UNADOPTED MINUTES

Mental Health Board

Wednesday, October 14, 2009

City Hall, Room 278

San Francisco, CA

BOARD MEMBERS PRESENT: James L. McGhee, Chair; Jagruti Shukla, MD, MPH, Vice-Chair; James Shaye Keys, Secretary; M. Lara Siazon Arguelles; Mary Ann Jones, PhD; Susan McIntyre; Tom Purvis; Errol Wishom; Iviana Williams; Lisa Williams; and Virginia Wright.

BOARD MEMBERS ON LEAVE: Officer Kelly Dunn; LaVaughn Kellum King; and Njoroge Tho-Biaz, M.A.

BOARD MEMBERS ABSENT:

OTHERS PRESENT: Mr. Edwin Batongbacal, Director of Adult Services Director of Community Behavior Health Services (CBHS); Charles Rivera, Director of Older Adult Services for CBHS; Loy M. Proffitt (MHB Administrator); Sarah Accomazzo (MHB Special Projects Manager); Francisca Oropeza, MFT, Southeast Mission Geriatric Services; Valerie Gruber, PhD, Clinical Psychologists Member, Northern California Commission on Psychiatric Resources; Samuel Patterson; Sarah Richmond; Tracey Walters, Physicians Organizing Committee; and Michael Wise.

CALL TO ORDER

The meeting was called to order at 6:38 PM.

ROLL CALL

Ms. Accomazzo called the roll.

AGENDA CHANGES

None

ITEM 1.0 DIRECTORS REPORT

1.1 Discussion regarding Community Behavioral Health Services Department Report, a report on the activities and operations of Community Behavioral Health Services, including budget, planning, policy, and programs and services.

Mr. McGhee:  In lieu of Dr. Robert Cabaj who normally gives the Director s report, Mr. Edwin Batongbacal, Director of Community Behavioral Health Services for Adults and Older Adult Services will give the Director s report for Dr. Cabaj.

Mr. Batongbacal:  Thank you for having me here tonight.

Substance abuse and HIV/AIDS have impacted much of the African American population in Bayview Hunters Point (BVHP), Potrero Hill and Sunnydale.  The Substance Abuse and Mental Health Services Administration (SAMHSA) awarded CBHS with a Targeted Capacity Expansion grant to provide services for Substance Abuse Treatment and HIV/AIDS services.  CBHS is looking at service expansion and project enhancement for African American communities.

On Wednesday October 21, 2009 at 5 pm at 242 Turk Street there will be a Behavior Health Court Graduation.  The guest speaker is Professor Terry Kupers from the Wright Institute who authored the book, Prison Madness: The Mental Health Crisis and What We Must Do About It.

About half-a-million dollars from the Workforce Development, Education, and Training (WDET) and the Capital Facilities were allocated to renovating Silver Avenue Family Health Center.

This month Director s Report lists projects that were selected and contracts that were awarded under the WDET and Prevention and Early Intervention (PEI) funding from the Mental Health Service Act.

Ms. McIntyre:  Can you please clarify the layoff of clerical workers?

Mr. Batongbacal:  The No news is good news.  For now, there are no instructions for further mid-year budget cuts at this time.  November 15, 2009 is the layoff date for about 200 clerical workers in DPH.  People with seniority and are still in the civil service system are being transferred to different departments.  But the fiscal year 2010-2011 may experience cuts depending on budget and the general economy.

Ms. Wright:  What is the Silver Avenue renovation?

Mr. Batongbacal:  I will need to get back to you on that question because I am not sure.

Dr. Jones:  What is the impact on services and programs from the substance abuse cuts?

Mr. Batongbacal:  Revenue generating programs are kept as best as possible but non-revenue-generating substance abuse programs were hit by the budget cut more than other programs. Substance abuse programs are considered non-revenue generator and non-matching fund support.  On the other hand, mental health programs have more matching funds.

Dr. Jones:  Is funding from drug MediCal for substance abuse programs smaller than the General Fund?

Mr. Batongbacal:  Yes, it is very complex.

Mr. Purvis:  Is there anything being done for substance abuse services?

Mr. Batongbacal:  The mega RFP is an opportunity to reconfigure our services.  Bidders were instructed this is how much outpatient substance abuse money is available and how much mental health money is available; submit proposals for integrated behavioral health outpatient services.  Hopefully we can leverage mental health funding to indentify people with substance abuse and mental health issues and treat them at the same time.

