Transcripts For SFGTV Government Access Programming 20240713

SFGTV Government Access Programming July 13, 2024

That. Thats one reason we now have psychiatrists a psychiatrist and a psychiatric Nurse Practitioner on the ride along with us. They have been extremely helpful when we approach that individual and recognize that this person does not have the capacity to care for themselves. So address your question specifically, we have a very Good Relationship with the police, but at times, it seems their mission is different than ours, and we are able to help the people that need help with the Behavioral Health team of street medicine. Commissioner veronese so i thank you for that explanation. And i think whats important for this commission to hear is that the Police Officers job is part of the criminal justice job. Theyre part of the criminal justice program. And i would assume its my opinion that theres many people in this room that would agree, that if somebody is unable to care for themselves or they have some mental instability, and thats typically what it is, that thats not Law Enforcements job. We dont want them in the justice system, we want them in the health care system. Its a trick question. That was a softball. And then, the other side to it is the Police Officers dont have that medical experience and especially captain you know, captain e. M. S. Medical Level Experience to know or to be able to make a call that this person has some sort of disability or ailment that is threatening to their lives. They just they dont have the training for that, correct . I would say that youre correct. Commissioner veronese okay. And then, the same is also probably true for psychiatric people that are with you. You mentioned you had some psychiatric people that are on your team that are with the department of health. They dont have the training or the certifications to actually make a medicalrelated call, correct . Id say yeah, i would say, commissioner veronese, you bring up the exact challenge with a lot of our clients is the interaction of all of these things and trying to sort out what is possibly behavioral versus psychiatric versus medical. And sometimes, i would say this is exactly why we collaborate on a multidisciplinary level because it takes all parties to be involved. You know, to our to the credit of our kind of Behavioral Health and street medicine collaborators and partners, they do have a lot of expertise in this area. But with that being said, our clients are people that are really, really challenging. So its not often, but there are times when everybody theres not consensus. We dont all agree with what the underlying cause is, but i readily agree with your point that it can be very difficult to tell sometimes. Commissioner veronese i think the point im making is that every Single Person thats a part of that team, whether its an e. M. S. 6 captain or a psychological team person or a hot team person, every one of those people bring a specialty skill to the table, otherwise, theyd be useless to that. And its obvious that e. M. S. 6 brings that medical part to it because thats what theyre there for. So i guess my question and dr. Yates, you can answer this question, or chief, you can answer it. But would it be helpful for your job for e. M. S. 6 captains to have the ability to 5150 people . Is that a tool that you would like to have in your tool box so that you could do it . Because i was a Police Officer back in my younger years, and i can tell you one thing, and you guys probably have that same exact experience. Is that when a Police Officer shows up to a mental case, and the Fire Department shows up to a mental case, its two entirely different reactions. And i saw it when i rode with captain simon that day. I think we were over behind the federal building, and we were there to interact with an individual that was there, and the Police Department showed up. And the moment the Police Department showed up, that individuals attitude turned hostile. And that attitude is not helpful for the our ability to give the type of care and the type of resources that we need, right . That happens out there. Am i wrong about that . No, it does indeed happen out there. Yeah. And that is the challenge. And i want to get back to your central question about the nature of involuntary holds and where that sits in terms of the tool box that we see in e. M. S. 6. I would say that taking away a persons ability to decide for themselves for their care, where they want to be and that is not something to be undertaken lightly. Its an immense challenge ethically, legally, even medically. And you mentioned things about the relationship or the clients and patients perception of whos trying to help them. That relationship that we establish is of paramount concern. Now to get back to your question, its something that we undertake as a last resort, and we we rely on the collaboration and ability to involuntarily detain folks when its done in conjunction with Law Enforcement Behavioral Health, and there can be agreement about that. One thing i do want to stress is a 5150, 72hour involuntary detention is a means, but too often, we dont think what has to happen after that. 72 hours is not a lot of time to change a life for someone. Unless we have the back end figured out, i think we should not be extremely, you know, too eager to involuntarily detain people unless we understand what the overall game plan is. So to answer your question, it is something that we do rely on in very in situations of last resort, and we do it in conjunction with Behavioral Health partners. Thats the only way we can make these things stick and make them work. Going back to someone again and again and again as a very disturbing cycle, and i think that thats something you would