To view graphic version of this page, refresh this page (F5)

Skip to page body
City and County of San Francisco

Meeting Information



2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 

 

Mayor’s Disability Council
Minutes of the regular Mayor’s Disability council meeting
held on Friday, October 15, 1999
at San Francisco City Hall.

MAYOR’S DISABILITY COUNCIL MEMBERS PRESENT:

Sergio Alunan

Vincent Behan

Edward Evans

Viola Jackson

Michael Kwok

Frank Marone

Susan Mizner

Grayce Regan (Co-chair)

EXCUSED:

Damien Pickering

ABSENT:

August Longo

STAFF PRESENT:

Walter Park, Director, Mayor’s Office on Disability

Richard Skaff, Deputy director, Mayor’s Office on Disability

Carolyn Snipes, Office manager, Mayor’s Office on Disability

The meeting was called to order by the Co-chair, Grayce Regan at 1:06 p.m. She introduced the new appointee to the MDC, Ms. Claudia Center, an employee of the Employment Law Center, and served on the Board of the San Francisco Depressive and Manic-Depressive Association. The agenda was approved. The minutes were approved as written. Director Park introduced the new office manager for the Mayor’s Office on Disability, Ms. Carolyn Snipes. He also pointed out to several handouts and documents available for the public. As well, the telephone bridge number, 554-9632 was announced. Director Park also announced that City Hall now had an accessible ATM, which was the product of the work of Treasurer Susan Leal and her staff. This was the first talking ATM in the entire country, and was located in the Treasurer’s office, on the First floor, south side of City hall. Ms. Susan Mizner noted that that days meeting was the first one devoted almost entirely to the issue of access to City services by persons with mental disabilities, and that Directors, Associate Directors, and staff from the various City departments were on hand to make presentations. She added that since the meeting was focused on access to said services by persons with mental disabilities, the discussion would necessarily center on programmatic access, instead of physical access, and gave a brief definition of the former.

Mr. Collins Muns, Acting Mental Health Director, Department of Public Health, thanked the MDC for inviting him and others to speak on the issue and services that his Department was providing. He said that not too long ago, mental health services were provided only at institution based programs, and these have now been moved from this model, for good reasons. The first reason is that the service was not the best in San Francisco, and the second reason was that there was a need to move these into community based settings, which was to bring services to the people, instead of vice versa. This would bring the services out to where the people lived, worked, or where they were, thus making the services more accessible in general. The challenge with which they were faced was that up to approximately 18 months ago, it was a system that turned away more people than it served, since it was a target based system that narrowly focused on the population it could serve, or who could have access to the system. Fortunately, on April 1, 1998, the criteria were changed and modified to the extent that service was now more accessible. The remaining challenge was to provide services to those individuals who were still not being reached. There was still much work to be done, with more flexibility for the program, with more drop-in hours, more outreach service, more and better training for staff, and how to engage populations that may not be as trusting of mental health services as previous populations, etc. His Department was working with several community groups to identify creative efforts in solving some of the issues and problems. Mr. Muns said that he was looking forward toward the progress on this work, and thought that over time, the additional progress seen over the last 18 or so months will be added to. Dr. Marone asked if Mr. Muns had any statistics on the numbers of persons in the population which was still unreached for services. Mr. Muns said that his best guess on this was that probably half of the people who really needed the services were being reached, and while progress had been made, more work needed to be done to reach these people. He added that a better job could be done if the resources and programming were available. Ms. Regan asked if the resources were available, could the caseload be doubled. Mr. Muns said no, because unfortunately there were no resources available, to double their capacity. However, capacity was slowly being increased with the help of their stakeholders and constituency. The Department was not in a position to increase capacity by 100% at that point in time. Ms. Mizner said that there was a wide agreement in providing flexibility and more drop-in hours, and more outreach, and asked whether there was a timeline for this. Mr. Muns said that some of the work on these had already started, with some of the work to begin between the third or fourth quarters of this Fiscal Year, which would continue through the next Fiscal Year, resources allowing. These would include more street based treatment, greater mobile outreach in treatment, more service integration, and more services in shelters in collaboration with community based organizations, among others. Ms. Center inquired as to how many persons were currently being served. Mr. Muns replied that approximately 20,000 unduplicated cases, annually. Ms. Center further asked for a description of the eligibility requirements which were recently changed. Mr. Muns said that up to 1 April 1998, the eligibility criteria focused on target population that would define one as seriously mentally ill in order to be able to access services. Under the new criteria, anyone who applied for services would receive an evaluation, then be linked for counseling, and/ or treatment, as may be required. Mr. Evans asked what Mr. Muns and staff were doing to link up with community based organizations to address the issues. Mr. Muns said that increased work with these organizations was being done, because it also increased access to resources recently approved by the Board of Supervisors, and it was important to work closely together with these organizations, and hoped that community support would be sustained and increased. Mr. Muns added that San Francisco had the highest rate of 5150 cases per capita anywhere in California. There were many contributing factors to this, and his Department would like to help people before they reached that level of distress, or desperation. The 5150 state is so serious that one who is at this stage of desperation is required to accept involuntary treatment, or forced to take treatment and be transported to a facility. He added that the Department would like to be able to help and intervene before that happens.

