The following post is 31 pages long. Much longer than usual. I post it because many of you have requested a copy and this seems the most efficient way to make it available to you.
Ellie Shukert, author of this letter, is also an author in Tomorrow Was Yesterday — Explosive First-Person Indictments of the US Mental Health System — Mothers Across the Nation Tell It Like It Is — by Dede Ranahan with 64 Co-Authors.
Ellie writes: “I've been volunteering with the POC/NCCPR (Physician's Organizing Committee/No. CA Coalition of Psychiatric Resources) and have analyzed reports. I read the CA Auditor's LPSA Report of her Audit, which I made the basic structure of my review of it, putting my comments and suggestions in the margins and backing up everything with documents and articles. It's a 2-in binder that weighs 6 lbs. and Tomorrow Was Yesterday is enclosed with it. I'll be sending the binders out this week.
Share the PDF with anyone who would like to read it. Love, Ellie
A massive undertaking, Ellie. You take no prisoners. Thank you.
July 7, 2021
Subject:
Lanterman-Petris-Short Act Report 2019-119, July 2020
CALIFORNIA HAS NOT ENSURED THAT INDIVIDUALS WITH SERIOUS MENTAL ILLNESS RECEIVE ADEQUATE ONGOING CARE
To:
President Joe Biden
Vice President Kamala Harris
U.S. Attorney General Merrick Garland
HHS Secretary Xavier Becerra
Governor Gavin Newsom
CA Attorney General Rob Bonta
CA Auditor Elaine M. Howle, CPA
Senator Scott Wiener
Mayor London Breed
District Attorney Chesa Boudin
San Francisco Supervisors: President Shamann Walton, Matt Haney, Rafael Mandelman, Gordon Mar,
Aaron Peskin, Dean Preston, Connie Chan, Hillary Ronen, Asha Safai, Catherine Stefani, Myrna Melgar
Hillary Kunins, MD, Director of Dept. of Public and Behavioral Health/Mental Health SF Initiative
Jessica Brown, MPH, Program Lead, SF Mental Health Services Act
Matthew State, MD, PhD, Chair, UCSF Dept. of Psychiatry and Behavioral Sciences, Dir. of Langley Porter
Lisa Fortuna, MD, MPH, MDiv, Zuckerberg SF General Hospital and Trauma Ctr., Chief of Psychiatry
Christina Mangurian, MD, MAS, Co-founder/Co-director UCSF Public Psychiatry Fellowships at
Zuckerberg SFGH
“Roughly every 36 hours, somewhere in the United States, a person with mental illness is shot and killed
by the police,” according to the Washington Post project to track every police shooting in 2015.
This letter accompanying my two-inch binder containing CA Auditor Elaine M. Howle’s Lanterman-
Petris-Short Act (LPSA) Report, CALIFORNIA HAS NOT ENSURED THAT INDIVIDUALS WITH SERIOUS
MENTAL ILLNESS RECEIVE ADEQUATE ONGOING CARE, includes investigations of SAN FRANCISCO,
Los Angeles and Shasta Counties regarding implementation of the LPSA, or lack of it, and the many
problems with data collection in all counties, tracking of expenditures and outcomes, and the use of
allocated Mental Health Services Act (MHSA) funds. For background on how we got to this point, I have
included a copy of “Transinstitutionalization of the Mentally Ill,” by Ralph Slovenko, Professor of Law
and Psychiatry at Wayne State University Law School, published in the Ohio Northern University Law
Review, Volume 29.
Transinstitutionalization refers to the transition of the seriously mentally ill from state hospitals that
were shut down, to the prison systems, which have become de facto mental institutions for people with
SMI who have gotten tangled up in the criminal justice system, due to the failure of our mental health
care system to provide early intervention and treatment before symptoms of SMI escalate to the point
that they become a danger to themselves or others. Police officers, who have not had crisis intervention
training (CIT), are not armed with de-escalation tactics that could prevent such unnecessary and tragic
deaths. Assisted Outpatient Treatment for those at risk is underutilized and police departments always
seem to have excuses for not making CIT training mandatory for EVERY officer.
Whether or not to use the LPSA, for Assisted Outpatient Treatment, Continuum of Care, or
Conservatorship, as a step to deliver crucial care to people with serious mental illness (SMI) is still
debated and avoided on various grounds, including whether or not involuntary care violates a SMI
person’s civil rights and how the costs of care will be met. There is still no parity in our health care
system when it comes to caring for the SMI, even though California has raised billions of dollars through
passage of the MHSA, or Prop. 63, also referred to as the “millionaire’s tax.” Funds meant to shore up
an inadequate system to deliver care to the SMI seem to have been largely diverted elsewhere,
apparently, for more general purposes with a broad interpretation for “mental health” needs for the
general public and what is meant by “prevention and early intervention.”
Proper facilities like mental hospitals with psych beds and staff that can provide a high level of care for
someone requiring a conservatorship, residential care or supportive housing and staff are necessary in
order to have somewhere to conserve a SMI person to. Restrictions on funding (Catch 22s) for this
component of the overall infrastructure necessary to implement the LPSA are obstacles to using it at all.
“Authority and Accountability: Evaluating California’s Conservatorship Continuum,” by Alex V. Barnard,
Assistant Professor, Dept. of Sociology at New York University (who earned his PhD in Sociology at UC
Berkeley in 2019), has made a thorough assessment of problems and challenges in California that create
formidable obstacles to providing care for the SMI. To read the draft of his report (February 2020) go to
https://drive.google.com/file/d/1H-hKxnd-xwNXap05VZPxSkAJT92ZzHN-/view?usp=sharing or contact
him at alexbarnard.org.
A critical point he makes is:
California has followed a national trend in deprioritizing people with the most severe conditions
in its mental health system. People potentially subject to conservatorship should be the system’s
biggest concern. Funding streams like MHSA should be able to finance the whole continuum of
services for this group. The state should increase funding for placements by asking for a waiver
from the IMD exclusion. It should develop services that bridge the gap between institutional
services and purely voluntary outpatient ones. Outcomes for conservatees should be a core
metric of the system’s success.
He concludes that:
California’s conservatorship continuum is a situation of “absent authority.” The system does
not provide coordinated interventions that are geared towards long-term outcomes of stability,
autonomy, and community integration. Conservatorship should be reimagined as part of a
mental health system that is a fully-funded entitlement to meet the whole needs of all people
who qualify.
Everyone must step up and accept the RESPONSIBILITY that goes with their AUTHORITY, all the way up
and down the bureaucratic ladder.
The Legal Action Center’s study, “The Medicaid IMD Exclusion: An Overview and Opportunities for
Reform” is enclosed. The IMD exclusion, which prohibits the use of Medicaid financing for care provided
to most patients in mental health and substance use disorder residential treatment facilities larger than
16 beds, was intended to ensure that states, rather than the federal government, would have principal
responsibility for funding inpatient psychiatric services. A recent modification allows the counties in
states to “request” a waiver for the exclusion, but technical glitches have apparently caused Governor
Newsom to have to move up the date to even request a waiver to 2022. A summary of two public
hearings on April 26, 2021 and May 3, 2021 that were held electronically was posted online in May 2021
from Will Lightbourne’s Office, Director, State of CA—Health and Human Services Agency, Dept. of
Health Care Services, includes this statement:
DHCS is committed to developing a SMI/SED IMD waiver request for the federal government no
sooner than July 1, 2022, and understands its importance to beneficiaries and families. Given
federal requirements for waiver submission, DHCS is unable to submit the request to CMS in the
CalAIM Section 1115 demonstration application, but is moving ahead with planning, recognizing
this critical area of need.
It sounds like this means we’re going down a bureaucratic “rabbit hole” here. What does “given federal
requirements for waiver submission” mean? What are the federal requirements that are causing DHCS
to be “unable to submit the request to CMS in the CalAIM Section demonstration application”? Who
can help with that? Families and SMI people can’t wait any longer. Tomorrow was yesterday! And
what is meant by DHCS “is moving ahead with planning, recognizing this critical area of need”?
An advocate reported in March 2021 that even though an IMD waiver can be requested, our legislative
bodies in CA added that counties can only ask for a waiver “if they have the funds for treatment beds,
which of course they do not and have no intention of ever having them.” Another gauntlet? Sounds like
a loophole counties will end up using NOT to do what’s necessary and right, so as NOT to be held
accountable for the health and safety of their residents and constituents. That’s an argument in favor of
possibly repealing the IMD exclusion altogether. It’s also an argument for tapping MHSA funds to help
“bridge the gap between institutional services and purely voluntary outpatient ones,” that would
establish a continuum of care that doesn’t exist now to meet the needs of our population.
I did notice a recent bill introduced by Assemblyman Chiu, at the behest of the CA Auditor, who was
complying with Judicial instructions regarding these matters, which included that dreaded, killer phrase:
“unless it creates a financial burden.” We don’t want to see this legislation end up in the “unfunded
mandate” dump. If the State of CA would stop diverting funds from the MHSA, which collects billions of
dollars every year, supposedly for the mentally ill, we would most certainly have a DEDICATED ANNUAL
FUND (if the state doesn’t keep adding restrictions for use of MHSA funds where it is REALLY needed
and giving millions in grants to very questionable programs) to pay for a restored and modern, sciencebased
continuum of care, including the infrastructure that has to go with it (also with a fair share of
support from the Federal Government).
My plea to all of you, tasked with the RESPONSIBILITY and varying degrees of AUTHORITY, is to see to it
that the neglect of SMI people in California and the nation at large is redressed. Many thousands of
Americans afflicted with psychiatric illnesses have deteriorated for lack of access to health care on par
with other physiological/biological illnesses.
