In less than a month, San Francisco built a city for the Super Bowl and tore it down as if it never existed — an amazing feat. Yet, on a recent drive down Division Street, my friend Steve counted more than 130 tents occupied by the homeless. “It looks like a Hooverville,” he said. A Hooverville was a shantytown built by homeless people during the Great Depression and named for Herbert Hoover, who was president of the United States during the onset of the Depression and therefore widely blamed for it.
Maybe we should call the city’s tented shantytowns “Leevilles” after Mayor Ed Lee, because he is often blamed for their proliferation. Though homelessness was at crisis levels long before Lee took office, he does seem rather obtuse about the current situation. Before rich revelers came to celebrate a football game played 45 miles south, Lee told the press he would give the homeless “alternatives” but they would have to leave the streets. The city hastily prepared giant warehouses on the outskirts of town to hide the destitute (at first, unlike Super Bowl City, the plumbing wasn’t even working).
Lee also supported building a $160 million jail despite the fact that the one at 850 Bryant Street is half empty, and he praised the state of California for offering to contribute $80 million to the project. “Thank you to Governor Brown for this $80 million grant to help kick-start our effort to build a new, state-of-the-art facility …” Lee said as if speaking at the ribbon cutting for a sports stadium. When the Board of Supervisors pushed back and called for a complex focused on the mentally ill, Lee lost his new jail, his $80 million grant, and his interest.
That’s too bad, because San Francisco desperately needs an innovative hub that focuses not only on the mentally ill homeless, but also on the sickest homeless who need long-term or permanent psychiatric care. I see the politically correct wave of shock washing over your face as you read this, but deep down you know it’s true. Some people living on the streets — those who cause physical harm to themselves and others — cannot be helped by bleeding hearts handing out more tents or the police taking them to San Francisco General Hospital for a 72-hour “5150” involuntary psych hold, or worse, to jail.
When I sat down before November’s election with then-Sheriff Ross Mirkarimi, I asked him why the mentally ill homeless population seemed bigger than ever. “The city has no plan — none — to deal with this,” Mirkarimi said. “When I look back on how many psych beds there were at San Francisco General Hospital 10 years ago, I’d say now it’s probably a fifth of that. The mayor was trumpeting all the construction cranes and building of five new hospitals, but this is the first time in the city’s history that hospitals are being built without requiring them to have psych beds.” That’s right — there’s no psychiatric bed requirement for those shiny new hospitals. Combine that with the loss of beds at current hospitals in just the past several years (69 at San Francisco General, 32 at St. Luke’s, and 20 at CPMC’s Davies Campus) and it’s easy to see why the situation has spiraled out of control.
Mirkarimi also pointed out that while the jail population is declining, the demography of that population is changing dramatically. “Now 30 percent of our population is dealing with mental illness, about 15 percent with significant mental illness,” Mirkarimi said. “County jail systems are not designed for this, and while I do think we have a top-flight in-house psychiatric unit, we’re like a MASH [Mobile Army Surgical Hospital], with people coming in and we’re triaging them and sending them right back out. All I have to do is go to San Francisco General and then go to the jails, and I see 8 out of 10 people going back and forth between our systems, and then I see them back on the streets. This is a direct result of the fact this administration has no plan to deal with mental illness. They’ll sweep it under the rug for the Super Bowl because they want the façade, but the day-to-day reality is they come into our jail system because there’s nowhere else for them to go.”
Until we realize that homelessness is not one-size-fits-all and that mental illness is the largest component of the problem, nothing will change. You can’t treat a veteran with PTSD the same way you treat a person strung out on meth; and you can’t treat people who are bipolar and off their meds the same as you do a chronic alcoholic prone to violent outbursts. In fact, research shows that violence committed by the mentally ill isn’t as prevalent as society believes, though it increases when substance abuse enters the picture. The crimes committed by the mentally ill homeless rarely rise to the level of those committed by the general population. Navigation centers like the flagship at 1950 Mission Street are a step in the right direction for the nonmentally ill homeless, allowing those living in encampments to stay with their possessions, partners, and pets in bungalows while receiving counseling and services, but this doesn’t address the severe lack of beds for the mentally ill, nor does it answer the question of what to do with the sickest of the sick.
In January, San Francisco District Attorney George Gascón, along with supervisors David Campos, Malia Cohen, and Jane Kim, proposed the construction of a behavioral health center that houses both inmates and patients on multiple floors with differing levels of security as an alternative to the failed plan for a new jail. Based on a successful model in Miami, the center would include rapid mental health assessment and secure facilities for those awaiting psychiatric beds. It would also provide referrals and transfers for patients and inmates, in- and out-patient treatment, and monitoring and follow-ups before and after an arrest. Gascón estimates that 40 percent of the current average 1,300 inmates in County Jail suffer from mental illness (slightly higher than Mirkarimi’s estimate), and about 80 percent of police calls involve mental health issues. With a current 90-day wait for a psych bed, mentally ill inmates are often released before they can access the help they need.
Gascón’s plan sounds promising, but it appears Governor Brown is as obtuse about the mentally ill homeless crisis as Mayor Lee: The proposed center would not qualify for funding under the state grant program that would have helped build a new jail. Instead, San Francisco’s state legislators will need to find possible funding at the state level. As for San Francisco, we’re spending a record $241 million on the homeless, but anyone visiting the city would be hard-pressed to figure out where it goes.
In February of 1911, President William Howard Taft signed a resolution designating San Francisco as the official World’s Fair City. Eight months later, Taft came to break the ceremonial ground and, during a lunch at the Cliff House, toasted San Francisco as “the city that knows how.” Over 100 years later, we proved we know how to build and tear down a Super Bowl City inside a month, but unless we put that same energy into building a behavioral health center, we’re going to see a lot more Leevilles popping up — and become known as the city that doesn’t know how to take care of its most vulnerable citizens.
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