-Caveat Lector-
>The choice of incarceration or medication should be up to them.
http://www.sfbg.com/News/35/13/13ill.html
Mad as hell
Advocates for mentally ill people battle forced "treatment" by cops and
docs.
By Cassi Feldman
LAST APRIL WE got a phone call from a woman in San Francisco General
Hospital's psychiatric ward. The 33-year-old was panicky, but she
articulated her problem clearly: she was being held against her will.
During an argument with her boyfriend, she told us, he pulled a gun and
threatened to kill her. After fleeing with her son to a domestic
violence shelter in San Francisco, she filed a police report and sought
medical attention. The officer promised that he'd get a social worker to
find her a "safe place" to stay. She didn't realize that meant a
lockdown ward.
Perhaps the woman seemed distraught. But according to California law she
should only have been taken into custody if she were "gravely disabled"
or a danger to herself or to others. While it's unclear whether this
woman fit the criteria, her case reflects a worrisome trend. Local
mental health activists say the city is routinely locking people up in
hospitals and jails instead of offering mental health treatment on
demand.
"If it's not voluntary, it's not treatment," said Sally Zinman of the
California Network of Mental Health Clients. People who are forced into
psychiatric care, she says, are then much less likely to seek it on
their own. "You can't fill in the gaps in service with more forced
treatment."
Zinman and other "psychiatric survivors" say the vicious cycle of San
Francisco's mental health system starts with a profound lack of
services. According to San Francisco Community Mental Health Services,
50 percent of those seeking mental health treatment last year in the
city never received it. One of the only ways to ensure medical attention
is to act out: become suicidal or commit a crime of some sort. But that
inevitably results in a confrontation with the police, who have little
training on how to handle psychiatric crises. Mentally ill people end up
committed and medicated, often against their will; they get released in
a day or two, and the cycle begins again.
Treatment not jails
"Treat us, don't beat us," more than 50 mental health consumers and
their
advocates chanted at a Dec. 12 action outside City Hall. To underscore
the conflict, protesters held up signs bearing the names of mentally ill
people killed in police confrontations. People such as Solano Silvano, a
homeless man who was shot by members of the San Francisco Police
Department in 1997 for allegedly firing a shotgun at police. According
to the October 22nd Coalition's Stolen Lives project, Silvano sought
treatment for paranoia at five different San Francisco mental health
programs during one month shortly before his death.
"Police are trained to command and control," Jennifer Friedenbach of the
Coalition on Homelessness told the crowd. "Folks end up dead or
brutalized because police officers don't know how to approach people
having mental health crises."
To address this problem, the San Francisco Board of Supervisors
earmarked
$180,000 for fiscal year 1999-2000 to help develop a "police crisis
intervention program," to help officers respond to these calls.
Community organizations such as local mental health nonprofit Caduceus
Outreach Services, Ella Baker Center for Human Rights, and the Coalition
on Homelessness designed a 40-hour curriculum covering such topics as
psychopathology, legal issues, developmental disabilities, and community
resources.
But the SFPD refused to implement the plan, claiming that the training
should be required for all officers, not just a special unit. Instead it
is considering a proposal by Dr. Forrest Fulton, director of the Police
Behavioral Science Unit, to train one entire station for 20 hours and
then devote the other 20 hours to nonlethal weapons training. According
to Fulton that could include the use of tear gas, nets, and rubber
bullets.
In a contentious Dec. 15 episode of KQED-FM's Forum, Caduceus director
Marykate Connor slammed Fulton for derailing the community proposal.
Fulton insisted that his curriculum would improve the safety of police
calls for both the mentally ill person and the officers involved. But,
Connor replied, "it's police officers training police officers. It has
nothing to do with a shift in focus and the difference in culture."
Reagan's scalpel
Today's emphasis on policing reflects years of disinvestment in mental
health treatment. California's desperate shortage of psychiatric
facilities dates back to the late 1960s, when then-governor Ronald
Reagan slashed 1,700 hospital staff positions and several state-operated
aftercare facilities. San Francisco never recovered and continues to
lose vital psychiatric services to deep budget cuts (see "The Budget Axe
Falls on Mental Health," 6/28/00).
