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Editorial: SF's mental health crisis needs fixing

by BAR Editorial Board

A slide from Dr. Anton Nigusse Bland's presentation to a Board of Supervisors committee last month shows how mental health reform is linked to the overall system of mental health care.
A slide from Dr. Anton Nigusse Bland's presentation to a Board of Supervisors committee last month shows how mental health reform is linked to the overall system of mental health care.  

Recently we published articles about a man likely suffering from mental illness or substance abuse who has allegedly harassed — and in some cases caused injury to — numerous people in the Castro. The man, Triball Zero, has not been charged in those cases, but he is facing assault and other counts in an unrelated case involving a San Francisco family and remains in jail after a judge last week declined to release him as he awaits trial. While it's clear to policy makers and area residents that he is a danger to himself and others, it is unlikely that he would meet the stringent criteria to be conserved, either under the state's traditional program or the newer state pilot program that San Francisco opted into more than a year ago as a result of Senate Bill 1050, which was authored by gay state Senator Scott Wiener (D-San Francisco) and signed by former Governor Jerry Brown. That's because SB 1050 requires an individual to be on a psychiatric hold at least eight times in a year to be considered to be conserved. As gay District 8 Supervisor Rafael Mandelman told us this week, while many people in apparent mental health duress have contact with police, there are usually no next steps like having them placed on a 72-hour hold (known as a 5150 hold). Since the arrival of COVID-19, Mandelman said that he has seen a lot more people in crisis.

"It's frustrating," he told us.

Right now, the city has a critical lack of locked subacute beds, which is where conserved people would go, which means that judges are unlikely to have someone conserved because there would be no place for them.

Mandelman held a hearing last month to discuss SB 1050 — and he will hold another one Thursday (July 23). He wants to find money in the budget — $10 million over the two-year budget — for an expansion of these locked critical beds. Dr. Anton Nigusse Bland, who is Mayor London Breed's director of mental health reform, presented a report at Mandelman's June hearing; in it, he recommends adding 31 locked subacute beds. Nigusse Bland also noted that COVID-19 will have an enduring impact on the city's mentally ill, including limits on outpatient care and reduced capacity in residential treatment.

It's unclear why San Francisco has not yet begun implementing SB 1050, which would apply to a small number of people and is a modest expansion of the conservatorship law. Mandelman said that in June, he told those who testified that he would call them back for this week's hearing. "It's just taking too long," he said. "It's a small, small piece and it's so hard."

It's Mandelman's goal to shape this year's budget process to include more locked subacute beds, even as the city is forced to cut $1.5 billion because of the novel coronavirus pandemic. "You'd think we could find $10 million for additional beds."

The Board of Supervisors should invest $10 million to increase capacity for those most severely affected by mental illness who cannot take care of themselves. The mental health reform package that Breed and Supervisors Hillary Ronen, Mandelman, and others are working on needs to go forward, even in these times. Mandelman said that if the gross receipts tax passes in November, it would unlock Proposition C money from the June and November 2018 ballots, which is key to getting these reforms started and is currently tied up in litigation. In fact, this week Breed and Board of Supervisors President Norman Yee announced the unified business tax measure for November's ballot. If passed by voters, it would free up the Prop C money by triggering a backstop tax to replace those taxes should the city lose lawsuits currently in the courts. It will complete the phase out of the payroll tax in 2021 and replace it with a revenue-neutral gross receipts tax.

In the meantime, Mandelman commended people who came forward and wrote letters to the judge regarding Zero's case. At least four people sent letters to the court, describing their interactions with him and why they felt he should remain in jail, even as many of them told us that they really wanted him to get help from mental health caseworkers and other social services.

Mandelman praised those whom his office assisted in drafting the letters.

"I think it made a difference for the judge and the district attorney," he said.

There are lots of services that likely will be cut because of the economic impact that the shelter in place order has had on the city. But mental health services, especially for those deemed a danger to themselves or others, have long been sorely lacking resources to be effective. The city must start to address these serious issues, and find the political will to begin fixing them.

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