Mr. Will Lightbourne, Executive Director of the Department of Human Services (DHS) briefly covered the major program services of the Department. He said that one of the major program areas was the Department of Family and children Services, which housed the child welfare, protective services, home placement, etc. One of the reasons that can bring children into these programs would be the mental illness of a parent or illness on the part of the child. The DHS worked closely with the Department of Mental Health children’s’ services program to do services for families while they are intact in the community, as well as if post removal of a child, both to the family and to the child. DHS was trying to emphasize services while they are intact in the community, and are now working with some State and Federal waivers so that some resources may be redirected. Historically, the resources became available when the child was removed, not while the family was struggling to maintain itself. Under the Adult Social Services program, there was the In-home Support Services, which provided assistance with daily living home needs. Adult Protective Services was a rapidly expanding program, which used to be a small program in the State. With recent funding through legislation which then Senator now Attorney General Lockyer carried, the services was now expanded. As part of that expansion, DHS was currently building new capacities to be able to work with dependent adults who, for age or any other reason, may need resolution or advocacy on their behalf. In the traditional program area of Welfare, there was now what was called the CalWorks program, successor to the former AFDC system, in the context of welfare reform. One of the better provisions of the State law to implement Federal Welfare Reform was the provision that mental health services should be available as a condition for clients being required to participate in the CalWorks program. Agreements throughout the Department of Mental Health had been made with the community agencies so that mental health professionals were present during all the CalWorks presentations for clients, as well as at the various locations if that appeared to be a need or an issue. Some community outreach workers, former recipients themselves have been engaged to do follow up with those CalWorks participants who had been referred by mental health agencies, and who had mental health issues, who had not been keeping appointments or made the service connection effectively. There was a concern about the low take-up rate of mental health services related to CalWorks statewide, although San Francisco was relatively ahead of that. This was a developmental process as the participants’ comfort level with the program and support services built up, issues will be disclosed whether they be mental illness, substance abuse, domestic violence survivor issues, etc. these can then be referred for service and treatment. Mr. Lightbourne said that the resources were available, and exceeded the utilization rate at that point. In the County Adult Assistance Program, formerly known as the General Assistance Program, one of the major program components for employable adults was the PACE program, designed to parallel the CalWorks program with the same contracts for mental health services, and on-site availability of professional staff. It likewise was expected to unfold developmentally over time. Under the SSI component of the assistance program, which is for persons who are awaiting determination for SSI by the Social Security Administration, staff had been specially trained to work with clients with long-term disabilities, and to work with community advocates to help pursue SSI advocacy applications. Within the CAP programs, there were accommodations made with special appointments for persons who need them, including home appointments for eligibility determinations for persons who were either home bound or may have phobias that make accessing program locations problematic. Similar special arrangements can be made for the Food Stamp program, and the entire matter of accessing this program was now under revisit and study. With the increase in the move from cash assistance to working but with low income, there will be ways of positioning access to the Food Stamp program at locations, places, times, and environments that were useable and desirable for special participants. The final component was the Homeless program, some of which fall under either DHS or Department of Public Health. Mr. Lightbourne said that there has been increasing work over time toward integration of activities for the homeless between the DHS and DPH. Joint budget planning is being done for the 2000-2001 Fiscal Year so that their services become mutually supportive. The local Homeless Board had a report on accessibility issues for persons with mental disabilities in the local shelters. DHS along with DPH was looking at the Homeless Board’s recommendations to study ways to respond to these issues. DHS and DPH were now in the design process for a Request for Proposal to go out for increased mental health outreach coordination services that can be attached to the service system. Mr. Behan inquired about share of cost in the In Home Support Services System, and asked if this would be eliminated in the future. Mr. Lightbourne responded that locally, the Department had been budgeted $100,000 to do a pilot project " patch" program to identify numbers of people who are eligible for IHSS, but are not utilizing this because of the share of cost issue. The study will look into " patching" people and services together with the intention of demonstrating improved quality of life, etc., and potential of cost avoidance in terms of usage of other systems. The second stage of Mr. Lightbourne’s answer was relative to the State budget cycle, where there was lack of willingness to engage by the administration on several areas of the IHSS program, on quality enhancement that would have allowed other counties to do the same things that San Francisco had been doing for the past few years. Unless there was some significant awareness raising with the State administration, Mr. Lightbourne said that he was not overly optimistic that responses could easily be secured at the State level. However, DHS was committed to working with the IHSS Task Force on the Patch program so that it could be possible to demonstrate that people who could afford to be on the program had measurable, demonstrable improvements on their quality of life, with potential cost avoidance and savings in other parts of the system. Mr. Behan also asked about the reduction of hours for IHSS. Mr. Lightbourne said that the amount of hours attached to participants in the program were based on medical practitioner’s assessment of needs. During the last few years, artificial hourly caps on the allotted hours had been removed, so that there would be no downward pressure on the hourly allotments. DHS monitors the hourly patterns, versus statewide averages, to make sure that there were no anomalies developing that needed fast attention. Mr. Lightbourne encouraged persons with such concerns to call him at 557-6541. Dr. Marone thanked Mr. Lightbourne for his presentation and asked about the under-utilization of the CalWorks program, and what outreach was being performed to address this issue. Mr. Lightbourne gave a brief history of the Welfare system, with its transformation from a previously command and control system to a more facilitative, cooperative, and problem solving one. That begged a certain lag time in credibility, and the Department has had to demonstrate the new system so that people can come to believe that it was a true thing. In terms of the active ways to encourage the utilization of the system, and that it is a safe thing to utilize, having the provision of service from outside non-governmental agencies, on the DHS locations would be part of that. Additionally, professionals will go to the training sites, which were non-governmental, to offer group work services there. There may be reluctance to discuss domestic violence survivor, substance, and mental health issues in an office setting within an agency that was the child welfare agency, for example. There may be concern that this would be information that could be potentially used against them in some other setting. A lot of system design had been conducted with the advocate community. From the beginning a sort of fire wall would be set up between the CalWorks program and the Child Welfare Program, so that information cannot be migrated from one program to another. Over time, when both systems build up their own credibility, with the community, and seen as a problem solving resource, it may be possible to reintegrate systems of service. At that point, realistically, people should be given the assurance that information will not migrate. Dr. Marone asked a follow-up question on the lag time in the change from a controlling to a facilitative system, and what the lag time was in terms of staff adopting the new system, in terms of how they communicate and work with the client. Mr. Lightbourne said that this was a real issue, and one of the things the Department did in the implementation of CalWorks was to create a new job classification of worker, which people had to apply for, instead of being grandfathered in. Most of the persons hired were from within because of their familiarity with the system, from training and emphasis in the program. There was an attempt to emphasize that this was a totally new system, and not simply an old system with a new name. Contracts had also been established with community agencies to come on site at all locations to be advocates for the clients, when necessary. If clients did not feel that they were being treated respectfully, or that if they simply were uncertain about their negotiating room, they could turn to someone outside of the agency who could help solve the issue with staff.

