cover for the loss of AB 2034."
.... That it would be supplantation. There was a big struggle about this.
Well just about 30 minutes ago, we got a notice that there is a secret MHSA fund. What we ve been hoping for the last two weeks is that there s a secret fund of Mental Health Services Act dollars that haven't been expended yet that was under the administration of the Department of Mental Health, and they agreed to release $64 million of that to cover AB 2034 cuts.
Ed: the then Director of California's Dept. of Mental Health, who retired on Dec 31, 2010, needs identifying.
"California's mental hospitals have been under federal court order to improve patient care and safety since 2006 but have nonetheless experienced rising levels of patient violence against other patients and staff, particularly at Napa State Hospital’s aging facility, where a psychiatric technician was slain in October.About 90% of the hospital system's patients have committed a crime related to their illnesses -- a trend that has increased dramatically in recent years -- and employee groups have called for a new director who has psychiatric experience working with a criminalized population."
And the beat goes on;
Consultant To California Mental Hospitals Abruptly Resigns - Los Angeles Times
"He created an environment that was much less safe than it was before."
Back to San Francisco;
..... They re going to amend the language of the bill so that the money will be allowed to be used. In other words, because of the problem of using Mental Health Services Act dollars, they re going to be able to define it as continuing expansion so it won t somehow qualify as supplantation.
The details will follow but that s very good news for us because we have about $2.8 million of programming that would have had to be eliminated.
Dr. Katz had promised to cover it in the general fund, at least through January, hoping we would have a resolution before that and it looks like we will. The details will be out in the next two days. So I just got a quick memo from the Governor s Office and from the Department of Mental Health that they are going to support the funding. Actually we may not get the full amount. We ll have to see what happens. Because they ve decided that if they re going to add extra funding for the Mental Health Services Act, every county should get it, andonly 42 counties actually have AB 2034 programs. So to spread it to every county gets us back into some kind of formula problems, but I will keep everyone posted.
ED; 16 Counties didn’t Have AB 2034 programs, so would they have had to get Their share of the $64 Million Dollar Secret Fund too and then commission another round of Executive Committee Meetings to figure out how to use it in some Meaningful way which kept Their lawyers employed keeping Them from being Sued?
Dr. Shukla: And yet it s considered separate and not supplantation?
Dr. Cabaj Yes. It s still from the Proposition 63 funds.
Dr. Shukla: Is that extra money from the Millionaire s tax?
Ed; Dr Shukla's presumption is breathtaking: "Extra Money, from the Millionaire's tax" as if Millionaires are simply a commodity for Disability Peddlers who produce a net Negative on the economy to Feed off of.
..... Dr. Cabaj: It was an administrative fund; so it was separate money from what they had already doled out to us, but it still could get into supplantation language. People are working hard with their legal team to find a way to phrase it, that because the program s being eliminated, their clients might end up in a worst level of care. This money could be used to extend new services or continuing services to prevent worsening.They somehow think that s going to get around the supplantation language.
At this point nobody would challenge it because they d be so happy to get the money. However, there s still talk of a lawsuit against the Governor for making the cut in the first place, and this is only a one-year fix. In fact, we d have to face this again next year. And there s some interest potentially in asking San Francisco to take part in this lawsuit; so we ll see, and that the lawsuit s based on the supplantation issue as well as the fact that the Governor defied the intent of Proposition 63, the Mental Health Services Act, which was to expand mental health services in the State, and that was a move that defied both aspects of it. So we may well look into that.
There was even a rumor that if there was a lawsuit we might also try to tag on and get the Children System of Care dollars that were cut just at the time the Mental Health Services Act was getting formulated. There was a vague question of whether that money really fit into the supplantation or not. But they may put that in, and it would benefit our county also because we had a nice big cut with the Children System of Care. So if the lawsuit proceeds, it ll take years and it may benefit us. But we won t know for a while. But at least we have a one-year fix, we think, for the most of our programs. We ll have to then see if the program continues and see what the funding is for next year, but again, there s been a lot of efficacy work, and I want to thank a lot of people who helped out with that. I know this is kind of confusing. We were hoping the budget would be all finished but it continues. Otherwise, the rest of the programs were fine in our budget.
Let me just walk through the other things since there s a lot of things to go over today. Our substance abuse prevention services strategic plan is moving forward. The reason we singled out substance abuse from all the behavioral health services is because there s a state requirement to provide one. We still are looking at integrated behavioral health services, but we had to satisfy the state s requirement. We worked in conjunction with Ginger Smiley and others, people in the Department of Health, around prevention efforts. And it s a very nice plan that will be coming forth. We think it will really help address some of the major needs. It s heavily focused on youth. And when the Mental Health Services Act prevention dollars ever get released or the mandate on how to use them comes from the State, we then will make sure that this plan dovetails with those planning efforts.
Prop 63/MHSA is a key component of the special interest grift that’s put California at the bottom of the economic mine shaft its in.
..... As I mentioned, the budget was okay. Just one added item. I think people may have been told thatWalden House was going to close its adolescence program, which was treating adolescent boys and girls at two separate facilities. Well in fact they did close but then reopened with some monies that we were able to find primarily through the Board of Supervisors additions.
Ed; Walden House is no corner lemonade stand.
The National Center for Charitable Statistics shows their 2010 total revenue being $62,220,442 and total assets being $24,493,958.
Ed; Right, and they needed Monies that were primarily through the Board of Supervisors additions to reopen.
..... They recreated a program that s only for San Francisco residents. Their other program was opened to children throughout the state. And at this point they reopened the boys program not too far from here on Haight St. , near Laguna, and the girls program is out near City College . As of yesterday, there were nine boys in the program. Eventually there ll be 20. And there were four girls eventually growing to ten. The program will be operating as a 30-bed unit, focused heavily on behavioral health needs. The main referral source will be children from Juvenile Hall. It s an attempt to make sure children can get out of the Hall quickly and into a treatment facility. And it s specifically oriented to help with family reunification; so they re going to try to tie families in as much as possible to avoid foster care and see if they can break the juvenile delinquency cycle early so there won t be future periods of jail time for these youths. So far, there s been good success even with the few weeks that the program has been opened.
Dr. Moses: What age group?
Dr. Cabaj: I think it s 15 to 18, although they can take a little bit younger range, and they do keep it separate for boys and girls. There s school training at the site so the children don t have to get transported somewhere else.
Dr. Turner: And who s been behind this family push, because that s a really important piece?
Dr. Cabaj: We were. It was a nice time to do this because we certainly didn't want to lose the program. The nice thing about Walden closing is we could redesign it, and we worked closely with them and they re very satisfied. In fact they re using evidence-based programs. We can get you more information for the next go-around. They put out a nice description of the program and it s one of the first ones, so to speak, that s run solely on evidence-based practices.
Dr. Moses: I think the reason why I asked for the age group, is because I know the City turns the youths out of the programs at 18. So what happens to a program like this?
Dr. Cabaj: Well same thing. They can age out. I believe they can stay until 18. They haven't had anybody in there up until the age of 18 yet because the program just started, but once they reached that age, they would then go to the adult system and we would have to come up with the right placement. But they re very excited about a program that isn t time limited. Their aim is that it ll be a 90-day program, but they don t put that limit on any child because they ve learned in the past if a child thinks they ve got 90 days, they don t do anything positive for the first 85 days; then they behave well for the last five days and then they re out. .....
ED; These College Degreed supra mentalists weren’t even bright enough to avoid being rope-a-doped by juvenile delinquents age 15 to 18, and younger. The kids essentially told their Behavioral Science Captors to F**k Off for the first 85 days, Knowing they’d get sprung by just faking it for the last 5 days.
And the "Back off man, I'm a Scientist" Behaviorist response to being laughed at amounts to a revocation of Habeus Corpus. Make the term of Incarceration Indeterminate in order to further intimidate and coerce the kids into submission. IF they were in a Juvenile Justice Detention facility they’d be in for a set period of time, and if they failed to learn from it and re-offended on release they’d get another lesson inside Juvenile Hall. When they became 18, depending on their offenses, they could Probably get their JD records sealed and build a real life. Not with Psychiatric Stink hanging on them, for life. Finding and holding a job? Good, God Damn Luck.
Can anyone whose not Defrauding insurance providers/tax payers to peddle this idiocy actually believe that this Indefinite Detention dog and pony show is going to breed Dr. FG Lu and Marsha Linehan’s Hegelian, Buddhist meditative, “What, Me Worry”gratefulness into these kids?
Remember Sheri Erlinson? Have another look at your grocery receipts folks.
Are you flooding with Dr FG $181,600 a year Lu's OurIlluminati.com"Gratefulness" yet?
..... And since the youths don t know when they might actually leave, they seem to get much more engaged, and so far they ve shown that children are moving up their privilege levels. So there seems to be real engagement and wanting to get better at the system level. So we re hoping it will continue that way.
ED; uhhhh, no. The kids wanted out, period, so they role played yet again until they Got out.
Walden House 2010: total revenue $62,220,442 and total assets $24,493,958
And the SF Mental Health Board is in a cold sweat over Walden's ability to lock up and Psychiatrically Label 30 Juvenile Delinquents. They could have $620 Million and it Still wouldn't be Enough, or Cure Any of those kids.
Dr. Moses: These are brand new programs, right?
Dr. Cabaj: Right.
Dr. Moses: Are there going to be any facilities in the southeast sector of the City?.
Dr. Cabaj: They re using the facilities they already have. There s no way to get a brand new facility. We could have lost them for any use whatsoever, so we were very thankful that they could be used. And the girls center is right on the edge of Visitacion Valley down in the Ocean Avenue area.
Dr. Moses: Well I just want to reemphasize the importance of this matter. Please don t forget the Bayview.
Dr. Cabaj: I understand. And I know you wanted some information from my last presentation, and we can talk about that too. It s never far from our minds but again, it s the idea of finding the funds and resources. I ll insert one thing now. We re looking at new ways of funding housing and if the State allows some flexibility, we might be able to do smaller housing units, which would open up some possibilities in the BayView and Hunters Point area that we didn't have before. We wouldn't have to look for very big buildings or very big housing units, which would be difficult to find. I ve been talking to Mark Trotts, who runs our housing programs for the Department of Health, and we re very excited that, if there s a change in the way we can use the money, we can start looking at areas that we couldn't normally use because of the size and cost before.
