After much shouting, perhaps it's time for talking about San Francisco's failing Behavioral Health Center. Photo by Joe Eskenazi

Barring unforeseen lunacy, Tuesday’s Health Commission meeting will feature a discussion of the strange and terrible saga of this city’s Behavioral Health Center

On prior occasions, this subject has been yelled about rather than talked about; mental health workers and others stormed the Sept. 17 meeting, shutting down the proceedings. This provided the dozen or so S.F. State nursing students attending as an academic requirement with a crash course on how this city’s health care system really works — or, to be more accurate, does not work. 

The students — so young, so positive — did seem to be enthralled by the notion of nurses as patient advocates transcending the hospital and taking their issues to the halls of power. What they felt about a system where this was, perhaps, the only way to (even potentially) ensure results is something they kept to themselves. 

(For what it’s worth, when a psychiatric nurse asked how many of the students planned on specializing in mental health, nobody raised their hand.)  

But, again barring unforeseen lunacy, nothing like that figures to happen on Tuesday. The union activists who effortlessly tanked that Sept. 17 meeting have given their word they won’t do it again — this time. This time they want to talk. 

Well, good. Because there’s so much to talk about. 

SEIU workers and others rallied outside the Behavioral Health Center on Aug. 22. Photo by Abraham Rodriguez.

Every few days, it seems, we uncover some brand new travesty about the Behavioral Health Center, a three-story structure tucked away in a quiet corner of the San Francisco General Hospital campus. Workers here say they feel isolated, physically and metaphysically. They feel out of sight and out of mind. 

Well, it shows. 

On the bottom floor here is the Adult Residential Facility, a 55-bed board-and-care facility housing the severely mentally ill. On the second floor is Residential Care for the Elderly, a 59-bed facility. And, on the top floor is the Mental Health Rehabilitation Center, a locked-door 47-bed establishment. 

And yet, in the past month, we’ve learned that 23 beds were willfully kept empty on the ground floor, and 22 more were intentionally left unused on the second floor. And, just last week, we learned that 10 to 12 beds were kept empty on the third floor. All of this, of course, is occurring during a mental health and homelessness crisis, during which unwell people are, by all the quantifiable indicators we have at our disposal, being left to fend for themselves on our city’s streets in greater and greater numbers. 

There is a deluge, and this city has an Ark (albeit an inadequate one). But it has decided to pull up the ladder. 

But we learned more last week. We learned that the system this city has in place to transfer mentally ill people out of jail and into psychiatric facilities is broken to the point where we can argue that there is no system.  

To wit, Mission Local was, on Sept. 25, the first to publish a jarring transcript from the “placement review hearing” for a previously incarcerated mentally ill man named Lamar Murry. 

Murry was arrested in 2011 for felony assault, but found incompetent to stand trial. He was in 2018 arrested for arson, but the charges were dropped. And yet, from December up until mid-September, he languished in jail. He was cleared to be transferred to a psychiatric facility in February — but, every few weeks, like clockwork, the Department of Public Health told his public defender there was no place to transfer him. He remained incarcerated — despite not having been convicted of a crime. 

So his public defender filed a subpoena, compelling testimony from Health Department officials at a Sept. 12 hearing. And then there was space for Murry. After sitting in jail for eight months — because, again, there was ostensibly no place to transfer him — he was transferred into the Mental Health Rehabilitation Center within weeks. 

You’d think placements into a high-demand, locked-door psychiatric facility are based upon clinical necessity. Think again: During that hearing, Health Department placement coordinator Annette Quiett confirmed under oath that Murry was No. 11 on the waitlist for the Mental Health Rehabilitation Center; confirmed under oath that 10 people hadn’t been admitted prior to Murry; confirmed under oath that Murry was “prioritized for admission” — and then confirmed under oath that the impetus for all this was “to get him out [of jail] before this hearing, so we wouldn’t have to appear.” 

That’s honest, but not refreshing. It’s sad to learn that mental health placements in this city are handled akin to credit card companies sticking you with specious late fees, and only clearing them up when you call and argue with some poor operator.

In addition to Murry, seven other public defender clients who’d been stuck in jail for between three and nine months — despite being cleared for residency in a mental health facility — were rapidly transferred in September.

Prior to subpoenas being filed, there was — supposedly — no place to put them, either. 

You should expect this to be talked about (or yelled about) on Tuesday afternoon. Because the plight of Lamar Murry is illustrative of many of the problems at the Behavioral Health Center — and how these faculties are failing San Francisco. 

When you shut off admissions at these centers, you create a cascading series of problems. When admissions were curtailed at the Adult Residential Facility and Residential Facility for the Elderly, it created a backlog upstairs at the Mental Health Rehabilitation Center. And when you do that, you create a backlog at the jails.

In a smart and thorough story last week, the Chronicle published statistics confirming that patients awaiting placement into a mental health facility are made to cool their heels for months on end. That quantifies what many workers on the third floor have been telling us. 