Mr. Jim Stillwell, interim Director of Substance Abuse Services, Department of Public Health said that for four years, the system had been expanding all of its services due to the Treatment on Demand initiative, passed by the Board of Supervisors in 1996. The Department convened a council of experts in the field, community representatives, client advocates, and clients themselves, to map out directions in their needs for expansion of services. The motivation was the need for services and inadequate supply of the same, and access problems, along with cultural competency issues, were identified by the community during this discussion. Service access to clients with significant mental health issues was a cultural competency issue. The council backed projects specifically designed to help clients with many different problems, but specifically clients with substance abuse and mental health problems. The projects included increases in outpatient services, day treatment services, women and family service, residential detoxification, and short term residential. Additionally, two recently funded but not yet operational programs, were the additional detoxification, and long term residential program. These have begun to address the access issues, in the sense that they were designed to serve persons with dual diagnoses, but may not perhaps address the question of whether each client should have a choice of which program to enter. A recent policy memorandum was signed that would create that kind of access across substance abuse and mental health services. Planning and movement toward the integration of substance abuse and mental health services was occurring, which will allow easier access to services for clients of one area to another, addressing all issues at one site. Substance abuse system was a traditional low cost system which was a peer-based system without clinical credentials or specialized academic training. It had a history of excluding clients with Psychotropic medications. This issue was initially addressed by opening programs designed to service such persons, with the plan that every program must have the capacity to open themselves to that clientele, without prejudice. Planning for such changes have now begun at the program level. Budget planning was also being conducted to ensure that the substance abuse program would do well.

