I’ve written extensively about the need to bring back locked facilities and court-ordered treatment for the severely mentally ill — those who can’t take care of themselves and who are a danger to themselves and others. The recent opening of the San Francisco Healing Center at St. Mary’s Medical Center, with 54 lockdown psychiatric beds, more than doubles the current number. It’s a step in the right direction, but the topic of forcibly taking the homeless off the streets makes people uncomfortable, particularly those who work with the 80 or so private agencies benefiting from hundreds of lucrative contracts that require no accountability.
It also upsets “A tent for everyone!” advocates like Jennifer Friedenbach, executive director of the Coalition on Homelessness, who said of the new ward at St. Mary’s, “We should be building up our community mental health system so that people don’t get to that point of needing to be locked up.” Nice words, but it takes just a quick walk down the mean streets of San Francisco dodging hypodermic needles, human feces, and tents to see, after years of doing things Friedenbach’s way, it’s time to try something new.
Just adding beds won’t solve the crisis. Courts also need more power when it comes to conservatorship. Currently, judges base their decision solely on the way someone appears after a three-day mandatory hold. That led state Senator Scott Wiener to introduce SB1045, which would allow counties to seek a 14-day extension and repeat the process every 30 days not only for the severely mentally ill but also for chronic drug addicts. Mayor Mark Farrell supports the legislation, as does Supervisor London Breed, who wants to transfer conservatorship oversight from the district attorney’s office to the city attorney’s office when there’s no criminal behavior involved, making it easier to coordinate help with other city agencies like the Department of Public Health. For the city’s 40 to 50 so-called “frequent fliers,” who repeatedly go from the streets to the emergency room, longer and sometimes even permanent stays in locked facilities are a necessity grown from more than five decades of ignoring the problem.
The vast majority of mental patients in the United States were released from hospitals and into communities under a policy now considered a total failure. Many in the psychiatric field during the 1950s and 1960s who helped craft that policy blame, in particular, the overreliance on tranquilizers as a cure-all. Politicians, pressured by the troubling image and financial strain of state-run hospitals, were equally culpable. In California, the number of patients reached a peak of 37,500 in 1959 under Governor Edmund G. Brown, fell to 22,000 in 1967 when Ronald Reagan was in office, and continued to plummet during the first administration of Edmund G. Brown Jr.
The senior Brown later expressed regret. “They’ve gone far, too far, in letting people out,” he told The New York Times. Then-director of the National Institute of Mental Health Dr. Robert H. Felix, who was a major player in the shift to community release, also expressed remorse. “Many of those patients who left the state hospitals never should have done so,” he said. “We psychiatrists saw too much of the old snake pit, saw too many people who shouldn’t have been there and we overreacted. The result is not what we intended, and perhaps we didn’t ask the questions that should have been asked when developing a new concept …”
ON THE STREETS
On a chilly, rainy day after a business meeting downtown, I decided to do a few errands. As I turned the corner from Fourth Street onto Market Street, I noticed a tall, bearded man staring at the cracked screen of an old iPhone. Beside him was a beautiful fawn-colored pit bull, tethered only by a thick rope, and as I approached she wagged her tail ever so slightly. “Can I say hello to your dog?” I asked. The man looked up, wiping his eyes quickly. “Yes, her name is Honey,” he said.
“Are you having trouble with your phone?” I asked. He nodded. “My friend sent me $50 on PayPal but I don’t have a checking account.” I said I could get it for him by sending it to my account. He handed me the phone and we headed to an ATM. I took out $50 and another $10 so he could get something to eat. He told me he’d driven his car from Florida hoping to find work up north. He stopped in San Francisco, where his car broke down. In the Haight, “some kid” punched him, and when he came to, his backpack and his dog were gone. He managed to find Honey, but his car had been towed. “I didn’t expect San Francisco to be so awful,” he said. “I just want to go home.”
We walked to Target, and I bought Honey a harness, a leash, and some food and treats. Then we stopped at Trader Joe’s, where I purchased a $25 gift card, along with a sandwich and bottled water. “This should help you get on your feet,” I said, “and if you and Honey want to go home, I’ll help.” He thanked me, and I added my number to his phone.
“I got out of the service a few years ago,” he said. “I wanted to make a change, but it won’t be here. It’s scary . . . so many seriously crazy people on the streets. I thought San Francisco was the richest city in the world. Why do they allow this?” That, I told him, was the million-dollar question.
As we parted ways on the corner of Market and Fifth Streets, a woman propped herself against the wall of the Old Navy store. She was disheveled, a mop of matted black hair framing her nearly toothless smile. As she covered her body with a filthy blanket, two teenage boys began taunting her. “Show us your boobs,” one said. “We’ll give you a dollar,” said the other. She obliged, pulling down the blanket to reveal her naked breasts. The boy snapped a photo and his friend threw a dollar at the woman as they scurried away. A couple with two small children flagged down a police officer, but I knew, with the current laws, not much could be done. Where would this woman and others like her be safer — here on the mean streets of San Francisco, or locked in a treatment facility with constant care? I think the answer is clear.