So let me just move on with the report. A lot of this is more information because we combined two months worth of material here. We had a new review of the program objectives for working with our Civil Service workers and contractors and we believe we ve had good input. I think we ve got some contractors here who may have some thoughts, but we believe we re coming up with objectives that are actually useful to measuring the progress of clients as well as the delivery of services.
We ve expanded our system to respond to gun violence. .....
Ed; San Francisco Formerly had 4 Federally Licensed Gun Stores. City Hall's Behaviorists ran all 4 of them out of business.
..... That was the original name for the program, but it s really all violence. It s been a program that s been operating for about a year or two through the Children s Crisis program. We re adding a heavier adult component because most of the victims of violence and the family members that are affected are between 18 and 30. We have gotten volunteers throughout the entire CBHS system to help out because we need a lot of evening coverage, and we ll be turning to more and more contractors for help and Walden House has already stepped forward with four volunteers and it s responding to the actual site of a shooting or killing. Response is based on the number of actual deaths.
We sometimes get involved with severe violence situations, but it s often usually a death, and there s a whole tiered system that comes in. So we re hoping it would both help the situation for the families and other people that may be involved and in the long run help prevent post-traumatic stress and other reactions that occur from these situations. So we ll be doing another wave of requests for volunteers because we hope to have 15 consistent volunteers that can rotate, and I ve been able to get some additional staffing for it through the Mental Health Services Act; so we ll have a core team of eight people working regularly. We re real excited. It started out with three volunteers so we ve really been expanding.
Dr. Turner: Just to insert one thing. When you make a comment say your name unless I call your name first for our transcriptionist. So far we ve had Dr. Shukla and Dr. Moses.
Dr. Cabaj: We re continuing our integration efforts and many of you have sat in on some of the meetings. We are still working with Zialogic, ....
Ed; Zialogic sells Dual-Diagnosis. NO Cures. 2 Diagnostic Billing Codes instead of 1 is good Only for insuring that CMS does Not turn down claims from Behaviorists seeking Reimbursement.
..... and they ll be here at the end of the month, September 27th and 28th so we re excited about that. The plans are moving ahead around trying to find a consistent way of doing better billings so we can capture all services, whether it s a primary substance abuse, primary mental health, or combined service, and we still have our active change agents who are leading the forefront. .....
..... There s also an update on the Mental Health Services Act. As you know, we re starting to keep that in as a regular monthly update so it will describe I won t go over in detail because it s right in front of you there the numbers of adult, older adult, transitional youth, and youth that have been served in the Full Service Partnerships as well as the continuing expansion of outreach and engagement through our programs that are not specific one-on-one client programs but are peer drop-in and other programs.
Dr. Shukla: I think it s great that the numbers enrolled exceed those expected. My question is about ultimately the goal of improving health outcomes. And so in addition to the enrollments, do you have any numbers or any measurements on how well these strategies are working? It s great that these folks are getting enrolled, but are they getting better?
Dr. Cabaj: We hope. It s a little too early yet because the programs are not even quite a year old. In terms of engagement and enrollment, every client is tracked through this thing called CSI, which is Client Services Indicators. It s a state devised evaluation tool where you log in the information when you first work with somebody and any time there s a critical incident like being hospitalized or if they end up in jail, it has a required update. So we will know exactly how people are doing once we get this information, and that data goes to the State. We will have the information first, and we ll work with it to improve client services. We ll combine that data with a thing called Caloms, which I ve talked about here before. It s a new evaluation tracking system for the substance abuse side of the programs and they re very similar but there s not total overlap, of course. We should have some outcomes data within a few months. It usually takes a half year to collect something that s significant and takes a half year to analyze it, so we should have something soon for you.
Dr. Shukla: Great. My second question was is there any work being done on improving communication between all of these services?
Dr. Cabaj: What do you mean?
Dr. Shukla: Sharing of information. .....
..... It seems like there are these peer-based wellness centers, supportive services, vocational and rehabilitation services, violence, traumas. Is information shared between all of the various groups? I know initially there was a lot of discussion about improved communications, improved IT systems between the medical centers, the outpatient services, and the housing services. Has there been any work done in the last year on that?
Dr. Cabaj: There s a regular weekly meeting of all the evaluators and program managers of each of those programs, and they all get together in a room with our coordinator, Deputy Director Alice Gleghorn, whom you ve met, and Maria Iyog-O Malley, who s coordinating the Mental Health Services Act work. I think it s once a month, that all the programs get together themselves to share what s going on. And I think I mentioned here previously, that we created an every other month Oversight Committee for the Mental Health Services Act.
The biggest communication gap is still electronic. We re working on that. As you know, our own system is primitive, to say the least. We re getting a new system within five years. I know that sounds forever but it s not very long in the scope of things. We ll have a brand new system. We ve been starting to use a thing called CliniciansGateway, which is an electronic clinical record tool that includes the CSI and other evaluation tools. So they have a little more electronic communication. I don't know if it s in any other part of our system, but it will get better within the next few months or half year to year. I hope that helps somewhat address the communication issues.
I think the rest of my report is looking at some of the things coming up. In regard to our Workforce Training program, the State has given us some clear guidelines but we still have to submit a plan. Most likely the money for education and training and workforce development won t be available until January. In terms of the Prevention and Early Intervention component of the Mental Health Services Act, the guidelines are not entirely clear.
In regard to our housing efforts, the State has given out such little money to the counties, and they ve made the application process so complicated that many counties are not even going to bother. But we will see what we can do to make sure we maximize whatever we get and that could also help support some of the housing I mentioned earlier that could be used in the BayView and other areas. The information and technology efforts are still very far down the road and innovations are so far off the screen they don t even talk about it.
One nice thing is the Oversight and Accountability Commission, if people remember, that s a Governor appointed body that reviews the Mental Health Services Act and has the specific power to approve prevention, early intervention, and innovation dollars.
Ed: 1 in 15 young adults being Made Miserable enough with Pharma’s garbage drugs to be DSM Seriously “Diagnosable” Still isn’t enough. This piece of funding grubbing SSI, SSDI, Medicare & Medicaid Breaking Stupidity is the State Legislature's Mental Health Services Act in action.
And Every Child they Do Catch, Dual Diagnose and Drug will be Integrated with:
State Police registration for the murders the FDA Knows their drugs cause, and Paperwork through Zialogic tagging them as Incurably Sick in the Head times Two.
..... Dr. David Patting, I don t know if people know him, he s an addictionologist and physician at Kaiser, has been appointed to this commission, and he s been very engaged. He s come to our Oversight Committees and he wants to meet regularly. So we feel we ve got a very nice San Francisco voice in this area which we hope will help.
And then there s a lot of training events coming up, but I ll leave that up to you to read and review. We re excited about the ongoing training efforts that we do for our county.
The Full Service Partnerships with the Children, Youth and Families Division of Family Mosaic Project are working in collaboration with Seneca in doing an intensive wraparound to have children and families stay in the community and work. This is based at Family Mosaic, which is in the BayView, but no BayView based program applied for the Mental Health Services Act dollars in the Request For Proposal (RFP). So again, you can t award services except to people who apply to the RFP.
There was also a request at the last meeting to show where people who are treated in the Full Service Partnerships live. We have 192 clients and we looked at where they said their zip code of origin was or if they were homeless. This would give you information on our Full Service Partnerships so maybe you can make a copy of that and we ll distribute that later. What I handed out is a list of all the programs just by zip codes that are in the southeast sector of the city, so they include everything, no matter what the funding is.
The first table was done by the Child, Youth, and Families program. The second set of information is all of our programs. As you can see, there s a good number of mental health subsidies and dual programs throughout, but very little or no residential programs except Jelani House, and that again has been partly a question of geography and partly of affordable housing. Many people targeted what was perceived as the homeless areas first for housing like the Tenderloin and the Mission and South of Market. And as we certainly have learned with the Homeless Outreach Team and others, there s a huge homeless population in the BayView in the parking lots and under the highways there. So we hope to extend the study of this issue, but this again is dependent on future funding. But this list is relatively comprehensive as of this afternoon.
Dr. Moses: I know you mentioned the Jelani House, and of course Jelani House is just for women, right?
Dr. Cabaj: And children.
Dr. Moses: And children. But our concern is there are no residential programs in this part of the City.
Dr.Cabaj: I hear you,
Dr. Moses: And I know you keep telling us you re going to do something about it. You know, we just want some action. It s unfortunate that not too many programs apply for the funding. I wish there is something that could be done about that. I know you can t force people to go into a program, just like you can t force anyone to drink water. .....
Ed; So HOW does one Define Force? Does DEFRAUDING a Lobotomy into people constitute Force?
Dr. Cabaj: Exactly.
Dr. Moses: But, you know, something needs to be done.
Dr. Cabaj: Sure. Any new monies we get will be used to address this issue. We hope and we encourage people to apply. I can t go to a particular program and tell them to apply because it will look like favoritism. But we offer training on how to fill out RFPs. We want to encourage even a smaller organization that may not have felt they had the wherewithal to do it to help them apply. So we ll keep looking at it as the months go on.
Mr. McGhee: When you say it looks like favoritism, it seems to me that community outreach allows you to help organizations with the process. It s not favoritism. And I always have a problem when someone says that well it looks like favoritism. We know that there are some organizations that are not as sophisticated as others. We talk about taxpayer dollars, and people in the BayView pay taxpayer dollars like everybody else. So I think when you re talking about educating any community and community outreach, for example, a proposal just came out from the San Francisco Public Utility Communication (PUC) on community outreach, So why can t you do, for example, a workshop in the BayView Hunter s Point area on community outreach? Does this contract state about not working with small micro businesses and community outreach so they re aware of the process of the PUC? To me, and I m not just talking about the BayView, in general, community outreach means every area in San Francisco . So, if you see an area that s not participating, then you have to say there s a reason why and it s up to me as an employee of the City to investigate why you aren t participating when it has such an impact on your community.
Dr. Cabaj: 1 know what you re saying makes sense. I just am saying what the legal counsel s told me. What I do is make sure that when notices go out, every program that we re aware of receives them, and I ask people to think of programs that aren t necessarily listed, and find a way to get to them. And the mailing has to come from the Office of Contracts because if it looked like I was doing it, it might be perceived as favoritism. I m supposed to be the ultimate decider of the RFPs so that s one of the reasons I can t say much. The idea of a workshop is great. We did that with the Mental Health Services Act and it did help people learn how to work with RFPs. We ve done trainings for peers and others who ve never been on an RFP review panel; so they can also help with selections. We ve been trying to make sure we get the broadest base of people that can help in the selection process.