In SAN FRANCISCO alone, over 4,000 SMI people are homeless and wandering our streets, delusional,
creating havoc and dying, some killed or injured by bullets fired on them by police, who answer 911 calls
and have insufficient training to respond to mental health crises. Others are preyed upon by drug
dealers who promise the homeless and SMI relief from their despair. In 2020, over 713 people in SF
died from overdoses (more than three times as many deaths than from Covid-19) and we’re on track for
even more overdose deaths in 2021, especially from fentanyl. Our “Outdoor Bedlam” has grown into an
emergency public health crisis. In addition to the known 4,000+ homeless SMI people, another
estimated 35,000+ people in the Bay Area are homeless and must be sheltered before they succumb to
living in the rough and relentlessly being chased from one place to another, arrested or shot.
Jennifer Friedenbach, Executive Director of Coalition on Homelessness in SF wrote an article, “Mental
Illness Shouldn’t Be a Crime in SF,” for the SF Examiner on October 19, 2014, which reported that:
The American Civil Liberties Union put out a video (www.overcomecrime.org) this week that
describes how the United States spends $9 billion on jailing over 356,000 people suffering
from mental illnesses. This lack of humanity has to stop, and the best way to halt it is at the
first response, before someone gets sucked into the criminal justice system simply for being ill.
We need mental health professionals to respond, but even with those in place, the reality is that
police are often the first on the scene and, Ironically, it is not just loved ones of the deceased who suffer;
police officers involved in these shootings often suffer greatly as well, leading to suicides, post-traumatic
stress and depression among officers.
My credentials to comment on this? I’ve been a resident of San Francisco (MA in Language Arts and
Literature from San Francisco State University) for over 40 years and a volunteer and advocate for the
SMI for over 20, together with many families and organizations, including having served for several
years on the board of the National Alliance on Mental Illness (NAMI) in SF. In the late ‘60s, I volunteered
(as part of a psychology course at Quinsigamond Community College) at the old Worcester State
Hospital (formerly called the State Lunatic Hospital at Worcester) in Massachusetts, a prototype in 1830
for a modern state hospital. Worcester State was expanded in the 1850s with the help of Dorothea Dix’s
crusading exposes in the Boston “Courier” about the deplorable conditions at the East Cambridge Jail,
where insane women were kept, chained, without heat in winter or adequate clothing and food, etc.
Dix had been unaware of this until she had been asked by some concerned citizens to visit them on
Sundays and provide some religious instruction. From that time on, it became her life’s work to improve
care for the insane. I’m a US Army veteran (Specialist 4, Signal Corps) who was also assigned to Race
Relations and Drugs and Alcohol. I served in Furth/Nurnberg, Germany in the ‘70s, in a support
company for a Cavalry (Tank) Battalion in Nurnberg. The German border had to be monitored for
intrusions by Russia. When Russian troops headed for the German border for “unannounced”
maneuvers, a red alert would be received which activated U.S. troops and the tanks were rolled out,
shaking the very foundations of surrounding buildings. We never knew if it was a false alarm or not until
later. What qualifies me most of all to comment on the subject of mental illness is that I have a son
with paranoid schizophrenia.
One of the groups I participate in was founded by Dede Ranahan (“Sooner Than Tomorrow”) who was
SF’s Director for the very first NAMI Walk in Golden Gate Park. Governor Newsom, you will remember
coming to one annual NAMI Walk to speak to us carrying your new baby in a pouch in front of you
(thank you!). Dede now lives in the Sacramento area. Her national blog, “Sooner Than Tomorrow—a
safe place for families to talk about mental illness,” has resulted in a book, Tomorrow Was Yesterday,
which was recently awarded the Nautilus Silver Medal, in the category of Social Change/Social Justice
(press release and book enclosed). I am one of the 64 mothers who co-authored the book with Dede,
giving painful testimony to tragedies that occurred unnecessarily because of the immense difficulties
involved in accessing care for a loved one with SMI.
Many thanks to you, Auditor Howle, for your reports on both the LPSA and on Homelessness in CA,
which I have read carefully. In addition to your request for an Inspector General (IG) for Homelessness,
along with permanent, funded staff to monitor all 58 counties in CA (in relation to addressing
shortcomings, helping with implementing mandates regarding sheltering the homeless and getting
everyone on board with the same data and reporting system so expenditures and outcomes can be
tracked properly, I’d appreciate it if you would consider having an IG and staff to do the same to monitor
MHSA funds. Oversight by the Mental Health Services Oversight and Accountability Commission
(MHSOAC) has been problematic. We absolutely need more transparency and accountability.
Governor Newsom, an article dated 2-18-21 by Katy Grimes for the California GLOBE (enclosed) noted
that KCRA Channel 3 reported that last year, Newsom vetoed a bill that would have created a uniform data-
collection system on homelessness spending, saying the measure was duplicative and would create
additional and unnecessary data collection costs.
Katy Grimes also noted that CA Auditor Howle reported a lack of coordination between agencies, and
largely no accountability by any agency. Without that modern, standardized, machine-readable data
collection system with expenditure breakdowns, and tracking for outcomes, and data sharing with other
counties, the auditor won’t be able to properly monitor spending and success or failure of programs to
provide care for the SMI. The whole system will continue to be vulnerable to more abuses and
misunderstandings about how the money is to be spent.
If counties need more staff and funding to do that, please don’t be penny wise and pound foolish about it. The
money bucket in this state has big holes in it that need to be plugged up. I would count that data system the
auditor wants as part of the “infrastructure” needed to make the system run properly and avoid continued
waste of funds on inappropriate programs with ancillary expenditures thrown in, on which many millions have
been spent—see Dr. Jaffe’s report and current examples I have added.
More funding needs to be focused on implementing the LPSA regularly as needed, and other such
involuntary (assisted) programs, such as “Laura’s Law,” in CA, and rebuilding the infrastructure
necessary to do that. Frustrated with lack of proper LPSA implementation (or involuntary psychiatric
holds when required), advocates have argued for repeal or reforms to the LPSA. However, where there
is NO WILL at the local level or above it to implement it, loopholes (and that old standby of an excuse
not to do something, “unless it would create a financial burden”) in the LPSA or any other law will be
found.
More attention must be paid to the many respected organizations that have weighed in on this issue,
especially the U.S. SUPREME COURT OF THE U.S. which ruled in 2015 (Sheehan vs. San Francisco) that
the SMI have a disability that requires accommodations under the ADA.
Auditor Howle’s interpretation of the provisions of the LPSA is the correct one, the least restrictive
response to avoid the need for a much more restrictive environment in the future. AOT can give them a
chance to recover their sanity by providing an evaluation and treatment plan for symptom management
and therapies that can start them down the road to at least partial recovery, if possible, before it’s too
late. Implementing AOT on a broader scale will save lives, which are currently in jeopardy due to neglect
and failure to provide health care equity for the seriously mentally ill. It will also help to keep SMI
people from being tangled up in the legal system and out of prison and the state IMDs which are now
completely full with a waiting list of 1,600 ISTs, according to the most recent report in June 2021. SMI
people incompetent to stand trial are imprisoned, indefinitely, effectively denied a timely trial mandated
by law. It also constitutes cruel and unusual punishment for being insane.
As CA Auditor Howle notes on page 24 of her report: State Hospitals has different populations who compete
for space in its facilities, and legal mandates require it to treat individuals involved with the criminal justice
system; however, these mandates do not exist for individuals receiving treatment through the LPS Act. In
particular, state law permits individuals charged with certain felonies—whom courts have found incompetent
to stand trial (IST defendants)—to be placed in a state hospital or other secured facility in order to be restored
to competency…due process rights of IST defendants include the right to timely and adequate treatment…the
State has up to 60 days from the date of commitment to a state facility by a court to admit an IST defendant. In
addition to the legal obligation to preserve due process by quickly admitting these defendants, federal
courts have more broadly required the State of California to address prison overcrowding
and inadequate in-prison medical and mental health care.
I’d like people who persist in bickering over a SMI person’s “civil rights” to pay attention to the negative
outcome of their arguments, regardless of any good intentions they may have regarding “rights.” We’re
not talking about people with SMI who can manage their illnesses and take care of themselves and use
outpatient services, or who are merely eccentric. We’re talking about people who are GRAVELY ILL and
absolutely need help, having lost the ability to care for themselves.
Page one of Auditor Howle’s summary includes this statement:
The LPS Act allows qualified treatment facility staff or other county-designated professionals
(designated professionals) to provide involuntary mental health treatment to people who,
because of a mental illness, are a danger to themselves or others, or cannot provide for their
basic personal needs of food, clothing, or shelter. Specifically, the LPS Act establishes three
main stages during which people can be treated involuntarily: short-term holds of up to 72 hours,
extended holds that generally last up to 14 days, and conservatorships of up to one year during
which courts appoint outside parties, such as county officials, to assume responsibility for
individuals’ care.
However, the “devil is always in the details,” and if you read the enclosed instructions issued by
Jo Robinson, MFT, Director of Behavioral Health Services, City and County of SF, Department of Public
Health, San Francisco Health Network, (Manual Number 3.02-19, Oct. 19, 2015),with instructions on
how to issue a 5150, or 72-hr. hold, it can be more complicated than you might have assumed, possibly
yet another deterrent to using it. There was a time when families weren’t even allowed to inform the
jail personnel of which medications had been prescribed for their SMI relative when they got arrested
for some conflict with police due to their illness (and possibly having failed to take their meds), but it
wouldn’t be accepted. We didn’t understand the logic in that,but learned later that “someone” told
them not to because “if they didn’t know at the jail about what meds someone was supposed to be
taking, then the City couldn’t be held liable for not seeing to it that an inmate got the meds.” Easier to
ignore that request or say they couldn’t comply with it. Eventually, they would accept it with required
paperwork. I don’t know how this plays out these days, it's hard to track. Just another example of a
gauntlet station along the way.