Ms. Jan Murphy, Administrator for Primary Care, SF Department of Public Health, said that there area of expertise and purview were the community health centers, as well as the primary care clinics, and urgent care center at the San Francisco General Hospital. A teen health center, and neighborhood health center, as well as some homeless shelters were under their jurisdiction as well. She spoke on access to primary care by persons with mental health issues, and said that the Department’s concept of primary care was holistic in that it covered physical, mental health, substance abuse, nutrition, public health nursing services, health education, and where possible, addressing of the spiritual needs of the clients. The Department was interested in developing a multi-disciplinary approach to the problems the clients were beset with. There were about 75,000 unduplicated clients on the caseload at that time, and staff saw a fair number of mentally disabled persons among these. Many were referred by other agencies, shelters, and providers, in the City. Many of the clients came for physical health services, but were later diagnosed for mental health issues, and were then provided services on site, or were referred to other locations for services. Ms. Murphy named some of the centers where the programs were working well, such as the Maxine Hall Center in the Western Addition, a partnership with the SF General Hospital Department of Psychiatry Psycho-Social treatment program, Castro Mission Health Center, and others. What was not working as well was the attempt to provide some primary care services at mental health clinics, which was partially a function of what it took to provide primary care, such as the equipment, hazardous waste disposal, and other issues which needed to be addressed in order to establish a primary care site. There was some success with programs involving the jail patient Department, and referrals, was to provide direct scheduling with the primary care clinics, where persons just discharged from jail were immediately given appointment slots so that they can visit primary care facilities. This has been coordinated with the emergency care Department, and was now being coordinated with the mental health providers. It has been difficult for the Department to know how many mental health patients were being served, since there was no connection with the computers in that system, which is a function of both systems and confidentiality. Dr. ---------- added the provider and medical perspective in the discussion. He said that many of the primary care clinics saw a number of mental health and substance abuse problems as regular clientele, and he gave the example of the Maxine Hall Clinic in the Western Addition Neighborhood. Some 60% of the patients at that facility had mental health, or substance abuse diagnoses, or both. Many of the Department’s providers were familiar with mental health and substance abuse. Most of the clients with such problems were treated by primary care specialists, and not specialists in mental health or substance abuse simply because the mental health and substance abuse systems do not have the capacity to see all clients with such problems. Many, if not most of those clients end up in the traditional medical health system, and those who were in the low income or underserved populations will often end up in their Department’s system. At his end, the trend in trying to provide mental health and substance abuse services was to do this on site, in the primary care clinics, as opposed to referring most or all patients to specialized mental health and substance abuse services. The reason for this is that there are many clients who, once they become familiar with their primary care clinics, will go there for services, but will become resistant to going to other specialized service locations, for a variety of reasons. The Department has a variety of pilot projects which do exactly this, with a number of substance abuse counselors and mental health workers assigned to various primary care clinics in the system. He believed that with more resources, additional mental health and substance abuse services may be provided on site.

Mr. Lawrence Andrews, Administrator of the Leased Housing Division, SF Housing Authority, (SFHA) thanked the MDC for the opportunity to present information on what reasonable accommodations the SF Housing Authority provided to persons with disabilities. He introduced Mr. Duane Walker, Director of the Customer Service Department which provided oversight to the public housing component. He said that with the Federal oversight on the program, the SFHA’s direction was on confidentiality, and it undertook not to distinguish between applicants under the program. With program delivery however, outreach activities touched all areas regarding disabled individuals in the City. The application process, when it was open, reached into the agencies that served the disability community, to ensure that the individuals that were served by these entities would also be served by the SFHA. With respect to the participating landlords in the program, there were definite efforts to seek out owners who were willing to rent to disabled persons. Additionally, best efforts were made to make listings of said landlords/ properties so that disabled individuals may be referred to these properties. One of the areas that was unique to the program was the opportunity for staff to inspect that property. While historically, the SFHA had looked at physical access, it has now focused on what services could be provided for persons with mental disabilities. One of these has been the project based assistance, which is rental assistance for persons with developmental disabilities, under a contract which went to the Aid to Retarded Citizens (ARC). Twenty units will be developed for persons with Developmental Disabilities, who will live in a shared housing system, at 416 Bay Street, in San Francisco. This was the first time that the SFHA has entered into a housing project of this nature, in that shared housing was not offered to any other participants in any of the SFHA programs. It was felt that this was a reasonable accommodation to study if shared housing could work for this population, and the SFHA was confident that the project would succeed. Additionally, the SFHA was recently awarded 75 housing vouchers, marked specifically for persons with mental disabilities, and these will be available within the next 60 to 90 days. The vouchers will be available to participants in several community-based organizations. It was felt that this was a great opportunity for the targeted population for the services, which will cover some 100 units.

