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BOARD OF DIRECTORS MEETING MINUTES - DOC

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									                    Fresno County Mental Health Services Act
              Public Hearing & Special Mental Health Board Meeting
                               Monday, September 26, 2005
                  4:00-6:00 p.m. (Hearing) and 6:00 p.m. (Special Meeting)
                                  Trinity Lutheran Church
                                  3873 North Cedar Avenue
                                      Fresno, CA 93726



CALL TO ORDER

Mental Health Board Chair Ken Katz called the Public Hearing meeting to order at 400 p.m.

WELCOME/INTRODUCTION

On behalf of the Fresno County Mental Health Board I would like to welcome everyone to
Fresno County Mental Health Services Act Community Support Services Plan Public Hearing.

A lot has been done since the passage of Proposition 63 in November 2004. Today marks the
end of our 30 day public comment period, a landmark step in the process. I believe we have
already realized how important the result of passage of Prop 63 and people all over California are
talking about mental illness and all of its issues, and communities are engaged. This is an
important effort for the number of people affected in the world today.

The Mental Health Services Act presents an opportunity to do something different from business
as usual, to provide services in a non-traditional manner, and services recognizing the united
concepts of wellness and recovery.

The purpose of today’s public hearing is to seek your input to the Fresno County Community
Services and Support Plan. We know the process could have been improved upon, but as good
as it may have been, the final PLAN will not satisfy everybody.

With that said, the purpose of today’s hearing is to focus on the PLAN and not the process. For
that reason, when testifying you must refer to a specific section, part and/or page number in the
PLAN. At a minimum, reference must be made to a specific section or recommended strategy in
the PLAN. And after I conclude these comments, we will go over meeting regulations.

A sign-in sheet has been provided for those that wish to testify. I noticed that some people have
already signed in.

You will be called in the order that you are signed in, please be ready. Each individual testifying
will be permitted 4 ½ minutes and we have timers over here. We’re going to try and motion you
when you are 2 ½ minutes left and let you know when your time is up.




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Members of the Mental Health Board may ask to clarify your question, but I am requesting
members of Mental Health Board for the sake of time, that such questions are kept to a
minimum. I hope that everyone has a copy of the public hearing regulations that we prepared
and I’m going to go over them. I’m hoping to use the time as efficiently as possible. Please
know where you are on the sign-in sheet so you can prepare to come forward to testify as soon as
the speaker before you is done.

Following today’s public hearing, we will take a brief break and then we’ll continue with a
special meeting of the Mental Health Board. You’re encouraged to stay for the board meeting.
The purpose of the board meeting is to review and consider all of the info received through the
input forms, written submissions and today’s public hearing.

Based on input and testimonial received, the Mental Health Board may identify
recommendations to or for the Plan. The County’s required to respond to any substantive
recommendations made by the Mental Health Board. This is our meeting and the County’s not
required to incorporate any or all recommendations but must nevertheless respond through the
PLAN to the recommendations.

I will be presenting the Mental Health Board recommendations to the Board of Supervisors
tomorrow afternoon sometime on the agenda when the PLAN is brought to the Board of
Supervisors. This item is on the agenda tomorrow for 2:00 p.m. so anyone who wants to have
something to say or to participate in that part; it is on the agenda for tomorrow at 2:00 p.m.

Let me just quickly go over the meeting regulations:
     The purpose of the hearing is to focus exclusively on the draft PLAN.
     All testimonials must address the contents only.
     To assure that every person who wishes to address the PLAN has the opportunity to do
       so; these guidelines will drive the meeting.
     One, public hearing will start on time; I have already violated that for today.
     Courtesy and respect for the time and opinions of others are required.
     Persons wishing to testify must sign in and be called in order.
     Each speaker must address a specific section, heading and page number in each
       comment. Every speaker may be allowed a maximum of 4.5 minutes; however, the
       time may be decreased to allow input from all speakers.
     Comments are limited to expression of support, opposition, suggested changes,
       additions, or deletions pertaining to specific sections, heading, and page numbered
       items.
     Focused, constructive criticism will be accepted; unfocused, negative personal or
       professional comments or opinions will not be allowed.
     Off-topic statements will not be given time; the Chair will stop the speaker in the event
       of inappropriate comments.
     Any speaker providing a written record of his/her verbal comments made during the
       hearing should provide two copies to assure that the information is recorded accurately.
     Discussion about the planning process will not be considered. Proposed legislative
       changes or advocacy for proposed legislation will not be accepted, nor will general
       concerns about California’s mental health system. Those comments must be addressed



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       to the appropriate state legislative bodies or departments.

That concludes the review of committee regulations, with that said I would like to invite our first
speaker or individual to the podium.

Dennis N. Torigian with Housing and Support Services. Can I be last? I was here early,
inadvertently signed up before anybody even sat down.

Mr. Katz: I have no objection to that.

MaryLou Brauti-Minkler. I am a parent of a mentally ill family member and member of NAMI
Fresno. I want to address my comments to the Section, Children and Youth. I was on the
committee that met throughout the summer, so this is the section that I was most familiar with.
On page 36 of the Mental Health Services Act Draft, Part II, Program and Expenditures Plan
Requirements. The nature of community issues related to mental illness for Children and Youth
are: 1. Work Force Development, 2. School Based Services, 3. Juvenile Justice, 4. Prevention &
Intervention, 5. Child Welfare and 6. Rural Services.

These issues were chosen by the committee after their extensive discussion and presentation of
data in relation to unserved and underserved populations related to mental illness and this is what
we will focus on through NAMI, is reference to mental illness.

From research cited on page 38 of the draft; 20% of children meet the diagnostic and statistical
manual DSM criteria for mental disorders. 10% of children have disorders that significantly
impair function, but only 5% received care for serious mental health problems. Furthermore, the
PLAN on page 76 states 51% of children with emotional behavioral disorders drop out of school
as compared to the national average of 10.7% of children. On page 39 the PLAN states that
diagnostic and/or treatment failure during childhood is associated with increased risk for juvenile
crime.

On page 36, section 3, on how the selection of initial populations reduces the specific ethnic
disparities. The juvenile justice system population is mentioned, but there is no mention of the
school population, which was #2 on the committee’s major issues. The only thing that is
mentioned about school populations is enhancing services to adolescent parents who are severely
emotionally disturbed and/or have a substance abuse or co-occurring disorder.

Page 70-74 proposed program strategies, initial funding recommendations. Page 72 school
services are planned to increase services of the incredible years, evidence based programs and a
K6 prevention program. Programs which are both based upon increasing social competence with
children and their families. Training for parents and teachers will focus on child development,
behavioral management and fostering academic readiness. NAMI Fresno asks, in what ways do
these chosen school programs address the stated mental illness issues of diagnostic and/or
treatment failure of the serious DSM mental disorders that lead to increased risks of both drop
outs and juvenile crimes?




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On the budget narrative, expenditures for family member and caregiver support consists of
miniscule amounts of money and client services, and only in such areas as clothing, food,
hygiene, travel, transportation, housing and other such family expenditures for P.G. & E. Again
these are not aligned.

Our recommendation from Fresno NAMI is to increase education and reduce stigma and to
increase awareness of the signs and symptoms of mental illness. Stigma and the lack of
awareness of mental illness and their symptoms is a major personal and social barrier to
prevention intervention and services all across the ages and especially for children and youth.

So we have several proposals to educate that development for the staff that work with children,
student mental health lessons that would be given in their house classes and there are lessons that
are already prepared at all grade levels breaking the silence, teaching the next generation about
mental illness. The youth depression screening initiative, which is a Columbia program that is
being used in many communities across the county.

We also like to see a central clearing house where families could go one place to find out what is
available in mental health services in the community. Fresno County Mental Health Services,
private providers, clinics, mental health treatments and so forth, families are desperate to know
the services that are possible and they spend months and years and maybe never finding ways to
get help. Thank you.

Loree Seigle

I hope I’m going on the guidelines, but mainly is the whole proposal for me 1 – page 231 or
whatever it is, is truly hard to understand and not consumer friendly and a lot of our consumer’s
did not have access to that so we could come up here to the podium and address the facts in
certain sections, and pages, and quotes. And even if they were, they wouldn’t understand it.
Thank you.

Yes, my name is Laura Lambert. I’m speaking on behalf of a consumer.
I’m representing myself. I am a consumer of Fresno County Mental Health. I’ve been a part of
the system since ’89. What caught my eye in here is ―Peer Services‖ which is on page 80 & 81.
Anyway, I work for a Peer services and its supportive employment. It gives structure & support
to people with mental illness who otherwise can’t work in an atmosphere that doesn’t have
support or structure. All I know is that thanks to ―Peer Support‖ I have a reason for getting up in
the morning. I’ve been employed almost 7 years and I’ve done really well, I have accomplished
a lot and that’s all I have to say.

Don’t go away yet. May I ask you a question?

Yes.

Mr. Katz: I am really glad that Peer Services has been helpful to you, and it sounds like you like
what you’ve gotten from peer services. What would you like to see?




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With supportive services, more outreach into the rural areas. I think that would maybe help
more. Maybe more positions, more education and advocacy, that’s what I’m trying to focus on,
what I wanted to say. That’s all I can think of, sorry.

Board member: What about housing?

Yes, Supportive housing. I hope to live independently someday in housing that’s supportive and
allows just a tiny bit more freedom. That’s all I can think of. Thank you very much.

Rosemary Diaz:

Hi my name is Rosemary Diaz and I am the Executive Director of the Deaf and Hearing Service
Center. I want to apologize to the board; I apparently downloaded the wrong document, should I
go ahead with the comment?

Mr. Katz: I appreciate the confusion. Do you need a copy of the document to review? You
could come back in a few minutes or if you have comments that are about the PLAN, probably
difficult without the document?

Yes – I believe I have comments.

About the PLAN?

Well, I hope so.

Would you to come in just a few minutes and just kind of review your comments with a copy of
the plan?

With a copy of the PLAN. Yes, maybe that would be better. Again I apologize.

No problem, there are copies of the PLAN in the back on the table.

Okay. Thank you.

Debbie Paulman

My name is Debbie Paulman. I’m a consumer/provider that means that I am a consumer myself
and I’m in the system. I also work with Peer Support UCAN Services in providing services to
other consumers.

Peer Support services were discussed on pages 80, 81, 102 and 103. This is what I am
addressing.

One thing that I think that bears addressing is the village model of recovery that you had in there.
About having a drop in place. I think we need more peer support groups, we need to do more
outreach to the community so consumers who are not currently getting treatment can find



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treatment and I think that could involve going into neighborhoods, or meeting at church’s
meeting or sometimes getting outside of the box in terms of doing outreach and I think it has to
do with hiring more staff and possible hiring a clinician and a couple of other people. I think we
need more student professional workers because we are consumers and there are very many
advantages to this because we know what it’s like. The consumer tells us he’s been waiting for
how many weeks to see a doctor we know what that’s like. I like the idea about what you wrote
up about the facility, about the building and having a drop-in center, taking care of the children,
youth and adult and older adult. I think that would be good. I am concerned about housing and I
don’t know what page that’s on. I think that we need more supportive housing and possibly we
have Cedar Woods and Cedar Heights and there’s Room and Board. I think something between
a room and board and Cedar Heights would be good. Something where people are taught
activities of daily living, something where there is more involvement, more public access to
become more independent. I think housing is a big issue and really appreciate that you’re asking
us to come here to talk with you. That’s all I have to say.

Mr. Katz: I have a question for you. When you talk about the supportive housing, what I heard
you saying is that we need something between room and board and Cedar Heights/Cedar Woods.

