In Memory of Sam

Regular readers of this column may recall that back in September I wrote about a college friend of mine who had lost his mind and ended up living on the streets of San Francisco. Well, in the intervening months, my friend’s situation only got worse. Arrested multiple times for all manner of petty crimes, he spent much of the last half-year in various Northern California jails before finally being released to a San Francisco halfway house in early April. Just days after arriving, he snuck out and made his way to the Civic Center BART station where he threw himself down in front of an oncoming train and died.

A great frustration for friends and family members of people with severe mental illnesses is the nearly complete lack of effective societal interventions for people who are going off the rails. As San Franciscans can see plainly every day on our sidewalks and in our transit stations, there are a lot of people out there who are not able to care for themselves and yet are left to rot on their own unless and until, like my friend, they start committing crimes. Then, of course, they go to jail, which in some cases may actually be an improvement over life on the streets, but is hardly a therapeutic environment.

The disproportionate over-representation of the mentally ill among the homeless is well established and obvious to anyone paying attention. The Substance Abuse and Mental Health Services Administration tells us that between 20 and 25 percent of homeless individuals in the United States suffer from a severe mental illness, and I have seen other estimates that are higher than that. To be sure, there are plenty of other causes of homelessness, most notably the painful and growing shortage of affordable housing for poor people in our rapidly gentrifying inner cities, but it strikes me that many of the most visible and intractable cases are actually simply individuals with untreated mental illness abandoned to spiral down in plain sight.

The disproportionate over-representation of the mentally ill among the incarcerated may not be as obvious, but is equally well established. A 2006 Special Report of the Bureau of Justice Statistics estimated that 705,600 mentally ill adults were incarcerated in state prisons, 78,800 in federal prisons and 479,900 in local jails. It is an ugly irony that the “deinstitutionalization” of the last half-century in too many instances has really simply meant moving mentally ill people out of public psychiatric hospitals and into prison.

Given the tendency of our politicians to pander to public outrage over the colonization of our public spaces by people who have nowhere else to be, without offering any real solutions, it is a welcome thing when one of them actually offers something positive and real. Former State Senator Darrell Steinberg did that back in 2004 when he got Proposition 63 on the ballot. The Mental Health Services Act, which increased taxes on millionaires to pay for increased funding for mental health programs and services, created a dedicated statewide funding source for the State’s mental health needs. Unfortunately, in the time since then, much of the newly generated funding from the Act has been used simply to soften the blow of cuts elsewhere in the State budget during the Great Recession. Plainly, the need for significant additional resources to address mental health is as great, or greater, than it was back in 2004.

Laura’s Law, enacted by the State Legislature in 2002, is a California state law that allows for court-ordered assisted outpatient treatment for individuals with a serious mental illness plus a recent history of psychiatric hospitalizations, jailings, or acts, threats, or attempts of serious violent behavior towards themselves or others. The heated debates over local implementation of Laura’s Law have pitted civil liberties advocates against groups like the National Alliance for the Mentally Ill, with its membership of family members desperate for any means to get mentally ill children, siblings and parents into treatment that could keep them alive, off the streets and out of jail. But I fear that the fighting over Laura’s Law is a distraction from the main story: unless and until we commit to providing treatment and care to those who need it, the debates about the extent to which the State should be able to coerce that care and treatment will be a sideshow, a lot of sound and fury signifying…not much.

No one can know whether a different set of interventions could have saved my friend’s life, but I cannot help but believe that fixing our broken mental health system would save the lives of lots of people like him. And meanwhile, my friend Sam, whom I still think of as a sweet, smiling twenty year old in a Yale College dining hall long ago and far away, is dead, much too young and much too pointlessly. At least he went out in a big way, taking down a major regional transit system on his way out. Rest in peace, my friend.

Rafael Mandelman is an attorney for the City of Oakland. He is also President of the City College of San Francisco Board of Trustees.