Ms. Brooke: Is it possible that the Mental Health Board be notified when the RFPs come out? I get a few here and there if somebody sends me one, but I m not on the regular list. And then maybe as a board we can be part of that process to let more organizations know.
Dr. Cabaj: Sure. That s a good idea. Just call Jackie Hale, and ask to be placed on the mailing list.
Mr. McGhee: Maybe we can do a workshop.
Dr. Cabaj: Sure.
Mr. McGhee: And then invite a city partner to come out and talk about how to get more involved.
Dr. Cabaj: That s great.
Mr. McGhee: And if you can t do it, then we can definitely do it.
Dr. Cabaj: Well we can help with a workshop. I just can t call the individual programs to apply.
Mr. McGhee: Sure, we understand. But I m just saying try to come up with the mechanism that will allow you to get more information out to the community.
Dr. Cabaj: Absolutely.
Mr. McGhee: They need that information. And if you can t do it then the board can talk about it.
Dr. Turner: Board members also can call places.
Ms. Brooke: If they come to me, then I can let people know.
Dr. Turner: Maybe we can come to a workshop.
Dr. Cabaj: It s a good time. Because of the interpretation of how long a contract is allowed because of county counsel, we ll probably end up doing a lot of RFPs soon for every service again. So that would be important if you came.
Ms. Kellum King: Thank you for this information, Dr. Cabaj. I have a concern because I live in Visitacion Valley, and if anybody s looked through what you handed out, there are only two programs in the 94134 area, where 94124 is full of programs. And we still have that turf issue. I think that it should be brought to the attention of CBHS that more programs are needed in the immediate Visitacion Valley area.
Dr. Cabaj: I included that map, which I don't know if it s exactly up to date, but again, it is glaring how some areas obviously are lacking in services.
Ms. Kellum King: It s true in many ways.
Dr. Moses: One question in regard to Item 6 in your report. I remember when Zialogic came here years ago, and I was around when their contract was awarded. Since we are talking about cost effectiveness, how does their contract stand?
Dr.Cabaj: We review every contract regularly. What we ve actually done is cut their contract year after year because we ve decided they ve helped us so much in the beginning but now a lot of it comes to us. So they more or less give guidance and check in periodically. They used to come monthly, now they come quarterly. So we ve reduced the contract dramatically in the last few years, and I said to our coordinator of the programs, Dr. Gleghorn, that this may be their last year. At this point we should absorb the ability. But we think they have been cost effective, both not only in shaping programs, but giving us guidance on the billing and other revenue issues. So we believe we ve been able to capture revenue in areas where we might not have done so without their help. So if we just look at it from concrete dollars that way, there s been some help. But in terms of getting a program design, it s hard when you re working in your own box, so they helped us look outside of the box, I think.
Dr. Moses: I just think it might be a good idea to see if we can find some money to provide real residential services to the BayView. They need it.
Dr. Cabaj: We are going to have another big meeting soon.
Dr. Moses: The fact that there are no FSPs in Bayview/Hunter s Point, a very important part of the city, is concerning.
Mr. Hines: I was going to piggyback off what Mr. McGhee was saying about us reaching out to these people. What if we formed a committee specifically for that, to reach out to communities that we are not getting a hold of, and that are not applying for these options and these RFPs. What if we had a committee of three or four people on this board that, once a month went out to different areas and I don't know how plausible this is, but went out to different areas and talked to these people about applying?
Ms. Kellum King: On last Friday night, just before the 11 o clock news went on, there was a flash that there was a post-traumatic stress disorder (PSTD) conference in Visitacion Valley the next day, which would have been Saturday. Well I looked all over Visitacion Valley where I thought it might be, and I wondered did you have any knowledge of any such conference?
Dr. Cabaj: No, I wasn't aware of that one.
Ms. Kellum King: It was going to take place on Saturday. So I went to the community centers, because if something is taking place in my community surely I d like to know about it, and neighbors would like to know. There was just that flash in the news, and I called someone and they said they had gotten an email the day before. They knew a Dr. Mills was putting it on but they didn't have a clue where.
Dr. Cabaj: Sorry, I didn't know it. There s a lot of focus on PSTD now, as you see.
Ms. Kellum King: Right, but serve the people who need it and who can use it.
Dr. Cabaj: Right.
Mr. Purvis: It d be very hard to go out just cold to talk to individuals. So do we know what s out there? I mean, a list of programs or even beginning programs?
Dr. Cabaj: The City keeps a list of all contractors or anyone who s potentially interested in providing a service to the City. We do not know about anyone who s starting up and hasn't had formal contact. If anybody calls me to say, I d love to help provide services and they ve not been a prior contractor, I immediately hook them up with the Contracts Office because they have to do a whole lot of pre-work. We will do what we can to help shepherd a new program. We can help teach them how to become Medi-Cal eligible; how to make sure they have their staffing patterns right, and other procedures and tactics.
Ed; Tactics as in making 2 Psychiatric Hospitals and their Staffs NOT EXIST.
So we do a lot of work with new organizations. For example, we re trying to work with the Lighthouse for the Blind. They ve been very interested in becoming a mental health clinic. They ve noticed that many of their older adults with vision impairments are very depressed and they ve been afraid to go somewhere else for care because it s hard to maneuver. So I would love to bring the care to them. It s right around the corner. So we re looking at a brand new way to shepherd them through a process of learning how to be a mental health program. But then they d have to apply for an RFP for services when that comes out.
Dr. Moses: On the positive side, I just want to thank you for compiling this information, and going out of your way to put it together for us.
Dr. Cabaj: Thank you.
Dr. Turner: Thank you Dr. Cabaj.
Monthly Director s Report
September 12, 2007
September 12, 2007
1. AB 2034. As is well known, the State Budget was passed quite late this year and included continued funding for AB 2034, a program that serves over 120 mentally ill, homeless clients in San Francisco with a budget of $2.8 million. The Governor "blue penciled" the program--that is, he specifically cut AB 2034 as a line item deletion--even though days before he said he would keep it in the budget. The Governor says he recognized the importance of that program but there were other ways to fund it, including MHSA funds. However, legal opinion--even noted by the Governor's staff--is that MHSA cannot be used since that would constitute supplantation and that the cut itself may be illegal since it cuts funding that was in place at the time of the Prop 63 passage and breaks the laws intent of expanding mental health services. There has been tremendous outrage across the State in reaction to this cut. The California Mental Health Directors Association is working with the State Department of Mental Health to see if there can be some emergency bridge funding from unspent MHSA funds held at the State level--with language that would allow the funds to be used without it being seen as supplantation. There is also talk of a lawsuit against the Governor. In San Francisco , Dr. Katz, the Director of Public Health, has said that we can keep the program going on general funds dollars until the resolution is reached about other funding sources. We cannot take new clients into to the program or hire into any vacancies, however, until the funding is resolved. For now, there are 120 clients in the program and their services will continue as they have been before the cut.
2. Substance Abuse Prevention Services Strategic Plan. The City and County of San Francisco submitted a five-year Substance Abuse Prevention Services Strategic Plan to the State Department of Alcohol and Drug Programs. The Strategic Plan is a result of a two-year community planning process that involved youth, families, public agency partners and community-based providers. The plan provides a broad framework that will guide S.F. substance abuse prevention services. The plan is designed to be a living document that is responsive to new challenges that may arise in substance abuse prevention, such as the recent methamphetamine epidemic. There are four major focus areas under the plan based on an extensive community needs assessment conducted during the planning process. These include reducing youth access to alcohol and other drugs, changing norms and increasing public awareness of alcohol and other drugs, empowering community and promoting environmental change, and building system capacity. Substance abuse prevention providers will be asked to meet new objectives in Fiscal Year 2007-08, such as engaging young people twice per year to better understand youth attitudes toward alcohol and drugs and conducting an inventory of current practices to determine the most promising practices in preventing substance abuse.
3. CBHS Budget News. A new initiative was included in the FiscalYear 2007-08 Budget. Walden House will provide residential treatment services to 30 juvenile justice involved youth (20 boys and 10 girls). Youth will be referred for services through the courts. The Walden House program was funded in addition to residential treatment offered through Edgewood Children s Center.
4. 07-08 CBHS Outcome Objectives. I am pleased to announce that this year's CBHS Performance Objective Planning Committee led by CBHS CYF Director Sai-Ling Chan-Sew completed the final document of the CBHS Performance Objectives for FY07-08. Much appreciation is deserved by all who served on the Performance Objective Committee, for staying with the process and providing valuable input and guidance, as well as data collection and analysis, towards the development of the final document. Thank you also to Karen Strickland from Golden Bear, who facilitated and wrote the drafts of the document.
One of the important changes we will implement this FY 07-08 is to conduct a system-wide evaluation to collect client level outcomes using a random sampling method for all clients receiving service from CBHS. This evaluation will be conducted jointly by CBHS Evaluation and Quality Management staff for this new fiscal year, with input from providers. This system-wide evaluation recognizes that while it may be difficult to measure specific outcome by individual providers, we need to have information on the impact of our services, collectively as a service system, on the lives of our clients.
Another significant change we made this year is to separate quality improvement objectives, from compliance objectives, and from actual performance outcome objectives. The result of this delineation is a more concise document (13 pages vs 25 pages for FY06-07).
Please let Sai-Ling know if you are interested in participating in our next planning
effort for the system-wide evaluation. She can be reached at (415) 255-3439, or at
effort for the system-wide evaluation. She can be reached at (415) 255-3439, or at
5. Standby/On-call CBHS Staff Needed to Assist Families of Victims of Violence. As you may well be aware, the needs of families impacted by violence continue to rise. Presently, we have a CBHS Violence Response Team that was created several years ago in collaboration with Community Programs and the Child Crisis Team. This Team, over the last two years, has responded to the needs of hundreds of families, including providing immediate crisis trauma support, as well as case management follow-up.