Yes, Cedar Heights, Cedar Woods, we have staff there, but the people are mostly independent
and they check in with the staff now and then. I think you need to be teaching the skills for a
person to become more independent. Like how to go shopping, how to cook your food, how to
clean your house, basic things, so we can get more people out of the board and cares, that’s what
I think is very important.

Thank you. Anything else?

Well, I’d like to say that (this is a little bit personal) but I used to think that the doctor would cure
me, but through UCAN and after working here I’ve learned my responsibility from my growth
and my involvement and I had no idea that that’s where it was before I started working at
UCAN, so I want to thank my colleagues at UCAN.

Thank you very much.

Kristi Williams

My name is Kristi Williams and I am a parent of a daughter that has bipolar and I’m also a
family advocate for families here in Fresno.

And my comments are in regards to page 70, beginning with Children and Youth which I served
on the Task Force here in Fresno and also a lot of the pre-staff in Sacramento that I was involved
in and on page 70-74 all the way down to #5 this is absolutely everything that this Task Force
came up with. None of this is in here without our approval and we worked long and hard
looking at these programs and approving these programs. You may have heard that the Children
and Youth Task Force, we were ugly. We were not fun to be around for a long time because we
hashed this stuff out, and Ricky can attest to that, and this is our outcome and this is our findings.
So I just wanted to say that and approval of all of this, that’s where it comes from, so Thanks.



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Mr. Katz: So Kristi your subject this afternoon is to reaffirm that the material on Pages 70-74 is
indeed a reflection of what came out of Task Force?

That’s absolutely everything that came out of Task Force. Thanks.

Hold on, Kristi.

Board member: I was curious as to why the focus is on behavior modification rather than on
diagnostic and treatment programs.

The incredible years program is the model that treats the child, teaches the teacher and also
teaches the parent how to deal with the child and I can speak personally about that, because I
work with a lot of parents of severely emotionally disturbed children that are in our school
system and I have seen the results that these children have had after just very short periods of
time working this program. It’s very hands on, so they use a lot of puppetry, a lot of getting out
of themselves and becoming someone else and being able to be someone else and actually
disclose a lot of stuff they couldn’t if they were themselves, if that makes sense to anybody. And
it is mental health, it’s all about mental health and it also includes the parents which I’ve seen
parents come through and come away with a new knowledge of their child having a mental
illness and not just being a bad child and the teachers as you know all need this help, this training
in regards to the severely emotionally disturbed and that’s what this program does. I know it’s a
limited age, but I’ve seen Fresno Unified use it all the way up to children age 12. Actually one
of the kids I’m working with is 12 and it’s phenomenal. He’s a different child!

(Additional comments from Board member and speaker, not audible).

Mr. Katz: I’m going to interrupt. This is really off target, because questions are to clarify.
Please hold till next session, would be more appropriate. Thanks, Kristi.

Billie Hughes

Good afternoon, thank you. This is a brief presentation, but if you would refer to page 80, under
the Adult. I’d like to speak about ―Peer Support‖ and how wonderful it has been for me,
although we are understaffed and I would be working probably for UCAN if the benefits were
such where I would not lose my Medi-care/Medi-cal. Also, the educational classes that we learn,
our medications, how to budget money, and how to live independently is a test and the volunteer
program that UCAN and peer support offers, has been able to give me a life and give back to the
community, even though I don’t get paid for it I really enjoy it and it is my way of giving back to
society. Thank you.

Mr. Katz: Thank you Billie.

Glenda Ervin

First I came through UCAN. I have been through the mental health system two times. I am a
consumer and I’m a survivor, and I am referring to page 80. I was lucky to have some of the



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people in this room help me, drive me and provide me with the support I needed to overcome the
problems I was having. On being employed after volunteering at UCAN, I now work for the
Greater Mental Health Association of Greater Fresno and volunteer on the weekends. I think
that you need to put a lot work into the peer support and into that program, because it does a lot
of good. It could do a lot more good as well if you have a lot more outreach and let people know
what’s available and let them know how you can help them. I have 2 children. Both are
Transitional Age Youth and both are consumers as well and I’m glad to see that you’re
transforming, or hoping to transform the Transitional Age Youth system. I have a son that was
kind of lost in the transition and I have a daughter that is 16 and was just diagnosed as Bipolar,
ADD and depression, so I’m hoping that she can take advantage of the system as well. I look
forward to the plans that you have come up with. I think you got a good start, but you need a lot
more permanent positions in the peer support area.

Mr. Katz: When you talk about Peer Support how do you feel about the strategies being
recommended in regards to peer support?

I think they’re a good start. It’s a good place to start. I’m hoping in the years to come, you
would base your choices upon experience. Experience based practices. That’s what I’m hoping.
You’ll find out what has worked best and continue with that. Thank you.

Katherine Kelso

 Good afternoon, my name is Katherine Kelso and I am a consumer also dually diagnosed and a
mother and a student at Fresno City College and what I would like to say is addressed again on
page 80. What we are asking you to do is consider us experts in our area although we
communicate maybe differently then yourselves. The context of our communication is valid and
I really appreciate the approach that we have the ability to offer this input to tell you what our
needs are. There’s a tremendous community out there that we have not tapped that continue not
to have the services that are needed that will help them be able to take care of themselves. We’re
not asking for someone to care for us, but the ability to have the funding put into the specific
areas that the consumers request in order to have affirmation for ourselves. I spent five years in
private care and I spent three years in the system for Fresno County behavioral mental health.
Today I am one semester away from graduating. I made the Dean’s list. I walk out of my house.
I walk out of my room. I have the ability to be standing here speaking to you today and that was
not always the case. My daughter has received services through the County also. She’s taking
the California __________ test. She’ll be graduating a year early and she has an internship with
Californians for Justice. My point is, in order for us to have the abilities to improve, we have to
have the assets to be able to think of ourselves as equal with yourselves and that is housing, it is
peer support. In substance abuse the attitude is that only an addict can help another addict. Well
all people can help all people. We’re no different than yourselves except that our
communication process is slightly different. We have goals, we have dreams, we want to earn
our right in our community today and we’re asking you to recognize, not to extinguish our hopes
for that. Thank you very much.

Mr. Katz: We appreciate that. You clearly are in support of consumer peer support. Are you in
support of recommendations with regards to Peer Support Consumer as stated in the PLAN?



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I spent the time to read the paperwork and it was hard to get it all. What seems to be presented is
reasonable as far as the housing. As far as the Peer Support it is the last thing that needs to be
cut that is a service that I feel that should be promoted. When I initially went into the system, I
already had received five years of care that did not touch me. It took me a year to get to my
appointment with services with the county, a year to get there. However when I did get there it
was my peers in the support groups and the work that I saw was being done and knowing that I
could be a part of that, it gave me hope to get to where I am today. I come from a professional
family; my mother has worked in the County for years. I’m not unfamiliar that everything has to
go through a procedure, there are certain things that are realistic and certain things aren’t. What
I am asking you to do is to truly consider us experts in our areas and to actually follow the words
and guidelines in the final draft for the funds to specifically benefit the consumer. What I am
advocating for is the peer support, housing, independent living services and follow up treatment
so people, we don’t have such a turnover and such in the PACT unit, where we don’t have crisis,
because all the services are followed through. I’m asking you to respect our rights as individuals
to be able to improve and care for ourselves, learn to care for ourselves. Yes I read the initiative
several times and I can’t say that I understand all of it. What I did understand was very positive,
but I am concerned about it, I’m concerned about the words and directions of the words being
followed through with, for example I would hate to see that this amount of funding, which is
going to change the mental health community for you and for me, to not be directed into correct
areas. So what I’m asking you is not just to hear, but to listen to the consumers that are
approaching you and realize there are limitations with everybody, but the way these limitations
are lifted is no different than schooling somebody. It’s just a little bit more time consuming but
you obviously are concerned as you would not be here spending your time today.

I’m very sorry. There was somebody else that attended this meeting and signed in, she is also a
student at Fresno Community College and she had to exit due to an emergency and she requested
that I read this to you. She feels that the priorities that are needed are residential training,
housing where consumers can be taught to be independent and successful. Her name is Vicky,
but I’m not sure what her last name is. Thank you very much.

Mr. Katz: Thank you. Just a reminder that the sign-in sheet if you want to speak is up here, so
that if you came later and you do want to speak you’ll need to let me know.

Kelly Brooks

Hi, I’m Kelly Brooks, current President of NAMI Fresno, and National Alliance for the mentally
ill. We’ve provided written documents for the Board members and we had faxed this
information late last week, we weren’t sure if you got it or not even though we had full
confidence in Vera and Greg. We just wanted to be sure you had it. Couple issues that pop up
on my page 3 we’re talking about peer and family support, which refers to page 80 and 81, 126,
132, 137, 173, 181 and 189 of the draft document. We reworded some concept on how families
should be included in the dialogue or how it should be laid out in the PLAN and if I could read
that for you.

―Adults, Older Adults, Transitional Age Youth and Children with mental illness and their family
members shall be provided support, education and advocacy services. Knowledgeable staff fully



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devoted to intake referrals should accommodate this process. They should have specific up to
date knowledge of all services in the Fresno County area, be they private, non-profit or
government run services.‖

We want coordination of services and collaboration of services. There’s a feeling that we have
many services in our County and they should all be used as needed. No one should be allowed to
fall through the cracks. Mental health as it exists today is hard to access and is fractionalized in
our opinion.

This, all comers, all providers health service would go a long way, in our opinion to improve the
access care and service process. Now, as I read the document and look at the Village concept,
this may overlap into that, but even as many times as I’ve read it I don’t understand it.

We, within NAMI Fresno talk about one-stop shop, we talk about a place where somebody in
trouble, somebody has a question, somebody in crisis, somebody that needs just additional
information or a new support, a new twist or new look at what their needs might be can go there
and be referred, regardless of all the barriers that we’d talked about; race, and educational
background and social status, whether they have insurance or no insurance or private insurance.
It’s an all comers, all providers clearing house that’s what we would like to see included if it’s
the village concept that has been referred to also as a one-stop shop.

In the arena of housing we are supportive of any housing for our loved ones, any! We’ll take
anything. We are in dire need of safe, low cost supportive housing, so AB2034 is a good plan
and a good program and it has a success record. We are also very much in support of other
housing services and providers.

Housing and Supportive Services has a program that can house 50 people today and we’ve talked
about this a number of times. These fifty people would cost our county $85,000 a year for 3
years. In the proposal for AB2034, which is a great program will provide care for about eight
people in bringing it up to the previous level for somewhere around $80,000. Eight people/fifty
people, to me the math speaks for itself.

I want the AB2034 program, don’t get me wrong. I’m passionate about the need for housing; I
just think that at this point in time with the funding constraints that we’re all under this is a better
deal.

We’ve leveraged the money, MHSA guidelines tell us that we should look for leveraging
programs. For $85,000 dollars we’re going to get a million dollars worth of value. Safe,
supportive housing, I think we should support it as a group and it’s not one or the other I want it
all, okay? So I’m not bad mouthing AB2034 or all the hard working people that support that
program. I am invested with you, but I think mathematically right now this is an opportunity we
need to take advantage of. Thank you; I appreciate the time I had.

Mr. Katz: Hold on.

(Board member question, not inaudible.)



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I think in pages 80-81 the first sentence or two is exactly as written. I think we probably added
―and children‖ in there, because from 80-81 we talked about Adults, Older Adults and
Transitional Age Youth, but don’t say anything about children.

(Board member question, not inaudible.)

That’s my understanding, yes, on page 80 is where we want peer services as a group but we also
want to make sure that family support is separated out more distinctly. So a lot of the dialogue in
our handout that we’ve given you speaks to that fact also, but it’s in page 80 to 81.