agree as a Law Enforcement officer. Commissioner veronese yes. And i think i hear you guys agreeing that this would be a useful pool because adding the Law Enforcement tool to that as a last resort but you guys are more qualified to assess whether somebody is capable of ending their own lives than any Law Enforcement is able to do it. So i guess my question is, is it a tool currently, legislatively, you guys cannot do it. But if it was a tool at last resort that you would like to have in your tool box in those cases in that you are more qualified than other people around you to use . Let me try to answer that. So i think that i think that if we could place a hold, we would do so effectively and judiciously. There are times when more people are not able, and in those situations, if we had the ability to do it ourselves, it would be helpful. But there are other considerations that are tempering my enthusiasm on being able to effect a hold. As d we would want a more collaborative Decision Making approach before putting someone on hold. So for example, Law Enforcement felt this way, we felt this way, a psychiatrist or social worker felt this way, and then, that hold has more weight. If we, you know, place the hold, then i would not want some advocate for peoples rights to suddenly think were the bad guy. Were taking peoples rights away. That would be really challenging for us. And the other thing would be, theres a benefit for something a psychiatrist placing a hold, and that is a psychiatrist has that relationship with the other physicians at psychiatric emergency or at the other hospitals. They could follow that patient through and lend their professional opinion in a way we could not. So that would be really the having a clinical a Mental Health professional right the whole i think is the best way to do it. Commissioner veronese so when a 72hour hold happens and i know this because ive done it as a Police Officer. That person is brought to a hospital by law. That person is required to be brought to an institution issued by the state. Many institutions at San Francisco do because theyre at that level. And then, immediately upon entrance, they are seen by a doctor who does an analysis themselves as to whether or not to waive off the hold to let that person go or to hold that person longer. So maybe you dont have the experience with it, doing the holds themselves, but i think a little bit of training behind what it is that goes behind that would be really helpful. But i guess what youre saying. My Biggest Issue when i brought this up is we have got such a great reputation out in the field, and this is why i didnt want to push it. Do we want to tar initial thni representation, when somebodys life is in danger that we want to take them in custody . I feel like the cops have the authority to do that, but this is not a criminal justice issue. Those people should not be in that system. Because the moment a Police Officer writes a 5150, theres a Police Report behind that, and then, theyre a part of that system, and they shouldnt be a part of that system if its a mental or medical issue. So i go back and forth on this thing. And i really would like you guys to have that ability, a tool in your tool box if you need it when other people arent around. And just for education of the other commissioners, i spent about four months on this issue with the City Attorney going over the 5150 law. And i actually wrote a resolution to come to this commission. Because the reality is that we can as a commission and then it would then go to the board of supervisors, designate e. M. S. Captains theres a specific term in the 5150 code. Its like an Emergency Task force, and it is. Its a task force to deal with a particular emergency. We could determine them to be under 5150, and it would give us the ability as the hospital sanctioned it. So there is a resolution thats within written to do this been written to do this. But i would push it if it came from you guys and the chief first and i ran it by the former union boss, who supported it. But my point is, if its a tool that you really want, talk to the chief about it. This commission has the ability to give that tool to you that would then go to the board of supervisors for approval. So ill move on from that and let the others comment on. Its a hot topic to really kind of its a hot potato topic, but it pains me to walk over people on the streets of San Francisco where they have a mental issue, and could possibly harm each other. We saw that event in north beach, and that lady had a Mental Health crisis. We see it occasionally, people that could have been helped by us, and i dont want to see us not helping people because we dont have the right tools. Quick question, and another potentially sensitive question for you is when we create a program like this, and we see that program is effective you guys 19 reduction is amazing. Those numbers are really, really, really good, and the department is throwing numbers at you because youre an effective unit. At some point, i dont want to create an institution around a problem, right . We do a really good job of that here in San Francisco is creating institutions around problems. And then, it gets really hard to, once you solve that problem or once you come up with ideas to solve that problem or really good, to do away with that unit because its no longer needed. So i wouldnt want to see that happen because i like the Fire Department getting money, but at a certain point, youre going to do your jobs so well that were not going to have frequent callers. I know its a pipe dream, but id like to see this Program Transition into Something Else when we become so effective, and the other departments have stepped up, where we dont have this need anymore. So id like to maybe