I am asking interested CBHS clinicians and other civil-service staff to volunteer to help us to respond to the needs of families impacted by violence. We especially need help during the most troubled times evenings and weekends and often in specific areas of the City the Western Addition, Bayview, Hunter s Point, Visitation Valley and the Mission. We would like volunteer standby responders to strengthen the Violence Response Team's efforts, and I am seeking civil service staff who would be especially sensitive to the racial and ethnic issues for the communities at risk in these different parts of the City. Staff who have training in trauma-focused and crisis intervention training are especially encouraged to apply, though training will be provided to all of the volunteers.
Stand-by responder volunteers will be organized into a schedule that matches the needs of the community. Civil-service standby staff will receive on-call/stand-by pay and, if called in to help, receive compensation for the additional work as outlined in the particular MOU for the Union they are covered by. The on-call/stand-by will be for evenings and weekends (usually 7:00 pm to 7:00 am plus 7:00 am to 7:00 pm Saturdays, Sundays and holidays) and will be scheduled at intervals that will not disrupt the ability to work at regular job and duties.
I have asked Edwin Batongbacal, Director of CBHS Adult/Older Adult Services, to organize the volunteer efforts and he will work with Charles Morimoto, Deputy Director of Community Programs and supervisor of the Violence Response Team, and Sai-Ling Chan-Sew, Director of CBHS Children, Youth and Families Services and supervisor of the Child Crisis Team. Please contact Edwin's assistant Antonio Trink at email@example.com to express your interest (please include the name of your immediate supervisor). Thank you for considering volunteering to help the Violence Response Team.
We are also piloting a collaboration with Walden House to have similar standby/on-call responders to provide immediate crisis support to families and loved ones of victims of violence.
6. CBHS Integration. Zialogic will conduct their Quarterly visit on September 27-28, 2007. They will present at the System Orientation Meeting and meet with the Change Agent Leadership group at the Ba Hai Center on Thursday, September 27th.
Ed; We haven't blogged the Ba Hai yet, but they Will get their proper due from us as supporters of the United Nation's Eugenic, Global Population Reducing Agenda 21.
In the afternoon, Zialogic will meet with CBHS committees at 1380 Howard Street. Additional meetings with Integration committees are scheduled all day for Friday, September 28th at 1380 Howard Street. For more information, please contact Kathleen Minioza at 415-255-3585 or email firstname.lastname@example.org
7. Mental Health Services Act (MHSA) Update.
COMMUNITY SERVICES AND SUPPORTS (CSS)
CBHS has conducted preliminary data analysis of the community services and support program funded by Mental Health Services Act (MHSA) in Fiscal Year 06- 07, and is pleased to announce that the total targeted enrollment rates were exceeded for the Full Service Partnerships (FSP) and Housing Service Partnership (HSP) programs. Eight FSPs were funded and all of these initiated services during the fiscal year. CBHS had proposed that 203 clients be enrolled across all the FSP programs during the initial year of services, 236 individuals were actually authorized during FY 06- 07. Two age groups (Adults and Older Adults) exceeded the targeted enrollment rates for the year (109 enrolled vs. 81 targeted, and 52 enrolled vs. 34 targeted for adults and older adults respectively). Through the Housing Service Partnerships, 32 clients received housing out of a targeted 30. General System Development funds were used to initiate 13 new programs to meet priority needs identified through an extensive community planning process. A grand total of 987 were served across a range of service programs including 736 at peer-based or wellness centers, 133 receiving supportive services to access of maintain housing, 32 participating in innovative Vocational Rehabilitation services, 28 in Violence/Trauma Recovery Services, 24 receiving culturally competent services targeting Gay, Lesbian, Bisexual, Transgender, Queer and Questioning (GLBTQQ) Asian youth, 16 enrolled in dual diagnosis residential treatment, 12 Transitional Age Youth (TAY) living in transitional residential housing, and 6 TAY receiving behavioral health services in primary care settings.
Congratulations to all the MHSA funded programs for their success in implementing these important new services!
WORKFORCE DEVELOPMENT, EDUCATION, AND TRAINING
The next meeting of the Workforce Development, Education, and Training Committee will be held on Thursday, September 20, 2007, from 12:30 pm to 3:00 pm, 4th Floor Conference Room, 1380 Howard Street. The Committee will convene to discuss final recommendations for the San Francisco Three Year Plan, to be submitted to the Executive Team for its approval and then to the State for its consideration and approval. If you have any additional recommendations or new comments, please e-mail them toProp63@sfdph.org
PREVENTION AND EARLY INTERVENTION
We are in the early stages of recruiting members to be on the planning committee for the Prevention and Early Intervention component of the Mental Health Services Act. Some strategies and priority principles already identified include stigma reduction, recognition of early signs, and outcomes and effectiveness. Please consider joining us, as we begin forming the basis for our formal recommendations, to be submitted to the State later this year. To join, leave a message on the Prop. 63 phone line at 415-252-3084 or contact Kevin Ledbetter, MHSA Administrative Assistant, at (415) 255-3513.
Negotiations are currently underway with the Mayor s Office of Housing and the San Francisco Redevelopment Agency to come up with a viable projects and develop an RFP/RFQ for agencies interested in applying for the housing monies being released by the State this year. More information will be forthcoming as this process moves forward.
We are now soliciting for recruitment of consumer participants for the Planning Committee, to be initiated sometime this fall. To join, leave a message on the Prop. 63 phone line at 415-252-3084 or contact Deborah Vincent-James, Information Technology Manger, at (415) 255-3635
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 date and location of the December community forum has yet to be decided, and will be announced at the October Advisory Committee meeting. The next scheduled meeting is as follows:
Thursday, October 25, 2007
Advisory Committee Meeting
1380 Howard Street, 4th floor conference room
8. Other Upcoming Events:
PERINATAL SUBSTANCE ABUSE: Motivating Patients (and Providers) for Change Friday, September 21, 2007, 8:30 am 1:00 pm @ Hiram W. Johnson State Building Conference Center, Ken Saffier, MD, Addiction Medicine Specialist.
ANNUAL CBHS SYSTEM ORIENTATION - Thursday, September 27, 2007, 8:30 am - 12:30 pm @ Ba Hai Center , 170 Valencia Street. This annual training is designed to provide CBHS, DPH and other county department personnel, both clinical and administrative, with an overview of CBHS mental health and substance abuse services. This is an excellent orientation for newer staff and interns. Come learn about what services are available, how to access them, consumer involvement and an introduction to administrative requirements. To register for this event, fax your name, organizational affiliation, e-mail and/or fax number to (415) 252-3057. Or for more info, call (415) 255-3553.
A FORUM ON THE RECOVERY MODEL AT WORK IN CBHS - Friday, September 28, 9:00 am - 12:15 pm @ Ba Hai Center , 170 Valencia Street. Keynote Speaker is Bob Cabaj, MD, CBHS Director. Moderator: Jennifer Baity Carlin, LCSW, of San Francisco Behavioral Health Center. Celebration of Recovery Month to follow at Glide Memorial, 330 Ellis St., @ 2:00 pm
THE IMPACT OF SUBSTACE USE ON THE BRAIN AND BODY by Jennifer Baity Carlin, LCSW, October 5th, 9:00am 5pm @ Ba Hai Center , 170 Valencia Street
To register for these trainings, please contact Norman Aleman, CBHS Training Coordinator at 415-255-3553 or email email@example.com
Past issues of the CBHS Monthly Director s Report are available at:http://www.dph.sf.ca.us/CBHS/default.htmTo receive this Monthly Report via e-mail, please firstname.lastname@example.org.
1.1 Public comment relevant to Item 1.0
There was no public comment.
Item 2.0 URGENT CARE CENTER
2.1 Presentation: Urgent Care Center, Liz Gray, Director of Placement, CBHS, Steve Fields, Executive Director, Progress Foundation, Dr. John Nikens, Director of Clinical Services, Progress Foundation, Erin Williams, Deputy Director of Clinical Services, Progress Foundation.
Dr. Turner: It s great to have Steve Fields here. Steve Fields is Executive Director of the Progress Foundation. I was hoping Dr. Katz would talk with us as well so that he might be able to answer our questions, since he developed the Urgent Care Center. Unfortunately Liz Gray was not able to be here this evening because she is honoring Roshashana.
Mr. Fields: Hello, good evening. It s nice to see many of you again. Some are new. With me is Dr. John Nikens, the Director of Clinical Services at Progress Foundation. He s been in that role with me for 25 years, and Erin Williams, who s a Deputy Director of Clinical Services, who has been in charge of our Acute Diversion Programs, where we have provided one level of care in San Francisco since 1978. Our Diversion Evaluation Team goes into San Francisco General Hospital s (SFGH) Psychiatric Emergency Services (PES) component and the hospital to work with staff there on diverting and getting people out. Ms. Williams will be the deputy in charge of the Urgent Care program. She and Dr. Nickens are here also to answer questions.
What I ll do is give a brief overview because I think probably the most important thing would be then to get to the questions that you have that aren t answered by my presentation. I have a write-up here that describes the Urgent Care process. I ll pass it out after I m done.
Progress Foundation, for those of you who don t know us, has been a contract provider in San Francisco since 1972. We started in 1969 before we developed our first contract. The agency s focus of service is to offer alternatives to institutional treatment. We started with what would be conceived as the old classic halfway house back in 1969. Since that time, our services cover Acute Diversion Units, which, those of you who are familiar enough with the system are represented by La Posada, Portland House, Schrader House and Avenues, which take all of their referrals directly from the PES at San Francisco General as a diversion from inpatient or cleared.
There are 40 beds total in that system of services. The most recently opened program, Avenues opened in 2000-2001. The second level of care is transitional residential treatment. We have La Amistad and Progress House that have been around a long time. And we have a seniors' residential program, and Carroll House that serve people in a social model. These are all recovery-based or rehabilitation-based interventions for people 55 and over. We have Ashbury House, which is the first program in the country for mothers diagnosed with a severe mental illness; so the children live with the moms while they go through up to one year of treatment. And we have Clay Street, which is a program that serves people coming from the Institutions for Mental Disease (IMDs) or being diverted from going into the IMDs. That s a one-year transitional program with that particular focus. Then we also have an array of what we call satellite apartments or co-op apartments, which are shared living. It s supported housing before the term was discovered by mental health, at least five years ago or whatever. We ve been doing co-op apartments since 1969, which is shared apartments by three or four clients. We provide 24-hour-a-day, 7-day-a-week case management support to the residents in those apartments. I think now we have something like 17 apartments.