Ms. Williams:  I do not see any organizations serving the LGBT communities?  Was there any LGBT program that applied for Mental Health Service Act monies?

Mr. Batongbacal:  Our ability to choose is dependent on who applied for the funding.  Competence in providing behavioral health services to LGBT population was one of the items mentioned as desirable in the RFP.  The department has used an objective tool of scoring to determine the awards.

1.2 Public Comment

No public comments. 

Monthly Director s Report

October 14, 2009

1.      SAMHSA TCE Grant Awarded to CBHS

Community Behavioral Health Services (CBHS ) was awarded the Substance Abuse and Mental Health Services Administration (SAMHSA) Targeted Capacity Expansion grant for Substance Abuse Treatment and HIV/AIDS services.  Southeast Health Opportunities Project (SHOP) is a service expansion and enhancement project that will serve the predominately African American residents of San Francisco s Bayview Hunters Point (BVHP), Potrero Hill, and Sunnydale neighborhoods impacted by substance use and abuse and HIV/ AIDS.  The San Francisco Department of Public Health s Community Behavioral Health Services (CBHS) and its partners will implement this project.  These partners will include contract agencies, affiliated community-based organizations, and stakeholder groups.  The program will focus on low-income individuals who use or abuse illegal substances, engage in high-risk sexual behaviors, are involved in the criminal justice system and are in need of comprehensive treatment services.  At least 300 people will be served annually.  The contract award is in the total amount of $2,250,000 ($450,000/yr * 5yrs). 

2.      Behavioral Health Court Graduation

Please join the San Francisco Superior Court & the Behavioral Health Court Team for the 6th annual Behavioral Health Court Graduation Ceremony. The graduation is scheduled for Wednesday, October 21, 2009 at 5:00 pm, Kroc Center, 242 Turk Street. The Guest Speaker is Terry Kupers, Ph.D. Terry Kupers is Professor at The Wright Institute, author of Prison Madness: The Mental Health Crisis and What We Must Do About It, and a 2005 recipient of the NAMI Exemplary Psychiatrist Award. A reception will take place immediately following the ceremony.

3.      Mental Health Service Act (MHSA) Update

MHSA REVENUES PROJECTED TO DRMATICALLY DECREASE IN THE COMING YEARS

The economic downturn and protracted budget planning this fiscal year has created apprehension over the ability to generate MHSA revenues through the 1% income tax on incomes above $1 million.   In response to this, the State has released projected figures covering the next three fiscal years.  Statewide, the current total MHSA allocation is $1.3 billion for FY 09-10, with the projected budget falling to $1.1 billion for FY 10-11, then $942 million in FY11-12 and finally $743 million in FY12-13.  At the present time, San Francisco is due to receive $25.1 million in budget allocations for FY09-10.  The projected numbers for San Francisco are estimated as follows:  $20.1 million for FY10-11, $18 million for FY11-12, and $14.2 million for FY12-13.  As a result of the delayed budget process, San Francisco hasn t as yet received any MHSA funding for FY 09-10, other than the Workforce Development, Education, and Training allocation of $854,000 and the Capital Facilities allocation for the Silver Avenue Family Health Center renovation project, coming in at $508,000.

With projections showing a bleak picture in the coming years, the prudent reserve requirement that mandates counties to set aside at least 50% of most current CSS (Community Supports and Services) appropriations, in the event that revenues would decrease, will be rescinded in FY10-11.  The reasoning behind this is that most counties would be dipping into their reserve, either partially or totally, to make up for this shortfall.  To date, San Francisco has not been able to set aside enough funds to fulfill the prudent reserve requirement.  The need to examine the effect of these projections and to start thinking about restructuring our MHSA programs is even greater for us locally.

PROJECTS SELECTED AND CONTRACTS AWARDED REGARDING WDET AND PEI FUNDING

The following agencies successfully submitted successful proposals in response to the RFP s and are currently in negotiations for contract awards.  The table below lists the agency name, projects, and amount of funding, in alphabetical order by agency:

CAPITAL FACILITIES

The Redwood Center renovation project has been approved by the State on September 8, 2009.  We are currently working with the Department of Public Works to move ahead with design and pre-construction plans.  The 30-day posting for public review and comment of the Sunset Mental Health renovation ended on October 3, 2009, with no public comments having been received.  We are in the process of forwarding this project proposal to the State Department of Mental Health for their approval.