At any rate, the CA Auditor’s guidance has been largely ignored. There have been no consequences for
those designated to act upon the behalf of the SMI, but fail to accept the responsibility. The effect of
that failure on SMI individuals, their families and society has been devastating.
In SAN FRANCISCO, Supervisor Mandelman, who has consistently been a champion for the SMI by
identifying those most at risk and making a case for why they need AOT, a Continuum of Care, and
sometimes Conservatorship, has been thwarted by most of the other supervisors who get bogged down
in continued arguments over whether or not a SMI person, who is deteriorating in the street or creating
havoc due to a mental health crisis, might have their civil rights violated by being “forced” into
involuntary, assisted care.
On January 23, 2020, Joshua Sabatini at the SF Examiner reported that it had been eight months since
the new “Housing Conservatorship Program” was supposed to be in effect to compel people in the
streets with both substance abuse issues and SMI into treatment, but no one, though many were
identified as eligible, had been conserved.
The program was made possible under state Senator Scott Wiener’s Senate Bill 1045, which passed in
September 2018. Finally, in June 2019, the Board of Supervisors approved legislation authorizing the
program, which is a five-year pilot ending in December 2023. Mayor London Breed’s spokesperson, Jeff
Cretan, said the delay in implementation was due to the need for the San Francisco Superior Court’s
approval.
In October 2019, Mayor Breed announced that SF would begin the program after a subsequent state
law, Senate Bill 40, passed, which fixed some issues with the initial bill. In order for SF to be able to
conserve someone under the new law, the person had to have a dual-diagnosis of a serious mental
illness AND substance abuse disorder and had to have been placed on 5150 holds at least EIGHT times in
a 12-month period. The Department of Public Health oversees the program and they estimated that 50
to 100 people would meet criteria for conservatorship.
According to Josh Sabatini’s article:
There were at least 5,754 emergency 5150 holds in San Francisco during the fiscal year 2018-19 that
were attributed to 3,810 different people. There were limitations to the data, however, and the
report said that the “true count” of 5150s during this time period “is likely higher, though it is not
possible to approximate at this time.”
Conservatorships under SB1045 are different from those allowed since 1972 under the Lanterman-
Petris-Short Act. The LPS Act allows counties like San Francisco to conserve individuals deemed
Gravely disabled due to serious mental illness OR chronic alcoholism.
On March 14, 2021, Josh Sabatini’s article in the SF Examiner reported that, finally, the first person had
been placed in court-ordered treatment. Supervisor Mandelman was quoted as saying: “It’s been nearly two
years since the board vigorously debated and ultimately opted into SB 1045. I said at that time, that even if SB
1045 only helped one person, I believed it was worth doing. And I still believe that, but I didn’t think that it
would actually be just one person.”
Previously, in January 2020, city officials blamed the process of setting up legal forms with the courts for
delays. By June 2020, the forms were finalized and Angelica Almeida, who oversaw DPH’s AOT and the
SB 1045 pilot said, “It really wasn’t until June 2020 that we were able to move forward with cases.”
Apparently, 63 eligible individuals had been identified with dual conditions “who had at least FIVE 5150s
in the past twelve months, of which 16 had at least EIGHT, and one is the one who was conserved.” She
expected to conserve “at least a handful of more individuals.”
Jill Nielsen, deputy director of programs for the Department of Disability and Aging Services, which
oversees conservatorships said that the “eligibility criteria is far too narrow” for conserving someone
under the pilot. She said SB 1045 was originally introduced to permit a conservatorship if a person had
THREE 5150s within 12 months, not EIGHT.
Jessica Lehman, Executive Director of Senior and Disability Action “refuted the characterization from
1045 backers that opponents of the bill succeeded in getting amendments that made the pilot overly
complex.” She is not a fan of conservatorships: “It is a significant deprivation of civil liberties. It is great
that we have as many protections as we do,” Lehman said.
Personally, I don’t think leaving people in the street when they are gravely ill, or imprisoning the insane,
constitutes protection of their civil rights. Can we find out just how many people died because of these
continued impediments to care? And how many ended up in jail or prison? Or will the city hide behind
“privacy issues” as an excuse not to let the public know? If it wasn’t for our intrepid reporters, we
wouldn’t have learned about Mary, Peter and Leo (ahead on page 13 of this letter). I’ve saved hundreds
of articles over the years about SMI people who made the papers after getting into trouble with the law
or getting shot by police. For sure, many do not make the papers.
I find it troubling, also, that Jessica Lehman was quoted as saying, “The people who have had multiple
5150s are disproportionately African-American men and the city must come up with a plan to address
that racial disparity before continuing.” She seems to suggest that bringing someone into care with an
involuntary hold is like being arrested, as if it’s punitive, like stopping someone who is “driving while
Black.” Health care, including mental health care properly given, is a human right that is currently being
withheld. This points to health care and income inequities in some Black communities that make it
harder to access psychiatric care when symptoms begin. How many people can pay $400 a week out of
pocket for a private psychiatrist? Even with insurance that purports to cover mental illness, there are a
lot of restrictions and often meager payments for psychiatric care that most doctors won’t accept.
When symptoms worsen and create dangerous situations, that’s when AOT becomes necessary. Early
intervention is critical to a better outcome.
I was very disappointed to read in the SF Chronicle that Supervisor Walton, President of the Board,
once said something similar. That reflects a very negative image of what a proper mental health facility
or treatment and therapy can be like. However, since the mentally ill are currently often criminalized
and end up in prison, it is probably that result which was on Supervisor Walton’s mind when he
suggested racial discrimination was involved? Who would choose possible incarceration over health
care?
Maybe there is just no faith in the inadequate mental health care system we now have (but where else
can a seriously mental ill person go to get help?) You can’t even get into the crowded Psych ER if you
voluntarily seek help these days. The fear is probably about ending up institutionalized for life, but that
is so unlikely to happen these days. There are many safeguards in place to prevent someone from
becoming institutionalized for arbitrary reasons. In addition to that, the few remaining state hospitals
are filled with people who are IST and have a waiting list of another 1,600 ISTs. There’s no room for
people in the general population who might need to be conserved there temporarily, unless they end up
in the judicial system and join the other people who have become incompetent to stand trial for a
felony. The State is out of compliance with the law that says someone IST has to be admitted to a State
Hospital within 60 days because there are no psych beds available, so they end up in jail indefinitely and
don’t get the treatment or care there that they need.
Conservatorship has been a topic in the news lately as it involves Britney Spears, the pop star, who is
seeking to end her conservatorship, with her father as her conservator. She has the right to argue this in
court and have her issues addressed, or ask for a different conservator, guardian, etc. On July 1, 2021,
the SF Chronicle printed a letter from the father of a man with bipolar disorder who weighed in on the
“conservator conundrum”:
From the point of view of many people unfamiliar with mental illness, it would seem that her [Britney Spears]
father and the law are infringing on her rights. It is hard for most people to recognize mental illness in others.
It is equally hard for those with mental illness to recognize their own mental illness. With bipolar and probably
chronic illnesses, there can be long periods of health interrupted by periods of illness. I have witnessed my
son spend all his money and go hopelessly in debt during such an episode. A good conservator could have
helped prevent such an occurrence. With timely intervention such an episode can be avoided or shortened.
Without help, such an episode can go from extremely difficult to fatal.
On the other hand, some conservators can be abusive. In most cases, the preferred solution is to change to a
better conservator rather than ending the conservatorship. It is a mistake to confuse helping someone with
controlling them. There are times when we all need help.
The Auditor also notes that there have been conserved SMI patients who were not ready to be
discharged from a state hospital, but they got released because the doctor who was required to testify
about their mental status at a scheduled hearing didn’t show up. Then the hospitals can’t hold them.
Those patients, unfortunately, can end up getting into the same kind of trouble with the law again. The
whole cycle repeats.
If a greater percentage of people of color are being brought into care under 5150s, that would signal to
me that they have a harder time, due to economic/health care inequities, to access care before their
illness progresses to the point that an emergency intervention is necessary. People who have MediCal
won’t necessarily be able to find a doctor who will accept it and private insurance also has lower
reimbursement rates for care than most doctors are willing to accept. How many people can pay $400
cash, the going rate, for a private psychiatrist in SF on a weekly basis? People who can afford to access
care before they lose their sanity altogether are less likely to need emergency hospitalization and holds.
Early intervention is crucial. Would you wait until Stage IV to treat cancer? There’s a stage IV for mental
illness, too, and it’s much harder to treat as well.
If you have heart disease, you need a cardiologist. If you have a mental illness, you need a neurologist,
psychiatrist, psychologist, or other trained professional to help you achieve your maximum state of
wellness, depending on what has caused your disabling symptoms of mental illness. You need a proper
evaluation and monitoring.
Maybe ignorance and fear is the enemy here, as well as stigma. We need social workers, nurses and
psychologists in our schools to screen and monitor children who show signs of emotional or physical
trauma or mental illness or disability, and proper resources to refer their families to for help. Schools
need to talk to children about mental illness in age and culturally appropriate ways and about disabilities
and conditions many children and adults have so that they develop understanding and don’t suppress
fear when they feel that something has gone wrong with them or someone else, but they don’t know
how to talk about it.
Herschel Hardin of the American Civil Liberties Association has commented, “Here is the Kafkaesque
irony: Far from respecting civil liberties, legal obstacles to treatment limit or destroy the liberty of the
person. The best example is schizophrenia.” For more information on schizophrenia and its prevalence
in our population, I have enclosed Dr. Jaffe’s report for Mental Illness Policy, “The NIMH Saga Continues:
How Many People Have Schizophrenia?”