(Board member comment, inaudible).

I think it’s specific on page 80 to 81 but I think the spirit is needed also. So I appreciate you
trying to clarify that with me. Ah, the concept of peer services and family support services for
me are distinct entities and so if you say peer support slash family support, they’re not equal,
they mean different things and have to be addressed separately, so if we could make sure that
that spirit was carried throughout the document we would feel better about it.

Board member: Are you saying then that the family part cannot be done by the peer?

No, I’m saying that there are peer service activities and there’s family support activities, and
we’re not talking necessarily about clinical, we’re talking about, you know, education, support,
advocacy, housing, I mean all of these concepts come in there, but not in the concept that you
have there for, need for clinical versus non clinical, that, that…

Mr. Katz: It sounds like what you are describing is peer support services provided by consumer
peers, family support services provided by family of peers. Is that close?

I think in the documents there’s peer support family support and they’re not making the
distinction about what is family support.

Mr. Katz: You’re distinguishing, so we’re not saying it all in one sentence. We need to separate
the areas.

Exactly. Thank you.

Mr. Katz: Before we go on to our next speaker, I wanted to ask Rosemary if she wanted to wait
a bit longer or if she’s had enough time to get her comments together.

Rosemary Diaz

Hello again. Thank you for giving me a second chance up here. Okay, so I have the right
document now and I am representing the deaf and hard of hearing community within Fresno
County. I would like to let you know that there are about over 70,000 in Fresno County with a
hearing loss. And I’ve had the pleasure of serving on two different task forces. One included



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Older Adult and the other was evaluation and we’re glad to have Kathy Phillips come to our
meetings and have the board recognize her.

I wanted to refer to page 91, to look at the 5th and 6th bullets, to ask the board to clarify that
because in the deaf culture we don’t have and we have to keep in mind to satisfy the deaf
culture’s needs. Physical access is also important as well. Cultural in the document relates to
ethnic, but obviously we have our own language, our own culture, but we’re not identified as an
ethnic group. For cultural and linguistic access, it’s not just access for families. We also need
education, outreach (tape indistinct).

Mr. Katz: I have a question, I was too busy writing. How many consumers did you say are deaf
and hard of hearing in Fresno County?

Consumers I’m not sure about, but there are about 70,000 deaf and hard of hearing. (Discussion
about services for the deaf and hard of hearing and other physically challenged, but tape
indistinct).

Board member: You mentioned a document. A state document or a state plan of some kind.
Toward the end of your comment. Is that what you gave him? (Response inaudible)

Faun Horton

Hi, my name is Faun Horton. (Indistinct) Adult schools, churches, parent-teacher organizations,
community colleges, court ordered programs and private agency providers, there’s not any lack
of parenting programs available in our community that has not been addressed is school
integrated and school based services.

In context of the least restricted environment, the best is for kids with the, first of all least
restrictive, at home with the parents and their families handling their mental health issues and
trying to cope. And a child really coping with his mental health behavioral issues. Next would
be outpatient treatments for adolescents and children. The great majority of clients are served in
central locations rather than school based programs. Some parents may wish to continue central
based services for privacy reasons. School site based programs are eliminated in recent years.
Educators tried to fill the gap with teachers, administrators and school psychologists with mental
health educational backgrounds or clinical experience. The results are high suspension rates,
incarceration, lack of integration of mental health services in the natural environment, higher
incidents of crisis when school is in session which is documented by your mental health, Fresno
County Mental Health, a lack of collaboration between mental health and school services.
Centralized services create several barriers for children and their families that result in the lack
of access to appropriate services and placement in more restrictive environments.

Mr. Katz: Can you tell us where you are in the PLAN, so members can follow?

I am referring to the section that does the parenting program for children (indistinct).

Mr. Katz: Do you suppose that we can locate that by section?



                                              12 of 40
No, SMART model is birth to 5. Okay. Yes. Yes. Incredible years.

Is that what you’re referring to?

Absolutely (the rest is indistinct).

My recommendation is to rebuild a quality school site based program for a system of quality
indicators for mental health outcome and academic achievement. The next issue of LREs, more
restrictive environment is adolescent day treatment. To the best of our knowledge there isn’t an
adolescent day treatment program that now exists in Fresno County.

My recommendation is that program; our recommendation is to build a quality system, a day
treatment for greater numbers of children and adolescents with a focus on successful transition
into a less of restrictive environment and to follow California Federal Department of Education
evaluation indicators of academic achievement for children and youth. Quality indicators that
demonstrate a focus and respect for language and cultural needs of children and their families.

The more restrictive environment is Fresno County in-hospital treatment. There’s none!

Fresno County has a population of 500,000. Excuse me.        Okay, I will conclude,
recommendations.

Fresno County revisited the hospital inpatient bidding process to allow Fresno County mental
health staff, parents and hospitals to develop a transition plan with appropriate support services
to address the individual child’s needs.

Monthly reports to the Mental Health Board are now coming for children and youth who require
inpatient services. Thank you for your time.

(Board member comment, indistinct)

Margaret Jackson

My name is Margaret Jackson. I have a couple of concerns. Everything looked great. I mean, it
looked great what was in there. The concern I have is in terms of the African American
population and the issue of mental health and how it relates to child welfare. What happens in
mental health has a great impact on what happens in child welfare.

Because the majority of the clients that are seen, get court ordered to get mental health
assessment and treatment. Page 54, one of the main concerns I have is the identification of who
is considered as unserved and I was concerned that youth, we did not show up as correctly
represented. I’m sorry, I think it was 30% and then adult population was zero and I find that
hard to believe when the majority of the children in child welfare are referred for an assessment
along with their parents and I know what that is. It’s that their parents are not coming for the
mental health assessment and when they do come, if they have a substance abuse, a lot of them
have substance abuse issues. They’re not accepted for services because they need to go get their



                                             13 of 40
substance abuse issue addressed, before they can be seen. So that compounds the problem,
because until they do that, they’re not seen for services.

Then their visits don’t progress, their case plans don’t move forward, because they don’t actually
come. So, I don’t think they’re showing up in your numbers is what I’m saying because they
never make it, in order to even be counted as part of that population. So it compounds the issue
of (indistinct).

On page 36 of the plan, you talk about prevention and early intervention that’s being identified,
but I don’t see any… what I’m concerned is that the issue of substance abuse is not woven
throughout. It should be addressed not only for youth, not only for adults, but it should be
addressed and the concern that I have about it, if it’s an infant and we know that women are
over-represented in child welfare, it’s a smaller child and the parent has to come for a bonding
assessment or bonding study or whatever. If they don’t get in and get seen, that’s a … I listen to
one of those bonding assessments, I saw it come back and the recommendation from an outside
provider said you know the mother was unkempt, she looked impoverished, and the bottom line
was a very harsh evaluation and the bottom line was not only do we recommend that she (not)
don’t get her kid back, neither do we want to have her as a patient. That’s very hard… I cannot,
I mean you can control for the safety, but that is a very hard for me to understand. And when I
read through the thing, when there were comments about her being unkempt, well the description
about her being unkempt she was orderly, but if you know anything about African American my
children when we get ready for church, we’re greased from head to toe. That means I’m
polished, I’m ready, I’m ready, I’m looking good. So if she came in and she was oily, she
thought she had prepared herself and was looking good and if you don’t recognize that, how
many of those things happen that get described as, ―she seemed medically‖ and what did that
mother say when she left went back to the social worker… she said ―That lady didn’t like me‖,
so she stopped going. Do you think, she’s going to come back and do anything different? No,
she’s not and the cost is high. So those are the things I’m worried about. So even if it’s right
and we get all our work done in house with Fresno County what about your outside providers?
Are they going to be up to par in terms of being culturally and linguistically appropriate?
Because it’s still true, even though you all do your work in house maybe it doesn’t happen
outside.

So I just want to put this above information about these proportionalities and the fact that there
are so many African American children represented in the system I don’t know the exact number
of many you see in mental health, but I know it has to be significant, each case that I look at has
a recommendation for least a mental health assessment and probably a bonding assessment and
these do not move, unless we hear from a therapist that they can move. So if these folks are not
getting in there and not feeling like they’re part of the system or welcomed when they get there
or they’re left out until they finish their substance abuse issue, they don’t get their services, hold
up their case, they never unify, which contributes to the issue of disproportionality. So that’s my
stuff. I’ll leave you some stuff on that and that’s all that I have. Thank you very much.




                                              14 of 40
Gilda Zarate

Good afternoon. My comments, I refer to page 111 and I have another page, but that’s coming
up later on.

And I think myself and two Native American (elders) others that are here with me today. We
just had access to this document 35 minutes ago, actually an hour ago when we first come
through the meeting.

And the first thing we’d like to say is that I was appalled by the number of Native Americans
you are predicting to serve in the next three years. That is 1% of the total, without any increase
over the period of this PLAN.

So 1%... 1% represents about roughly 130 Native Americans, there’s 13,000 Native Americans
living in the city according to Census 2000. So I don’t know how you projected the numbers of
Native American individuals that you will serve. But it seems that you took those numbers by
the numbers of Native Americans that we access your program and also kind of instead that
you’re basing your numbers on the tribal and rural area Native American. And, just FYI 70% of
Native Americans live already in the city. They’re urban Native Americans, so the majority of
them are in the city and not accessing your services in the city. So that can also be justified by
the systemic ratio misspecification. And I would encourage you to learn a little bit about South
Western U.S. History, so you can learn why Native Americans have Spanish last names so
they’re identified as Hispanics or Latinos, but they’re really Native Americans, so I would really
encourage you to do that.

Native Americans have over 30% of incidence of mental health diseases. So we’re talking about
approximately 3,000/4,000 Native Americans that are going to onset a mental health disorder
and you’re planning to offer the services to only 130. So as far as your page 84 regarding future
considerations of integrated services …(indistinct).

I would like to encourage you to establish partnerships with truly competent organizations that
are non-profit and have already proven to be truly competent serving this community. There’s
already two, one specifically serving the rural Native Americans and one serving the urban
Native Americans. And clients are certainly going there because they cannot access the county
health system.

Again I would like to emphasize that Native Americans do not know what the county has to offer
and have very little knowledge and how to navigate the system.

Ken Katz: Hold on.

Board member: You mentioned two providers in the county who serve Native Americans. Who
are they… these providers?

Rural Native Americans go to Central Valley Indian Health and Urban Native Americans go to
_______________ Native American Health Center.



                                             15 of 40
Thank you. I’m going to again remind people that the sign-up sheet is up here with me and if
you want to come up and speak you need to get your name to me. Is there anyone else besides
Dennis who wants to speak today?

Dennis Torigian

 I’m Dennis Torigian, I’m a long term member of NAMI Fresno (National Alliance for the
Mentally Ill Fresno). That means that I’m a family member. I’m also chairman of the board of a
nonprofit which spun off from the Family Alliance for the Mentally Ill Fresno and NAMI
Fresno.

The name of it is Housing and Supportive Services of Fresno. We provide subsidized housing
and supportive services for persons with serious and chronic mental disabilities in our
community. We have 51 people at a site near here. We recognize that there’s a need for housing
arrangements for persons with mental disabilities in our community, that’s even become
apparent here again today at this meeting.

On that basis and the fact that we got a good success record and you have this information in the
county as well as information developed for AB2034 that indicates that supportive housing is a
wonderful thing for folks with mental disabilities.

On that basis we saw an opportunity to apply for a HUD grant through the Fresno/Madera
continuum of care to provide additional housing and supportive services for folks with mental
disabilities. In fact, we propose to replicate our program by another 50 people.