MHSA ADVISORY COMMITTEE MEETINGS:

The Mental Health Services Act Advisory Committee meets bi-monthly from 3-5 pm, alternating between advisory meetings and community forums.  The next scheduled meetings are as follows:

Wednesday, October 21, 2009                                      Thursday, December 17, 2009

Community Forum                                                        Advisory Meeting

Community Youth Center                                            1380 Howard Street

1038 Post Street, San Francisco, CA 94109                  San Francisco, CA  94103

_____________________________________________________________________________

Past issues of the CBHS Monthly Director s Report are available at: http://www.sfdph.org/dph/comupg/oservices/mentalHlth/CBHS/CBHSdirRpts.asp

To receive this Monthly Report via e-mail, please e-mail richelle-lynn.mojica@sfdph.org

Item 2.0 SENIORS AND DEPRESSION AND OLDER ADULT SERVICES IN SAN FRANCISCO, EDWIN BATONGBACAL, LCSW, CHARLES RIVERA, MPA, FRANCISCA OROPEZA, MFT, SOUTHEAST MISSION GERIATRIC SERVICES

2.1  Presentation: Seniors and Depression and Older Adult Services in San Francisco, Edwin Batongbacal, Charles Rivera, MPA, Francisca Oropeza, MFT, Southeast Mission Geriatric Services

Mr. McGhee:  One of the priority areas for the Mental Health Board is the needs and services of seniors, especially those with depression. Edwin Batongbacal, Director of Adult Services and Charles Rivera, Director of Older Adult Services for Community Behavioral Health Services will provide an overview of the services we have for seniors. Then Francisca Oropeza will give a brief presentation about the needs of seniors at the Southeast Mission Geriatric Clinic.

Presentation: Older Adult Services

Mr. Rivera:  Thank you for the warm welcome.

Good evening ladies and gentlemen, thank you for the opportunity to address you this evening.

My name is Charles Rivera.  I am currently the program manager for the Older Adult System of Care.  9 years ago, I was the program director for both the civil service outpatient units, Central City Older Adults and Southeast Mission Geriatrics Services.  At that time I also served as the Assistant Director for the Older Adult System of Care.  I returned to the Older Adult System of Care after serving as director of outpatient programs for Laguna Honda Hospital.

Upon my return to 1380 Howard Street in April of this year, I was mostly struck by the changes in personnel.  The majority of the colleagues I left behind 9 years ago had either retired or moved on to face new career challenges.  How was the  new 1380 Howard being managed without the guiding presence of the seasoned community based mental health warriors of the 60 s and 70 s?

It was no longer Community Mental Health Services, but Community Behavioral Health Services.  Integration and Access issues were on the table when I left 9 years ago; these concepts are now part and parcel of CBHS.  In my opinion these are all good signs of a healthy system of care that in spite of dour fiscal predictions continues to demonstrate the capacity to evolve their service delivery model in stride and almost seamlessly.  This ability or capacity to remain proactive is one of the true strengths of the current mindset at CBHS.

While this may sound a little maudlin, being proactive, in many ways is the only path one can opt to take, especially in light of our current economic state.  Despite the budget woes, the Older Adult System of Care continues to strive to be true to its mission as the behavioral health safety net for our frail older adult San Franciscans.  While this may sound a little maudlin, being proactive, in many ways is the only path one can take, especially in light of our current economic state.  Despite the budget woes, the Older Adult System of Care continues to strive to be true to its mission as a behavioral health safety net for our frail older adult San Franciscans.  Here is a brief synopsis of our current state of affairs.