Mr. Bill Hirsch, of the Mental Health Association, spoke on the work of the community which led to that point. This began with discussions among community members about the City’s lack of response to people with disabilities, and later, a lawsuit was filed by certain individuals against the City for its failure to comply with the ADA. In the resulting settlement, a consultant was hired to assess the City’s physical and programmatic access. That day’s meeting was the first of its kind focused on access to City programs for persons with mental illness, and he was glad that Ms. Claudia Center was appointed to the MDC. Mr. Hirsch also expressed his observations on ways City programs effectively precluded people with mental health disabilities from accessing City services, and retaining the same, once they have actually received these. He hoped to point out some of these specifics during his presentation, for the City personnel and consultant to consider. Mr. Hirsch said that one could not expect people who were sick not to act sick, and for people with mental disabilities, there were very serious manifestations of their illness which effectively precluded them from accessing services that non-disabled persons may easily obtain. He gave an example of a person with major depression, who essentially stayed in bed, and who could neither sleep nor eat, and could not access a service by contacting the program via a telephone number listed on a form. Conversely, that person may already have been connected to the service, and will receive some other forms, but due to great difficulty in concentrating, the person may just throw away the form without reading it. He asked the city officials to think creatively on how to reach out to this person, knowing that there was that type of disability to ensure that the service becomes accessible to that individual. Mr. Hirsh said that he understood that there were limitations on resources, but there was also a responsibility and an obligation under the law to make reasonable accommodations to policies and procedures. The criteria for accessing mental health services was for the most part, based on the State’s medical necessity criteria. This required a showing of a serious mental illness, and that your life was significantly impacted as a result of that illness. Then, a showing of the existence of some type of treatment which was available which could help that disorder. There was a narrow group of people that were targeted, using that medical necessity criteria. The mental health system budgeted its funds based on people’s inability to comply with the program, which estimated a 50% non-compliance rate, which was the information brought before the Board of Supervisors as a basis for the modest expansion in services for persons with mental disabilities. Mr. Hirsch said that there was a long way to go, and encouraged the MDC to listen to the other comments that would follow. Ms. Regan said that a number of members of the MDI also worked with clients, and were employees of Non-profit agencies, and were well aware of the issues. She added that she personally worked on Section 8 issues, and knew that it was inaccessible as currently structured. Ms. Regan said that the system was inaccessible to persons with disabilities, and certainly for anyone with any type of psychiatric disability, since the system caused confusion, and she was prejudiced against it. Mr. Mike Wise, of the Consumer Family Task force prefaced his presentation by stating that he had given the same recitation three weeks previously at Golden Gate Park during another event for persons with disabilities. He stated that he was a mental health services consumer, and psychiatric survivor. He added that for many years, he had been lending his aid and support to make the necessary changes in the treatment of persons who were mentally ill. Mr. Wise said that it was up to persons like himself to spread the seeds to make the necessary attitudinal changes in the public. He was lucky to be able to access the public services that helped him through his illness, despite the difficulty in overcoming a condition which was not of his own making. What was most helpful was the consistent support and dedication of the many persons in the mental health community. What was absent was the feeling of being ignored, systematically neglected, and ultimately necessarily expendable. Because he was important to others, he was given a second chance, and he now wished to help others in the same situation, and to help these prove to others that their lives have meaning and value. He said that lives were interconnected, and each should be given the same quality of life. With the decreasing availability of resources, desperation will be an increasing phenomenon, and no one would be immune. Blaming the leaders was not the solution, who in the end will listen and look to the consumer for solutions, and decisions that will make life better. Mr. Wise added that the testimony will include problems, but also methods that worked to help those who were suffering. He encouraged more work toward housing, humane treatment, and decent respectful medical care for the disabled. Ms. rosemary Dady, a staff Attorney with the San Francisco Neighborhood Legal Assistance Foundation said that her agency provided free legal services to persons on low income, in the areas of housing, domestic violence prevention, public benefits, and health care access. She added that many of their clients had mental disabilities and had sought services to access services in the county which they needed, or if they were wrongfully terminated from the same. She cited the pertinent section of the ADA relative to discrimination in the provision of services and benefits to disabled persons. She added that an obligation existed whereby a county had to ensure that application for, and retaining services was as easy for a disabled person, as someone who was not disabled. This further meant that the county’s rules should not disproportionately impact people with mental health disabilities. Ms. Dady said that her agency had seen the result of the county’s failure to follow the ADA mandate. She gave an example of a person with mental illness, who received In-Home Support Services and could not fill out the form, and nearly lost the service and housing. She cited similar problems with Medi-Cal, food stamps, general Assistance, and other programs where people with mental illness could not fill out forms due to the application forms and process being too difficult to understand or cumbersome. For the same reasons, clients