The third thing we ve done since 1990 is build permanent supportive housing through the United States Housing and Urban Development Office (HUD). We have four buildings in the city that we have built that are affordable housing for the maximum stabilized level of service. Again, we offer case management to residents there if they want it. If they don t want it, it s not a condition of being in the HUD housing.
So that s the array. I think outside of looking at underserved populations such as women with children and seniors, most of our emphasis as an organization since we developed the first Acute Diversion Program, La Posada, has been looking at where people are at risk of being institutionalized and trying to develop a community-based service that whenever possible diverts people from or gets them out faster from institutional settings. We believe community-based services when they re done right are the best places to serve people; and the resources of inpatient services, particularly. They are valuable resources that are not growing financially and in other ways, and we need to use them in the most efficient, targeted way possible so whenever a community alternative can be developed, that they can take the pressure off. This makes sense.
I think we developed the first Acute Diversion Program (ADU) in the country at the level that we have, working with people referred by Psychiatric Emergency Services (PES). And when we first proposed it, nobody thought it was a good idea except me and a few people who were crazy enough to go along with me. I think the Mental Health Board in those days actually voted against it because it was too risky a thing to do. I didn't have a lot of support, but we did it and the ADUs now are a central and important part of our community treatment system because they ve proven that the premise behind them, and I would add because of the support of Dr. Nickens and others, the competency of our organization proves that when we re proposing a program we generally aren t out in left field making things up out of nowhere.
To cut to the chase, for at least eight years I ve been proposing to different mental health directors and to different health directors and to different health commissions the idea that we should look at doing a community-based emergency capability to take the pressure off Psychiatric Emergency Services (PES), that that service should have logistics working in its favor. Meaning that it should be connected to an alternative, an ADU, right in the same building just like PES is connected by an elevator ride to the inpatient units; so that if we want to divert, we should have the opportunity for the assessment and triage to occur whenever possible in the setting that you d like to be able to refer people to if you can possibly avoid hospitalization.
It hasn't necessarily been an idea that has caught fire for a lot of reasons that I ve become familiar with throughout my entire career. I ve spent a lot of time in the public mental health system, a lot of time analyzing what we do wrong and what we could do better and a lot of time developing programs that actually put our money, I guess you d say, where our mouth is and trying to do things that actually change systems.
There are a couple of circumstances that we could spend a day s seminar on that have made it important to look at the proposed ADU model again. First one is that for at least a year and longer, somewhere around 60% of the people on psychiatric acute units do not qualify for the full acute rate. They ve been on what s called administrative days. I don t have time to explain that all to you in this meeting, but it s a lower rate than the full acute rate for Medi-Cal. So we have our most expensive, important service for the people who need it, whereas as much as 60 %, and that s a low estimate on some days, of the people in those beds are not by Medi-Cal review. There s no fault in this except I would add there s a systemic fault. We could have been addressing that and we should ve been. It is not right to have people in an involuntary setting who don t need to be there, whether it s one or it s 30. 60% of 82 beds is almost 50 beds. So we have that problem. We have the backup that contributes to that problem, waiting for IMD beds. You have the question of whether or not there needed to be an admission in the first place, depending on how tight we are at the PES level about diverting whenever we can.
Ms. Brooke: Could you not use acronyms? Not everybody understands them?
Mr. Fields: Oh, I m sorry. Do you want me to use the full word every time? PES is Psychiatric Emergency Services and ADU is Acute Diversion Unit. IMD is an Institution for Mental Disease, .....
ED; So now we have an Institution for Mental Disease, which isn't actually disease except for theEmotional, and Physical Brain and Whole Body Damage that Mental Health drugs Cause when they're Defrauded/Poisoned into a person.
..... which is the billing terminology for skilled nursing sets, mainly out of county, but we have one here that s now called the MERC, the Rehabilitation Center.
So that reality plus the pressure hitting PES, the Psychiatric Emergency Services, that creates the red alert situation, the backup in that center, then the frustration of the police and an ongoing story that waves through us on a regular basis is a problem. I believe that we can develop a community-based psychiatric service that could shortstop people who are on their way to PES, get a full triage assessment capability done, not at PES in the hospital but in the center, a voluntary setting, with beds there to refer someone into an Acute Diversion bed right there in the same building; so that we have a 24-hour capability. If we keep doing the same thing we re doing over and over, we re going to keep getting the same results, which is beds backed up in the hospital because we still haven't moved people out fast enough who don t need to be there, thus not having beds available for people who, when they get to PES, are acute and relying forever on a relatively un-expandable, high cost service that if we just kept opening inpatient beds it will eat up, disproportionately our mental health budget over time. I think, because we ve had a great partnership with the hospital since we opened La Posada, and I think an even better one in the last eight or ten years, that the hospital agrees with the idea that we re not going to double the unit. We re not going to add beds to hospitals, we re going to have an increasing complex set of issues hitting us as a system, with a need to make sure those 82 beds are used in the most efficient way. And no matter what else we say that we ve all participated in, they re not used that way now when 60% of the clients are not even qualifying. One way to do something about it is to try and divert that emergency admission in the first place.
So I put a proposal together again. I already had one but I updated it, and met with Barbara Garcia, Liz Gray and Dr. Katz to present the idea of doing this; saying now is the time. I would have thought it would have been a great Proposition 63 program, but there was only $80,000 in the whole allocation for residential treatment. So even if someone in the BayView or other community wanted to apply, that s not enough to open a treatment program. Residential treatment actually got the least amount allocated to it.
So I presented it and it got rolling. The choice then that Dr. Katz made and I m not saying this because I am distancing myself from it, but it was not my proposal to fund this new program through closing 14 acute inpatient beds and shifting the resources from that to this program was his call in consultation with Community Behavioral Health Services (CBHS). I will say I agree with it, but I didn't propose it. I agree with it because I think it s a sound and conservative step to take.
There are a couple of things about the program that have been misunderstood that I want to clarify, and I take responsibility for them. A). I apologize for not coming to you sooner and talking to you about it. B). There s a lot of misinformation out there that I probably could have helped clarify. I want to make sure if we disagree, we disagree over the right thing. There is not a unit being closed at San Francisco General Hospital. There are 14 beds being reduced. A unit is 22 beds. There s no decision made to close the Asian Focus Unit or the African-American Unit. In fact, Gene O Connell, the Executive Director of the hospital has said as much to me. That s not what they re doing. There are 14 beds being reduced out of 82 in order to shift the resources to this project. Those beds will not be reduced until this program opens. So if it takes us until June to open, the beds aren t reduced until then. And there s been a lot of misinformation, for whatever reason, out there about how precipitous this is or this isn t. The closing of the beds is meant to be segued into this program.
The program is designed now as a 16-hour urgent care program. The drop-in triage PES piece is between 6:00 a. m and 11:00 p.m. And the reason for that is both caution and finance. When we looked at designing the program and I met with Dr. Katz about designing the program,we looked at our own curve of frequency of people brought into PES, and by far the lowest time that people are brought into PES is after midnight up to 6 a.m. The peak is during the day. So there s a cost efficiency issue of staffing an alternative PES sitting there from midnight to 6:00 a. m., and getting maybe three, four or five people brought in. So we re opening smaller, and if it proves that it works and we need to expand it, it s easier to add hours than to go the other way and open it 24 hours and have people drain the resources and have people sitting around. So it s a 16-hour urgent care program with a 24-hour acute diversion residential treatment program attached to it. .....
Ed: Is THIS some of that "lot of misinformation, for Whatever reason" they're on about?
Because THIS says they're not only 24 hour, but they're the ONLY 24 hour PES in SF.
...... We ve been doing a lot of talking to Mobile Crisis, to PES, to Westside Crisis, and we identified at least two, we hope three, of the community-based programs that have the highest number of people who are brought in on 5150s so that we can put our program in the pathway reliably of the highest utilizers of the 5150s, the premise being a community clinic knows somebody is heating up and getting more and more agitated.
You cannot call the police when they re just being agitated. You have to wait until they can be 5150 d and brought into PES or the police will just go away. You can t do a 5150 until you have the basis for it. But at this stage, we are able to identify people who are close to being 5150 d. In another day they will be acute enough to be brought in. We re proposing that that person come to urgent care earlier, or first, as an example. Mobile Crisis feels another place to bring people where they can leave and go, where the assessment will be done and where they don t have to worry about a bed or an admission, will work for them too, and they ve been very supportive of this project.
There are a lot of questions to answer. There were a lot of questions when I proposed La Posada in 1978. If I d waited to answer every question before I got excited about a programmatic idea we wouldn't open anything new in the City. Everything Progress Foundation has done, frankly, I was told by the powers that be, you can t do that, that won t work, .....
ED; This is 1 of 3 members of the SF Progress Foundation at this meeting. And what are They worth?
Total Assets: $16,140,282
They’ve been in business since 1969. Refer back to Ca. State DMH Director Mayberg’s jpg
August 1, 2005
… US Justice Dept Officials accuse officials at Napa State Hospital of impeding its investigation into patient safety, …
Dr Mayberg, …. “the best patient care possible.”
CAUSE Statewide Law Enforcement Association: “We’ve known for years about the drug violations, beatings, rapes, and assaults that go on at all the hospitals,”
Description of Crisis Residential Programs
Progress Place est. 1982, is an 8 bed psychiatric crisis residential treatment program. This program is able to work with all adult and young adult age groups including Transitional Youth (TY), who are 16 and 17 and with persons over the age of 60. It is located in the City of Napa in Napa County.
So the Progress Foundation’s Also Johnny on the Spot, when drug violations, beatings, rapes, and assaults are going on in Napa, and Law Enforcement's known about it FOR YEARS, and the State DMH Director was Shocked and Amazed that anyone would question his “best patient care" that America’s money can be wasted on, ..... gets questioned, ..... by law enforcement.
ED; and BTW, the Progress Foundation boasts of its Grievance Procedure complying with SF C&C's Grievance Procedure.