• Southeast Mission Geriatric Services continues to remain in its current location, serving the Mission District, Bay View, Excelsior, and sometimes beyond.  Due to the severe demographic and geographical demands upon our Cantonese speaking clinical resources, two of the bilingual/bicultural Cantonese staff have been re-deployed to Sunset Mental Health and South of Market Mental Health respectively. Another full time Cantonese clinician working under the Southeast Mission Geriatric umbrella is assigned to the Ocean view Merced Ingleside OMI clinic. In response to its current on-site clinical staffing of 2.5 staff, Southeast has curtailed it s drop-in capacity, however, depending on staffing for the day, will open its doors on a case-by-case basis.  Southeast Mission continues to work in partnership with the Mobile Crisis Team and will continue to respond to its concurrent caseload. The Mobile Crisis Team in turn will respond to new unduplicated older adult clients. In those cases, the Southeast Mission staff of course will be available for consultation and/or if staffing allows, will accompany the MCT to the site.  We are also exploring ways of maximizing the living space at the Southeast site. We have initialized discussion with a Family Service Agency older adult behavioral health program as well as a civil service program from the nearby neighborhood. The notion is that by having additional programs on-site, we will enliven and invigorate southeast as a more vibrant community site.  The addition of more staff will also increase safety as well bolster the office support.  With only one on-site dedicated part time bilingual bicultural Spanish speaking staff, the capacity for Southeast to serve the growing Hispanic population and the increasing demands for our services is another challenge we must resolve. In this light, we are determined to hire another full time clinician who can bring both language and cultural skills to the table. We currently have a live full time social work requisition and we hope to  fill it in order to meet this challenge of providing adequate and culturally competent services for our minority community.  In the mean time,  realizing that our bilingual Spanish speaking staff member was becoming a  scare resource we began networking and coordinating with our partners in the Adult System of Care, specifically, Mission Mental Health and Central City Older Adults.  A special thank you goes out to Manual Mena and Kim Schoen, the respective directors of the two sites for their cooperation and team work.  Mission Mental Health will assist us by enrolling unduplicated older adult Hispanic monolingual clients into their system of care.  The Older Adult System of Care of course will continue to be available for consultation and absorb those clients who may present with more complex older adult behaviors/issues more in line with our expertise and experience. Central City Older Adults other  scare resource a full time bilingual bicultural Hispanic clinician has worked in concert with her counterpart at SEMG in order to coordinate caseloads and response.  I should mention also, that SEMG is in the process of implementing some of the initial aspects of the primary care initiative.

• Central City Older Adults continues to remain dedicated to the often times mercurial older adult population of the Tenderloin and central city.  The biggest challenge for CCOA is to maintain their current level of excellence and ability to respond. With reduced resources and travel times increasing due to demands on the system of care, the clinic has been in dire need of an automobile. We are currently working with our partners in DPH to procure a car for CCOA staff in order to reduce their travel time and increase their ability to respond. CCOA continues to have the capacity to serve clients in Tagalog and Spanish.  CCOA has also historically worked in partnership with the Curry Center, a primary care clinic site.

• Cantonese Speaking staff. As mentioned earlier, the OA SOC has also responded to the increasing demand for our services from the older adult monolingual Cantonese speaking community. The OA SOC now has 3 excellent full time bi-lingual bicultural staff that can respond and work with the older adult monolingual Cantonese speaking population. We have also initiated coordination with Chinatown North Beach behavioral health in order to provide each other with mutual support and aid. The recent Chinatown fire was an excellent example of the system of care coming together to support the community during a dire time of need.  Cantonese speaking staff from the Mobile Crisis Team, South of Market Mental Health, and Chinatown North Beach, within one hour of notification all made their way to work with the local crisis coordinator in order to provide language as well as clinical support services. Kudos to the system of care and the excellent staff response.  All of them remained until late in the evening.  Wilma Louie of Chinatown Northbeach, Dr. David Pine of the Mobile Crisis Team, and Ernestina Carrillo of SOMA should be acknowledged for their clinician s response during this crisis.

• Contractors: Family Service Agency continues to be a very valuable partner within the OA SOC. FSA continues to address the needs of the older adult specialized population with their OA Intensive Case Management team and Full Service Partnership programs. Both programs have been successful in their capacity to serve their respective target populations.  However, like most programs, waiting lists do occur as their capacities are maximized due to the high demand for their services.

• Progress Foundation Rypins House Residential Treatment continues to be the only Transitional Residential Treatment program dedicated and focused primarily on serving older adults. In conjunction with their excellent Day Treatment program, Rypins/Carroll House continues to work in close partnership with the Older Adult System of Care in order to both maintain and sustain older adult clients who otherwise would have great difficulty transitioning to the community upon their discharge from an institutional based setting.

• We have also re-invigorated the Older Adult System of Care monthly meeting.  We have met monthly now for the last 4 months and have expanded its stakeholders to include Adult Protective Services, the Mobile Crisis Team, Curry Center, Progress Foundation, Family Service Agency, Mission Mental Health, Sunset Mental Health, OMI and SOMA. This monthly is dedicated to presenting and hopefully resolving operational issues in a proactive manner through dialog and mutual agreement.

In closing, I would once again like to thank the board for your time and allowing me to address you all.  Yes the next several months will indeed be challenging. However, the ongoing dedication of the staff, while admittedly being stretched, remains resolute. We will continue to work creatively and effectively.  This will take ongoing partnership, communication and working with a sense of priority that takes into account ultimately, the well being of the patient.