We were ranked #1 in our region, with that grant application and received the grant notice of
acceptance early this year. Because of funding issues which we face on a regular basis
everywhere in our community, country, county, you name it. We were short by $85,000 per year
on a grant that provides $500,000/year to house persons with serious and chronic mental
disabilities.

So very simply speaking we have $500,000 per year coming into our community but we are in a
shortfall of $85,000 per year to make that program that work. Over 40% of that funding goes to
provide subsidy, a subsidy for the rent that our folks pay… Okay.
Now I don’t want to make comparisons with AB2034 program which you have provided for this
PLAN. Page 84, did I mention that earlier, so you know what I’m talking about.

Paragraph 3: We’re talking about over the period of three years about $1.7/1.8 million dollars
for AB2034 program. Increasing it by total of 100 people. Actually 107 people, seven people
the first year and 50 people for two more years total, of 107 people.

Bang for your dollars, folks… Granted I recognize that the programs are not totally alike. We
don’t provide wraparound services, we’re not set up to do that. We have referred to the county
for those services or elsewhere in the community for those services. But we are a valuable
housing resource for our community. For $85,000 per year, we’re going to house and provide a




                                            16 of 40
subsidy, and I’m not sure, in fact, I’ve asked the question and nobody can tell me that there’s
even a rental subsidy in the AB2034 program.

Half of our funds, nearly half of our funds provide for rent subsidy for these folks. They cannot
afford $700 per month to pay large rents out there in our community. We’re talking about
$600/$700 a month for 2 bedroom apartment or $600/nearly $600 a month for 1 bedroom
apartment, with an income of $700. It doesn’t work! That’s why we need rent subsidy
associated with the living arrangements that we provide.

So the question is folks – you guys knew of my problem, it’s not my problem. It’s a problem pf
Housing and Supportive Services and it’s a problem of our community. A problem of our loved
ones from my perspective. Why didn’t you fund $85,000 per year for this program?

Mr. Katz: Once again, we’re just accepting public comments.

Okay. Then we’ll call it a statement, that’s all I can say.

Mr. Katz: Thanks Dennis. Is there anyone else that would like to sign in and speak? (No
response).

Audience Member: I have a question. If we haven’t spoken today, but did at another meeting,
do we have to repeat it to have it included?

Mr. Katz: If you spoke at any of the meetings it got recorded. (All recommendations that have
already been given have been transcribed and given to the Board.) Did that answer your
question?

Yes, thank you.

Mr. Katz: Having no further speakers, we will conclude this portion of the public hearing.
Given the time I think what we will do is break, I’m very reluctant to begin the Board meeting
before 6 o’clock since that was the time that was published, so we’ll take a 30 minute break and
we will see you in the Mental Health Board meeting at 6:00pm, at which time we will consider
all the input and make our recommentations. Thank you.


CALL TO ORDER

The Special Mental Health Board meeting was called to order at 600 p.m.)

Mr. Katz: Once again, welcome to this evening’s special Mental Health Board meeting. We
have an important task before us this evening. The job of the Board is to evaluate the input and
testimony we received and determine the appropriateness of the assessment and
recommendations made to the plan. We will present our recommendations tomorrow afternoon
to the Board of Supervisors; all of you, members and audience are invited to attend. The staff
will be there. Once again, the County must respond in the plan to any recommendations made
by the Mental Health Board. This does not mean the County is required to incorporate any or all


                                              17 of 40
of our recommendations, but must nevertheless respond in the plan to any substantive
recommendations. We cannot come up with recommendations based on every public comment
we received. We must be judicious and ….before formulating our recommendations.

We have to identify patterns in feedback. I want to remind the Board that the role of the Board is
that of …for con summer, family members and stakeholders, and that we are here to represent
the Board of Supervisors. The Mental Health Board should not be used to further anyone’s own
personal agenda. I hope that in the process of formulating our recommendations we do not try to
micromanage the plan. I encourage the Mental Health Board to consider broad language that
communicates our input and recommendations for the County without specifying specific
language that makes it difficult for the County to essentially incorporate them into the plan. The
County staff and Plan Coordination Team members are here this evening to help us formulate
our recommendations. There are revisions that may have already been made, but we do not have
copies of those at this time.

Remember that transformation of the system has already begun; people are openly talking about
mental health and mental health issues, and all of you here this evening have been a part of the
…….of silence. I’m personally and professionally excited about what’s going on in our
community and (tape indistinct). I trust that we, as Mental Health Board members will be able to
work together in this process, with members being willing to com promise when (indistinct).
There’s no way everyone is going to get exactly what they want. The most we can come up with
is something sensible that…. So with those comments. Before we begin, I want to ask members
of the Board, does everyone understand what we’re going to do today? Are there any questions
about what we’re going to be doing? You are reminded, too, that everything you say we want to
record, so be certain that when you speak you use the microphone.

Because we’ll be taking actions this evening, we’ll develop the actions and then we will be
taking public comment so be sure to use the mike. I don’t have a specific plan about how to
proceed. What I hope to do is see if people identified specific patterns or themes that came out
of written submissions or any of the forums or the Board meeting on the 14th or this evening.

(Board member comments regarding a shorter version of the plan, mostly inaudible).

Mr. Nevarez: Ken, I’d like to echo that. First of all, you guys did a great job, there’s a
tremendous amount of detail in this document and a lot of work went into that, so first of all,
good job. But it is very difficult to digest, and on my full time job I’ve had a lot of opportunity
to read a lot of administrative reports, and this information, it is hard to digest. Maybe some
visual aids; I know I was looking for expenses, and I had to go through the whole document to
pull out items piece by piece just to kind of get a picture of what the expenses looked like.
Something like a visual graphic, pie charts are real nice, maybe with 25% here, 32% here, it
makes it really easy to digest that way, and I think that’s what they’re talking about, something
that people can visually look at, gather it all up, and if you need the details you can look at that
later. But overall it’s just very detailed, needs to be a little bit more consumer friendly.

Mr. Katz: With that one particular issue, we can move into a recommendation. I think it would
be worthwhile, in fact I’ve already heard discussion from staff, about something more user



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friendly in the next round, better for consumers, and so on. I don’t see any problem with making
some kind of recommendation that the version be prepared as a more user friendly document or a
summary or something. So if someone wants to propose something (indistinct) and put that in a
recommendation. No, not a motion, all we’re going to do is we’re going to come up with some
language regarding recommendations. Could I ask staff, in terms of what Katherine and the
supervisor are talking about, is there a plan to do this any differently with the document the next
round? Well, this format is required by the state, but what we’re talking about today is at the
same time, something that (indistinct).

(Staff response inaudible)

(Discussion from Board member regarding going to where the population is, mostly inaudible)

Mr. Katz: Giang?

Giang Nguyen: I appreciate your comments in regards to the next year’s document, I think I am
speaking for the group here, certainly we want to produce a document that is user friendly
(indistinct).

(Board member comments, inaudible)

Mr. Katz: Okay, we can keep talking about this or we can get on with the recommendations for
the current plan. (Indistinct)…we shouldn’t relax too much because we’re basically going to
take up this cycle again in less than six months. So, we’re going to begin that process again.
Curt?

Curt Thornton: Can I comment that, let’s not worry about next time, let’s just take care of what
we can do now, we’ve got plenty of time to work on that and also that (indistinct).

Mr. Katz: Thank you. Cindy?

Cindy Toews: I just want to say, sitting through these meetings and listening, the adult side, it
sounds like it’s pretty well focused, it maybe needs some things, in the peer, the housing, looking
at the rural areas, at having the support there, having the life skills change, it seems like it’s
pretty well on the right path. But I have to look at (indistinct). I think on the child’s side, just
having a child that has gone through the system and helping (indistinct) through the system, I
know that for families, that (indistinct) Incredible Years is really good for certain things, but for
mental health issues, there’s not a whole lot in here. And that’s just a concern.

Mr. Katz: I was not part of that work group, so I want to ask if there’s anything that staff wants
to comment on about this before we get too into developing the recommendations area. Karen?

Karen Rea: I just want to say that this was a phenomenal process for me, plus the fact that it was
one time for our agency to actually sit back and tell the community ―whatever you want to do,
it’s up to you.‖ I don’t care, it’s not my call – whatever you want. And that’s exactly what we
did with the children’s process. It was a very difficult process (indistinct) put a child in a silo



                                              19 of 40
(indistinct). You’re absolutely right, one of our biggest concerns was, and Incredible Years is
not a normal prevention/intervention program. But there are other programs do that exact thing
(indistinct) as the Parent Child Interaction Team which is truly diagnostic, evidence based and
(indistinct) for that population.

Cindy Toews: (Indistinct) because I have it here…

Karen Rea: And it is in the plan, but I talked to Vera and it’s not anywhere, but it will be in the
document for the Board of Supervisors tomorrow. That is one of the (indistinct) for that
population. (Further comments indistinct) But the task force looked at school age children, they
looked at Head Start all the way through high school. And one thing we have to look at is the
whole point of having this transformation is that the County does not provide services to the
families. (Indistinct) clinicians in a school and you’ll have child receive that service in that
school. But the services should go out to the families, after hours, so they’re working when the
parents are there, and have the siblings to support that child if they have (indistinct). And that is
what the Parent Child Interaction Team is all about, Functional Family Therapy goes into the
home, Infant Mental Health clinicians go out to the home, and we wanted practices that are
school age practices, from Head Start through high school, that are outcome based and evidence
based. So that is the problem, it’s how do you do this (indistinct). We asked all the task force
groups, how do you want to prioritize, and children’s was very specific, they did not want any
programs cut. We have to serve school children well, we would rather than (indistinct). So
that’s how we came up with the decisions having all these programs. Now the CAO Leadership
did a priority of these things for children, but nonetheless they’re all still school-based services.

Mr. Katz: May I ask a question as long as you’re on that point? There was a lot of talk today
about school sites and school based services. We talked about that in light of the plan and also
(indistinct).

Karen Rea: We’re currently at 19 school sites, and we’re not there all the time. It might be one
day a week. We also have to look at anti-stigma situation, because you go into a school and you
tell a child you’re coming out of school to go see a mental health clinician (indistinct)
…organizational providers, providers that do have evidence-based practices outside of the
schools so that the child is not stigmatized. So, I’m not really sure how to answer that any
differently. We can put more clinicians in the schools, but it’s not transformative, it’s business
as usual and that’s one thing they asked us not to do when the task force focused here.

Cindy Toews: I wasn’t concerned so much about that aspect because on the prevention side you
have to (indistinct) and that’s good, and I think Incredible Years is a good program. But my
point is that working with families is important, but if kids have true mental health issues they
need more. And one of the things you said that you were going to work with the doctors, the
pediatricians are horrible about referring, recognizing. I deal with it all the time, I cannot get
services for the kids I work with in the current system and that’s an ongoing problem here.

Karen Rea: I agree and the transformation is not that if you don’t have evidence based practices
you don’t have the referral sources from Infant Mental Health (indistinct) and transition them to
a primary care physician that willing to (indistinct) so the transformation will be that referral



                                              20 of 40
process where all organizational providers and the county will be able to tell the consumers and
tell the provider where to go next and how to get that referral (indistinct).

Cindy Toews: And then if we look at up to age 12 and most mental illnesses actually we start
seeing more dramatically in the high schools (indistinct).

Karen Rea: I agree, and we are addressing that from the County perspective, right now we’re
working with schools on an expulsion team which is for the younger children because they’re
getting expelled more, so we’re dealing with the 5150s, mobile crisis is going out more, and
we’re having weekly meetings on that. We’re also dealing with the young perpetrators, but what
we have there is a county school where we’re not bringing other providers that provide mental
health services (indistinct).

