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Police and the Plight of the Low-Income Mentally Ill The full text of a column in the San Francisco Chronicle written by Jon Carroll is reproduced below. We believe it is a fine portrayal of how low-income mentally ill people are shuffled into the background, even in one of America's more enlightened cities. Carroll is, of course, writing about the most severely ill group of people with mental problems, and he uses the word "crazy" several times. He means no offense by that, and most people with a problem are not "crazy" anyway. In any case, there is a great deal of passion behind what Carroll has to say.A Mere Drop in the Bucket by Jon Carroll Here's a fact: The Los Angeles County Jail is the largest mental health care provider in Southern California. Here's a second fact, closer to home: Ninety percent of the people who come to the psychiatric emergency room at San Francisco General Hospital are brought there by other people--usually the police. San Francisco General Hospital is a rare place, an example to the nation. What with cutbacks in almost everything and the disgraceful way mental health needs always get the smallest crust of bread, very few big cities have open treatment facilities for the mentally ill. Which means, of course, that they do have treatment facilities--they're just called jails. The mentally ill are not criminals, although many of them may have committed crimes. They are people with brain chemistry imbalances, or major head trauma, or grotesque family narratives. San Francisco can be proud that it chooses to meet profound misfortune with compassion and help. The psychiatric unit at San Francisco General must take anyone. It gets a lot of tourists, people fresh from the airport who think San Francisco is going to solve their problems. It gets a lot of citizens, too. Already, its 87 beds are not enough. It turns away 100 people a month, sending them to other facilities. This is a challenge because very few other places will take Medicare and Medi-Cal crazy people. (Privately funded crazy people have a better time of it, but it is the nature of mental illness that it does not attract steady income). So already it is insufficiently funded. The really bad news: The new city budget calls for eliminating 22 more beds. Sock it to the crazy people; they won't care. The psychiatric facilities at S.F. General are divided into wards, or "units." There's one for Asians (14 different Asian languages spoken); one for African Americans; one for women, particularly pregnant women; one for Latinos (Spanish spoken); and one for what's now called LGBT (Lesbian-Gay-Bisexual-Transgender). The units are needed because the problems are so culturally linked. A broken leg is a broken leg for anybody, but the symptoms of mental illness are more complicated. In some cultures, shame is a major issue. In other populations, AIDS-related dementia is a major concern. For instance, said Mily Trabing, a director of psychiatric social work at S.F. General: "Suppose there's an African American patient who tells me that the clerk follows him all around the grocery store. He may be mentally ill, but paranoia is not a symptom because the clerks really are following him around the store." The math of budget-cutting works like this: In order for the Department of Public Health to find the $3.1 million cut demanded of it, one of the units is going to have to be closed. Of course, the politicians will be long gone when someone has to decide whether the Asians are less important than the Hispanics, or maybe pregnant women trump the African Americans. Bureaucracy is a culture of cowardice. And of course the police, knowing that there are fewer beds, will put more crazy people in the pokey. That will cost money too, so really less money will be saved. And with decreased patient beds, Medicare and Medi-Cal payments will be lowered, so that's even less money "saved." Maybe it's a wash; maybe it's worse. We may "save" ourselves into deeper debt. But it looks good on paper. Forget the human misery, concentrate on the alleged bottom line. The budget is with the mayor right now. In his terms, $3.1 million is not a lot of money. He could find it; he's good at that. We're not talking about coddling
criminals. We are talking about the hallmark of civilization, its ability
to care for the wretched, the accursed, the blamelessly afflicted. Cutting
the budget will not make the crazy people go away; it will only move them
to the jails, the street corners, the dark places under bridges. The mayor
has a moral choice to make. Jon Carroll's column expresses his indignation about the treatment of mentally ill people in San Francisco, but they receive treatment that is as bad or worse in most big cities in the United States. In February of 2000 Utah wrestled with this thorny issue; the Utah State Senate debated a bill that would let homeless people be committed if they couldn't provide basic necessities for themselves. The attempt to lower criteria for commitment was prompted by a shooting incident involving a person with a past history of mental illness. California started considering a similar bill in March. We wish both states, and other states as they take up the issue, well as they try to balance civil liberties against the welfare of the public and people who would be helped by commitment. In December, 2000, the Coalition for Juvenile Justice reported to Congress that 50 to 75% of juveniles in the justice system have mental health problems. There are very few programs to help them, but the Coalition urges Congress to allocate funds for that purpose. Although we hope people with mental problems will be treated better in the future, for the present it is up to them, their families, and their friends to do everything in their power to take care of them and keep them off the streets and out of jail. We hope this web site will help you find ways to do that. Last updated 12/19/03 |
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