Thank you.

Mr. Keys:  What are your thoughts on integrating mental health and substance abuse with primary care, especially for the Southeast sector?

Mr. Rivera:  In light of current financial concerns, integration is great.  We are in the process of developing contacts for mental health, which is difficult, in the Southeast sector.  We have trainings scheduled together so far.

Mr. Keys:  Have students who can obtain educational credit by doing internships or by getting volunteers helped out the staff?

Mr. Rivera:  It seems there is more interest in internships that focus on adults rather than older adults.  I guess working with the older adults is not a  sexy program.  We need to work more on this.

Dr. Shukla:  The geriatric population needs to be integrated because they may have primary care needs as well as mental health issues.  Sometimes it is a situation of: is it a low grade infection or is it just dementia.  Medications could be over prescribed if misdiagnosed.  Does your staff have any plan with primary care?

Mr. Rivera:  Yes, we do.  Untreated depression can lead to serious mental and behavioral health illnesses.  Out-patient clinicians must deal with them daily.  We see many older adults who have established a long-term relationship with their primary who are often left out in the cold when their primary care physicians retired.

Mr. Batongbacal:  Curry Senior Center is one of our primary care center providing behavior health services.

Mr. Purvis:  A few months ago, we heard that National Public Radio (NPR) had reported on the collaboration between University of California in San Francisco (UCSF) and Family Services Agency (FSA) on early intervention with schizophrenia.

Dr. Jones:  Does CBHS have a map showing populations being served and how older adults come into the system?

Mr. Batongbacal:  We have an organizational chart which is available on the web but not a map.  We can construct one.

Ms. Wright:  When older adults are seeking services for the first time, how are they qualified?

Mr. Rivera:  We have a motto.  No door is the wrong door.  We also provide walk-in services.

Dr. Shukla:  Do you feel your staff have language proficiency?

Mr. Rivera:  We currently have two populations in demand for language proficiency.  They are Cantonese and Spanish speakers.

Mr. Batongbacal:  If we do not have in-house language interpreters we will utilize San Francisco General Hospital s interpreters because the hospital has many different interpreters.  We have the can-do attitude.

Public Comment

Mr. Wise: He inquired about housing services for seniors in the Southeast Mission area who need board and care and supportive housing.

Mr. Rivera:  Board and care is expensive.  We look at affordable housing by the year 2020.

Presentation: Southeast Mission Geriatric Clinic

Ms. Oropeza:  Thank you for the supportive letter to keep funding for Southeast Mission Geriatric Clinic.  The Southeast Mission Geriatric Services provides services to seniors who are economically poor and disenfranchised people.

The clinic is conveniently located for ease of public transportation.  It is safe and quiet as well as anonymous which takes away the mental health stigma.  We serve clients in the Mission, Bayview Hunters Point, Bernal Heights, Diamond Heights, Excelsior, Glen Park, Noe Valley, Portola, Potrero Hill, East of Twin Peaks, Outer Mission and parts of Crocker-Amazon neighborhoods.

These areas have a large numbers of people over 65 years old, and many of them are Latinos, Cantonese Chinese, and many of them often have co-occurring disorders.  Some these seniors are, themselves, caregivers for their grandchildren.  Many of them are uneducated, are living below the poverty line, and are living alone or have no family.  A few of them have undocumented status.

Besides having staff who are both culturally competence and linguistically proficient, the Southeast Mission Geriatric clinic provides care giving, dual diagnosis treatment, traumas and self-esteem counseling.  Without family to care for them or living alone, a lots of seniors have psychiatric issues; physical disabilities and need help in living independently in the community.  There are common psychological problems such as behavior disorders, dementia, schizophrenia, paranoia, personality disorders, and bereavement.

For examples, Latinas tend to have later on-set of post traumatic stress disorder (PTSD) from rapes and some older adults who were immigrants have recurring flashbacks from crossing the borders.

The clinical staff has expertise in working with geriatric population issues such as depression and risk of suicide.  The staff has knowledge in co-morbid physical health and cognitive decline issues as well as life-transition issues related to aging.  We have staff provide home visits and field visits to clients who are homebound or psychiatrically impaired seniors.  We also intervene in cases of elderly abuse.