(Other Board member comments, indistinct) to provide whatever services the doctors need
(indistinct) to get my daughter’s diagnosis and medicine so that I can take her to school, I have to
have that there and I’m not seeing how we’re going to get that (indistinct) for these kids.

Karen Rea: (indistinct) and we do have .5 psychiatrist just for this population in that mental
health plan. We also have a nurse practitioner that will work with this population; in the first six
months we’re serving 145 kids so we want to make sure (indistinct) nurse practitioner that will
take up part of her time to educate the primary care physician and also to assist the psychiatrist in
providing excellent service to this population (indistinct).

Sheila Kornzweig: (indistinct) nurse practitioner to train the physicians a quarter of the time?

Karen Rea: Not train, they will be going to the Fresno Madera meetings, there’s a lot of different
primary care physicians there to educate them in important early interventions and the referral
process for a child psychiatrist (indistinct).

Ken Katz: Okay, so looking at Board members, is there some recommendation, or to support the
direction that the department is going in (indistinct).

(Further Board member discussion and comments re children’s services, mostly inaudible.)

Mr. Nevarez: Ken, I just have a question more than anything else, I heard it pretty loud and clear
from the people here that peer support, anecdotally anyway, appears to be something that the
community wants. Is there statistics out that support these stories that we’re hearing today?

Karen Rea: I don’t know about statistics, but I do know that once again that it is what the
community did ask for, for the transitional age youth and children, and also that the majority of
our services will be contracted out, using stipends to go out into the high schools. We’re going to
have more peer support groups for transitional age youth which will be 16 to 24, youth advocates
which will be contracted out, parent partners which are part of that family dynamic (indistinct)
we will contract all of those services out for that peer support (indistinct).




                                              21 of 40
Mr. Nevarea: OK, now I heard the story from the family and from what I’ve heard peer support
works. But I’m just wondering, is there evidence out there that it works, numbers like statistics.
(Response indistinct)

Mr. Katz: Before we go any further with this, I hate to intervene but we need to move on. What
I’m hearing is that people are satisfied with the additional inclusion of the PCIT program, that
people could be satisfied with…

(Board member comments indistinct).

Karen Rea: I will – it’s an assessment of the entire family, and they actually work with this
family and they have a mirror, and they have a clinician working with the parents who will
actually tell them when there’s certain behaviors, after an assessment and a diagnosis is done by
a clinician or a therapist. It’s done by a doctor only if there are issues where they have to put
them on medication (indistinct). The clinician will work with the family, giving them clues,
helping them work with the parenting (indistinct) based on the child’s needs.

(Board member comments indistinct)…focused on biological conditions, it’s just like having
diabetes that has to be addressed.

Karen Rea: I agree with you 100 %, and what we’re trying not to do, we’re trying not to
categorize a child in one little silo, there are 7 different evidence based practices that can be
utilized based on what the child’s needs are, you still have the county that has clinicians that
specialize in psychotherapy, you still have 5 child psychiatrists that are there and we’re trying to
expand our services so that the nurse practitioner can educate the primary care doctor and that
will assist them (indistinct).

(Board member response indistinct).

Karen Rea: You’re absolutely right (indistinct) parent to be a part of that so the parents will also
go in along with the doctor, along with the county, along with the organizational provider; we
want it to be a holistic approach. What you’re saying is absolutely right, we don’t have the funds
to do it for 100% of the Fresno population/

(Board member comments partly indistinct) basic problem is the medical, not the mental health,
the medical resistance (indistinct) that children with mental health issues need to see the
appropriate therapist and (indistinct).

(Further discussion re: children’s services in the plan, mostly indistinct)

Mr. Katz: I want to make two comments. One is, would the county not build the infrastructure ,
lots of new staff, because (indistinct) contract out if (indistinct) decide it will work. So the
emphasis is going to be on contracting out (indistinct), at least that is the intent (indistinct). The
question (indistinct) are people basically satisfied with the discussion we’ve had around children
with the addition of PCIT, recognizing that this is beginning steps (indistinct). So we need to let




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that go and move on. The question had to do with peer support and whether or not the belief is
support by statistics.

My name is CeCe Lomeli, I’m with Poverello House (indistinct) I’m here to represent those who
are not being heard today, which are the uninsured and our homeless in Fresno County. I
understand about peer support, but if you don’t have access to services peer support doesn’t help.
What I want to say is that there’s another story to your question, which is that we need to look at
also access to services. Peer support is one part of that question, but the other part is access to
services for those who are not being served. That’s my concern (indistinct).

Mr. Katz: I’m sorry, but we’re not accepting testimony now and we really have to move on.

CeCe Lomeli: I just have one more comment. The other comment is the gentleman that spoke
about the housing, the $85,000 why can’t that go to Poverello House? We have (indistinct) that
we can care for people there, we don’t have $85,000 there. So my question to you is where that
money is going. I’d just like to know. Thank you.

Mr. Katz: Really, the only purpose is when we have a question regarding a recommendation I’m
asking staff to respond with helping understand how that (indistinct). So I’m not accepting
comments from the public as I said earlier and we really need to move on. I apologize, I need to
be firm. Debbie, can you come up and talk about peer support?

Debbie Di Noto: I can answer your question from earlier. The proposed program that was
recommended. The Village model, is a best practice model. It’s one of the ones that actually
prompted AB 34. AB 34 is (indistinct). Peer support doesn’t have a lot of evidence but it is a
best practice model.

Mr. Katz: Chief, does that answer your question?

Mr. Nevarez: Yes, it does, that’s exactly what I was looking for, thank you.

Sheila Kornzweig: (indistinct) I read the plan, every single solitary word. But I think that,
having worked with the mental health (indistinct) I think that one of the issues, or attitudes, or
feelings that people have had is that certain populations don’t always feel like they have access.
I know it’s written, but I would like some statement initially in the plan that access will be
provided to everyone in the community who evidences the need for mental health services and
that people will not be excluded because they’re hearing impaired, they won’t be put off at some
level, or because they’re slow learners or because they speak a language, and I know we’re much
more sensitive to language differences now and social differences, but still I think that just a
global statement in the plan that mental health services will be provided for all in our community
who need them.

Mr. Katz: When you say in our community, (indistinct discussion). Staff, is that in here, I
support Sheila’s point, I just don’t want to be overly redundant. Does anyone feel they can draft
it now or (indistinct discussion).




                                             23 of 40
Supervisor Perea: In fact I had mentioned to Ken earlier that the Board weigh this tomorrow
(indistinct). There’s just a couple of points I want to make. I think some valid concerns have
been raised today and I know you’re taking note of it, and I look at this as a pretty big ship that
we’re turning and sometimes that moves slowly. I just want to make sure that when we turn the
ship we turn it in the direction that will meet the needs that are being addressed here today
because they’re very serious and viable concerns, so if I can have those assurances from staff
that would be good.

Gary Zomalt: You have those assurances. This process has all along been about a community-
driven process (indistinct) addressing substantive concerns, issues and then involving the
community in setting priorities for programs. So (indistinct).

Henry Perea: OK, and for sure the Mental Health Board and Supervisors (indistinct) really
dynamic (indistinct) and share the expertise from all backgrounds makes for very strong
community input, that’s something that won’t be taken lightly. We’re going to make sure that
you’re very involved in the process as we move forward. The last point I’m making, with regard
to what Ken brought up with respect to costs and sometimes (indistinct) because this is a new
process for all of us, what I want to make mention of is that the more (indistinct) since the last
leadership meeting where we reduced our administrative costs from 10% to 3%. I’m starting to
feel that may not be a completely viable number and as a supervisor I’m going to look at that, but
I want to make sure to mention this. One is, in that leadership meeting we did make a
commitment that we weren’t going to have two separate administrative structures to do the same
things, one in children’s and one in adult. It’s one oversight group that would oversee both
departments, so I want to go on the record (indistinct). The other is, I want also to tell you that I
want to make sure that no administrative costs into other parts of the plan that’s before us now. I
want to make sure that the field is level all the way across so that when we tell you it’s 3% or 4%
the number is a real number and everything’s on the table that should be.

Ken Katz: (indistinct) is that right now we’ve identified 3% as the administrative cost to support
the plan and we’ve learned that other counties are as high as 15%, so keep in mind that we’re not
just talking about administrators, we’re talking about the costs for implementation of this type of
plan, monitoring performance, especially when we want to contract out (indistinct).

(Board member comments indistinct) an RFP on it, basically.

Curt Thornton: I don’t really have any preference whether the county uses its own staff or
contracts out. It doesn’t make any difference to me. We’re saying that families, in the past peer
support theoretically would serve them, but it not being a priority it hasn’t happened. So right
now, when families are in crisis they call Kelly, they call me, there’s nobody specifically in the
county system that’s the person they need to go to whose job is to help them.

Mr. Katz: Other comments from the board?

(Discussion re: adding family support language, mostly inaudible)




                                              24 of 40
Katherine Walker: I’m all right with (indistinct) in terms of changing other parts of the plan to
accommodate that language, I wouldn’t be OK with that. There’s a lot of thing I’d like to have
in that plan, but I recognize that we’re talking about (indistinct).

Mr. Katz: Here’s what I would personally support is language that acknowledges the historical
nature of ways that families, have not been served adequately and with more to it than just that,
but that’s what’s forwarded to the Board of Supervisors as a recommendation and that will then
be discussed at the board. I really, but to go beyond that level that Curt’s recommending because
of some of the other issues that Dr. Zomalt and Katherine would feel a lot more comfortable
with. Dr. Levy?

Dr. Levy: I think that I can say that on the adult side of services we do not have family
advocates and that’s something that’s becoming more and more (indistinct); there’s eleven
counties now in California that have a family advocate and it’s in the plan for us to have one,
whether it would be contracted out or done by the county, that’s not clear at this point, but I think
we do need to be clear that we do need a family advocate, someone who is adequately trained
and can communicate and works both with family members, the community, and as well as staff.

I’ve been in contact with somebody down in Orange County who runs a program like that and he
is advocating and working with other counties to put it into their plan as well, so that it can be
done in as many counties as it can be done. And it’s something on the children’s side that is very
important; it’s very important to both sides.

Mr. Katz: Is it in the Village model?

Dr. Levy: It was mentioned (indistinct) it’s a position in that , but because this could be
contracted out it hasn’t been more clearly defined, rather it’s been viewed as part of a larger
program. There probably should be something in the language, I think, especially a family
advocate for adult services.

Mr. Katz: All right, given Curt’s comments and Dr. Levy’s comments, we have been talking
about peer and family but we’re really talking about peer support, so what you’re saying is that
we need to specific that this individual is family support.

Dr. Levy: Yes, and the question is do you do that in the plan as a singular position or do you do
that as a programmatic approach. We don’t know that yet because we don’t know whether it
would be contracted out or whether it would be done by the county. But the concept is
important, the need for it is important.

Katherine Walker: So are you saying that (indistinct).

Dr. Levy: That’s my personal opinion.

(Further discussion, indistinct).




                                              25 of 40
Debbie DiNoto: Curt mentioned (indistinct) for family members and we used the position
basically in the dollar amount, we had to go with something as far as dollar amount. So whether
we do this in-house or whether we contract it out there is something specific in there. Now a
contractor would be able to have three positions for the same amount of money, but we won’t
know that until we go to RFP. The positions and funding are just a guideline so that we knew
how much money to put in for each strategy.

Mt. Katz: Curt, do you want to go on?