Our San Francisco programs follow the San Francisco County Pubic Health Department, Community Behavioral Health Department grievance process. A copy of the policy can be obtained by contacting CBHS at 415-255-3434 or athttp://www.dph.sf.ca.us/MentlHlth/CMHSPolProcMnl/3.11-03.htm. All programs inform clients of their grievance rights upon intake, and have grievance forms and envelopes and make them readily available to any client who requests them. They are mailed to Jim Gilday, CBHS Performance and Compliance Manager at 1380 Howard Street, San Francisco CA 94103 or call 255-3661
We'll take that at face value, because if it Does comply with the C&C of SF's Grievance Procedure, ...... well, ..... draw your own conclusions. This, is ALL the info clicking on the C&C's Grievance Procedure at SF General Hospital returned us.
The same response we got by clicking on SF General's link explaining Your, excuse us, Their, Medicare Monies.
And one of our perennial favorites: Link
And of course, they're also in bed with
This bought and paid for
PHARMA STORE FRONT: NAMI
CHECK NAMI'S MONEY:http://www.nami.org:80/Template.cfm?Section=Major_Foundation_and_Corporate_Support
Crap like this is a huge part of Why America's broke. Lost
productivity, skyrocketing Medicare/Medicaid Waste,
Fraud, and Abuse, and 1 in 15 College age Americans a Disabled,
Emotional Wreck, for Life.
Back to Steve Fields, Executive Director, Progress Foundation:
..... and I just don't listen to that anymore. I just try to solve the problems that need to be solved. There are a lot of questions to answer. But we're in September and the budget is based on opening at the earliest mid-January. We're not going to make that date because the site search is taking longer than I d hoped. So we have time to work with the police and the other system elements, to get the ADUs in place, to work with our major partner, which is going to be PES, around the threshold between us and them, and then to produce 14 acute inpatient beds. But remember, probably those 14 acute diversion beds are going to be people more acute, certainly more in crisis, than at least the 14 that are waiting on the inpatient list.
So I would argue we re presenting an exchange of beds that s at least at a higher acute triage contribution to the committee than people sitting on the unit waiting for an opening at a skilled nursing setting. That s what we re planning. There s no bad guy well maybe us, depending on how you feel about it there s no bad guy. We re trying to improve a system that s going to break even more if we don t try something different. And our experience tells me that this will happen if things don t change. If we can divert just 30% of the police calls going to us or being avoided altogether and instead of to the psych emergency, we will help the police out. There are enough people who should be 5150 d waiting, who are at that level who aren t 5150 d because we don t have another service to offer. They re waiting to turn into 5150s and we re proposing to target as much of these people as possible where they are and divert them quickly. So if we can cut 30% of the police workload, they re going to get to do police work. They re going to not be pressured to be a taxi service for psychiatric services and that s the working premise in our getting a probably complicated process, a cooperative arrangement with the police. So I ll stop there with that part and take questions.
Ms. Brown: Will this new ADU be able to seclude and restrain patients?
Mr. Fields: No. Like none of the existing ones do, it will not do that.
Ms. Brown: And since this is voluntary, do they have to take the medication that s being offered or do they have a choice?
Mr. Fields: They have a choice but they can refuse medications in involuntary treatment too. But they have a choice in our program.
Ms. Kellum King: Let s say my daughter has been ill for a few days, the agitation has grown and she s escalated and I bring her into that facility. Can you describe the level of care that would be provided for her and who will staff it?
Mr. Fields: Dr. Nickens can answer that question.
Dr. Nickens: The Urgent Care Center is staffed primarily by licensed medical professionals, psychiatrists, nurse practitioners, and licensed mental health workers, with the support of lay counselors to help do some case management. What happens is an immediate assessment and then a triage to determine what would be the best course for the person. But that s what the Urgent Care Center was for, rapid assessments, triage, onsite treatment and referral out, if that s appropriate, and referral into the crisis residential program, if that s appropriate.
Important early in the process, is both developing our own services that we have access to right now, the existing 40 days plus the new beds that we would have, and also in the process of developing MOUs and understandings with other providers at different levels the residential treatment level, hotel levels, supported hotel levels, and shelter levels and then also working closely with PES. So our intention is not to put people out on the street. Some people might go back home. It depends a lot on the assessment that was done and the person s capacity to self-manage in the setting where he s taken to.
Ms. Kellum King: When you say go home, like to the room they were living in or back to their parents home?
Dr. Nickens: Both.
Mr. Fields: Both, depending on what they wanted. They would need to want to go there and then the receiving home would want to receive them. But it would be their choice based on where they were.
Ms. Kellum King: So if the family says no to the patient coming back to their home, what happens then?
Mr. Fields: Then we have a dilemma to solve, which we will. We don t put people out on the street with that dilemma. One of the things about the new ADU beds is that they re two weeks length of stay, maximum. They re a rapid turnaround. Average stay has always been somewhere between 12 and 16 days, depending on circumstances in the system. Our working premise with the new 14 beds is it s as short as a one to five-day turnaround so that we keep beds open just for that one set of circumstances.
Dr. Shukla: I want to applaud your energy and your commitment to this field from everything you ve described with this program and all the other connected programs. I think they are really impressive. And I really appreciate this idea of a community-based emergency resource for these patients. I think it s a great idea. Where I m a little bit confused is the connection of your program that is starting, and the closing down of the inpatient locked rooms, and how those two have come together. In a way to me, they seem like apples and oranges. I kind of understand your logic in that there may be patients that are kept longer than needed; and so the idea is that by decreasing the number of beds there will be efficiencies created in the wards so that hopefully there could be better use made of those beds. But at a time when the psych wards are on red alert and most of the patients are on diversion, I don't know even if you find yourself in this sort of program with patients that you find really need that sort of facility and don t have the beds that are available to refer them. It seems that the connection isn t as clear and as obvious and as easy as just closing one down and opening this type of unit up.
Mr. Fields: I agree with you. Describing the efficacy and necessity for this idea is not wedded to the idea that it s funded by closing beds. But the money it takes to do something like this has to come from a capacity to find a large amount of funds even though the ADU beds are one-third the cost of inpatient beds. And so I can t speak to where Dr. Katz went in making his decision about how to fund it.
The system could do better. How about addressing that problem? I would argue if we d addressed it eight years ago, five years ago, three years ago, and come up with back door discharge capability for the hospital, then there would not be people clogging up the beds that make it look like there s no room for an acute entry. There should be room for acute patients. If we could just move 20, 25, 50, we could keep those beds open for acute admissions, my argument would be they may have empty beds for a while. We re opening a new program that s a replication of Clay Street that is targeted at IMD clients that will open on October 1st. It s been sort of under the radar. The idea is to help the hospital have a community-based place to send people that are otherwise waiting to go to long-term care, to help take some of the pressure off. This will be a 14-bed program seeing patients on a regular basis.
I also think we have to do more to assess why people don t move out of the skilled nursing settings faster. We do know they sit there even more inappropriately for months and months when they should be back in the community. So it is a kind of movement game where the real solution would be a systemic solution. Do this urgent care thing, try to focus the hospital s capability on what it s designed to do and get people who are sitting there into the IMDs by moving people out of the skilled nursing into the community. There are some people there who could be in supported housing, let alone another 24-hour treatment program. So I m not saying it s a direct connection but we ve got to start somewhere and this is where the pressure point is. I believe that if we start now, while we re developing this alternative, to develop solutions with the hospital and the skilled nursing settings about emptying out those beds aggressively that we won t by the time we open this new ADU with 14 beds, at least 14 acute beds will be available for more acute people in the hospital.
Dr. Shukla: I guess that s my point exactly, is that there doesn't seem to be a direct connection; yet it s been made explicit that there is a direct connection, that the services that are lost through the closing of these beds will be in some way compensated for by the opening of these services. And I don t see that direct link. This seems like more preventative-based early acuity, and get these, patients that are just going in that direction safer, versus the higher acute locked bed patients that maybe are coming in and need that higher acuity but maybe at the back end need to go out and have placement that s better. And so I m not sure that anyone s looking at that back end about the placement at the same time.
Mr. Fields: They are. Barbara Garcia and Liz Gray are looking at it, and how fast it moves and whether it moves. But the only thing that I would disagree with is that this isn t preventive. Who s divertible at 8 o clock at night out of PES when they don t have any beds left looks a lot different than who isn t diverted at 2 o clock in the morning if there are beds available on the unit. That s a reality of our relationship with the hospital. If there s an open bed it s usually going to get filled, whether it s a new resident or a patient already there. So what I m saying is we have the capacity to serve involuntary clients, but sometimes that s a specious distinction in terms of how acute somebody is. This new ADU staffing is much richer in the urgent care side, of course, than anything we have in our current acute diversion setting.
That I did not make the nexus and if somebody was misleading about that, it s only because the problem s more complicated; but I do believe that this program will have an impact on the number of people who would otherwise have been in PES directly that day. It s not just guessing who might be getting acute. This is diverting people. And that s why Mobile Crisis is pleased to have it because the only place they have to take people now is PES. And then there s a high chance that they might have waited long enough or the person s deteriorated enough that the only option is an inpatient bed at that time. And we re hoping that we ll head those very people off, 30% of them, to take the pressure off. That s the premise.
Mr. Purvis: I just have a question about the voluntary nature of this. It would seem to me if you re bringing in people just before they re ready for 5150, they re coming in on a voluntary basis. But aren t there a lot of people who just refuse to come in and if so, how do you deal with that set of people, people who are unwilling to come in?
Mr. Fields: Well there are a number of complications to that. First of all, we fully expect to be receiving people who ve been brought to us by the police who were held for transport on 5150. 5150 is a hold for evaluation methodology, as well as a post-assessment triage category, so that one of the things, the more subtle things, we re going to be working with the police on is bringing them here, and then we ll work with them and drop the 5150. That s the highest end of our intervention. The Acute Diversion Programs regularly deal with the resistance of going to any place at all and some people just won t go. But a lot of people do, and one of the things that s always made a difference, is that they see where the patients are going. The abstract is worse sometimes than the reality. So if they come into a place that s designed in such a way that it s meant to be inviting and responsive and done on a model, we find that involuntary decisions are sometimes reality- based decisions. I m not going there voluntarily. And we re basing it on our experience in the ADUs along that line too. You put your finger on one of the issues that s going to have to be sorted out as we go into the next several months of actually planning the implementation of this program. Some of these questions aren t automatically easy to answer.
Mr. Purvis: I ve been dealing with this personally for years. Thank you.