had also been terminated from services. Ms. Dady also said that such persons needed help from county workers, but were not getting it. Ms. Dady further said that the paratransit office workers did not recognize mental health disabilities as preventing one from using public transit. Further, her agency saw the difficulties that clients faced in accessing and retaining services, and the lack of training that county social, health, and other workers had in dealing with persons with mental health disabilities, and the mandates of the ADA. She said that there also was hostility from workers against persons with mental disabilities, and problems resulted in the eligibility or recertification process. She urged the MDC to consider the concerns seriously. Ms. Carol Paterson, a peer counselor with the Independent Living, Resource Center, said she also worked on mental health issues, among others. Ms. Paterson further commented on a list compiled by the Coalition on Homelessness, which were: Long time waiting in line for cash assistance. She gave herself as an example of a person with a psychiatric disability who may encounter difficulties standing in line. This may trigger certain adverse reactions or behavior, or make the mentally ill person simply give up waiting, to return another time. 2. Disorientation to place and time, as a result of the disability. Some persons with mental health issues may find it difficult to go to new places, or even be fearful. She said that she was a recipient of involuntary treatment, and as a result, was fearful of trying to access any type of health services for many years. Experience with involuntary treatment led many persons to become untrusting, fearful, or adversarial against the system. IN the case of the 30-day long-term beds at the homeless shelters, case managers were needed, and for persons with psychiatric disabilities, failure to make the appointment with the case managers may cause the loss of the bed. There were some mentally ill people who may need the bed, and not the case manager, or vice versa. Ms. Paterson cited the case of a mentally ill woman who preferred to live in her car, where she felt safe, instead of the shelter, where the atmosphere was adversarial. She said that most Psychiatric disabilities were aggravated by lack of sleep, and if a person with such disabilities sleep at a shelter, the disability became worse. Such persons will need some type of privacy, such as curtains, not just a mat in a crowded room. She suggested reasonable accommodations, allowing pets, private soundproofed rooms to prevent agitation from outside noise or persons. Regarding IHSS, she said that psychiatrically ill persons can benefit from this service by having someone help organize or plan things, such as going shopping since the lack of the ability to concentrate or disorientation was one of the problems of those with such disabilities. She added that these persons might need paratransit since they often are confused, or cannot cope in crowded situations on the buses during rush hour. Ms. Paterson finally said that over the past five to Seven years, the system had been reorganized several times, and this had made access to services difficult. Instead of accessing clinics where clients once went to, persons with mental illness often were now referred to a toll-free number. The case of someone whose services were terminated as a result was given. Ms. Eve Myer, Director of San Francisco Suicide Prevention said that her agency received 220 calls per day, 72,000 calls per year, answered by 150 community volunteers. The calls come from those who were beyond the radar screen of the community, primarily because of the depths of their own disability. She added that as a culture, mental and emotional pain was still unrecognized in this country. Unfortunately, over $2 Millions were denied to the mental health system last spring on the premise that half of the clients would not appear for the interviews. Ms. Mayer said that this was social Darwinism at its worst. As a member of the community base service network for the past 10years, she had seen community and peer based services to be the last programs funded, and first ones ended in every budget process. Such services are used by people who will function when they can function, and can only function, when they can. She recommended that the $2 Million is restored, and that treatment on demand also is restored to the substance abuse programs of the city, and the funds are directed to community based organizations. Ms. Regan asked a question on the denial of Psychotropic drugs. Ms. Myer replied that this was done in 12 step groups, where the participants needed to be substance free, although this has been changing recently, it was a problem for persons who have been dually diagnosed. Ms. Shannon Coughlin, of the Committee for Health rights in the Americas, and the Emergency Coalition to Save Public Health, addressed the issue of the accessibility of out-patient pharmacy services at San Francisco General Hospital to persons with mental illnesses. She stated further that this pharmacy was used by thousands of persons in the City, who had no insurance, who were on low income, General Assistance, MediCal, Medicare, homeless, substance abuse clients, the elderly, and the mentally ill. Access to this service was hard enough prior to the massive pharmacy budgetary cuts and policy changes implemented by Dr. Mitch Katz early this year. Maneuvering the current system was now a harrowing experience even for the healthiest person. She gave the process on the budget cuts, and changes in policy that created difficulties for the clients. The process of what a patient who could not pay, after waiting in line to drop off the prescription was described. It was noted that the Board of supervisors approved $200,000 to eliminate the point of payment service system for certain persons who lived below the poverty level. She said that the system was unwieldy, inaccessible, and how stressful the process was for anyone, especially those with mental illness. Examples of clients encountering difficulty were given. She asked the MDC to direct Dr. Katz to change the policy. Ms. Regan said that she personally observed the situation, and the description given by the speaker was not as severe as the actual problem was. She added that the number of persons who had stopped taking their medications as a result of the system would eventually cost more than the savings realized now. Ms. Regan said that this cost cutting was the most shortsighted event that she had ever witnessed.