Schizophrenia is an “equal opportunity” affliction that affects 1% + of the population, worldwide, no matter
what ethnic background they come from or the color of their skin. Why schizophrenia happens is still not fully
understood and needs more research, along with other major illnesses that affect behavior, including bipolar
disorder and clinical depression. If you are unfortunate enough to develop autoimmune encephalitis, the
reason for your psychotic behavior may be passed over and you’ll be treated like “just another crazy person in
the street” and not get the care you need. If you remain ill for too long, the damage can be irreparable.
Susannah Cahalan, author of “Brain on Fire: My Month of Madness,” a memoir about her struggle with
that rare autoimmune disease, illustrates how irreparable damage to the brain can happen without
proper diagnosis and treatment. Another patient she describes who was found to have the same illness
wasn’t properly diagnosed for two years, too late to reverse the damage that was done. She wrote:
Emerging studies exploring the link between the immune system and the brain—as is the case
for autoimmune encephalitis—have galvanized the quest to understand how thoroughly
the body itself influences and alters behavior, spurring studies of immune-suppressing drugs
on people with serious mental illnesses. Researchers have estimated that as many as a third
of people with schizophrenia display some immune dysfunction, though what that means
about the underlying cause of the illness remains unclear.
People with serious mental illness accompanied by anosognosia (inability to comprehend that they are
delusional, psychotic or mentally impaired by their illness and pose a danger to themselves or others in
that state) require accommodations and assistance into care. I’ve included many newspaper reports
about the tragic outcome of failures to come to the aid of the SMI most at risk and to ensure public
safety. Included are stories about two people from Supervisor Mandelman’s district, who were on his
list of the most at risk, Mary Botts (28) and Peter Rocha (54). A third person, Leo Hainzl (94) was
walking his dog in a park in May of 2020, when he encountered Peter. Heather Knight wrote articles for
the SF Chronicle about Mary (December 8, 2020) and about Peter and Leo (May 30,2021).
Mary Botts, also called “Princess Leia” because she often wore her long hair in two buns at the side of
her head, sometimes held together by syringes,” was often seen to walk into traffic at busy Market and
Castro Streets, narrowly escaping being hit by a car. Many people called 911 and 311 to try to get
assistance for her to no avail. Heather Knight attributed her death “to bureaucratic inertia and the
misguided idea that people who are extremely mentally ill should be left to do whatever they want….”
Rafael Mandelman commented that “This was avoidable. This is all our failure. This is about a broken
system that we still haven’t figured out how to fix…We wouldn’t allow a terrified child to keep walking
into traffic and to sleep on the raised bumps on the sidewalk above a gutter without taking any action to
help. Why do we look the other way for young women? Or anybody?” Mary died of an overdose on
November 18, 2020.
Peter Rocha’s brother said he grew up in the outer Mission and had a happy childhood. After serving for
four years in the U.S. Marines, Peter returned to the Bay Area and opened a jujitsu studio in Berkeley.
As symptoms of SMI started, Peter sought medical assistance and hit roadblocks in the health care
system and at the VA Hospital. His mother and brother had moved to Arizona by then and were at a loss
for how to intervene when Peter grew increasingly psychotic and stopped communicating with them.
Peter became homeless in 2004 and was sometimes seen sleeping in a planter box outside St. John
Catholic School in Glen Park. Many people in the neighborhood called on the city to intervene to help
him, to no avail. In May of 2020, Peter, who became terrified of large dogs, acted defensively when he
encountered Leo walking his dog and struck Leo with a stick. Leo fell , hit his head and died hours later
at a hospital.
On May 30, 2021, a year after this tragic incident, Heather Knight wrote that Peter “languishes today in
a County Jail, trapped in an all-too-common purgatory. A judge said he’s too mentally ill to stand trial.”
Peter was ordered to a locked psychiatric hospital for “compelled treatment that could make him well
enough to face a judge and jury. But California’s psychiatric hospitals have no available beds. And so
Rocha waits behind bars, where medication is optional. Incredibly, he’s on a waiting list of 1,523
people—all of them incarcerated and in the same situation. Then there’s this: If a state hospital
eventually restores competency, he will be sent back to County Jail, where he’s free to refuse
treatment.”
A landmark case, Sheehan vs. San Francisco, went all the way to the U.S. Supreme Court in March 2015.
In August of 2008, Teresa Sheehan, a 56-year-old Japanese-American woman with schizophrenia, was
living in a group home for people with mental illness in San Francisco’s Mission District. Teresa had
stopped taking her medications for 18 months. (Her siblings would have encouraged her to resume her
meds , had they been informed of that, according to her sister Frances.) When a social worker visited to
check on her, Teresa had so deteriorated that she became very aggressive and threatening. The social
worker then called 911 for assistance to transport her to the SFGH Psych ER.
Details and opinions on Teresa’s case are included. The first two officers who responded had little
experience. They failed to wait, as told, for a more experienced officer to arrive. When they entered
Teresa’s room, she picked up a knife on a plate nearby and told them to get out. When she didn’t drop
the knife, they shot her five times (there was some confusion at the time about how many times she’d
been shot because of entry and exit wounds). The last bullet was a kill shot to the head when she was
on the floor. It entered near her left temple and eye socket and exited through her mouth, breaking
teeth.
Teresa’s sister Frances said the only reason she survived was that when she arrived at SFGH’s trauma
center, the surgeons were gathered at a meeting and they all rushed to the operating room. Together,
they saved her life. There was just a small notice, buried in the SF Chronicle, about the incident.
In spite of the gravity of her wounds, Teresa was released early and sent to jail. She had to have hip
surgery due to damage caused by one of the bullets and was in terrible pain and asked for help. Finally,
she was sent back to SFGH, where a surgeon had to operate on her hip again.
Dr. Paul Applebaum (ps.psychiatryonline.org, Oct. 2015—Law and Psychiatry) noted that “Roughly every
36 hours, somewhere in the United States, a person with mental illness is shot and killed by police.” He
was referring to a Washington Post project to track every police shooting in the U.S. in 2015. Six months
into that year, at least 25% of the 462 fatal police shootings were determined to be shootings involving
someone with mental illness. Other such studies included one in Maine, where the figure from 2000 to
2012 was 58%.
Many of the killings of mentally ill people by police appeared to be questionable, but officers rarely
faced sanctions. USA News, March 21, 2015, reported: In a review of 52 officer-involved shootings in SAN
FRANCISCO, KQED found that 58 percent of the people killed by police--11 out of 19 cases—had a mental
illness. The ACLU argued in its brief that the last Bureau of Statistics report showed half of the 375-500 people
killed by police each year in the U.S. have mental health problems, and 700,000—or a third of the
2.1 million people in jail and prison--are mentally ill. Shootings of the mentally ill tend to follow a pattern.
Someone calls the police about a person in crisis, the police arrive but the person in crisis fails to immediately
respond to police commands because they are in a crisis related to their mental disability. When they don’t
comply with police commands, an officer starts shouting and draws their weapon. They may surround the
person or spray them with mace, escalating the confrontation. In panic, the mentally ill person grabs a nearby
object like a knife, a screwdriver, pen or mop. The officer generally fires and the disabled person dies or is
injured.
The Sheehan family called SF NAMI and asked if any volunteers could come to Teresa’s trial (San
Francisco vs. Sheehan) to offer emotional support and witness what was happening. I was serving on
the SF NAMI board and volunteered with other members to attend the trial and sit with the family.
Teresa sat uncomfortably in her wheelchair throughout, due to her injuries. It was shocking to think
that SHE was the one on trial, for supposedly endangering the police.
Eventually, in 2015, the Supreme Court heard Sheehan vs. San Francisco to establish whether or not the
Americans with Disabilities Act (ADA) “requires law enforcement officers to provide accommodations to
an armed, violent and mentally ill suspect in the course of bringing the suspect into custody.” The
Supreme Court ruled that the ADA applies because serious mental illness is a disability that requires
accommodations. However, those “accommodations” have not yet been spelled out. Charges against
Teresa were dropped, but the police officers who shot her were not prosecuted and the case was
referred back to the Ninth Circuit Court in SF to determine damages. Teresa had lost her original
placement and was put in a Single Room Occupancy (SRO) hotel, where she lives in squalor and
continues to be psychotic because she doesn’t take her meds. Judge Breyer of the Ninth Circuit Court,
who presided, did not mandate her meds, although he did speak to Teresa directly in court saying, “If
ever there was a case that demanded a humanitarian response, it’s yours.” Regardless, Teresa’s living
circumstances are worse than ever before. Her behavior is aggressive and she doesn’t want visitors.
She is barely surviving in the “ghetto” of run-down SROs in SF that “house” the unfortunate, including
addicts and the insane.
Vice President Harris, you were the SF District Attorney when Teresa was shot during a mental health
crisis. I have to tell you that I did not trust you after your performance as D.A. You clearly favored
protecting police officers from accountability and, no doubt, sparing the City of SF from lawsuits (of
which there were many). The jury disagreed with you.
Lauren Rosenhall of KQED news reported, on September 11, 2019: When San Francisco police broke down a
door inside a group home for mentally disabled people in 2008 and shot a 56-year-old resident, then-District
Attorney Kamala Harris didn’t charge the officers, alleging she came at them with a kitchen knife after they
forced their way into her room.
But the jury was not convinced. It deadlocked in favor of acquitting Sheehan on the assault
charges, and found her not guilty of threatening to kill a social worker who had called the police
for help to get Sheehan into a psychiatric hospital.
“Somebody used very poor judgement in deciding to bring these charges,” said Laurie Levenson,
a criminal law professor at Loyola Law School in Los Angeles. If (Harris) actually looked at it and said, ‘This is a
righteous case, I want to go after a mentally ill woman who was shot,’ then you question that decision. If she
didn’t know about it, then you question her management skills.”
Today Harris, California’s junior U.S. Senator, is trying to win the 2020 Democratic presidential
nomination by highlighting her experience as a “progressive prosecutor.” The Sheehan case,
though, is an example of her complicated record in criminal justice.