Dr. Moses: I want to firstly, commend the work Progress Foundation has been doing. My question is, with this new program you re proposing, how will you handle the revolving door issue, and also the program shelters, with people moving from one place to another? Do you have a plan for them on how to handle these kinds of situations?
Mr. Fields: On a resource level a revolving door in a step-down place takes pressure off PES, so we re contributing to the system. We re not going to worry too much about the revolving door except around the cost effectiveness of that being the only intervention. So to us, a revolving door, when someone comes back the third time, is an opportunity to insinuate a different choice in their life. It s a chance to engage the client sometimes when the first couple of times aren t as effective, if at all effective.
I would like to see more 24-hour options for people to continue structured rehabilitation and recovery, and we haven't really added any beds at that level of care in the system in a long time. I m hoping one of the ways to use this new program that the Department has put a lot of energy into, is as a leverage point for getting these other resources, to say if you want this to work, we ve got to have a place besides hotel rooms to send people to. But we re going to be in that system.
Ms. Kellum King: The Mental Health Board had a lot of concerns about what was going to happen to people once the PES beds closed. We sent letters to Dr. Katz, and the Board of Supervisors. Just in terms of the process, people didn't really get back to us and respond to us very much at all. We had very little receptivity or communication about our concerns and in fact, I think we were told that we were misinformed but not really given very much other information.
Mr. Purvis: Same with NAMI. We wrote letters and I ve never got this type of explanation that you ve given tonight.
Mr. Fields: I apologized when I started about the fact that I didn't anticipate some of this. So what I will say is I was not aware of any of those inquiries for more information. If anybody had ever let me know NAMI had a concern, or the Mental Health Board had a concern, put aside the fact I should have thought of you, I d have been at any meeting you needed me to go to. I think we have some work to do with CBHS and the Department of Public Health (DPH) about coordinating information, and not creating these misconceptions. Like I said, if we re going to have disagreements let s disagree about the facts on the table and not let you have to make up what you think you know and not get answers. So I apologize.
Dr. Shukla: I just had a couple logistical questions in terms of where this urgent care would be located, what s the anticipated opening date and what sort of ancillary services like laboratory, urine tox screens, medications would be available?
Dr. Nickens: The Urgent Care Center will have laboratory services available, will have full medication services available and will be connected to the systems that Dr. Cabaj talked about that are electronic. These would give caregivers access to medical records of people being treated, so that their status could be assessed what medications should be prescribed, do they have allergies, etc.?
Dr. Shukla: That s San Francisco General Hospital s medical records?
Dr. Nickens: It s the Department of Public Health records.
Mr. Fields: We re looking for sites. Because we re attaching a residential treatment program to what s being termed a service or clinic model, there are zones that won t even let us apply for a conditional use permit for the urgent care piece. We re looking at different sites now in the zones where we re able to at least get a use permit for them. So that has limited our search a lot and then it s just looking for the right kind of building. A building that s ready to be residential but needs an urgent care build out is one kind of problem. So we re in the middle of that right now, and we have three leads we re looking at. And our plan within the budget structure with a January 15th opening was optimistic. If we found a site by October 1st, it wouldn't be open before April 1st of next year, I believe. So I m thinking we re looking at somewhere in April and May.
I d be happy to come back and give an update on it. I ll talk with Ms. Brooke about it and answer some other questions that may remain so this doesn't end up being our last conversation.
Dr. Turner: As you can tell, there s a lot of interest.
Mr. Fields: Yes, absolutely. I depend on that
Dr. Turner: Thank you for your presentation.
Mr. Fields: You re welcome.
2.2. Public Comment:
Dr. Leary: I m Mark Leary from the Psychiatry Department at SFGH. Mr. Fields, first of all, I want to echo what you said about the importance of our working relationship with the Progress Foundation. It s very important to us and we feel very good about it. Fortunately, all four of our community inpatient, and locked inpatient units are going to be kept open as far as we re being told. That s been confirmed, and we re very happy about that. But we are being told at the hospital that the bed cut is not going to be 14 beds, but 23 beds; so that each of the inpatient units would have 16 beds. So I wanted to make sure that that was clear. But I know throughout the whole budget process there s a lot of uncertainty about was it 14 beds, was it 21, 22, but that s the information that we re being given now at the hospital. I just wanted to clarify that.
And to echo our support, particularly for the Acute Diversion Unit part of it. I think we desperately need those additional resources. I m hopeful about the Urgent Care Center, that it can take some of the load off of PES. I m also happy to hear you say that, to repeat what Dr. Katz had said at one of the Health Commission hearings, that the beds wouldn't be closed until the services are open. Of course we would propose that the beds not be closed until the services demonstrated the need that the beds be closed; but we don t have that agreement at this point.
Ms. Fisher: Pam Fisher, President of NAMI. We certainly have some concerns about this. We re very pleased with the thought of more beds in the community. We know that s a tremendous need. But we also fear that the County has lost hospital beds over the last ten years and this is just a continued drain. At the present we know that patients are sent out of county to locked facilities, PES is on red alert most of the time. Will these conditions change and if they don t change after six months or a year of the new program can we have some promise that the beds will be restored to the hospital? I understand that s not a question you can actually answer.
Mr. Fields: You re right. I cannot comment on that.
Ms. Fisher: This is something that we are going to be watching and following very closely.
Mr. Martin: My name is Fred Martin. I ve been active in San Francisco affairs for over 50 years. I worked with Orville Lester and Percy Finkney in Youth for Service. I also served on the review panel; and I read virtually all of the County plans in connection with Proposition 63, and they simply failed to meet the treatment concerns. I think Mr. Fields has a good program. I would take nothing away from it. It s been around for a long time. But I think he did a Hail Mary and pulled the rug out from under some needed beds at San Francisco General, and I think we have to go back.
I have two cousins who are dead because of a lack of 5150s. I have another family member who s alive because of the 5150. The hearing officers in San Francisco, until we got the Behavioral Health Court, were never required to know anything about mental illness. That s true of all the counties and states. They don t have a Mental Health Court. And if you want to know the entry point for the chronically mentally ill, one of the symptoms of which is denial, and unless they get put into a 5150 they re not treated. And when I met with Willie Brown when I was doing the Mental Health and Public Policy Conference for the University of California, I said I think the majority of the chronically mentally ill are the chronic homeless. He said you re crazy. Virtually all of them are mentally ill.
We should be supplementing those beds. We should not be taking one of them away.
Noah: My name is Noah. I m a San Francisco citizen. I was questioning a statement you made earlier saying that you would have to extend the deadline from January, into probably June or October. What district is on your radar for the location of this facility?
Mr. Fields: It s not really districts as much as particular zones. I would say that on the eastern side and south of Market is our programmatic preference and that s where the predominance of those zones would be. We re not looking in the Sunset, the Richmond, the Marina, Chinatown, even the Haight.
Mr. Johnson: My name is C.W. Johnson. I m a mental health advocate with the Mental Health Association (MHA). I suffer from mental depression and schizophrenia myself. I suffered with a crisis not too long ago, where I ve been to some of the hospitals around here. I also have been volunteering my services. And I didn't feel comfortable enough when I got into a crisis to even want to go to a hospital. So how is this, is this a preventive type thing where if you get to a point where you feel suicidal, you may feel so depressed where nothing s going good in your life and you just need some help, would this be that kind of place or are those kind of places being closed? Are those kind of beds being allowed for people, to prevent a suicide?
Mr. Fields: The short answer, Mr. Johnson, which isn t adequate, is no. The goal of this program is to target as much as possible for that high end, already at the edge of 5150. We ve got to prove that we can take that pressure off PES and do it or else, and that s the dilemma.
Mr. Johnson: So it s more of a relief program, to relieve some of the overflow; to free up those beds there (SFGH-PES) so that you could help people before they get to that point?
Mr. Fields: Yes, that is the premise from which we are starting.
Mr. Johnson: Thank you.
Mr. Fields: You re welcome.
Dr. Turner: Thank you Mr. Fields once again.
Mr. Fields: Thank you everybody.
ITEM 3.O Action Items:
3.1 Public comment relevant to Item 3.0
There was no public comment.
3.2 Proposed Resolutions
3.2.a PROPOSED RESOLUTION: Be it resolved that the minutes of the Mental Health Board meeting of July 11, 2007 be approved as submitted
Minutes approved unanimously.
ITEM 4.0 Reports:
4.1 Report from the Executive Director of the Mental Health Board.
Ms. Brooke: I will be on vacation September 13-30, 2007. Ms. Baltrip-Balagas will be handling things in my absence.
The next Police Crisis Intervention Training is October 22nd and the part in which any of you will become involved is October 23rd. That s a Tuesday. If you want to be on the panel you can call me after October 1stand we can talk about it.
I just want to make sure it s on your calendar that December 8th is the retreat. That s a Saturday.
James Keys brought to the San Francisco Mental Health Education Funds attention the desperate plight with the South of Market Childcare Center. The children there were scheduled to go down to the Monterey Bay Aquarium at 7:00 in the morning and were waiting for their buses, holding their little lunch bags that had been donated to the organization. The buses never showed up. So, they approached Mr. Keys. Mr. Keys called me concerning this, and I contacted Dr. Moses, who s Chair of the San Francisco Mental Health Education Funds, who made the decision to donate $200 for lunches for the following Sunday so that they could go. I m going to pass around a photograph of the children I received after they went to the Monterey Bay Aquarium. This is not the total number of children, but this is some of them that benefited from our donation.
The Immigrant Rights Conference is happening on September 15, 2007, this coming Saturday. I think you received mail about that. Dr. Moses sits on the Immigrant Rights Commission. There is also a reception this Friday night.
There is a Suicide Prevention Workshop in Emeryville on September 21st. You ve got that in your packet. I m just calling attention to it. The California Strategic Plan for Suicide Prevention public workshops, just to take a look at that.
Finally, Ms. Kellum King, and I believe Ms. Lebish are going to the Substance Abuse Conference presented by CBHS. All conferences at CBHS are free, so if you want to go you ve got a copy of that information.
4.2 Report of the Chair of the Board and the Executive Committee:
Dr. Turner: I don t have a report tonight, per se. I sent everybody a letter to tell you all how much it s meant to me to be your Chair and just be a Board member for the past four years. So I just really wanted to address more of the emotional side and some of my sad feelings about leaving. I also wanted to let you know why I m leaving a little early. I m doing it because I ve just been quite overwhelmed with work. I ve taken on some new responsibilities in my job. Some of it has required me to travel and I ve been away a lot so I just think it s time for me to move on.
