In 1972, an enterprising young reporter named Geraldo Rivera clandestinely recorded appalling footage at the Willowbrook State School, a New York psychiatric institution.
Nearly 50 years later, psychiatric hospitals such as these no longer exist, in part because of the horrific conditions exposed by Rivera’s camera. And yet the status quo (like Rivera and his shtick) has not aged well.
Now a journalist — or a politician or a tourist — doesn’t need to break into a mental hospital to record damning videos of men and women unable to care for themselves living in filth, squalor, and misery. She can just wander down Mission Street.
With an eye toward this, Supervisor Rafael Mandelman this week introduced an ordinance that would expand the city’s ability to place mentally ill people into conservatorship — that is, institutionalize them, against their will if need be — and appoint a “conservator” to mind their affairs. This is the local enabling legislation following Sen. Scott Wiener’s statewide efforts, which resulted in the passage of SB 1045 in September.
Denying people their civil liberties and potentially bringing about a One Flew Over the Cuckoo’s Next scenario is not something anybody is taking lightly. Wiener emphasized that his law, which only applies to San Francisco, San Diego, and Los Angeles, is intentionally narrow in scope. “These are the people who you see running into traffic, sleeping in their own feces — they are unraveling and dying,” he says. “It’s not a silver bullet, but this will save lives.”
But how many lives? Quoting figures given to him by the Department of Public Health, Wiener says his new rules will apply to perhaps 50 to 100 more San Franciscans than fit under prior conservatorship rules. Mandelman said he was not certain it would even be 50. Simon Pang, who helms the San Francisco Fire Department EMS-6 team, told the media that he puts the number at “less than 10 individuals have such severe substance-abuse disorder and mental disorganization that they cannot perform routine acts of daily living.”
That is not a lot of people. And yet, for opponents of this approach, even that is too many.
But, at this point, perhaps it’s worth looking at who qualifies to be remanded into conservatorship via Wiener and Mandelman’s bills. There are a great number of qualifications, and a person must meet them all.
First, you must be mentally ill. You must also be addicted to drugs (prior conservatorship laws only covered alcoholism, meaning chronic inebriates could potentially be institutionalized, but not drug addicts).
You must also have been detained for evaluation and treatment via a police 5150 order eight times or more in the prior 12 months (A judge needs this new stipulation, Wiener says, to more fully evaluate the totality of a person’s condition rather than merely gauging how they behave during a brief courtroom appearance).
But wait, there’s more: If you’re a mentally ill drug addict who’s been 5150’d eight or more times in the recent past, before applying the conservatorship enabled by SB 1045, the city must also attempt to put you into assisted outpatient treatment. If that works out, SB 1045 won’t be evoked. But if the city fails to get you into that program, or you fail out of it, you could qualify for conservatorship under the new Wiener/Mandelman legislation.
But not yet.
After all that, a judge must rule that there is not a less severe course of action the city could take; the judge must essentially rule that assisted outpatient treatment is insufficient.
All of these conditions must be met; all of these boxes must be checked.
And yet, opponents of this legislation are not reassured. Jennifer Friedenbach of the Coalition on Homelessness testified against it in Sacramento. Police, she notes, are not mental health professionals, and they may impose 5150 detentions spitefully.
Jessica Lehman of Senior and Disability Action felt SB 1045 and its San Francisco enabling legislation are poor choices in terms of resources. Why force drug addicts who’ve been 5150’d eight times into treatment — when there’s no money to fund voluntary treatment for people who actually want to quit?
“Why anyone is talking about how to force people into treatment when people who ask for treatment cannot get it is very disturbing,” she said. “The problem we’re facing when we look at substance abuse and mental health is that voluntary services are not available.”
So, in a nutshell, nobody is happy. Everybody is angry. And the conditions on our streets are still Willowbrook State School circa 1972.
Mandelman, however, feels we can change that. Ever so incrementally.
“The value of doing something is better than doing nothing,” he says. “Even if it only applies to 10 people, that’s 10 people’s minds we’re saving and 10 people who are, surely, a huge drain on the system. So, that’s a win.”