Harris did not re-try the case after the jury deadlocked, and Sheehan went on to sue the police
for excessive force. After a legal battle that lasted several years and included arguments before
the Supreme Court, Sheehan won a $1 million settlement. Her civil suit also resulted in a
landmark appellate court ruling that says police must take more care when interacting with
people they know have a mental illness. [Note: The Sheehan Family doesn’t know what
happened to that settlement money. They had to cover the costs of the lawyer they hired
to appeal Teresa’s case. The City of SF had to absorb their own costs. If the money went to the
State of California or City of SF, why is Teresa living in such a deplorable state? The family can’t do
anything about it.]
Over her years as district attorney and California attorney general, Harris developed a
reputation for being cautious on criminal justice issues and took criticism from across the
political spectrum. Those on the left deride her for upholding wrongful convictions and the
death penalty, while law enforcement and moderate Democrats were upset that in 2004 she
declined to seek the death penalty for a man who had killed a police officer.
Harris recently released a plan for criminal justice reform that involves reversing some of her
earlier positions. She now supports independent investigations of police shootings—though
she didn’t back proposals to do the same thing in California when she was attorney general.
She says she wants a tougher national legal standard allowing police to use deadly force only
when necessary—a standard California just signed into law. But a key part of the new state
law holds officers accountable for their actions leading up to a shooting—a provision that
allows officers to be prosecuted if they escalate a confrontation before it becomes deadly.
In the Sheehan case, Harris cleared the officers of wrongdoing, and wrote an article in the
San Francisco police officer union’s monthly newsletter touting a judge’s decision to allow the
charges against Sheehan to go to trial. “The DA’s Office is committed to working with the
Police Department to get dangerous criminals off our streets and make San Francisco a
safer city.”
That Sheehan could be considered a dangerous criminal was unfathomable to her attorney.
“She had no record. There was no reason to believe that this was criminal behavior,” Kleigh Hathaway,
Sheehan’s public defender, told CalMatters.
Hathaway said she thought she’d be able to quickly get the case dismissed, and was surprised how hard the
district attorney’s office fought it. “It was really clear hearing from potential jurors how outraged they were,”
Hathaway recalled.
In your book, Vice President Harris, “The Truths We Hold,” you wrote: My vision of a progressive prosecutor
was someone who used the power of the office with a sense of fairness, perspective and experience,
someone who was clear about the need to hold serious criminals accountable and who understood that the
best way to create safe communities was to prevent crime in the first place.
I “womaned” a table for Senator Elizabeth Warren’s presidential campaign at the Farmer’s Market in the
parking lot of the Stonestown Shopping Center in SF and just happened to be placed next to Attorney
Suzy Loftus who was “womaning” her own table. She worked with you at the D.A.’s office and was
running for that job against Attorney Chesa Boudin, a progressive. I asked her about the duties of a D.A.
toward both the police AND residents, in regard to the Sheehan case. She looked away and said, “A D.A.
has to learn to dance both ways, forward and backward, like Ginger Rogers.”
Many more SMI people in a mental health crisis would continue to be shot and killed and police were
not held accountable, regardless of the circumstances. The goal is supposed to be to protect police
officers AND residents of their city. Our proven to be progressive candidate, Chesa Boudin, was more
likely to be the one who would weigh all sides. He won.
Aside from giving proper health care to SMI in the first place, we all need to keep advocating for more
crisis intervention training (CIT) for ALL police officers. No more lame excuses about not having time or
funding. Parents who’ve sued the city when a SMI relative was killed by police often made it part of the
settlement to require CIT training, but somehow, that just doesn’t happen. I’ve included articles about
one outstanding man, Officer Hofstein, who should be an example held up to police recruits as to what
an exemplary officer is like, who is truly dedicated to the safety of our citizens. He has retired and will
be sorely missed. We need more officers like him. CIT should be mandatory for every police officer, no
exceptions. It will save the lives of residents AND police officers.
When you served as Acting Attorney General for CA, Vice President Harris, one mother of a severely
mentally ill son (he swallowed razor blades) wrote to you in 2011 and begged you for help for her son.
She said her packet and letter were both returned to her with the explanation that it wasn’t your “scope
of authority.” This mother said, “All we wanted to do is get ( ) into a state hospital. Why was that so
hard…not that state hospitals provide protection or immunity for our loved ones from being arrested
while in a hospital…family members found that out the hard way. What families have to go through just
to have an opportunity to be failed by the system….”
If it wasn’t your “scope of authority,” whose scope of authority was it in? I don’t understand why it
wasn’t in your power to do something, or to refer her to someone who had this “scope of authority,” or
would at least look into this problem.
Joe Garofoli’s column on July 1, 2021, in the SF Chronicle noted: Kamala Harris used to refer to herself as
California’s “top cop” when she was the state’s attorney general. The current, more progressive Attorney
General Rob Bonta prefers a different framing: He calls himself “the people’s attorney.” He looks at his job as
being the protector of the little person—or as Bonta describes it in his rapid patter, “our most vulnerable,
voiceless, hurt, harmed, abused, mistreated, cast aside, forgotten.”
Once you decided to run for President, you seemed to have changed your perspective. Doctor Jaffe
praised your proposals to reform the way we treat our mentally ill citizens. An advocate told me that
you met with Dr. Jaffe when you were running for President and put your mental health proposals into
your campaign after that. However, once you became VP, you dropped it. Is that true? I hope not.
Please let us know where you stand.
As Vice President, you could do so much now if you stick to those plans and resolutions. Please, please,
please, work to enforce reforms for equity in our health care system, not only for ALL Americans, but for
all illnesses, including serious mental illness, which are, after all, biological and physiological. Without
mental health, there is no health at all. What is more important than brain health? When you lose your
mind, you lose everything.
You wrote a lot in your book, The Truths We Hold, about the values your mother instilled in you. I
think she would have been happy to see you do something now to repair the damage done by the
dismantling of our mental hospitals decades ago and failing to replace them with an adequate spectrum
of care. Millions of Americans with SMI and those who love them are counting on you and everyone
who needs to work diligently on this issue.
Given the humanitarian crisis that has evolved over decades and threatens to worsen every year, why is
it so difficult to get counties to implement assisted outpatient treatment? Well, everyone knows that
even with a 5150, or 72-hr.-hold, a longer hold or conservatorship (up to one year), chances are that
with all the state hospital (and other hospital) closures and constant elimination of psych beds, as well
as gaps in the continuum of care needed, there is NO PLACE to BRING SMI PEOPLE INTO CARE.
How and why do hospitals continue to eliminate beds? Even “go-to” designated hospitals like
Zuckerberg SF General Hospital (22 beds) and University of California SF, Langley Porter (44 beds), with
Psych ERs, either “public” hospitals or part of “anchor” institutions, have reduced beds dramatically over
the years, even though our population has increased. Nobody wants to say outright that they DON’T
WANT TO deliver care to the SMI. Private and nonprofit hospitals resist opening psych beds and say
there is no law that says they have to. If they do admit psych patients, they prefer to “cherry pick” and
don’t want to take the more serious and forensic patients, who require more staff, security and longer
stays, which means added costs and liability.
Other hospitals in SF designated as “nonprofits,” claiming to serve the health needs of the communities
they are responsible for, have minimal psych beds, if any. Families who try desperately to get help for a
loved one in a mental health crisis and can’t find a psych bed anywhere up and down the peninsula have
been told that “there are no beds available.” That’s not always true. (I know a UCSF doctor who had
that happen to him at Langley Porter when he needed emergency psych care for his child—if they could
do that to one of their own, what chance have the rest of us got?) That happens for various reasons.
Sometimes, it’s a Friday and weekend staff will be reduced. Sometimes, families learn that the hospital
was seeking a reason to eliminate beds and wanted to claim that they would do so because the psych
beds were “underutilized.” When a bed is actually available for a 5150 hold, but the patient has not
even begun to be evaluated or stabilized within 72 hours, families have asked hospital staff for a longer
stay, or 5250, but are discouraged from doing that as “they’d need a judge to sign off on it and you’ll
never get one to do it.”
A ”nonprofit” designation does not mean that the hospitals don’t make a “profit.” It’s lucrative to have
that status because of the tax breaks. I’ve enclosed an article that relates how many such hospitals get
twice as much benefit from tax breaks as compared to what they return to the community, with care for
the seriously mentally ill getting the least attention and having long wait times for appointments. Parity
for the care of SMI patients is mandated, but not enforced, not a reality. Psych staff at Kaiser routinely
demonstrate on behalf of their patients who aren’t getting timely care. I have gone to hearings and
protests at SF City Hall myself with SFGH psych staff and SEIU members over the years. Still, there is no
meaningful progress. Supervisor Alioto-Pier was the staunchest advocate on the Board in the early part
of the 21st century and was thwarted then, much as Supervisor Mandelman is now. Private hospitals can
“cherry pick” the most. Why should they admit the more difficult cases if they don’t have to?
The California Hospital Association reported on “California’s Acute Psychiatric Bed Loss in Feb. 2019:
As of 2017, California had 32 hospitals licensed as freestanding Acute Psychiatric Hospitals (APH)
and 28 county-based Psychiatric Health Facilities (PHF), which provide care only to individuals
with acute behavioral needs. An additional 79 facilities are dedicated psychiatric units within
General Acute Care Hospitals (GACHs). California has nearly 440 GACHs, of which about one-fifth have such
dedicated psychiatric units.
Combined, these hospitals supply the 6,777 beds available to the general public.
None of that data includes the five state-owned hospitals in Fresno, Napa, Los Angeles, San Bernardino,
and San Luis Obispo Counties because those beds aren’t available to the general public. They are full
and have long waiting lists (l,600 ISTs reported on wait list in June 2021) for patients that have to be
admitted under court order because they are incompetent to stand trial.