Curt Thornton: I would say two things, one that having staff for family services, right now that
is not clear in the plan. The second is the level of (indistinct) recognition on both sides, but I
think we need to (indistinct).

Mr. Katz: My inclination and to just to kind of keep this moving is to insert language that
emphasizes the importance of family advocacy functions and that there is expectation and
stipulation that that is provided, somewhere along the lines that Dr. Levy had suggested. I’m
personally much more comfortable with that. And Curt, my intention is not to rain on your
parade in terms of your recommendation, but again I think we can accomplish what we’re
looking at by reinforcing what Dr. Levy was talking about. Other comments from other Board
members?

Sheila Kornzweig: I would just say that, in addition to that, the level of sensitivity and
awareness of that person might be dependent upon either their experience as a family member
and familiarity with services and with what the family goes through or someone with
professional training but again I concur with Curt it’s critical who that person is in that position
and what the expectations will be for that person so it is not just a contact person that brokers
information but somebody with a level of sophistication. So I would like to see that second
sentence in that , that that would be included.

Mr. Katz: So you want it to say something like…

Sheila Kornzweig: The person selected will have a depth of knowledge, and understanding of
the issues the family is facing and expertise to be able to help them.

Mr. Katz: To get away from again the notion of a staff person because it could go either way,
(indistinct) you said in terms of the provider of this service (indistinct) the external or internal
service person will have an appreciation for (indistinct) somewhere along those lines. I don’t
think we’re going to nail down the specific language right at this moment, but - the pleasure of
the group?

(Further Board member comments, mostly indistinct) but I don’t see why we need to do it. It’s
there, exactly what you said (response indistinct).

Mr. Katz: And as RFPs are developed, we will have an opportunity to participate in the
language that goes into these RFPs, so in terms of how we design a position that’s going to
(indistinct) families, we’re going to have input into the language of what the expectations are and



                                               26 of 40
the performance outcomes are in the RFPs. This act has changed the life of the Mental Health
Board and this is going to be a significant part of what the Board does from now on, in the
foreseeable future, at least for the next couple of years.

Do we have a consensus on, again oversimplified, but to take the language that Curt is
recommending or something that really is more of a couple of sentences emphasizing the
historical nature of family advocacy being ignored and that we’re stipulating to the provision
family support, family advocacy services, that providers of such services will have appreciation
for and expertise in …that kind of language.

(Further Board member discussion re: wording, mostly inaudible.

Mr. Katz: Ok, Curt’s onto something here.

Curt Thornton: I guess this is, the families of the mentally ill should be provided educational
support and advocacy services by a staff fully devoted to family services and capable of serving
these families.

Mr. Katz: Do we have a consensus for that language? (Board member response inaudible)

Mr. Katz: Well, we’re not committing to anything, it’s just a recommendation. We’re not
setting any policy. We’re basically making a recommendation that communicates to the county
staff and the Board of Supervisors how much this function is valued.

Cindy Toews: (indistinct) I work with a lot of family advocates and parent advocates , I work
with them on a constant basis, there’s quite a few in special ed and mental health for children and
all of that, and they do provide invaluable services to the families. I mean it’s amazing the level
of help just having someone. I know even when I would go to my own child’s meetings I would
someone there for me because I was too emotional, I didn’t know everything but I had the
education, but they really did connect me with services and know the laws and know the ropes,
and I think it is invaluable.

Mr. Katz: Well I think we certainly hear the input of members of the mental health board, I
think we certainly have heard the input of family members, from the public and I think that the
language that was settled on communicates recognition of the importance of it.

Board member, partly indistinct) Where would you put the language?

Mr. Katz: We don’t have to decide that.

Curt Thornton: OK. The second thing I want to bring up, we heard from Dennis today about the
need for $85,000 to salvage the Federal HUD grant that Housing and Supportive Services has.
Nearly every consumer that we heard from today, talked about the need for housing. Our own
mental health board took a position on this issue back in June, saying let’s move on and help him
get it. I don’t know why the process didn’t produce this, but we just need to do it and I would
like to propose that we make this recommendation for $85,000 per year.



                                             27 of 40
Mr. Katz: It’s already done. This is an item that there’s been a lot of discussion about in the
reaction of the PLAN. Dennis will be going before the Board of Supervisors tomorrow and
hopefully we can get year one, but our back up plan for all 3 years of money will be in the PLAN
and the state agrees to fast track it so basically we submit it as part of the CSS PLAN and they’ve
agreed to kind of separate it out and fast track review it so as the rest of the PLAN is going
through it’s 90 day process they’ve agreed to take this one item and fast track it through the
approval process. Giang, do you want to add anything else to what I’ve stated?

Giang Nguyen: No, I need a couple of minutes with Dr. Z real quick and (indistinct.

Mr. Katz: OK, then we’ll come back to that. Do you want to go to #1?

Curt Thornton: Well, indistinct) anything in writing, I would just like to have us on record as us
recommending this. Is there any problem with that?

Mr. Katz: Having staff here, I don’t think (indistinct) maybe if we don’t need to make a
recommendation, then we wouldn’t do that. That was the intention of having staff here to
respond to that. Is there a representative from the CAO’s office (indistinct).

(Further conversation between Mr. Katz and Giang Nguyen, indistinct).

Vera Kennedy: Point of Clarification, you’re recommending something that is not currently in
the current draft. You must make an official motion to recommend it on behalf of your Board.
Because again, this item is not in the current draft. The only changes being made are
clarifications, even public comments that asked for revisions, we have not made revisions to the
PLAN. Everything must be approved by the Board tomorrow. So what you would do if you
want this change indicated, you are recommending that it will go to the board. The Board’s
decision will decide if they will make the change. So anything in the PLAN that you want
changed, you must recommend it to them.

(Board member question, inaudible)

Mr. Katz: Did you read the language? The language from the state is that the Mental Health
Board’s function is to make recommendations. The county has to respond to the plan and
substantive recommendations. The idea is that we have to stay true to the process, and housing
has been identified as a need.

Curt Thornton: OK. I will move forward this recommendation, the plan to be amended to
include the $85,000 a year, 3 years needed by Housing and Supportive Services of Fresno HASS,
a local non-profit so as to be able to salvage the federal HUD grant for supportive housing for
mental health consumers (indistinct) recognize the resolution…by the Mental Health Board some
months ago.

Mr. Katz: We’re not actually taking these as motions until the end and (indistinct). Supervisor
Perea?




                                             28 of 40
Supervisor Perea: Yes, this is not so much on the motion or the merit of the issue, more so on
the process. Where did this discussion occur? The one now of allocating $85,000 for three
years, outside of this Board meeting. I mean, where did this discussion occur, number one, and
number two, if we’re going to go for housing and I mean I heard a lady make a comment with
respect to housing somewhere else. Is it more appropriate to say, we’re going to look for
housing or we’re going to make it a component, fund it and put it out to bid? Is it a fair process,
is what I’m asking?

Mr. Katz: This actually, and no one has been able to explain to me how this happened but the
copy of the plan that went to the CAO Leadership Committee, this item was in there. And then it
subsequently disappeared, but I haven’t been able to find out how it disappeared, but it actually
was in the plan. It is not in the draft that we have. But this has been a discussion with regard to
funding prior to MHSA, and subsequent to MHSA. Sometime at almost every single board
meeting in the context of MHSA.

(Board member comment, inaudible).

Vera Kennedy: The county asked me to address why the $85,000 item wasn’t in the draft
released for public comment and as a result of the CAO Leadership Committee, the minutes were
on the web as well, and when they voted their priorities, housing was not one of their top
priorities. So when it came down to the funding, they just went down the line of what they could
afford to fund. And that’ s why it wasn’t included.

Mr. Katz: And my confusion about that explanation has been that the agreement that we have
with the CAO Leadership Committee is that everything would remain in the PLAN, if something
would be recommended as far as funding. So I heard that explanation before; it still doesn’t
explain it to me. Anyway…

Gene Garcia: Yes, I want to make a comment. I don’t disagree with the funding, my concern is
that we’ve talked about one element of housing. OK. And I think one of the concerns I’ve had
from the get go about housing is that we need a whole spectrum of housing and we haven’t
talked about the whole spectrum of housing. We need housing for the homeless, we need
housing for people who happen to need treatment at the time, we need board and cares, and we
need all these things. OK. And now you’re taking one element, what I call is towards the final
phase. You’re trying to initiate it, you’re gone towards independent living, which is great, but
you’re still not addressing it. I still don’t see the support of the other housing, which got
dropped. It was one of my issues that got dropped at the leadership. There’s issues I push and
one of the issues I push is housing. Total housing, so consumers can go where ever he or she
needs that service. Whether it is treatment, whether its transitional, whatever it is. And if you’re
going to support this then you’re going to get people from the community saying ―Why are you
supporting this one when I have a program over here that’s transitional that I need $60,000 for
and I’m doing all this work.‖

Mr. Katz: Well the question would be, is do they have an existing grant. And there’s an existing
HUD grant that would serve 50 consumers. And that’s why the discussion and support from the
Mental Health Board. It’s not that anyone in the community can’t come forward but that there’s



                                             29 of 40
a grant that’s already been awarded that we can actually provide services to a lot of consumers.
And the Mental Health Board position consistently has been, in fact, we talked strongly during
the budget process that someone with unprecedented passion, we actually submitted a Board
Briefing Report so this could be considered through the budget process. So to me that is the
difference, Gene, there’s already an existing grant. Debbie?

Debbie DiNoto: (Indistinct) you’re asking where in the plan is the housing; that is number 4,
items to be funded in the future (indistinct) was not one of the top priorities of the Leadership
committee.

Giang Nguyen: Gene Garcia brought up a good point, (indistinct). However, if you (indistinct)
at the Board of Supervisors tomorrow, your request….this $85,000 for Mr. Torigian is a sole
source agreement because of the uniqueness of the services he’d be providing and that’s
(indistinct) to leverage federal funds. So that is something that perhaps the Board can review
tomorrow (indistinct) because we need to be clear and be careful how we (indistinct) those
policies (indistinct).

Mr. Katz: And sole sourcing is (indistinct) the county so Giang’s point is that that should be a
part of our language in the recommendation. Supervisor Perea?

Supervisor Perea: Ken, if I could just say, that’s an excellent point, if you want to move this item
that would be the way to do it. The only thing I would ask is Giang and our attorneys and Dr. Z
if it’s appropriate be ready to stand up and make the argument (indistinct) be a pretty sensitive
issue tomorrow.

(Board member comments, inaudible).

Betty Brown: Just a point of clarification, I’m (indistinct) the CAO. This is not a sole source
agreement, because there are other agencies who also provide housing, but what you’re talking
about is a request that the Board make a finding that unusual circumstances exist that warrant a
waiver of the competitive bid process (further discussion indistinct).

Mr. Katz: Because if we’re going to incorporate it in the PLAN, to do it the way we’re talking
about we have to have that language.

(Discussion inaudible)

Mr. Katz: Any more discussion on this item?

Giang Nguyen: Also, I think (indistinct) about some of these issues, and I think whoever is
going to consider providing services in this area, that individual or organization needs to make a
commitment that the services will be provided for consumers who are MHSA funded. So that
has to be in there. Funding is going to be provided for consumers under the MHSA, not just
others. So the state will certainly consider that part of the agreement.




                                              30 of 40
Mr. Katz: And thanks for reminding me, that was one of the requirements of the state in this
discussion and when I talked to Dennis about this, in fact 100% of his clients would be referrals
from the county so they would all be MHSA clients.

Donell Steirs: I have a question regarding (indistinct).

Mr. Katz: They’ve agreed to review our request (indistinct).