Mr. Rob Roth, Executive Director of Deaf counseling and Referral Agency spoke on mental health services to the Deaf. He said that the prevalence of mental illness in the deaf community was the same as in the general population, but this problem was magnified by the lack of communication, or its barriers to the hearing impaired. He gave certain examples, such as mentally ill deaf persons who were unable to communicate in a way they were used to, or who did not have English as a first language, leading them to be frustrated and utter guttural noises, or raise their voices. This will appear to the county worker as being adversarial or threatening. And the client is terminated from service. Mr. Roth gave examples of certain agencies that provided services to mentally ill deaf persons. He made several recommendations to help resolve these problems in communication between the client and service providers. There was a perception among the deaf that service was inaccessible at government agencies, and service agencies on a walk-in basis. Staff assumed that clients could simply be plugged into the system without realizing that there is a communication barrier that stopped the clients from receiving the services they needed. Mr. Roth concluded by saying that funding for agencies that served mentally ill persons who were deaf or hearing-impaired was urgently needed. The Chair called a ten-minute recess.

Mr. Evans noted that there should have been some opportunity for the staff to respond since some of the Department staff left during recess. Ms. Mizner said that she was sorry for the scheduling of the speakers and staff, and in future meetings, there should be public comments first, then have Department staff respond to these. Ms. Arnette Watson, an advocate for people living in homeless shelters spoke on the difficulties which she observed regarding persons with mental illness. One of the issues was the need for case management for people who required the use of long term beds at these facilities. This created a barrier for mentally disabled persons because they would miss appointments, miss the 7 p.m. curfew, and will result in termination of services. She said that case management should be voluntary, and not mandated for persons to qualify for long term beds. She added that there should be intensive training for all shelter staff for both physical and mental disability issues. Recognizing the various types of physical and mental disabilities, how to de-escalate tensions, and provide reasonable accommodations will go a long way in providing access to the shelters. Further, the range of shelter living conditions also presented problems. The physical layout of these facilities precluded certain disabled persons from accessing them, particularly those who had difficulty with congregate living conditions. They should be provided with solitary, in congregate living conditions. Ms. Watson said that mental health services should be available at the shelters, with necessary staff with sufficient training on hand. Ms. Magdalena Soul said that she was thankful for the mayor’s Office on Disability, and the Mayor’s Disability council, and appreciated the community organizations’ comments, as well as those from the disabled persons. She added that she was a person on low income with mental disabilities, who was happy with the mental health services which she had received, as well as the low cost she had been paying for her medications. Her concern was that she had been unable to see her physicians or therapists more often, and how other people similarly disabled were encountering this problem, and therefore had difficulty accessing the system’s services. Ms. Soul said that she thought a bigger budget would be able to solve this problem. Mr. Chris Miller asked that the Mayor and the MDC vote against involuntary treatment. He said that this took the client out of the family, and community, as well as removing certain rights from the clients. Ms. Jane Rousseau, a long time care provider, and occupational therapist, said that the mental health community was both fragmented, and under-funded. She cited certain examples of the difficulties of clients in accessing mental Health services that she had observed at the Homeless Advocacy Project. She added that there was a growing number of clients who could not access services due to environmental illnesses.