Sheree Lowe, vice president of behavioral health for the California Hospital Association noted that 25
counties in CA have no psychiatric services. The SF Chronicle has quoted her as saying, “If we as a state
put more of our time and energy and resources into prevention and early intervention, we may not have
this backlog of people who are being criminalized because they’re sick. We don’t criminalize anybody
because they have diabetes or congestive heart failure, but we want to do it for people who have brain
illness.”
The federal, state, local and city governments and their administrators, hospital executives, manager
and insurance administrators are the GATEKEEPERS who continue to REFUSE to enforce the mandates to
provide parity of care for the SMI, psych beds and step-down levels of care, integral parts of the
infrastructure necessary to gill the “gaps” for a real continuum of care.
What we have is this very expensive, inadequate maze of fragmented “respite” centers (in-and-out),
“safe” injection sites and “sobering” centers that are proliferating, mere band-aids on open wounds, not
care. The second “respite center” (located in the Mission District, far from SFGH) and called
“Hummingbird Valencia,” opened after years of delay and cost overruns. It’s described in a SF Chronicle
article of May 19, 2021, as intended to “ease the burden in the (SFGH) emergency room,” which is
always chaotic and overcrowded, and also the burden on the emergency responders called into the
streets to respond to mental health crises. The article is accompanied by a photo of what looks like a
living room with some reclining chairs (I count eight) and a TV on the wall. This feels like some kind of
public relations stunt, perhaps some damage control after the scandal in August 2019 at SF General
when the Psych ER resorted to something called “vertical treatment” (I kid you not!—article enclosed).
SMI patients had to sit in uncomfortable, upright chairs to deter them from waiting for hours to be seen.
The Psych Dept. said they didn’t want people dozing off. (I met a schizophrenic man who once waited
for three days, stretched out on the floor.) The “respite center” is said to be a “30-bed facility for those
struggling with extreme mental illnesses and drug use. That’s deceiving because it’s not a treatment
center and those aren’t “psych beds.” The original plan was for 30 “overnight” beds and 25 “daytime
beds,” but by the end of June they expected to have only 26 overnight beds, due to social distancing. It
looks like a lot of posturing to me.
Some substance users have been going to “safe injection sites” for over two years, according to one
worker who spoke to a SF Examiner reporter. This worker said people like that were “their bread and
butter.” Are these places really a gateway to treatment? Is there any data on outcomes? What we do
know is that 713 people in SF died in 2020 of overdoses and we’re on track to exceed that tragic figure
in 2021. Mothers have held protests in areas where open drug dealing occurs. Kids frequent those
areas, become addicted or die of overdoses. It’s a nightmare.
The newer Mobile Crisis Teams are zooming around the city like “ghostbusters.” They can’t begin to
cope with all the calls they get for people in a mental health crisis, calls from neighborhoods and
businesses where SMI people linger because they have no place else to go and they scavenge for food
and things they need. Sometimes, they collapse wherever they are.
I’m adding copies of comments between this page and the next from parents as examples of the
gauntlet that they have to get through to try to get psych care for a family member. Also, notes from a
city meeting so you can see what they’re like. The fiscal year report posted online by the SF MHSA is too
long to include here (over 200 pages, lots of photos of SF murals, smiling staff…it reads more like a
public relations effort and doesn’t have critical information advocates look for, but I’ll repeat a story
(since taken down) posted by a crisis team member describing a call they answered about a naked man
in the neighborhood who was wandering around, disoriented and possibly looking for food in garbage
cans. When the team arrived, this man was apprehensive and when they asked if he wanted help, he
declined. He was offered a bottle of water, which he took. Then a cookie was offered, which he also
took. Then one of the team members went into the van and came out with some clothing and asked if
the man would put the clothes on, which he did. But still he refused any “voluntary” medical assistance.
This experience was touted as a success, because the man grew less fearful of them and maybe, maybe
next time, he would consent to going with them to the psych ER. However, the stated reason for these
crisis teams is to “meet people where they are,” and KEEP THE SMI OUT OF THE PSYCH ER! SFGH is
totally overwhelmed by the SMI who fill their waiting room. Try to imagine that this man was your
father, your brother, your son, a friend. He could have gone missing and has family looking for him and
worrying about him desperately. Did the team get his name? How do they expect to be able to track his
whereabouts? Will there be a next time? So often when the teams go out on these calls they say they
can’t even find the person they are sent out to look for. This is NOT a good outcome.
Additionally, there are statements in reports that don’t make sense, like DPH’s AOT home page: “How
many people will meet criteria for Assisted Outpatient Treatment? Based on national data, it is
expected that less than 100 individuals in San Francisco will meet criteria for the program.” How
absurd! What “national data”? That makes no sense at all. Many hundreds meet criteria. When their
numbers swell, the city raises the bar for who meets criteria—people die in the meantime.
Auditor Howles noted that less than 9% of people who came to the SFGH Psych ER (in the 20-patient
sample examined by investigators), who were put on a 72-hr.-hold, were linked to outpatient services.
She also noted that 56% of patients coming to the SFGH Psych ER were being routed elsewhere. She
thought that odd, since SFGH is THE DESIGNATED PSYCH ER/HOSPITAL (only 22 acute psych beds). The
outcomes are not known for the other 91%, but you can depend on it, most ended up on the street
again (or back home, if they could still live with relatives, fearful of them when they are aggressive and
unstable ).
Counties have been resistant to using the tracking and data systems that the CA Auditor wants them to
use. The reasons for that have to be explored. Surely, that will involve costs and increased staffing and
a commitment to a more professional response to caring for the mentally ill. The Auditor has offered
help with this from the state and asked for estimates of costs, including possible expansion of building
infrastructure that might be necessary. She wants to know what the psych bed count in SF really is and
get as accurate an estimate as possible of how many more psych beds are really needed to serve the
SMI population. This is an opportunity. SAN FRANCISCO, please RESPOND! BE HONEST! BE
ACCURATE! NO OBFUSCATING!
On page 5 of the CA Auditor’s report, it says that SAN FRANCISCO HAS UNTIL AUGUST 2021 TO
CONDUCT ASSESSMENTS TO DETERMINE THE NUMBER AND TYPE OF TREATMENT BEDS THAT THEY
NEED TO PROVIDE ADEQUATE CARE TO INDIVIDUALS RECEIVING INVOLUNTARY TREATMENT. ONCE THE
ASSESSMENTS ARE COMPLETE, THE COUNTIES SHOULD ADOPT PLANS TO DEVELOP THE NEEDED
CAPACITY.
If resistance isn’t really about whether or not a SMI person in crisis can be assisted, involuntarily, into
care, what is all this about? Why is the LPSA being used, perversely, to NOT allow access to care for
those who need it so desperately? It’s not the dedicated medical staff or social workers who trained for
years to care for the SMI and who have advocated for their patients and against eliminating psych beds
for their care. It’s not the people who try to access care before the symptoms of SMI take over their
minds. It’s certainly not families and concerned citizens who advocate relentlessly on behalf of the SMI.
Catch 22s in the system make it difficult to use a community health center at all, the lack of professional
staffing, the case overloads, and lack of supportive, subsidized housing to provide shelter while they
learn to manage their symptoms all sabotage a patient’s/client’s progress.
How absurd that SF is spending over 1.2 million dollars a year to lease a private empty lot and spending
$60,000 a year for every homeless tent on the lot, and millions more on power cleaning the streets
because homeless people have no other place to “go” and relieve themselves. That money should have
gone into dedicated housing and facilities to care for the SMI and to alleviate homelessness.
If hospitals keep refusing to provide sufficient care for the SMI, what can you do? UCSF’s Langley Porter
(44 beds) is going to be demolished and not replaced as a psychiatric hospital. People say they will have
some psych beds at Mt. Zion, but how many? A few years ago, SFGH had 82 beds and more before that.
An entire ward was shut down. I’ve known them to decrease beds down to 18. They are often on “code
red,” which means NO BEDS. Currently, SFGH’s home page says they have 22 acute psychiatric beds.
The Auditor reprimanded DPH for saying at the time of her audit that they did not know how many
beds they had or needed. At least Los Angeles knew now many psych beds they had and said they knew
they needed 1,500 more. Since the audit, the city hired a firm to help with that and they did some
“modeling,” but advocates are not certain of what they are actually calling “psych beds.” It’s all just too
difficult to track, this shuffling of beds, adding them and then eliminating even more. And how it is that
so much funding seems to go under the heading of “prevention and early intervention”? What would
the breakdown of those expenses or programs look like? What are the outcomes? The auditor wants to
know and so do all the stakeholders in San Francisco County (and the State of CA). More details, please.
Mayor Breed, could you explain about the process involved in “licensing psych beds” and how that’s
done? Who calls the shots when it comes to deciding how many psych beds we can have in SF County?
Who decides at City Hall, in the court system and at the hospitals, etc., up and down the chain of
authority in our city and state? Our intrepid SF Chronicle reporter, Health Knight, noted: “When Covid-
19 struck, SF Mayor Breed immediately asked the government for 5,000 more beds. The mental health
emergency requires some of this same urgency.” Over three times more people in San Francisco died of
drug overdoses last year than from Covid. We don’t even know just how many SMI people and
homeless people die of exposure, illness and want in our streets every year.
Senator Wiener, thanks for your advocacy on behalf of the SMI. Can you answer some of these
questions? How do we get SF hospitals to open more psych beds? There is an IMMEDIATE need for
them. Families, advocates and people with serious mental illnesses are tired of being told that “there is
no law that says we have to have psych beds.” But we will PERSEVERE!