Donell Steirs: So does that mean that each piece of the plan reviewed and funded separately by
the state.?

Mr. Katz: Right. They could fund any or all of the plan. Any more discussion on this issue?
Curt?

Curt Thornton: Well, I’m not sure, the other two items, you all received them when they were
sent out, they are kind of tied together because there’s money involved. And, this was the
discussion that our group and also with the NAMI group, that the most glaring omission related
to adult services, also really related to transitional age youth and older adults as well, is the
omission of the adult mental health court and related services. We did as a board recognize that
as a top priority (indistinct) back in May. I recall making the suggestion early in the task force
process that somehow we needed to reach out to the mental health consumers who are or have
been incarcerated and to the families but that just didn’t really happen. Because of that we didn’t
have it come down as a priority, but I can tell you that for families or individuals who are or have
been in jail because of their mental illness and the aftermath of that, they would definitely tell
you that this a real top priority for them. So, the recommendation that I’m suggesting is
including funding the first year for a plan of study to determine what might be needed to institute
an adult mental health court, and the 2nd and 3rd year funding necessary to actually institute that
court and related services.

Now, you talk about the Court, part of the problem is, where do you get the money? And I
argued, and NAMI concurred in it, it is suggested that we could (indistinct) mainly because there
has been a loss of equity with the various age groups in the way the money was finally split and
(indistinct) look at that. I sent out a spreadsheet, I hope you all had a chance to look at that. The
CAO Leadership group was the one that really dealt with this, and they took some round number
of percentages but then went on from there and came up with specific programs and even those
percentages weren’t truly advisable. I know that they were submitted as guidelines but my point
is that there really should be equity across the various ages and so the way to come up with the
money for this is to restore the equity.

Right now as it is, it’s not a minor amount of money. I think the total over funding of youth and
transitional age youth for the 3 years is about a million and a half dollars and the under funding
for the adults and older adults run to about a million and a half under funding, so again these
amounts (indistinct) shift based on the data we have on hand. So my suggestion is to cut the
children and youth would amount by about 5.8% cut from the 3-year PLAN. In my view that
could be done without changing a whole lot and then the transitional age youth will be of more
significance 23.1% cut, but again (indistinct).



                                              31 of 40
Let’s keep in mind how many individuals we’re talking about serving in transitional age youth. I
think if I recall right it’s 190 transitional age youth, so 23%. So we’re talking about cutting
services to 38 individuals, something like that 40 maybe. And if we were able to institute a
mental health court, we’re talking about helping a whole lot more consumers and family
members. And I would like to see that recognition (indistinct).

Ricky Miller: Curt ,did I hear you say that you want a separate adult board?

Curt Thornton: No, court.

Ricky Miller: Okay. Thank you.

Mr. Katz: Just a couple of comments. I’m not sure what document you referring to where
mental health court was a priority. It wasn’t identified by the MHB (indistinct) in any of the
meetings over that year, but just to clarify the MHSA won’t fund the mental health court. They
will fund clinical positions to work with judges and public defenders, D.A.’s office. But they
won’t fund the mental health court. They also talked about that they won’t support something
that hasn’t been a part of the process. So if it hasn’t been a part of a regular task force groups,
community process, and I could be wrong but I’m not aware that it was.

Mr. Katz: One option could be just in terms of doing the research before the national mental
health court, but still wouldn’t fund the (indistinct) now potentially be one time funding through
the Mental Health Services Act. But again, that would be exploratory in terms of development
of such a court, but the Mental Health Services Act won’t fund the Mental Health Court. And
the clinical people that work in the Mental Health Court are this much of the Mental Health
Court. We’re talking about judges, and public defenders, and D.A., and people that work with
jail systems and criminal justice systems. So, Curt you know I’m a supporter of the Mental
Health Court, but I don’t believe we can pull that off because of (indistinct).

Curt Thornton: Ken I agree, you’re saying, we probably could not fund every thing necessary to
run a health court, judges, attorneys and all of that, but there’s need for the clinical staff working
the courts. Really what I was hoping to persuade all the public defender’s office, D.A.’s office,
courts to develop their staff, they’re dealing with people anyway, so they would devote their
staff, it’s just that we don’t have our funding right now (indistinct) but I don’t really know what
that means right now. I don’t know how much staff that is. A lot of the supportive services
including the residential dual diagnosis (indistinct) in terms of what you suggested what we had
in this time was at least some money to study what would be necessary and at least we’d be
wanting to consider that in subsequent years. I would be happy with that.

Katherine Walker: I think Mental Health Court services (indistinct) I don’t know that talking
about it right now is a (indistinct) in subsequent years, but it wasn’t part of the task force process
(further discussion indistinct).

Mr. Katz: The other thing, is if we were to do what Curt is suggesting with adjusting the
percentages, it would be absolutely impossible to submit a plan tomorrow. It would destroy
basically the entire plan because it’s major mechanical changes.



                                               32 of 40
Juanita Fiorello: I would point out that based on the technical assistance conference call we had,
both of those ideas would constitute substantial changes to the Plan and would require us to go
back out to the 30 day public hearing process. So it would not only stall the PLAN, it would stop
it completely at this point, because you’re not just tweaking something that has already been
brought up. It is a substantial change and we would be starting back over with square one again.

Mr. Katz: It’s absolute, with those changes we would not be able to submit our PLAN
tomorrow! Again I am a supporter of mental health court, I just don’t see how we could do it
today. This would be something I would encourage us to explore, something that should
certainly be discussed in the next series of go-rounds, just remember we’re setting up a plan for 3
years, but we’re really submitting a PLAN for the next six months January through July. So I
really support this coming back for future discussion. Curt you want to make any more
comments to that? (None)

I brought something, we may not need them. I would appreciate input from staff because it may
be something that’s not necessary, but it’s really with regard to transforming the system rather
than doing business as usual. I’d like us to consider appropriate language in terms of contracting
services out. We know the County doesn’t want to build a bigger County. That’s not the
direction of the Board of Supervisors. There’s been a lot of talk about contracting out services
that we can. Obviously, a lot of the community-based organizations aren’t ready today to take
on some of these services. But there’s been discussion about the potential of, during the year one
contacting what services we can but also during year one support the system for local
organizations to help them be prepared to go out to bid for subsequent years. Actually, that
would be my proposed recommendation. So, is the language in the plan sufficient (indistinct).
To further stipulate the commitment during the first year, to train and provide technical
assistance to local organizations (indistinct). I’m curious about comments from staff because
there’s been a lot of talk about contracting out (indistinct) so I’m hoping for feedback from staff
and (indistinct).

Gene Gacia: Well, the comment I have is because I have not had conversation with Dr. Z, but I
had conversation with Giang and I thought they wanted to have the ability to do either way. And
to look at, whether county employees could do it better or private sector could do it better. And
what you’re saying, let me finish. What you’re saying, now you want the Mental Health Board
to take the position that it should be contracted out!

Mr. Katz: No—those services that are appropriate…

Gene Garcia: Why are we even taking a position, why not let them make that decision?

Mr. Katz: That’s why I want some input. There’s just a lot of talk about contracting out and
really a spirit of contracting out, especially in the last two weeks than it was early on. Early on
we kind of imagined that a lot of this was going to be county program, which was very business
as usual. But the spirit of the MHSA is transformation. I’m not going to die on this the intention
was really just to support this spirit of the transformation.




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Gene Garcia: Let me make one more comment. The transformation – (indistinct) I want to
remind this board, this transformation would not happen if it hadn’t been for your county
employees and the union. They put a lot of energy and time and they’re not saying that the
mental health should not be transformed. They have been supportive from the get go with
Proposition 63. We were instrumental up and down the state, instrumental in getting this
proposition passed.

And one of the things that really bothers me right now is the County, the county employees have
never said ―business as usual‖. They’ve been in the fore front of wanting to change and wanting
to do this differently but don’t discount them because you think private sector can do better. It’s
been proven and you can look at the studies I did, that public employees a lot of times can do it
better, but a lot of times their hands are tied by, and I’m not calling either of these directors non-
innovative directors, I’ve enjoyed both of these directors, they’re innovative. And it’s been a
pleasure to work with them. But to start thinking of that mind set, that’s not what we support the
(indistinct) for. Transformation, can be the transformation of the County but still they may have
to go out to bid, we’re not saying that!

Mr. Katz: You’re talking about the union, I’m not…

Gene Garcia: No! I’m just talking about working with your employees (indistinct).

Mr. Katz: No, I’m not saying anything about county employees, that’s not what it was about.

Dr. Zomalt: One of the questions that came up when we had the plan reviewed (indistinct) that
capacity building is something we have to do with our community based organizations
(indistinct). So, it’s not a zero sum game, I think we’ll look at it (indistinct) come before the
Board (indistinct).

Mr. Katz: Dr. Zomalt, do you feel that within the PLAN that’s clear in the plan, do you think?

Dr. Zomalt: The question was raised about whether our intention was to include the non profit
sector. I think the history is for most services being provided by the County and so because of
that history, I think it would serve us best to say we’re looking at both sectors.

Mr. Katz: Did the PLAN incorporate that type of language already?

Cindy Toews: Ken, I’m with Gene, I don’t see it as being relevant. I think you’re unnaturally
tying the administrators’ hands with that language. They’re going to need the flexibility to run
the best programs the best way they can (indistinct).

Mr. Katz: Actually, I’m fine with that, so we’ll move on. Any other recommendations?.

Emily Manoogian: I wanted to bring up the anti-stigma issue (indistinct). I read through the
PLAN, it does pop up (indistinct) funding I could not find any thing of where it’s coming out of.
If it’s there, OK, like in a different category, I’m not aware of it! And if it isn’t where are we
expecting that to come from: More specifically, I think (indistinct) I looked over the



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recommendations brought up and they were very direct about anti-stigma as far as the funding
goes, I am at a loss of where it is if it exists at all in there! Funding for any type of commercial
or media (indistinct) outreach and education (indistinct) the public

Mr. Katz: Dr. Levy you’re being asked to come up. You know there’s a lot of information I just
want to ask Giang, I have some notes here, but I remember hearing that the state is actually
developing an anti stigma campaign, that’s actually is going to come later in the process because
they recognize the counties don’t have the expertise and resources to do that.

Giang Nguyen: Thank you. I had the opportunity to attend the Mental Health Director’s
Association meeting about 3 weeks ago. At that meeting Dr. Mayberg, who’s in charge of state
mental health, talked about the state vision and desire to implement an anti-stigma campaign
across the state. It has (indistinct) and has to be (indistinct) for everyone (indistinct) and it’s OK
that we understand it can be treated. At the local level I expressed the concern that I understand
that there’s a need for consistency across the state, however local issues and all of that need to be
taken into consideration, especially language needs.

If we don’t have something that’s (indistinct) in language and cultural competence as well as
ethnic issues. So Dr. Mayberg said the state is considering fixed funding for early intervention
and prevention and that would be part of the anti stigma campaign. And I think in the PLAN we
do have some plan for anti-stigma and we do have in there from each task force (indistinct) we
recognize that.

Further discussion about anti-stigma in the plan.

Mr. Katz: So, what we’re hearing this item is that the State is looking at a more broad anti
stigma campaign that would be state wide so there would be some consistency. And in addition
to that there are already areas that are recommended for anti stigma funding in the PLAN. So,
board members, based on what we have heard, do we want to make any recommendations in that
area or do we want to go with what’s there?

Mr. Katz: Other areas? I don’t have a recommendation, but I want to make sure that we don’t
stop because it’s almost eight. I just want to make sure (indistinct). So basically my
recommendation that they develop language that future iterations of the PLAN will be more user
friendly or a companion document to support it and so on. We have a recommendation
regarding family support and advocacy services. We have a recommendation regarding housing
support services. And we really never finished the issue that you (indistinct) questions about it
so it’s worthy of being talked about.

