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The Community Mental Health Service in the City and County shall be administered by the Director of Health for the City and County. The Director shall have the following powers and duties:
(a) Chief Executive Officer. The Director shall serve as chief executive officer of the Community Mental Health Service and shall be responsible to the Board of Supervisors.
(b) General Supervision. The Director shall exercise general supervision over mental health services and facilities furnished, operated or supported as part of the Community Mental Health Service in the City and County.
(c) Recommendations to Board of Supervisors. The Director shall recommend to the Board of Supervisors, after consultation with the Advisory Board, the provisions of services, establishment of facilities, contracting for service or facilities and other matters necessary or desirable to accomplish the purpose of the Community Mental Health Service.
(d) Annual Report. The Director shall submit an annual report to the Board of Supervisors, reporting all activities of the Community Mental Health Services, including a financial accounting of expenditures and a forecast of anticipated needs for the ensuing year.
(e) Studies. The Director shall carry on such studies as may be appropriate for the discharge of duties, including the control and prevention of psychiatric disorders.
(Ord. No. 193-58; Sec. 2; amended by Ord. 337-99, File No. 992043, App. 12/30/99)
(a) There is hereby established a mental health board pursuant to the requirements of California Welfare and Institutions Code Sections 5604 et seq., to be known as the Behavioral Health Commission (“Commission”).
(b) The Commission shall consist of 12 members. The Board of Supervisors shall appoint all members, one of whom shall be a member of the Board of Supervisors.
(c) As required by California Welfare and Institutions Code Section 5604, at least six members of the Commission shall be consumers or the parents, spouses, siblings, or adult children of consumers, with at least three members being consumers and at least three other members being family of consumers. For purposes of this subsection (c), “family of consumer” includes domestic partners and significant others. For purposes of this Section 15.12, a “consumer” is a person who has received mental health and/or substance use services in San Francisco from any program operated or funded by the City, from a State hospital, or from any public or private nonprofit mental health agency. The Board of Supervisors member position shall not count in determining whether the “consumer” and “family of consumer” requirements of this subsection are met.
(d) In addition to the requirements of subsection (c), one member of the Commission shall be a veteran or veteran advocate. For the purposes of this subsection (d), a “veteran advocate” includes a parent, spouse, or adult child of a veteran, or an individual who is part of a veteran organization including but not limited to the Veterans of Foreign Wars or the American Legion. Additionally, one member shall be a child advocate. For purposes of this subsection (d), a “child advocate” includes a family member of a child consumer or consumer advocate for minors who use mental health services. A member may satisfy the requirements of both subsection (c) and this subsection (d) concurrently. The Board of Supervisors member position shall not count in determining whether the requirements of this subsection (d) are met.
(e) In addition to the requirements of subsections (c) and (d), on or after July 1, 2024 two members shall be from the following professions: psychiatry, psychology, mental health social work, nursing with a specialty in mental health, marriage and family counseling, psychiatric technology, or administration of a hospital providing mental health services or of a community mental health facility.
(f) Any positions on the Commission not allocated to specific types of members may be filled by persons with experience and knowledge of the mental health system representing the public interest, which may include, but need not be limited to, people who engage with individuals living with mental illness in the course of daily operations, such as representatives of county offices of education, large and small businesses, hospitals, hospital districts, physicians practicing in emergency departments, city police chiefs, county sheriffs, and community and nonprofit service providers.
(g) The Commission membership shall reflect the ethnic diversity of the client population in the City. The composition of the Commission shall, to the extent feasible, represent the demographics of the City as a whole. Except as provided in subsection(h), no member of the Commission or the member’s spouse shall be a full-time or part-time County employee of a County mental health service, an employee of the State Department of Health Care Services, or an employee of, or a paid member of the governing body of, a mental health contract agency.
(h) A consumer who has obtained employment with an employer described in subsection (g), and who holds a position in which the consumer has no interest, influence, or authority over any financial or contractual matter concerning the employer may be appointed to the Commission. Such a member shall not participate in any matter concerning the member’s employer if prohibited by state or local law.
(i) References in the Administrative Code or any other part of the Municipal Code, or any City ordinance, to the Advisory Board of the Community Mental Health Services, or to the San Francisco Mental Health Board shall be deemed references to the Commission.
The Department shall provide administrative staff to the Behavioral Health Commission with Department employees.
(Added by Ord. 229-20, File No. 200951, App. 11/13/2020, Eff. 12/14/2020)
(a) Except for the Board of Supervisors member, the term of each member of the Behavioral Health Commission (“Commission”) shall be for three years. No member shall serve more than two consecutive full terms. A member shall be deemed to have served a full term only if the member serves at least half of a full term. The clerk of the Commission in consultation with the Clerk of the Board of Supervisors, shall, upon the effective date of the ordinance in Board File No. 231076, change the number of the seats on the Commission, and assign existing Commission members, including members with expired terms serving as holdover appointees, to Seats 2-12 in accordance with the requirements of Section 15.12. Their terms of office shall be aligned with the terms of office extant prior to the effective date of the aforementioned ordinance; with the understanding that holdover appointees shall not thereby acquire any permanent or other special status. The Clerk of the Board of Supervisors shall equitably stagger the appointments so that approximately one-third of the appointments expire in each year, as required by California Welfare and Institutions Code Section 5604(c). Seats occupied by holdover appointees shall expire June 30, 2024. New appointments made to Commission Seats 2-12 following the effective date of the aforementioned ordinance shall be made in accordance with Section 15.12. The Board of Supervisors member shall be appointed to Seat 1.