have the department to come up with some sort of plan, a tenyear plan of some kind of how we transition this unit into Something Else once weve solved the problem because solving the problem is the goal, not creating another institution that the taxpayers are going to have to pay for around, you know, a problem that were not going to solve because were getting money every year. Ive seen city departments do it. I worked for welfare fraud back in the when i was in my 20s. I was a senior investigator for the welfare fraud division, and i saw how that department didnt want us taking people off of welfare because it was less money for their department. I dont want to see that. I want to see us doing our job so far that its not needed anymore, but transition this department into something more effective. So id like you to have a pipe dream with Something Like a tenyear plan so we can transition into something because weve solved that problem or working towards solve that problem. My last question is commissioner hardeman had mentioned the touchy issue of at a certain point how many calls becomes a crime . And i know theres questions you asked about that. Whats the mental capacity of this person . Is he doing it intentionally . But do you ever come across people that are just calling 911 i know you told me about one guy that called 911 because he was having troubles with his remote. It turned out he was just lonely, but when you call 911, were going to respond. How often do you see those types of calls in this unit and what do you do about it . Well, first of all, ive been in the Fire Department for 24 years, and i do know that there are times when people maliciously activate emergency services, and it sure is irritating. But in the last nearly four years, our people that weve been working with, that has not been the case. Its entirely rooted in dysfunction, disregulation, untreated mental illness, Substance Use disorder, one subset, because not all of our people are homeless. Theres about 28 of our people annually that have residences that live in the sunset, the richmond. Maybe theyre end of life, and we help them, too. Its a totally different set of tools. We assess the situation, we call their doctors, we all i. H. S. , we call d. H. S. Fortunately for us, i dont think of a Single Person whos, like, been on our list thats been [inaudible] but it hasnt been if it has been malicious, their primary cause is mental illness, Substance Use disorder. Commissioner veronese and thats part of the job. I guess it. Thank you so much, all three of you, for answering the questions. They were sensitive questions, tough questions, but were here to ask those questions. If theres anything that we can add to your tool box to make your jobs more efficient, better. Thank you. President nakajo thank you very much, commissioner veronese. Before i get the other commissioners in, doctor, did you have anything . Yes. Thank you, commissioner veronese. One of the things that weve learned is its about the multiagency coordination. I do not think that at this time that thats an overriding need for us to independently do something. I would emphasize and assure you that it is something that we do undertake. It is something that we undertake with our partners in collaboration because of all the reasons that are sort of specified. Well definitely take it up if we have issues that need to be addressed. Thank you. President nakajo thank you very much. We have other commissioners. Commissioner cleaveland . Commissioner cleaveland yes. Id like to pick up on commissioner veroneses comments on the mentally ill. What percentage of your clients are mentally ill people versus addicted people and whatnot . I was looking at our internal data, and frankly, we dont have any internal data that measures what percentage of of the individuals that are homeless. Id say its very high. And what i would we dont have an exact number. I would sort of tell you that the the the rate among our highest users is very high, so people tend to have the combination of Substance Use disorders, mental illness, and medical challenges, and those three things together have caused people to require a lot of needs in the safety net. I do want to also just emphasize that that is not to say that the opposite is true, that people who do have Behavioral Health issues are automatically frequent users. So sometimes we get confused about that distinction. But to be clear again, many, many, the majority of clients that were seeing on a highest user basis do have competent psychiatric and incompetent psychiatric and psychological challenges. But the opposite is true. All people that have Behavioral Health challenges are not frequent users of 911. But we continue to see those people that do. Commissioner cleaveland so the people that you do continue to request a 5150 through Law Enforcement, what percentage of those what percentage of the people that you deal with are actually detained under 5150. Thats a good question. We dont also have that we also dont have that. Yeah. I think one of the challenges as i kind of alluded to before, a shortterm involuntary hold is exactly what it is. Its a shortterm involuntary hold, and the longterm challenges persist after that. If you put someone on a shortterm psychiatrist hold and they demonstrate that they have Decision Making abilities, we have no right, nor should we, of detaining them against their will. And if that happens many times again and again and again, then, we have to look at some possible solutions. And one of the cases that we looked at illustrates that process. It has to do with conservatorship, it has to do with things like longterm stablization. We try to avoid looking at those situations, but it

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