We are seeing the following trends.  Generalized Anxiety Disorder is the most common anxiety disorders among older adults.  Manic Depressive Disorder is the most common late onset psychological problem.  Many senior women with mental illness tend to stay out of the public eye until a crisis situation precipitated them in an emergency circumstance.  Suicide is the highest in many senior Caucasian males who live alone.  Older Black Americans will triple by the year 2050.  The older Hispanic population will increase from 4% to 16% among the older adult population.  Older widowers have the highest prevalence rates of alcohol abuse among older adults.  Beside alcoholism, we see a lot of substance dependence on prescription medications.

Ms. Arguelles:  What is the ethnicity of the rest besides Cantonese and Spanish speaking clients?

Ms. Oropeza:  We recently lost a Tagalong speaking clinician who would serve the Filipino clients.  We right now have mostly Cantonese and Spanish speaking clients.

Ms. McIntyre:  What would you like the board to do for the Southeast Mission Geriatric Services?

Ms. Oropeza:  I would like to maintain our current location because it is conveniently located for people in the Mission and the Southeast sector.  Also, we ask for an increase in the number of social workers.

Public Comment

Ms. Gruber: She empathized with Ms. Francisca Oropeza struggle for funding due to budget cut.

Item 3.0 MENTAL HEALTH SERVICE ACT UPDATES AND PUBLIC HEARINGS

3.1 Updates

No updates.

3.2 Public comment

No public comments.

ITEM 4.0 ACTION ITEMS

4.1. Public comment

No public comments.

4.2. Resolutions

Mr. McGhee:  Ms. Accomazzo will read the resolution in its entirety and then we will discuss the resolution. If there are any changes suggested, we will vote on the changes first, and then vote on the approval of the entire resolution with the changes.

4.2 a  PROPOSED RESOLUTION: Be it resolved that the minutes of the Mental Health Board meeting of September 9, 2009 be approved as submitted.

Resolution unanimously approved.

4.2 b  PROPOSED RESOLUTION: Be it resolved that the Mental Health Board of the City and County of San Francisco remembers the late Elaine Mikels for her pioneering contribution to psychosocial rehabilitation and the community mental health movement by her creation of Conard House, and congratulates Conard House on its 50th Anniversary.

Resolution unanimously approved.

4.2 c  PROPOSED RESOLUTION: Be it resolved that the Mental Health Board urges DPH to continue to keep the Southeast Mission Geriatric Services open in the community.

Resolution unanimously approved.

ITEM 5.0 REPORTS

5.1 Report from the Executive Director of the Mental Health Board.

Mr. McGhee: "Ms. Brooke is on vacation visiting her son and her two brothers. Ms. Accomazzo will give her report.

Ms. Accomazzo: Ms. Brooke asked me to announce that we have been approved to have a Coro Fellow spend four weeks with us to focus specifically on the needs and issues of girls and women in the Southeast Sector.  She will be meeting with executive directors and community leaders. At the end she will have a presentation and a written summary of what she finds.

5.2 Report of the Chair of the Board and the Executive Committee:

Mr. McGhee:  Before Ms. Brooke went on her vacation, she submitted the proposal for San Francisco Mental Health Education Funds, Inc. to continue to staff and operate the Mental Health Board.  On another matter, we were sad to have to accept Jagruti Shukla s resignation from the board, effective tonight.  We will truly miss her great questions and comments at the meeting and her leadership as Vice Chair. I would like to present her with this Certificate.

Next, my term as Chair and the term of Secretary for Mr. Keys ends in February 2010, plus we have the open Vice Chair opening.  The Executive Committee will be inviting those of you who are interested to serve on a Nominating Committee in November to nominate new officers.  The slate will be announced at the January 2010 meeting and voted on in February.  If you are interested in running for a position on the Executive Committee, please feel free to let the Nominating Committee members know.  Also, if you are on the Nominating Committee you can still run for a position. Finally, at the February meeting, nominations can be added from the floor.

The Executive Committee voted to change the date of the November Mental Health Board meeting to Tuesday, November 10th at City Hall, Room 278, because Wednesday the 11th is Veterans Day and a City holiday.

5.3 Report by Members of the Board on Their Activities on Behalf of the Board.

No reports.

5.4 New business - Suggestions for future agenda items to be referred to the Executive Committee.

Mr. Purvis:  I suggest having NAMI to participate in a joint meeting with the Mental Health Board of San Francisco.

Mr. Keys:  I would like to discuss housing beds for people who have been 51/50 d, and for people with mental illness and for San Francisco indigents.

5.5 Public comment

No comments.

ITEM 6.0 PUBLIC COMMENT

No public comments

Adjournment

Meeting adjourned at 8:39 PM.