Homelessness Revisted

Since my first article I have learned much by reading the news on many newspaper outlets. These last two weeks the SF Chronicle has run a special series on the problem. I am going to use some of them for this review.

In an article on Sep 4 is an article entitled “S.F. Counts 4000 Homeless, Addicted and Mentally Ill.” by Dominic Fracas and Trisha Thadani.

In SF approximately 4000 people suffering what the authors call a “perilous trifecta” the mentally ill, the drug addicted and the economically suppressed.

The San Francisco Chronicle has taken the lead in exposing deficiencies in our mental health “industry,” a testimonial to the homelessness/untreated Seriously Mentally Ill (SMI) in our previously progressive city.

In an article, “San Francisco at War against the Mentally ill,” by Robert Okin also on September 4^th the most egregious policies allow large corporates (Sutter Health) to gobble up hospitals, refurbish them and then eliminate psych beds.

San Francisco General Hospital, now ridiculously called Zuckerberg G.H., cut acute psychiatric beds at “the General” by more than half. As well, the General moved long-term mental health beds out of the hospital.

 S.F. also let Sutter Health abolish all psych beds at St. Luke’s in 2005 and a 20 bed psychiatric unit and at Ralph Davies hospital the latter in 2009. Both of these eliminations of psych units followed the purchase of both hospitals at the cheap by Sutter. When remodeled it was decided to leave out psych beds, not traditional money-makers.

New hospitals on Geary and Van Ness and on Cesar Chavez and Valencia are to have no psych beds. The city eviscerated the number of subacute beds for meatal ill people who need longer-term care and the number of board and care homes have fallen to almost nil for lack of funding to meet overhead.

Mayor Breed was against Proposition C which would have funded the creation of a thousand residential and shelter beds for homeless mentally ill people.

The article notes that the mayor’s also plans to implode the Adult Residential Facility at General Hospital as 41 long-term beds are switched to short-term shelter beds.

The County jail inmates with mental illness now make up 20% of the population. That makes the jail the largest psych facility in the city. 

Another piece in the S.F. Chronicle from Aug31, 2019 is titled “SF Streets are a Tragedy Waiting to Happen. Do we have the will to head it off?” by Willie Brown, former mayor and state assemblyman.

He notes that people in the city have become not only inured to the in your face homeless but “disgusted with the behavior they have to deal with on the streets.” Law enforcement and the public must see psychotic persons in crisis in stores, on the streets or Starbucks. Next will be as it is around the country a violent death at the hands of folks with untreated schizophrenia, the largest percentage of the seriously mentally ill (SMI) of society.

These following are from my research. The commonly accepted figure for all forms of schizophrenia is 1% of the population. That would make the figure about three million. From my experience as an advocate interacting with others that is an underestimate. A more correct figure is probably four to five million. If half of those have paranoid schizophrenia then 2.5 million is the approximate number with the worst form of schizophrenia. 

Fifty-percent of folks with paranoid schizophrenia are NOT AWARE they are sick and therefore will not take medications. There is a term for this, anosgonosia. That leaves 1.25 million who cannot remain in the home because of their violent tendency. So they end up on the streets cycling between homelessness, short term psych facilities and jails. The number seems accurate considering that 4000 alone are in SF. and 61,000 in NYC.

Returning to Mr. Brown’s article, Austin James Vincent is in custody for the attack on a woman trying to enter her Embarcadero condo. He said he was trying to protect her from robots. The old adage that the SMI are more likely to be the victims of violence then the perpetrators is WRONG.

As Brown points out the answer is that the sickest and most violent SMI need to be in locked mental health facilities. But since the ‘60s such facilities for the most part just do not exist or if they do the dearth of conservators hired by the State to facilitate these cases are overwhelmed.

In an article from Sep 6, 2019, “Beds for SFs Mentally Ill, Drug Addicted Sit Empty despite Huge Need,” by Trisha Thadani spotlights the truly awful of underutilization of existing beds. Dozens of beds remain vacant for mental illness and drug addiction on any night.          

The report states that on random checks 27 to 70 beds were vacant involving three programs including HealthRight 360 (addiction treatment), Progress Foundation and PRC Baker Places.

A SF social worker Rachel Rodriguez, writes, “There is zero chance that on any given night, those beds could not be filled with appropriate referrals.”

The following reasons are cited: holding beds for a couple days for clients, arduous paperwork to satisfy federal and state requirements and limited ability to admit patients because of staffing shortages and the hours required to admit one patient.

SF has in excess of 2,000 beds in 300 programs that help 30,000 people a year. The city expenditure for its behavioral health care system for the care of both mental health and drug addiction is $400 million a year.

There is a shortage of psych social workers to access the patients. One patient had to wait eight days to get a bed. The concern was that he would lose his motivation.  Rodrigues notes, “Each day I had to leave him knowing he was going to continue to use meth and heroin…The rejections fortunately didn’t shift his desire to get clean and sober—but that’s not true for everyone.”

The writer notes that for progress Foundation and PRC Baker Places vacancies are smaller. Of Baker Places’ 94 mental health and addiction treatment beds there seven to ten empty beds on certain nights. However Steve Fields director of Progress Foundation sees up to a dozen vacancies on a given night out of program’s 190 beds.

I could go and on reviewing the Chronicle’s series on homelessness but I feel I have hit the high points. The newspaper is to be congratulated for putting the problems in the public’s view.