(b) A member shall be removed from office if the member is absent for four meetings in one 12-month period, unless the Commission grants that person a leave of absence. The Commission may grant leaves of absence for one or more meetings. Upon determining that a member has been absent for four meetings in a 12-month period and that no leave of absence had been granted for these meetings, the Commission shall provide written notification to the Board of Supervisors. Upon receipt of the notification, the position shall be deemed vacant.
(c) The Commission may recommend to the Board of Supervisors that a member be removed from the Commission on the grounds that the member’s conduct is seriously disruptive of the functioning of the Commission. The the1
Board of Supervisors may remove a member from the Commission for cause or upon the Commission’s recommendation if it determines that the member’s conduct is seriously disruptive of the functioning of the Commission.
CODIFICATION NOTE
(a) The Behavioral Health Commission (“Commission”) shall:
(1) Review and evaluate the City and County’s mental health needs, services, facilities, and special problems;
(2) Review any City and County agreements entered into pursuant to California Welfare and Institutions Code Section 5650;
(3) Advise the Board of Supervisors, the Health Commission, the Director of Health, and the Director of Behavioral Health Services, as to any aspect of the local behavioral health program;
(4) Review and approve the procedures used to ensure citizen and professional involvement at all stages of the planning process;
(5) Review the procedures used to ensure the involvement of interested members of the behavioral health community and the public in the development of the budget for behavioral health services and report on the matter to the Board of Supervisors;
(6) Submit an annual report to the Board of Supervisors on the needs and performance of the City and County’s behavioral health system;
(7) Review and make recommendations on applicants for the appointment of Director of Behavioral Health Services. The Commission shall be included in the selection process prior to the selection of a person to fill this position;
(8) Review and comment on the City and County’s performance outcome data and communicate its findings to the State Mental Health Commission;
(9) Assess the impact of the realignment of services from the State to the City and County on services delivered to clients and on the local community; and
(10) In accordance with California Welfare and Institutions Code Section 5848(b), conduct a public hearing on the Adult and Older Adult Mental Health System of Care Act, California Welfare and Institutions Code Sections 5845-5848, draft three-year program and expenditure plan, and annual updates at the close of the 30-day comment period, as set forth in California Welfare and Institutions Code Section 5857(a). The Commission shall review the adopted plan or update(s) to the plan, and make recommendations to the Board of Supervisors, the Health Commission, the Director of Health, and the Director of Behavioral Health Services.
(b) Members of the Commission shall abstain from voting on any issue in which the member has a financial interest as defined in California Government Code Section 87103. The Commission is subject to the provisions of California Government Code Sections 54950 et seq. relating to the conduct of open meetings by local agencies.
(Added by Ord. 98-93, App. 4/13/93; amended by Ord. 337-99, File No. 992043, App. 12/30/99; Ord. 240-19, File No. 190497, App. 10/18/2019, Eff. 11/18/2019)
The Community Mental Health Service may provide any or all the following services for the City and County:
(a) Out-patient psychiatric clinics for those who are unable to obtain private care, including referrals by physicians and surgeons.
(b) In-patient psychiatric services for those who are unable to obtain private care, including referrals by physicians and surgeons.
(c) Rehabilitation services for patients with psychiatric illnesses for those who are unable to obtain private care, including referrals by physicians and surgeons.
(d) Information services to the general public and educational services furnished by qualified mental health personnel to schools, courts, health and welfare agencies, probation departments and other appropriate public or private agencies or groups authorized in the approved plan for Community Mental Health Services.
(e) Psychiatric consultant services to public or private agencies for the promotion and coordination of services that preserve mental health and for the early recognition and management of conditions that might develop into psychiatric illnesses.
(f) Any other services which are now or which may be subsequently permitted by the Short-Doyle Act (Sections 9000 to 9058 of the State Welfare and Institutions Code).
(Ord. No. 193-58, Sec. 5; amended by Ord. 337-99, File No. 992043, App. 12/30/99)
(a) Legislative Intent. By enacting this Section the Board of Supervisors declares its intent to more specifically delineate the long-range planning and budgetary uses of the San Francisco Community Mental Health Services Plan. This Section shall be construed as an expression of the policy of the Board of Supervisors with regard to the Community Mental Health Services Plan, but shall not be construed as an enactment of specific legal provisions. Nothing in this Section shall supplant existing law. Upon passage of this Section, the Department of Public Health and the Health Commission shall take whatever steps are necessary to implement the policies contained in this Section.
