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First, the voices would come at night. Then he sometimes would hear them during the daytime as well, but at some point, the hour — morning, evening, afternoon — ceased to matter. The voices would come.
Kill. Kill. Kill. Rape. Rape. Rape.
With unkempt thinning hair and blurry eyes, Patrick Dillan, 63, hunched at the busy corner of Ellis and Taylor streets in San Francisco’s Tenderloin, near the shelter where he stays. Dillan, who said he was diagnosed with paranoid schizophrenia, was raped by family members when he was 4, and has dealt with the trauma ever since. He said he can’t find help for his illness in San Francisco.
Around 27,000 people in San Francisco use mental health services, according to the Department of Public Health’s annual report. But the services available for them are fragmented and dispersed.
In SoMa, for example, there’s one facility for every 35 patients, but the ratio is much worse in Civic Center: one facility for every 124 patients, according to the health department.
The disparity has come about because the city’s demographics have changed, but the services have remained were they were established, said Helynna Brooke, executive director of the Mental Health Board, a city citizens advisory group.
The board members are considering a variety of ways to reach people who are not getting help.
Several board members suggest deploying vehicles that would cruise the streets of San Francisco. Staffers on board would help people in crisis and bring them to clinics and other facilities.
Two street outreach programs will be presented to the board in September. After that, the board will advise the city’s Behavioral Services Department to fund one of the existing programs — or create a new one, Brooke said.
When treatment becomes an exception
For now, San Francisco offers treatment, but doesn’t have enough programs, staff and money to do it efficiently, said David Elliott Lewis, co-chair of the Wellness Van Committee and a survivor of disabling mental health challenges. The city gives help, but not enough and often not when and where people are ready to receive it, he said.
With fewer services available in the Civic Center area, it might seem easy to just go to facilities in SoMa, but for people enduring a mental health crisis even an adjacent neighborhood is often too far, mental health specialists say.
There are 200 mental health programs with different kinds of funding, and they report data separately, Brooke said. Having many smaller agencies instead of one large one makes it easier for them to focus on specific problems, she said.
But it also can make it harder for patients to navigate the system, said Jacob Savage, director of the Tenderloin-based alternative crisis intervention organization Concrn.
James Brown, a 24-year-old homeless man, said he has had a hard time finding outpatient behavioral services. With dusty hair and tired watery eyes, he was standing in line near the City Hall to get directions to recovery services. A woolen beanie protected him from the chilly wind during the monthly event that provides food, clothing and haircuts for homeless people.
Brown has been hospitalized for mental illness several times. “After that, they just gave me phone numbers but didn’t help with an appointment (for long-term treatment),” he said. “You don’t really get help in San Francisco, you just get back to what you’ve been doing.”
In San Francisco, half of the clients discharged from psychiatric facilities are not seen for outpatient follow-up within a week of discharge, and over one-fourth are not seen within a month. Over 20 percent of clients get re-hospitalized a month after discharge, according a 2015 report by the Department of Public Health’s director.
One of the reasons clients don’t follow up with treatment is fear. The behavioral system is not welcoming and they avoid dealing with it, said Richard Heasley, executive director of Conard House, a supportive housing facility.
To get help, people sometimes need to wait for months, said Lewis of the Wellness Van Committee. In addition, many of the buildings that house mental health facilities are unmarked and that confuses potential patients.
“We keep mental health care a secret here, in San Francisco,” he said.
Such systematic problems are not unique to San Francisco. They are consequences of a nationwide trend known as deinstitutionalization. Beginning in the 1960s, state and local governments moved large numbers of severely mentally ill people from state facilities to community-based treatment, according to the 1998 book “Out of the Shadows: Confronting America’s Mental Illness Crisis” by E. Fuller Torrey.
But the new-style facilities are not an adequate replacement, Fred Markowitz, a professor at Northern Illinois University who studies mental illness, crime and social control, said in an email exchange.
What the city could do to help
The Mental Health Board is considering a number of options to bring resources to those who need them.
One is a new program that would deploy a fleet of Mobile Wellness Vans later this year. The vehicles would be available around the clock every day of the week, Lewis said. Another option is to extend the Mobile Crisis Services, now available only 15 hours on weekdays and eight on weekends.
Meanwhile, the board is also considering an expansion of two existing mental health-related programs.
In the Concern program, staff members approach people in mental crisis on Tenderloin streets, try to calm them down and then help them find housing and counseling.
“The crisis is an opportunity to build relationship and connect them to other services,” said Savage, Concrn’s director.
Residents who witness a person in mental health crisis in Tenderloin have an option to contact Concrn by text or via the free Concrn App, instead of calling 911. Concrn has 12 responders who take turns monitoring the neighborhood and responding to requests.
Another program, City Resources, has a van that monitors the Lower Polk section of the Tenderloin and provides a public restroom round-the-clock, as well as some health care and connection to city agencies.
Services provided by City Resources are essential for people with mental health issues because clients will have a hard time talking to a case manager or counselor if their basic needs for hygiene and health care are not met, said the program’s founder, David Hato.
“I have been blown away at the phenomenal way that these young people are working with our clients,” Brooke said about Concrn and City Resources. “They even work with the folks covered in feces who can’t even walk into a hospital and get help.”
Hato hopes to expand the program by creating a trailer with more services. A detachable van would travel around the city and bring people in. Meanwhile, a shower-equipped trailer could stay parked and offer homeless people a place to clean up. It would also be a place for them to receive basic health care and talk to a case manager.
Twenty-six-year-old JD Contreas has been using the services from volunteers in the city and said he appreciated the help he has received. “I’ve been homeless for almost two years now,” he said. “Man, I would be skin and bones if it wasn’t for them, I’d probably be hungry, starving, naked, cold. They keep me warm, they keep me good, they keep me on my feet.”
To help people with mental illness, homeless or not, the city should take a humane approach, Savage said. “If people are invisible, they can’t be helped,” he said.
By Alena Naiden
Bay News Rising Staff Reporter