Sheila Kornzweig: (Indistinct) we heard from woman from deaf and hard of hearing services
that (indistinct) what services are provided. I talked to (indistinct) and I know that certain people
in the system where I work need mental health services (indistinct) but there are still people who
call us and say that someone has turned them away and they’ve been told that because they’re
(indistinct) and so I think that as a vision and as a philosophy (indistinct) agree with what I’m
saying. Nobody disagrees but yet somehow at the line it doesn’t always happen.




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Grace Gomes: I just want to say that at the County, we offer mental health services for all of
those (indistinct).

Sheila Kornzweig: I know it seems like an (indistinct) but it doesn’t always work out that way.

(Further discussion).

Cindy Toews: If I could just interject, what if we said ADA compliant, or something like that,
because that covers the whole range, regardless of disability or any condition whatever, if it’s
always ADA compliant, a written statement in there that talks about cultural, language
(indistinct).

(Further discussion) they do have to be MHSA eligible, but you can’t discriminate based on any
of those other factors, if they meet the criteria (indistinct).

Mr. Katz: It sounds to me that this is again, kind of the spirit of the law, and I don’t have any
objections, I know that we are ADA compliant, but I know that what (indistinct) is that there are
just some people who have difficulty with access and in this case she’s talking about deaf and
hard of hearing people, but specifically (indistinct). Any further comments?

Giang Nguyen: (Indistinct) but we need to be clear that the spirit of the MHSA is really for the
unserved and underserved, whether they’re (indistinct) but we need to make sure that we focus
on the (indistinct) and certainly (indistinct) is to increase access and stay focused and not dilute
the language so much that it gets distracted, and when it gets to the state (indistinct). Thank you.

Cindy Toews: All I was saying is that there are places in here where it is worded (indistinct) but
if you’re going to use the language at all you have to (indistinct).

Mr. Katz: Keep in mind that this is what would happen, and Sheila I’m in support of what
you’re saying, but if we make that recommendation, the County would come back and respond
throughout the document, so to speak. They would be required to respond to the
recommendation, so it’s important but I just hate to see it get (indistinct).

Sheila Kornzweig: You know I think the reason I thought of it is because I did ethnicity,
language, culture, and I’m sure that’s why these other people came and talked, because they
didn’t see disability, they didn’t see other (indistinct). I think I’m not here to impede the process
but I do think… I was reading that and I thought (indistinct)

Mr. Katz: Well, let me suggest that perhaps we add something to the recommendation that says
take the language that’s there, that says we just want to emphasize that, underserved individuals
that may have access issues or disabilities such as (indistinct)…

Cindy Toews: That’s just part of it, that what I’m saying. Part of it is written into the document
but there’s a few categories missing.

Mr. Katz: So why don’t we make a recommendation that those categories be added?



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Cindy Toews: Yeah, because that’s throughout the document. I just think that’s an oversight.

Ken Katz: Well, maybe we could get some verbiage, submit some language, about that.

Cindy Toews: Well, actually, I have the exact language about that from the Office of Civil
Rights.

Mr. Katz: OK, who should that go to then? Juanita?

Juanita Fiorello: The problem is that it has to be to the Board, tomorrow.

Mr. Katz: Yes, this is all going to be worked on tonight.

Cindy Toews: OK, it would be, it would be regardless of, and I know that it has ethnicity. Yeah,
just the one sentence, but it’s got ethnic, cultural, ethnic, gender, disability, and orientation,
sexual orientation age, also. (Indistinct) that’s what it has, it has all those components. It
doesn’t have, that’s what I’m saying, it’s just missing a few words, and we just have to add those
to the end. It’s throughout the document.

(Discussion continues about placement of the language.)

Mr. Katz: So we recommend that final PLAN document include language consistent with the
ADA (discussion indistinct). Let me ask Dr. Levy.

Dr. Levy: I think the issue behind the statement is really the fact that this Plan (indistinct) and
that I encourage people to keep coming out and focusing on it. I mean we had one meeting in
Pinedale that was (indistinct) focused very strongly. In fact, in fact we just don’t have the
resources to really keep doing all the things, we are not educating well enough on how we deal
with this population. We talked a lot about outreach with the Asians, for example, people in hard
to reach communities, especially in rural communities. We don’t do that well enough. So I
think as the years go by, we can keep focusing on the areas of special needs that we need to pay
more attention to, and try to reach those populations, in a more effective way. That’s really
what’s behind it. Let’s put this language in, and we need to keep it in front of us. But people
really need to come and we really need to look at how we really put it into effect.

Mr. Katz: OK, so we actually have 5 recommendations, 4 recommendations, and they relate to
again user friendly, creating at the next go around, a user friendly document of the PLAN,
shorter version, family support advocacy services, we have language for that, we have the
language for housing and supportive services for match for the grant and then we have the
recommendations for final print document include language consistent with the ADA. Anything
else?
(Discussion re: addition of PCIT).

Mr. Katz: OK, so we have these four. Do we need to take them one at a time, or can we take
them all at the same time? There’s a first, and there’s a second. I always forget.



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Hold on. Juanita?

Juanita Fiorello: I’m sorry. Before you actually vote on this, it might be worth a few minutes to
ask our PLAN Coordinator, if it’s stated clearly enough, that she can make the changes.

Mr. Katz: I’ll have to work with her after this.

Gene Garcia: I would like to have them vote on it individually. I have a concern with one of
them. I can support most of them, but I don’t want to support one of them.

(Tape indistinct; motion to vote for all at once is withdrawn)

Gene Garcia: OK, I mentioned that I would like them broken out. The one for the housing, I
can’t support that. I can support the other ones, but I can’t support that because of what it
(indistinct). and if I have to, I will vote against all of them, if that’s what I have to do. I don’t
want to do that, but...

(Discussion re: parliamentary procedure)

Mr. Katz: OK, Do we have a motion on the first one (moved and seconded). Public comments
regarding the first item. The first item is to again prepare the next iteration of the PLAN in a
user friendly format to be published at the same time. So any public comment on that? Okay, all
those in favor say aye. Opposed? (Passed unanimously)

Mr. Katz: Okay, the next one. This has to do with family support. Families of the mentally ill
shall be provided educational support and advocacy services provided by (indistinct) people who
serve these families. (Motion made and seconded, no discussion). Any public comment about
this item? Dr. Brooks.

Kelly Brooks: I appreciate this motion that’s before this Board. I appreciate Curt making the
(indistinct) on this and Dr. Levy’s kind words earlier tonight. We’ve been very, very careful
about the language for ethnicity, we’ve been careful about the gender and sexual preference, and
then we get into the document we talk about the people we’re serving, consumers and the family
members which Mental Health Services Act is all about and then it jumbled. And so, I really
would appreciate a positive vote on this to clarify specifically what you’re going to be doing for
families, because it’s so important. I’m agreeing with the language, yes, very much so. Mixing
peer and family support doesn’t quite get it, so being very clear on the language.

Mr. Katz: Any other public comments? OK, all those in favor say ay. Opposed? Unanimously
approved. Okay, #3, regarding housing and supportive services and, Curt, I know you were
writing it down, I can’t quite follow all of your notes, you want to read it?

Curt Thornton: We recommend that we appropriate $85,000 for 3 years for housing supportive
services of Fresno, a local non profit (indistinct). And further support the HUD grant by for
mental health consumers (indistinct)




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Mr. Katz: First, second, discussion amongst the Board.

Gene Garcia: The only thing I want to say is that I am voting against it, not that I don’t think it’s
a good program. It’s just some of the concerns for me is opening up a can of worms, first of all.
I think, second of all, Mr. Torigian presented to the Board [of Supervisors] directly and I think if
the Board chooses, they’ll fund it. I think the Board is going some where; the Mental Health
Board is going somewhere, where it may regret it. That’s your choice.

Mr. Katz: The funding request before the Board of Supervisors, funding is unlikely. But it’s
only for one year. Any other discussion from the Mental Health Board members? Discussion
from the public?

Cindy Toews: Just so that I understand what your concerns are, Gene is that they’re two-
pronged. One is that it kind of precludes developing a continuum of care option, going all the
way from (indistinct) and then the second one being that it opens the door for all the money to be
siphoned off for housing. Is that correct?

Gene Garcia: Also the third one would be the CBOs, the other CBOs.

Mr. Katz: OK. Any other public comments?

CeCe Lomeli: My concern is that, I understand that it’s a good program, the $85,000, but I’d
like to know how can I have access to it, can I send my clients there to your housing. That’s my
concern, because right now, our clients are living in tents, with no power, no water, and no
toilets.

Mr. Katz: That’s good. I would say that if your clients, clients in that village qualify as MHSA
clients, then they are eligible and all referrals are coming through the Department of Behavioral
Health, so (indistinct) Dennis?

Dennis Torigian: I couldn’t have said it better. This program is for your clients. It is not
transitional living; it’s permanent, we call it independent living because we’re not a licensed
facility to provide certain, you know, care provisions, but, in fact, so we call it independent
living. You have support staff. So it is designed for your folks, get them out of other living
arrangements and develop any other independent living that they deserve.

Mr. Katz: Is there any other comments, questions? OK. We will call for the question. All those
in favor, say ay. Opposed? OK, there’s one no, and there’s one abstention. OK, lastly. That the
Mental Health Board recommends approval of the final Plan document including languages
consistent with the American Disabilities Act. OK, we have a first and we have a second.
Discussion amongst the Mental Health Board. Is there any public discussion? (None) So, we
have a motion to approve the August 25th plan document. No, we’re not approving the plan;
we’re just making recommendations to go before the Board of Supervisors, and adoption with
the recommended revisions including the addition of PCIT. We had a first, do we have a
second? Any discussion by the Board? I just have a comment that this is not an insignificant
vote that we’re taking. This is a culmination of a huge process and I honestly think Vera has



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been beat up a lot in this process. We wouldn’t have gotten here without her. I don’t know
where she is, but this is an important moment. It’s also a huge amount of down time, but I think
it’s really gone (indistinct) we owe all the staff, departments. We recognize all the hours and a
lot of those will be working all night long to prepare this for tomorrow. I also appreciate all the
families and consumers; I was so proud that consumers came out and spoke tonight. This was
the culmination of a huge process. I want to thank the Mental Health Board. First part of
meeting, we had discussions, do we have any public comments?

Giang Nguyen: I think this is a very special moment and I want to acknowledge (indistinct) and
this is true transformation. I want to thank the public and the Mental Health Board, all our staff,
Vera Kennedy and her staff, and I would like to thank Ken Katz, and Dr. Levy, who’s our
medical director, a very busy physician, Vicki Samarin, our deputy director, she’s been on board
only 3 months and she’s already part of the team, Grace Gomes, Debbie DiNoto, Eloise Gilbert
(indistinct), and just say thank you.

Dr. Zomalt: I’d like to be very, very brief and just say that I am so proud of our community.
This has been perfect. I was telling Dr. Brooks, this is democracy at work and is what leadership
is all about. And so, thank you all from the bottom of my heart. And I look forward to
continuing with the process. Especially, thank all of you on the Mental Health Board. I am
really proud of our Mental Health Board. I think that you’re going to be a model for the rest of
the state. Thank you so much.

Mr. Katz: Okay, all those in favor of approving the 8/26 document, including the recommended
revisions, say aye. Opposed? (One opposed). The meeting is adjourned. Thank you

Meeting was adjourned at 7:56 p.m.




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