(b) Standards. Prior to the submission to the Board of Supervisors of the City and County budget, the Department of Public Health shall establish a mental health service priority schedule to be included in its San Francisco Community Mental Health Services Plan.
The Plan shall intend as a goal, the reduction of reliance on acute hospital care through the development of a comprehensive range of noninstitutional community services which meet the California Mental Health Services Act mandate of provision of services in the least restrictive settings.
The County Mental Health Plan shall include:
(1) A stratagem for addressing any current overuse of State hospitals, detailing specific steps necessary to assess the capacity of the City to operate within allocated State hospital patient days. This in no way is to preclude the City from arranging for increased State hospital allocations if required.
(2) A proposed maximum number of acute inpatient beds, exclusive of those at State hospitals, per 100,000 City population. This proposed use level shall be consistent with accepted state-wide standards for inpatient use, and shall reflect current use levels as well as any factors which uniquely affect inpatient utilization levels for San Francisco mental health clients.
(3) A proposed maximum number of skilled nursing care beds per 100,000 City population. The proposed use level shall be consistent with the policy to serve clients, to the maximum extent possible, within the City as well as the policy to serve mental health clients in least restrictive, community settings.
(4) A description of the range and type of community programs and services necessary to achieve the goal of reducing reliance on acute hospital services and other institutional levels of care. Emphasis shall be made on the use of mental health services to achieve the highest degree of independent functioning by clients in the community. The description shall reflect a commitment to the development of services, at all levels, which are responsive to the needs of cultural and linguistic minorities including implementation of planning specifically for minority services. The range of service elements shall include, but not be limited to:
(A) Emergency services, crisis intervention, screening and evaluation;
(B) Levels of residential treatment services including acute alternatives, long-term residential services, transitional residential services, and cooperative housing programs;
(C) Day treatment services;
(D) Levels of vocational programs including pre-vocational services, transitional employment programs, and job placement;
(E) Outpatient services;
(F) Case management services which address the requirement for continuity of care and ongoing community support for a broad range of mental health clients;
(G) Socialization services;
(H) Housing programs, including support for clients who are living independently;
(I) Advocacy, including ongoing assurance of clients' rights protection; and
(J) Community outreach services, including consultation and education, community organization efforts.
(5) For each type of service described, there shall be stated an estimated minimum level of service necessary to achieve the goals of this Section. This may be expressed in terms of beds per 100,000 population or full-time equivalent staff (F.T.E.) per 100,000. In addition, current levels of service in each category shall be compared to projected minimum level goals to establish areas of programmatic need.
(6) The development of the full range of required levels of care, including the implementation of maximum bed levels described in (1) and (2) above, should be accomplished by July 1, 1990. This shall include an estimate of the cost of maintaining current levels of necessary services as well as required funding to provide the full range of required services described in the County Plan. This estimate shall include the identification of funding shifts from existing inpatient and skilled nursing categories to achieve the service goals for services described in Subsection (4) above.
(7) At all levels of the County Plan, specific attention shall be paid to addressing the current capacity, and the projected need, to assure cultural, ethnic and linguistic relevance and responsiveness of City and County mental health services. Specifically:
(i) All existing and new programs shall have bilingual and bicultural staffing in adequate proportions in relationship to their community population and need. At minimum, there shall be parity in terms of staffing on all levels including administrative, clerical and clinical. In addition, all non-minority staff who are involved in the provision of services to minority groups shall be qualified to do so.
(ii) All programs shall indicate the cultural relevance of the treatment procedures including the availability of services or programming in culturally relevant languages, sensitivity toward particular elements within the cultures served, in-service training of staffing for administrative, clerical and clinical staff, and minority consultation and supervision. All changes in programming shall address the specific effects of such modifications on minorities both linguistically and culturally.
(8) The range and type of services required to meet the special mental health needs of mentally disabled clients with substance abuse problems. Specific attention shall also be paid to the development of services to address the mental health issues related to AIDS and associated problems including mental health clients with AIDS or ARC and mental health clients with AIDS or ARC and substance abuse.
(9) Programs serving children and adolescents shall follow the guidelines and principles set forth in this Section and, in addition, shall meet the following criteria unique to this population:
(i) The programs shall, to the maximum extent feasible, be designed so as to reduce the disruption and promote the reintegration of the family unit of which the child is a part;
(ii) The programs shall have an education focus and shall demonstrate specific linkage with community education resources; and
(iii) The programs shall contain a specific follow-up component.
(10) The range and type of services required to meet the special mental health needs of geriatric clients and of children and youth.
(11) A plan for addressing, at all levels of service, the mental health needs of individuals in the criminal justice system.
(12) A plan for incorporating self-help concepts and significant involvement of consumer participation at all levels of service in the mental health system.
(13) A management plan to develop and implement a method of coordination of the entire range of services so that all levels of care are reviewed and monitored to assure continual accountability of all program elements in the effort to achieve system goals. This shall include the coordination of inpatient services at San Francisco General and Laguna Honda Hospitals with the full range of community resources.
(Added by Ord. 25-88, App. 1/28/88; amended by Ord. 337-99, File No. 992043, App. 12/30/99)
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