One Solution to SF’s Mental Health Crisis

by on October 5, 2015

San Francisco, like all major cities, struggles to assist those on the streets with mental health issues. So here’s one solution: the city should assign workers to walk neighborhoods identifying those in public crisis and getting them the help they need.

If this strategy sounds obvious, I agree. But San Francisco does not currently follow this approach, and to my knowledge it never has.

For all the complaints about street homelessness and encampments, I find people  are most upset about people on the street suffering psychotic episodes that leave them a potential danger to themselves and others.

I’m talking about the man I saw with his pants down for almost two hours on the major thoroughfare of Hyde Street who ended up going into the middle of the busy intersection blocking traffic. Phil Matier reported on this in the SF Chronicle in late August. Or the man I saw last week in the middle of another busy intersection twirling in a circle as cars tried to pass; the man was earlier seen banging his head against a light post.

While these individuals are often associated with “the homeless,” some may be people with housing walking the streets because they have gone off their meds or taken a wrong dose. If they are homeless, they can’t access housing until their mental health issues are stabilized.

Missing Street Strategy

If San Francisco has a strategy for getting immediate help to publicly disoriented people on the street, it is failing.

Compare us to New York City.

I have long disputed those who saw New York City’s performance on homelessness as superior San Francisco’s.  NYC simply pushed its homeless people away from   tourist areas, creating a false impression among visitors.  New York City invested heavily in shelters while San Francisco has prioritized permanent housing, a far more effective strategy.

But on street outreach, NYC beats San Francisco hands down.

I was in New York City for nine days around Labor Day. I did not see a single person walking down the street screaming, or a troubled person wandering in a street to block traffic. What San Francisco accepts as common was entirely absent from New York City.

New York City has a far better street outreach program than San Francisco. Its benefits are seen from the comparative lack of troubled people on the street.

San Francisco has a Homeless Outreach Team (HOT) that primarily focuses on encampments, particularly those under freeways.  These campers are typically not the seriously mentally troubled population left to fend for themselves on the streets.

The Department of Public Health led HOT program is not held accountable for the people in crisis on our streets. That helps explain why the problem continues.

A Simple Plan

The city should assign people from its HOT program, or shift some of the millions of dollars DPH is not spending on “stabilization” beds, to hire fulltime staff to walk the streets and call for help for those suffering a mental health crisis. I know this sounds obvious, but it is not happening now in San Francisco.

Obviously, these monitors cannot protect everyone. But most of the very troubled people I see are on the street for hours, and a monitor would notice them.

Once identified, people would be 5150’d for the immediate help they need. In some cases, a stabilization of meds will soon get people back in their homes. This process could also get some who are homeless access to the benefits that will lead them to housing.

San Francisco lacks sufficient facilities to permanently house those whose acute mental disabilities leave them unable to live independently in SRO’s.  That’s been a major problem since our Board and Care facilities closed down in the 1980’s and 1990’s, never to be replaced. Adding street monitors will not impact this, whose solution requires millions of state and federal dollars.

But our inability to solve that problem does not mean San Francisco should not have workers ensuring that mentally troubled people acting out on the streets get help.  Supervisor Mark Farrell told me that he thinks it would even make a big difference if there were a phone number people could call or text for immediate city help for people undergoing public mental health breakdowns.

San Francisco has the resources to do this. It only awaits implementation.

Randy Shaw is Editor of Beyond Chron and Director of the Tenderloin Housing Clinic, which provides permanent housing for homeless single adults. He is also the author of the new book,  The Tenderloin: Sex, Crime and Resistance in the Heart of San Francisco

Randy Shaw

Randy Shaw is the Editor of Beyond Chron and the Director of San Francisco’s Tenderloin Housing Clinic, which publishes Beyond Chron. Shaw's latest book is Generation Priced Out: Who Gets to Live in the New Urban America. He is the author of four prior books on activism, including The Activist's Handbook: Winning Social Change in the 21st Century, and Beyond the Fields: Cesar Chavez, the UFW and the Struggle for Justice in the 21st Century. He is also the author of The Tenderloin: Sex, Crime and Resistance in the Heart of San Francisco

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