Former Mental Health Rehabilitation Center behavioral health clinician Aimée Armata recalled that, on a weekly basis, she would attempt to transfer clients from the locked third floor to the board-and-care facilities within the same building. And, every week, “the refrain was ‘there are no board and care beds. We are closed to admission.’” Armata says she personally discharged patients who had been warehoused on the third floor, without medical necessity, for years — even a decade.

Armata’s erstwhile colleague, Connie Truong, in August told us that she had been working with a third-floor patient who’d been cleared to move downstairs “six or seven months ago” — but she remained on the locked third floor due to management claims that the downstairs facilities are “on suspension.” 

Oh, about that: Mission Local talked to some one-dozen workers here who claimed management had specifically told them the reason no new patients could be admitted was a state-imposed “probation.”

But that’s not true.

None of these facilities are on probation; the choice to pull up the ladder in the midst of a deluge was internal, and, just that: a choice. 

All of these details, mind you, came to light because the mayor’s office and Department of Public Health in August moved to fold 41 permanent housing beds at the Adult Residential Facility into temporary shelter; the excuse that the beds weren’t being used is what started us on this misbegotten journey.   

San Francisco is an exhausting place. Attempting to get your arms around this city’s entropy and decay can be a dispiriting affair. But the Behavioral Health Center is a small facility meant to provide meaningful lives for 151 mentally ill people. 

Yes, this is merely a microcosm of San Francisco’s larger dysfunction. But this is a place with a specific and limited raison d’être — and, in the end, not a particularly large place. 

So, we can fix this. Starting today.  

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Managing Editor/Columnist. Joe was born in San Francisco, raised in the Bay Area, and attended U.C. Berkeley. He never left.

“Your humble narrator” was a writer and columnist for SF Weekly from 2007 to 2015, and a senior editor at San Francisco Magazine from 2015 to 2017. You may also have read his work in the Guardian (U.S. and U.K.); San Francisco Public Press; San Francisco Chronicle; San Francisco Examiner; Dallas Morning News; and elsewhere.

He resides in the Excelsior with his wife and three (!) kids, 4.3 miles from his birthplace and 5,474 from hers.

The Northern California branch of the Society of Professional Journalists named Eskenazi the 2019 Journalist of the Year.

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  1. 4,000 mentally ill homeless and likely as many mentally ill in homes and the outcry is about 50 inpatient places not used continuously? Well, for starters, there have to be some places available at all times because people go into actionable crisis randomly and a there has to be a place for them. Seems there’s always places in jail that are available. Why not a outcry about unused jail places? And empty places are always available in hospital emergency rooms for random traumas. Why no outcry about that?

    The sober facts is even if all those 50 mental health treatment places were occupied, the situation on the streets and households with mentally ill people who go into crisis would’t change noticeably. Will city funds ever be found to pay for 4,000 permanent mental treatment facilities with 24/7 care and annually cost $100,000(and rising) each? That’s $4B. I don’t think so. So this brouhaha is really about creating more positions for City employees making City wages.

    The solution is to return to the pre-Reagan system of State mental hospitals that are located where costs of care isn’t top dollar SF prices and are enough to have economies of scale, land to expand, and more types of care to accommodate the many variations of mental illness.

  2. You have to wonder where that 12 billion dollars SF spends every year go’s ? It seems to disappear into thin air.

  3. This is why I too refuse to throw money at the issue. It’s not good enough. Greedy mismanagement. The progressives here are just as bad as conservatives in their cruelty towards those with disabilities, touting they have a crisis they want to fix and then doing stupid stuff like this. I bet all of em drive into work everyday and never have met fists of fury on the street. A few black eyes from the mentally disabled on the street and the tune would change. But they don’t and will never. Too precious and special to care too insulated from the daily consequences all the rest of us face. Hope y’all are happy with yourselves!

  4. So we pay supervisors. We pay service providers. We kinda pay advocates sometimes. We pay SEIU and IFPTE, contracts and their members pay for representation. And we pay City employees.

    Yet with all of these eyes on the problem, with the profile of psych crisis on our streets dominating most everything else, all of these highly trained professionals (supervisors excluded) could not figure out how a government facility, one of the scarce centers intended to address one of the most pressing political problems, was allowed to be used way below capacity.

    And what about the Mayor’s staffers lying to the Board of Supervisors about this for all of these years? Does the Board need to swear in Mayoral staffers under oath to guarantee honest information?

    This is why I could not vote for Prop C last year. Throwing that amount of money at this constellation of operators will not result in $1 or more in results for every $1 spent. To the contrary, such funding will only further consolidate the comedy of incompetence that the Mayor, Board, Service Providers (HSN, Human Services Network), labor and the advocates have performed for us all of these years.

    Meanwhile, out on the streets….