Mr. Al rose requested that some photographs be placed on the television screen. The two photographs showed were of women, some who were well dressed, and the other of a woman with a severe physical injury to the jaw. Mr. Rose said that he was also a victim of such violence twenty years ago, and that while there were some persons with mental disabilities, there were also those who were mentally ill that could become violent, and added a political statement. Ms. Regan then asked him to leave the podium. Mr. Alan Pross introduced himself as a member of Senator Jackie Speier’s staff, and spoke on his hope to help accomplish things for the disabled at the State level through that work. He said that the Senator represented half of San Francisco’s population, and that any issues, ideas, or recommendations the MDC had for disability issues, Senator Speier would be glad to address these. He wished to speak on paratransit issues, but the Chair requested that these be discussed off record, since the focus of that meeting was on mental health and service access. Ms. Mizner thanked all the persons who provided testimony, and said that the MDC would work on the issues, and that there would be future discussion on the subject.

OTHER MDC MEMBERS’ COMMENTS:

Mr. Evans addressed his comments to the department heads who had left. He said that shelters and mental health or substance abuse programs needed to be placed in neighborhoods that were not already saturated with them. He observed that these were concentrated in the Tenderloin, south of Market, and Mission districts, and while the programs were necessary, there was no need to oversaturate particular neighborhoods with the same.

COUNCIL CHAIR’S REPORT:

Ms. Regan said that she was working with the Department of Justice trying to research and come up with a definition of " Service animals." She said that she had a number of clients who had legitimate problems but could not convince anyone that their animals were service animals. She added that the problem was the Federal government had never issued any clear definition of the term " service animal, with virtually no case law, and whatever little she could find, referred only to one type of animal in one place. She said that there was no overview, and was asking the Department of Justice " to get a grip" on this. Ms. Regan said that this was a very serious and interesting problem.

MAYOR’S OFFICE ON DISABILITY STAFF REPORT:

Director Park said that staff was now located at the new offices at 401 Van Ness Avenue, Rm. 300, San Francisco 94102. He added that staff had a number of issues which were being worked on, such as the Farmer’s Market on Alemany Boulevard, which had problems regarding the parking where people in wheelchairs had to pass the back of the cars, and there was to be a community meeting there on Saturday, October 23. He also had a meeting with a representative from BOMA to speak to the MDC on Building Code issues. Director Park said that notices of public meetings of other agencies could be sent to the homes of MDC members, if they preferred, or could be received at the new office address. Staff was also engaged in theater issues, such as accessible seating and line of sight issues, with the State of California, which Richard Skaff had been involved in. Additionally, a meeting was held during the past month regarding Laguna Honda, and Long-Term Care issues in general, which had begun a series of meetings between the disability community and City staff. He said that this was a crucial and productive meeting which was going to involve the MDC through the years.

Mr. Peter Margen, of Margen and Associates gave an update of the work on the ADA Self-Evaluation and Transition Plans. He said that his group had a pilot questionnaire which was going out the following week to test 11 selected programs for testing. Second, a questionnaire was to be sent out to the various Departments to identify what programs, services, or activities they provided. He also introduced Mr. Paul church who was hired to assist him in this work. Mr. Margen also reported that Logan Hopper and Associates was working on the City Library system, and was surveying City libraries. The two firms had agreed to report to the MDC on an alternating basis. He said that they listened to the various presentations with intense interest. Ms. Center asked if Mr. Margen noted the issues regarding the Pharmacy program. He replied yes, and that once all the programs had been identified, each would be analyze. Ms. Regan said that the pharmacy issue was " her thing" too.

ELECTION OF OFFICERS;

Ms. Regan said that decided that she would be of better service to the MDC if she were not the Chair, and declined the nomination. Ms. Mizner and Dr. Marone were nominated, and accepted. There were no other nominations. Without objection, Ms. Mizner and Dr. Marone were elected as Co-chairs. Mr. Alunan thanked Ms. Regan and Mr. Park for the work they had done during their terms as MDC Co-chairs. There being no public comments, the meeting adjourned at 4:00 p.m.