Chance Martin, the editor of Street Sheet, has felt the cuts firsthand.
Years ago a major depression left him homeless and suicidal on the
streets of Los Angeles. After several temporary hospitalizations, Martin
eventually found his way into a residential program. But, he says, most
people aren't so lucky: "It seems like every time a budget cut is made
in the Department of Public Health, it's made on the backs of mental
heath recipients."
A survey this June by the Coalition on Homelessness found that 92
percent of 224 homeless people in San Francisco who were interviewed
would enter a program – if one were available that met their needs. It's
unlikely. Community Mental Health Services estimates that the wait for a
residential mental health treatment slot is at least six months.
And while applicants wait in line, the SFPD is cracking down on the
mentally ill.
According to Bill McConnell of Community Mental Health Services, some
8,000 to 9,000 people are involuntarily detained for psychiatric
evaluation each year. The SFPD estimates that one in four police calls
are "5150s": responses to 911 calls regarding individuals "acting with
bizarre behavior."
Under California law, people with disabilities are entitled to treatment
in the least restrictive setting possible. A 5150 results in exactly the
opposite: it's the most restrictive setting possible, sometimes
involving full-body restraints or forced medication.
Involuntary commitment is also far more costly than the voluntary
alternative, according to Mike Reiter, director of inpatient
authorization at Community Mental Health Services. One day of
psychiatric emergency services at San Francisco General costs the city
approximately $1,500, Reiter says, while a day of residential treatment
in a halfway house costs an average of just $186.
"It doesn't make sense in terms of economics; it doesn't make sense in
terms of public health," said Tony Platt, a professor of social work at
Cal State Sacramento. Platt likens the mistreatment of mentally ill
people to the economic neglect of poor people and people of color.
Attempts to marginalize these groups, he says, are fueled by politicians
who appeal to "people's fears and their racism."
Tough pill to swallow
Countering those fears, activists say, involves changing the way policy
makers understand mental illness. Rather than move toward treatment on
demand, they say, some continue to perpetuate the myth that mentally ill
people are dangerous and must be sedated against their will.
This thinking is reflected in A.B. 1800, a bill sponsored last year by
California
assemblymember Helen Thomson (D-Davis) to establish an "assisted
outpatient treatment program" for those considered at risk for
commitment. The legislation was ostensibly designed to enable families
to require treatment for their loved ones, but some mental health
advocates consider it a grave threat to civil liberties. The state can
already intervene in emergencies, they say, and should not be allowed to
intrude earlier. A.B. 1800, which died in a state senate committee last
year, would have lengthened involuntary commitments and allowed the
state to overrule a person's right to refuse psychiatric drugs.
Street Sheet editor Martin acknowledges that medication works for many
people, but he points out that even "wonder drugs" can be toxic. "Once
you're court ordered, it doesn't matter if you come to them and say,
'I've had diarrhea for six weeks or dry mouth,' " he said. "The thrust
is to make sure that you're medication compliant, not to make sure that
your medication isn't killing you."
Meanwhile, there is little proof that mandatory outpatient programs
work. In one pilot project at Bellevue Hospital in New York City,
doctors found no statistical differences in the number of
rehospitalizations when comparing subjects who were forced to take
medication with those who were not.
There may be other motivations behind the support for approaches like
A.B. 1800. A November/December 1999 Mother Jones article revealed that
the National Alliance for the Mentally Ill, one of the organizations
supporting forced treatment, received more than $11 million in donations
from 18 drug firms between 1996 and mid 1999. "What a way of making
money," said Zinman of the California Network of Mental Health Clients.
"The consumer can't say no."
Support Coalition International sponsors a forum titled "The Movement
for
Human Rights and Alternatives in the Mental Health System." Fri/5, 7
p.m., 255 Ninth St., S.F. Free. (541) 345-9106.
E-mail Cassi Feldman at [EMAIL PROTECTED]
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