I also feel like this Board is so capable and competent. It s just been amazing to me. I really appreciate your support, and I m very excited for the future and where the Board is going. So you ve all meant a lot to me. I don t want to not see you anymore. I plan on seeing people. I ve been here for four years and the Board has turned over completely. I told Dr. Moses earlier, with the exception of him, the Board has turned over during my time. There are two people who left and came back Ms. Kellum King and Ms. Brown. Others have come and gone like Benito Casados and Michael Medema, Rich Snowdon, Bob Douglas, Dorothy Schafer, Idell Wilson; there have just been many people who really left their imprint on me; and I think of you all at various times as you ve shared your stories and it s just been a wonderful experience. So thank you for the privilege.
Ms. Brooke: And we say thank you, Dr. Turner.
Dr. Moses: I just want to also thank Dr. Turner for the wonderful job and contribution you have provided. I know when we harangued you to become Chair. You were very reluctant so I had to call you at midnight and say, Listen, I think you should take it. And she has been doing a wonderful job since. You know, we really thank you for bringing us together and being involved. We re really sad to see you go, but you have to do what you have to do. So, we thank you very much for everything that you have done.
Mr. Purvis: I just want to say we re going to miss you very much. You ve been wonderful.
Dr. Turner: Thank you.
Mr. McGhee: As Vice-Chair, I want to thank you for taking the Board in directions it hadn t gone before. Some areas were risky, and your leadership had great impact.
Dr. Turner: Thank you, Mr. McGhee.
4.3 Report by Members of the Board on Their Activities on Behalf of the Board.
Mr. Hines: I ll be in Santa Barbara September 17th speaking at the 13th Annual Planning Association Suicide Prevention Forum. Tuesday, September 18th, I ll be speaking at St. Mark s Church in Los Alamos, and on the 19th, I ll be speaking at Allen Hancock College of San Maria and then back to Santa Barbara.
I just got back from Missouri, where I spoke at the Annual Suicide Prevention Conference over there and it was quite fruitful and a great learning experience.
Dr. Moses: In addition to thanking the staff, we also have to thank you Mr. McGhee for using your influence to bring Assemblyman Dymally here, and the out going president of the Board of Psychology.
Ms. Kellum King: I was able to attend the California Mental Health Policy Forum in Napa last week, and I found that there are so many states that are teaming up, forming unlikely alliances to help better mental health issues. Many of the things that we discussed tonight are things that they ve already addressed.
Ms. Brooke gave me a proposal of an event that took place in Boston, the Boston Strategy, where everyone came together, put aside their differences and their egos to help address the killings and violence that were taking place in that city. I have started to touch base with the clergy in the southeast community. It s going to take all of us to address these issues. This is San Francisco, this is our city, this is our community, so I can t point the finger and say you do it, it s your part. No, it s for all of us. And I definitely have committed myself to see a positive change. I m a part of the baby boomers, so I m going to be booming for the better.
If anybody needs to call me about anything, there are a lot of conferences; that are up and coming so we can attend those.
Dr. Moses: To echo what Ms. Brooke said earlier in her report, the Immigrants Rights Commission is having its conference. I am a commissioner and would like to have you come this weekend. The reception is Friday night, and the conference is Saturday from 8am to 4pm.
4.4 New Business
There was no new business.
4.5 Public Comment to Item 4.0
There was no public comment.
5.0 Election of Officers for 2007 to February 2008
5.1 Public Comment Relevant to Item 5.0
There was no public comment.
5.2 Report from Nominating Committee
Dr. Moses: Madam Chair, thank you for the opportunity to Chair this Nominating Committee again. Ms. Williams, Ms. Brown, and I worked day and night to choose qualified candidates from the Board. I really thank them for the time they dedicated to this process.
For the position of Chair we have nominated James McGhee, who has been doing a wonderful job as Vice-Chair. For the position of Vice-Chair, we have nominated Dr. Jagruti Shukla. Mr. Keys is Secretary, and we ask him to continue in this position.
This is our slate.
5.3 Proposed Action: Election of Officers
Dr. Turner: Thank you Dr. Moses, Ms. Williams, and Ms. Brown. I think it s an awesome slate and our nominee for Chair is James McGhee. I would like all in favor of James McGhee as Chair of the San Francisco Mental Health Board please say aye. All opposed, nay. The ayes have it. James McGhee is the next Chair of the Mental Health Board.
Mr. McGhee: Well I want to thank Dr. Toye Moses, Ms. Williams and Ms. Brown for the honor of nominating me for Chair. As you all know, I take this Board very seriously and the people that we represent very seriously; so I accept this great challenge. I started four years ago, so thank you very much for the honor and opportunity.
Dr. Turner: We have one more vote to take. The nominee for Vice-Chair, is Dr. Jagruti Shukla. All in favor say aye. All opposed say nay. Okay, Dr. Shukla, you are Vice-Chair of the San Francisco Mental Health Board. Congratulations.
Dr. Shukla: I m obviously honored that the committee thought of me for this position. I know I didn't respond to some of Dr. Mose s emails, at least initially, and, like Dr. Turner, recently I ve had a significant increase in responsibility at work. I was actually elected Chair of the Department of Primary Care for the entire County of San Mateo recently and also accepted for a two-year fellowship with California Healthcare Foundation for the future Healthcare Leaders of America. So, in addition to my role as Medical Director and a few of the other committees that I sit on, work has been overwhelming and I do take the work of the Mental Health Board seriously. I am really passionate about it and I think that it s important to take this new Board position; so, I m very happy to serve as Vice-Chair. And I have some literally big shoes to fill. I ll strive to do that. Thank you.
Dr. Turner: You ll get a lot of support. You just have to work on that executive team.
Dr. Moses: I would like to thank LaVaughn King for all her guidance and all her help. She has previously served on the Board as both Vice-Chair and Secretary.
Ms. Kellum King: Thank you Dr. Moses.
Dr. Moses: The next elections will be in February 2008.
Ms. Brown: The committee also wanted you know that we considered James Keys for Vice-Chair and the struggle there was that we couldn't have two public interests appointees be in the Chair and the Vice-Chair positions. I just wanted to acknowledge that he was a serious consideration to move up from Secretary.
Dr. Turner: One person I will be seeing sometime is John Kevin Hines because he now works at Alliant.
Mr. Hines: I got the job thanks to you, Dr. Turner.
Dr. Turner: Thank you all again, and thank you, Ms. Brooke for four years of guidance and Ms. Baltrip Balagas also.
6.0 Public Comment
There was no public comment.
Meeting adjourned at 8:35 p.m.
Ed; If you're still here after that pile of Funding Wrangling: returning to Robert Whitaker:
Dear Congress: Are you even remotely Serious about fighting Fraud, Waste, and Abuse?
Are you even remotely Serious about saving SSI, SSDI, Medicare, and Medicaid?
Or are you going to Continue your Insider Trading while Personally investing in Pfizer, J&J, and the other culprits breaking All of those programs with their Psychiatric hustle?
Convening yet another Congressional Investigation of the Fraud eating SSI, SSDI, Medicare/Medicaid down to the bone without every Congressional Investigator first reading Whitaker’s Anatomy of An Epidemic is useless: a meaningless show.
A thorough vetting must precede the seating of every member of any future investigating committee. No place at the table for any Congressperson who owns stock in a company making Psychiatric Drugs.
1: has never cured any of its own opinions
2: will never cure any of its own opinions
3: it is the type of moronic hubris only an Academic Socialist could embrace to believe that anyone can change/cure anyone else’s opinion by Poisoning or Electrocuting them.
1: do not cure anything
2: can not claim to permanently cure anything
3: And the antipsychotics, at least, don't even work, ...... .
"Though a positive outcome has not been observed with the NJ Algorithm to date, researchers suspect that a larger sample size might generate significant findings in the future."
Not only are the drugs worse than defective, but the endless, obscenely expensive Medicare, Medicaid and Private Insurance Raiding Psychotherapeutic misdirection engineered to justify the changing of BILLING Code Paperwork is also a complete, and utter FRAUD.
Why do you suppose Psychotherapy is an ongoing, lifelong Billable? If it worked, and it doesn’t, 6 weeks to 1 year tops should completely Cure any non-biologically discoverable Political Illness.
Not a single cure to date, None. Zero. (Unless of course you Bought a Medical Work License allowing you to Opinionate People who Haven’t bought a Medical Work License into a very profitable Incurable.)
Since so much of the psychological theorizing we’re inundated under is derived in one way or another from the bloviatings of Carl Jung it’s vital to understand that Jung was a FRAUD. And it’s impossible to build a house fit to live in atop a foundation of rotten concrete.
Jung, who as late as 1939 proclaimed Hitler to be a Demi-Deity concocted his neo-pagan, collective unconscious out of Nietzschean, sun worshipping, Theosophical populism. He lied about another Psychiatrist’s (Honegger) work to set himself up as the leader/prophet of an elitist pyramid. By the 1930s when Nazism was on the rise Honegger had been usurped and the patient became Jung’s.
But it still took him till 1952 to figure out that he should edit his references to Honegger out of his own, earlier published work. Who knows? Perhaps he was just too preoccupied with looking over his shoulder for Wiesenthal.
Jung was Still lying about the case on the BBC in 1959, commandeering Honegger’s work as his own: two years before death Finally shut his Psychiatric pie hole forever.
The Patient Jung Ideated his Collective Unconscious upon reported having a vision of the sun exposing a tail and waving it around in space like an erect male sex organ, from which, the wind arose. From that vision, which wasn't a part of the Semitic racial/spiritual archive Jung concocted his Aryan Collective Unconscious which Did possess a racial/spiritual memory of this Solar Flasher, ….. proving that his Aryan - and the keyword IS Collective - Unconscious possessed a superior potential for Individuation, ….. which the Jews and other Semites got short changed on.
The Jung Cult: Origins Of A Charismatic Movement by Richard Noll (pg 181-184)
And you Wonder why Nobody ever gets cured.
Since you've been patient enough to Reach the end of this post, here's a Library of Drug Industry Sleaze for dessert.
Financial Disclosure: The preceding post was brought upon you by "Let's get Government to give us So much Free Stuff that we can't even Afford to buy our own anymore."