Supervisor Melgar, I live in your district and I know you have been involved with planning affordable
housing in the Mission District, but what about your stance on supportive, subsidized housing for those
coping with SMI? I didn’t vote for you. I didn’t like your “clean up the streets” campaign ads. Too often
that is just a euphemism for getting rid of homeless and SMI people and “sweeping” them from one
block to another. I voted for Joel Engardio because he has consistently been an advocate for the SMI and
victims of crimes. Joel got over 1,000 more votes than you did but he lost the election because of this
“ranked voting” scheme we have, which I consider to be a rip-off.
Every district has constituents who have SMI people—it’s a fact of life. Every supervisor has a
responsibility to ALL of their constituents and you ALL have to keep EVERYONE’s health and welfare in
mind, which most definitely includes the mentally ill. The SMI in our streets are being treated like
outcasts. They’re being discriminated against. Families pay taxes and insurance premiums and all that
goes into a pool meant to be drawn from when illness strikes. If you are unfortunate enough to be
afflicted with a mental illness, you can’t access care the way someone with cancer , diabetes, or a heart
condition can. Or you have to pay cash out of pocket, if you can, for private psychiatric care, but there is
insufficient infrastructure for a higher level of care than outpatient care, if needed. So in a sense, other
illnesses that get treated under our health care system are being subsidized by lack of care given to the
mentally ill. Higher costs of imprisoning the mentally ill still fall on everyone who pays taxes, so nothing
is gained in the public sector—the costs are just shifted from health care to imprisonment, which
doesn’t seem to bother people who keep insisting that a SMI person’s civil rights might be violated if
involuntary care is implemented, but indefinite imprisonment? No problem! Dying in the street, shot
by police? No problem. Not mentioned. I want people to think about that. I hope common sense will
prevail.
Prisons are the most restrictive, cruel and punitive environments you could subject a SMI person to.
Contrary to what people may think, medication and therapy are not necessarily mandated or enforced.
Although some SMI people may actually get treatment for the first time in prison, it seems aimed more
at restoring sanity, temporarily, in order to convict someone of a crime they committed while insane.
The rudimentary question posed to a SMI person is “Do you know right from wrong?” That hardly
begins to cover what that could mean to this person, especially in an acute state of paranoia when their
actions are often defensive because of imaginary perceived threats. As psychiatric beds were
eliminated, the SMI prison population increased accordingly (transinstitutionalization of the mentally ill.)
Since 1995, the California Hospital Association reported that the state has lost 42 facilities, either through the
elimination of psychiatric inpatient care, or complete hospital closure, a drop of 23%. California has lost nearly
30% of the beds it had in 1995, a drop of more than 2,570 beds. Fifteen psychiatric experts on a panel
concluded that 50 public psychiatric beds per 100,000 individuals (or 1:2000) is the absolute minimum
number required to meet current needs. In 1995, CA fell short by nearly 1,400 beds, with only 29.5 beds per
100,000 residents. That gap increased to 4,000 beds short in 2017, with the state having only 17.16
psychiatric inpatient beds for every 100,000 residents—a loss of over 42% of the beds per capita in
CA since 1995. However, our population increased by more than seven and a half million people to
more than 39.5 million in 2017. (complete report included)
AS OF 2017, CALIFORNIA’S BED RATE IS ONE BED FOR EVERY 5,834 PEOPLE, WHICH IS WORSE THAN
THE REST OF THE NATION’S AVERAGE OF ONE BED FOR EVERY 4,238 PEOPLE.
The California Hospital Association’s August 2018 report, “California Psychiatric Bed Annual Report,”
notes on page 10 that EXPERTS ESTIMATE A NEED FOR A MINIMUM OF ONE PUBLIC PSYCHIATRIC BED
FOR EVERY 2,000 PEOPLE FOR HOSPITALIZATION FOR INDIVIDUALS WITH SERIOUS PSYCHIATRIC
DISORDERS.
In addition to failure to provide the infrastructure for care of SMI adults, the State of CA has failed its
youth in need of residential care. Investigative reports by the SF Chronicle revealed in Dec. 2020 and
Jan. 2021 that about 2,500 children were “outsourced” to substandard, abusive placements in several
states. Again, how is it that CA has not provided the infrastructure for residential care for emotionally
disturbed, traumatized and mentally ill youth in need of care closer to home? That went on for years.
The State of CA ended up paying $8 million dollars to bring them back (and there were inadequate
placements for them in CA, of course) when those places were shut down. Some of the kids went
missing. (Those articles are included, too.)
I’ve looked at models and settings for care of the SMI and included information on the Massachusetts
Dept. of Mental Health’s Worcester Recovery Center and Hospital (WRCH), which opened in
October 2012. This 320-bed recovery center and hospital serves 260 adults and 60 adolescents .
Projected cost was $302 million with annual operating cost of $60 million. Its design reflects the stages
of recovery from serious mental illness by using familiar environments, which range from a house, to a
neighborhood, to downtown. There is a shared village green outside each living unit. A low-rise scale
emphasizes a residential character.
Why is it that Massachusetts could build WRCH on the grounds of the old state hospital that was
demolished, as part of the University of Massachusetts Medical School and Hospital system, and UCSF
Hospital and Medical School has no such facility or plan for one? The County of San Francisco (and
surrounding counties) have a great deal of government land and buildings that could be converted and
renovated to benefit our residents in dire need. A three-tier hospital system could actually provide a
real continuum of care, along with supportive housing , instead of our current fractured, labyrinthine,
Kafkaesque, Catch 22 of a dysfunctional approach to meeting the needs of our population (supposedly
in the street because the psych ER can’t handle it, or doesn’t want to). May I be so bold as to
recommend space in the Presidio, which once had Letterman Hospital when the Army was in residence
(since torn down). That setting would be conducive to promoting steps to recovery and a chance to
learn to manage a mental illness. It would be a supportive community, within the community.
Another model is Gould Farm in Massachusetts, a therapeutic community for 40 or so residents, based
in farming, where residents feed animals, prepare meals, participate in fitness activities, maintain
walking trails and run the farm’s caf and bakery.
The American Psychiatric Association promotes a broad spectrum of modalities for a continuum of care
including therapeutic communities, farmsteads, recovery campus settings, as well as a range of
hospitals, both public and private that should be affordable. Not every patient needs a long-term stay.
In an article in the Wall St. Journal on May 19, 2018, by Howard Husock and Carolyn D. Gorman,
Dr. Jeffrey Geller, medical director of the Worcester Recovery Center and Hospital asserted that state
hospitals, run well, should not be “wildly more expensive than community treatment” and are crucial as
treatment options. They also noted that today, we face the same problem that [Dorothea] Dix found [in the
19th century]: that treatment for mental illness is fundamentally inconsistent with imprisonment. As Dominic
Sisti, Andrea Segal and Ezekiel Emanuel of the University of Pennsylvania argue in a 2015 essay in the Journal
of the American Medical Association, “It is difficult to imagine how ethically sound treatment of mentally
ill prisoners can be delivered.”
UCSF’s Dept. of Psychiatry and Behavioral Sciences home page at https://psych.ucsf.edu says, “We
provide advanced and caring psychiatric treatment services through our inpatient, partial hospitalization
and outpatient programs, for a wide range of conditions: depression, anxiety, attention deficit disorder
and many others.” Although they certainly do get patients with schizophrenia and bipolar disorder, the
focus of their care seems more and more centered on the conditions they chose to mention. UCSF
itself, touted as one of the best hospitals in the U.S., is very concentrated on research, including lab
testing for pharmaceuticals (very lucrative). The new Pritzker Building will cater to children with
conditions like eating and sleep disorders and ADHD. There are offices, but no treatment beds there.
Families and advocates would like to hear from the Chair of the UCSF Dept. of Psychiatry and Behavioral
Sciences, Matthew W. State, MD, PhD, and President of Langley Porter Psychiatric Institute and also
from the Chief of Psychiatry at Zuckerberg SFGH, Lisa Fortuna, MD, MPH, MDiv, about what influence or
desire they have to expand care for the SMI in a substantial way that includes infrastructure. It’s very,
very obvious to everyone in SF that we need many more psych beds than we currently have and you
preside over the departments that are designated to care for SMI patients. I can’t believe that you
would not want more psych beds and services for the people of SF and the counties nearby that you also
serve, Oakland, Alameda and San Mateo, for instance, and also patients at the SF Veterans
Administration Hospital. Families and advocates urge you to speak up for these vulnerable people who
are counting on you. We never hear about people in the financial departments who make decisions,
and I’m sure they prefer it that way. However, people have a right to more transparency. When we
vote for funding, like the MHSA, which collects billions of dollars supposedly for the seriously mentally ill
and we just see more and more homeless SMI people suffering in the streets, we know something is
wrong. We want accountability.
The Biden Administration is committed to Building Back our Healthcare Infrastructure Better. The CA
Auditor is following the request of our Judiciary to investigate and audit what’s happening with the
funding going to local governments and facilities to alleviate homelessness and provide a continuum of
care for the seriously mentally ill. She’s asked for an accurate count of psych beds and also how many
more we actually need. She’s ENCOURAGING people at the county level to get on board, implement
AOT, a continuum of care and use conservatorships when necessary and use the same data and tracking
system recommended so it’s possible to see what programs work best. She wants counties to share
information about what works well. If there’s no clarity about what the problems are or RECOGNITION
of problems, things won’t get better for the SMI, they’ll get worse and our “Outdoor Bedlam” will grow.
That is unacceptable on any level. It’s up to all of us to DO SOMETHING ABOUT IT.
One promising program I read about in the UCSF newsletter of May 16, 2019, is the UCSF Public
Psychiatry Fellowship at Zuckerberg San Francisco General Hospital. Christina Mangurian, MD, MAS, is
co-founder and co-director, as well as a UCSF Professor of Psychiatry. She saw “that many of the
obstacles to mental health care were systemic, from poverty to the lack of integrated care in hospitals.”
Dr. Mangurian and many public psychiatry fellows believe that “health care, including mental health
care, is everybody’s right. She goes on to say, “Everyone has somebody they love or care about who
suffers from mental illness, and since at UCSF we’re focused on health equity, the question then
becomes how can we build a system that delivers high quality mental health care to not just those who
we know, but everyone, especially those who are the most vulnerable.” (SFGH has only 22 acute
psychiatric beds. I understand that there is some intention to increase psych beds, but past experience
dictates that advocates need to see it happen before they believe it—and we sure don’t want to see any
psych beds elsewhere disappear.)
It's very troubling that Langley Porter will be demolished and we will not have any hospital truly
DEDICATED, in practice, to treating the mentally ill. Can UCSF get behind an effort to provide a 3-tier
mental hospital and expand Public Psychiatry on a permanent basis? Dr. Mangurian talks about the
increased need to address mental health issues and notes inequities in access to care. She said, “the
public sector needs to expand to provide the care needed by this population, especially for those
without means, especially the poor and marginalized.” She also points out the problem of fewer
psychiatrists being available to care for the most vulnerable: Forty percent of psychiatrists now work in private
practices that accept only cash. The rest— the number of psychiatrists working with public sector and insured
populations—has declined 10 percent from 2003-2013, according to a report by the National Council Medical
Director Institute. Reasons for the decline include low rates of reimbursements, burdensome requirements
for documentation, restrictions on sharing information that can better coordinate care, and high
rates of burnout.
A bigger investment on the part of UCSF/Zuckerberg SFGH into Public Psychiatry could make such a
positive difference for all the people you say you want to serve as an “Anchor” Institution. You could
address the lack of public psychiatry by supporting and training more fellows and other types of
professionals to provide healthcare and therapy for the mentally ill. How many of the fellows are there
currently and how many actually stay in SF County to serve our population? You could support more
research for better medications with less side effects for psychiatric illnesses. Also more research into
immunology and how it possibly relates to various mental illnesses and autism. I would think this would
be a very exciting field to work in. What organ in our body is more important than our brain? Healthy
brain function should be a priority. Serious mental illness may seem expensive to treat, but inadequate
access to psychiatric care becomes a whole lot more expensive when you look at the big picture. I’m
sure you could find organizations concerned about this area of medicine that would contribute to
funding a major effort in this field.
Doctor State and Doctor Fortuna, please advocate for your patients in a big way with the “mystery”
people unknown to us who are who making the financial decisions that seem to govern which patients
will be served in our system, and those who will be left behind. Our seriously mentally ill population
deserves better than the inadequate, disappearing system that exists now. You are the professionals
who know what will help mentally ill patients most. Please pay attention to Elaine M. Howle’s LPSA
audit—give her the estimate she wants for what it would cost to increase care for the seriously mentally
ill. The State of CA is currently in a position to help you expand care, not reduce it. We can’t afford
another increase in the ranks of the homeless SMI. Our new Director of DPH, Dr. Hillary Kunins needs all
the help she can get for what she has been quoted as saying (in the SF Chronicle) is the biggest challenge
of her professional career.
On the bright side, our current U.S. Attorney General, Merrick Garland, recognizes that it is in his “scope
of authority” to look into whether or not the constitutional rights of SMI people have been violated, and
also their right to accommodations under provisions of the Americans with Disabilities Act. On CNN and
MSNBC (4-22-21), U.S. Atty. General Garland stated that he is going to investigate cases where the
people who are qualified for protections and accommodations under the ADA (such as the SMI) have
been discriminated against. The Judiciary has stated that denial of constitutional rights and violations of
the ADA in relation to the seriously mentally will be examined. Also, with regard to how people of color
are even more adversely affected where racial and income inequities compound the situation.
The headline, “The Justice Dept. blasts mental health care—Alameda County ‘institutionalizing’ patients,
inmates, probe finds,” in the SF Chronicle on April 26,2021, has given families, advocates and the SMI
some hope of reform and mental health care inclusion: Alameda County is violating the U.S. Constitution by
“unnecessarily institutionalizing” people with mental health needs and by subjecting them to prolonged
confinement in the county jail, the Justice Department concluded after a five-year investigation…the Jail [Santa Rita] also
denies prisoners with mental health disabilities equal access to programming and transition services.
This five-year investigation included visits to the Dublin Jail, John George Psychiatric Hospital in San
Leandro and other county psychiatric facilities, as well as board and care homes (also closing down
faster than they can be replaced), where federal investigators and psychiatrists interviewed patients,
staff, providers and others. The Alameda Sheriff’s Office, which operates Santa Rita Jail, was
determined to have FAILED TO PROVIDE CONSTITUTIONALLY ADEQUATE MENTAL HEALTH CARE TO
PRISONERS WITH SERIOUS MENTAL HEALTH NEEDS. This included access to jail services, programs and
activities and was also a violation of the ADA.
The most recent article I’ve read in the SF Chronicle, “Court upholds mental care for defendants,” on
June 17, 2021, said …the First District Court of Appeal in San Francisco upheld an Alameda County judge’s 2019 order
requiring the state to provide medical care, in a hospital or other facility, 28 days after receiving orders to provide treatment
because of a court’s finding of incompetence. The order by Superior Court Judge Winifred Smith is scheduled to take effect
next year. Plaintiffs in the lawsuit said about 1,600 jail inmates are now on the waiting list for hospital admission, an increase
of 500% since 2013, and between 300 and 400 a month are sent to hospitals.
California has “systematically” violated the due-process rights of all (incompetent to stand
trial) defendants in California” by keeping them jailed for extended periods before
hospitalization, Presiding Justice J. Anthony Kline said in a Tuesday 3-0 ruling.
He said mentally incompetent defendants often suffer further harm in jail, where crowded
conditions, violence and the absence of treatment programs can cause more deterioration
and delay their recovery.
This suit was filed in 2015 by the American Civil Liberties Union and five relatives of defendants who had been found
incompetent to stand trial. “These people have not been convicted of any crime and cannot even demand a trial because of
their condition,” said Attorney Michael Risher, who represented the ACLU case. “The ruling affirms that they must have access
to prompt treatment, and it highlights the need for the Legislature to address the root causes of this crisis once and
for all.”
The best approach, Risher said, would be placement and treatment in the local community.
Ira A. Burnim, legal director of the Bazelon Center for Mental Health, one of the plaintiffs in the lawsuit
that prompted the investigation said, “I hope the racial inequities, particularly for the Black community
members who have experienced the brunt of the County’s failures, will receive the attention they
deserve.” KATELYN SMITH, AN INVESTIGATOR WITH THE SPECIAL LITIGATION SECTION—CIVIL RIGHTS
DIVISION, SAID IT WAS THE BIDEN ADMINISTRATION’S INTENT TO WORK WITH LOCAL OFFICIALS.
On June 25, 2021, National Public Radio (88.5 SF—KQED) broadcast a story from a Boston News station,
with reference to Kaiser Health News, about Psych ERs in Massachusetts being overwhelmed with more
children than ever since the Covid crisis. In order to cope, they started “Emergency Room Boarding” in a
lecture hall, where they separated 200 patients by a curtain and “watched” them, as many had suicidal
ideation or had actually attempted suicide and had various symptoms of mental illness. “All hospitals in
Massachusetts were full.”
Melinda was in the Psych ER for the 4th time since November 2020. Her mother Pam said, “she’s out of
control” and suicidal. Melinda had spent two weeks in the ER this time, with her Mom visiting daily,
bringing treats and trying to cheer her up. The isolation caused by the pandemic was believed to have
exacerbated symptoms of mental illness in many of the children the hospital staff was seeing.
Suicide attempts by young girls were up 50%. Melinda was on the list at seven hospitals, none of which
had beds, having been completely full for two weeks. Finally, a psych bed opened up.
Life expectancy in the U.S. continues to fall, not just for adults with SMI who die 20 years prematurely
on average, but for our children and our whole population. There is no health without mental health.
There is no time to waste. This is a national crisis that must be addressed ASAP.
Thank you, President Biden, U.S. Attorney General Garland, HHS Secretary Becerra and CA Attorney General Bonta for your
commitments to ensuring that people with serious mental illnesses will not continue to have their rights under the ADA and
constitutional rights violated. It will require an ongoing effort to BUILD BACK our MENTAL HEALTH SYSTEM BETTER to achieve
such equity.
Thank you Senator Wiener for urging Congress to act and do something about insurance companies that still flout the parity
mandates for mental health coverage and your work to ensure that mental health is treated with the same URGENCY as other
medical issues. As you said, “If you break a leg, you can expect to receive immediate follow-up care—no one with health
insurance would be told they have to wait 6 months to get a cast removed because there are no providers. Yet that’s how we
currently treat mental health and substance abuse disorder treatment.” (quoted in SF Chronicle article of 1-18-21)
I do hope for an acknowledgement from all of you, which I will share with my network of advocates in California and around
the country. Our ranks are growing, unfortunately, because every year more and more people seek mental health care and
can’t access it, resulting in more people who go missing, become homeless, end up wrongfully imprisoned and IST and they die
prematurely, sometimes killed during a mental health crisis. The necessity to advocate for those we love, as well as all
Americans afflicted with SMI, becomes more urgent by the day.
Thank you for your attention. I know everyone has a lot on their plates to deal with. Families pleading
for equity in our health care system for mental illnesses would just like to know that their concerns also
have some room on that plate. I wish you all well and the strength, wisdom and fortitude to reform our
broken mental health system.
Very sincerely,
Elfrieda (“Ellie”) Shukert
60 San Felipe Ave.
San Francisco, CA 94127
eshukert@gmail.com
Ellie, dressed as Dorothea Dix, with San Francisco General psych nurses at City Hall protesting the reduction of psychiatric beds in 2014.