chance martin streetsheet@sf-homeless-coalition.org
Tue, 12 Dec 2000 11:35:38 -0700

DECEMBER 12, 2000

Across the nation, there is a great need for publicly funded psychiatric
services. Both the debilitating nature of psychiatric illnesses and the lack
of adequate health insurance to cover this illness often thrust individuals
into poverty.  Unfortunately, here in San Francisco we have a system that is
nowhere near meeting the need.  The result:  Individuals with mental
illnesses unnecessarily end up in the hands of the police, and locked up in
our jails and our hospitals.

Mental Illness in San Francisco
o  Over 50% of those seeking mental health treatment last year never
received it.  (1999/2000, CMHS)
o  Approximately 3,000 people go to SFGH Psychiatric Emergency Services for
severe psychiatric crisis every year, who have not had previous contact with
the mental health system.  (Phyllis Harding, DPH)
o    A large proportion of homeless people are veterans, and 35% of them are
mentally ill.  The Veteranšs Administration does not provide residential
treatment services, nor outpatient therapy. (Swords to Plowshare, 2000)
o    There are an estimated 2,000 - 2,700 individuals parents receiving
CAL-Works (welfare for families) who are in need of mental health treatment.
(SF DHS, 1999)
o  Approximately 30 - 40% of homeless San Franciscans are mentally ill; this
could be as many as 5,600 homeless people with mental illnesses (SF McKinney
Application, fall, 2000)
o  About 4,000 individuals who receive County Adult Assistance have mental
illnesses (Dorothy Enisman, DHS, 2000)

Involuntary Commitment in San Francisco
o  San Francisco has the highest 5150 rate in the state.  5150's are
incidents of people being involuntarily detained for 72 hours for
psychiatric evaluation.  (Bill McConnell, Division of Mental Health, 1996)
o    In 1997, there were 3694 separate incidents of 5150's.  (Phyllis
Harding, 3/98)
o  Due to the involuntary nature of 5150's, the process is intrusive and
counter therapeutic, and can result in someone who needs mental health
services losing trust in the system.  At the same time, it is a response
that occurs only after an emergency takes place.
o    The  average cost for one person just to be seen by Psychiatric
Emergency Services under a 5150 in San Francisco is $162 per hour, while
outpatient treatment services cost approximately half that or $76 per hour.
(Jo Ruffin, Division of Mental Health, 1996)
o    Often people 5150'd to Psychiatric Emergency Services are literally
discharged to the streets because no other option in either Social Services
or Mental Health is available due to limited capacity. (Psychiatric
Emergency Services 1994/5)
o    Contrary to the state law that states people have a right to treatment
in the least restrictive setting, 5150's present the most costly response to
psychiatric illness in the most restrictive setting.

Mentally Ill People in San Francisco Jails
o    Individuals with mental illnesses are more likely to be victims of
violence, rather then perpetrators.  Persons with psychiatric conditions are
not more likely than others to commit violence.  (MacArthur Risk Assessment,
o    One in four police calls are responses to individuals in psychiatric
crisis, or individuals "acting with bizarre behavior".  (SFPD, 2000)
o    From 1/00-11/00, in the San Francisco jails, 9,907 unduplicated
assessments for mental illnesses took place, and 5,198 resulted in admission
into the system. (Jail Psychiatric Services, 12/2000)
o    11% of San Francisco's County Jail population have persistent and
severe mental illnesses.  Of those, 85% are homeless. (Jail Psychiatric
Services, 12/2000)
o    One quarter of arrestees booked in San Francisco were found to have
contact with Mental Health Services. (1991, SF Prisoners as Multi-System
Users, Research Project of Forensic Services, DPH)

o    Approximately 30- 40% of homeless San Franciscans are psychiatrically
disabled.  These individuals are often shut out of the shelter system,
comprising only  5 - 15% of the shelter population.  (Polaris Study, 1993)
o    Only 2% of San Francisco Mental Health system's clients can be housed
in supported independent living. (Division of Mental Health Supported
Housing Plan, 1995)
o    Approximately 40% of the individuals seen by Psychiatric Emergency
Services were homeless (Aline Wommack, Director, Psychiatric Emergency
Services 94/5)
o    Over half (650) of the beds in Board and Care facilities have been lost
in the city since approximately 1984.  (Jo Ruffin, Division of Mental
Health, 1996)

o  Just under a quarter of the population in the United States will
experience an episode of  mental illness  in their lifetime.  (Rogier, 1990)
o    The nation's prisons and jails held and estimated 283,800 mentally ill
inmates in 1998 (Associated Press, 6/99)
o    Rates of homelessness was more then double among mentally ill inmates
than others.  (Associated Press, 6/99)


Data is not available on exactly  how many people arrested, hurt, or killed
by the police are homeless and/or mentally ill. We pulled some of the people
who are known or thought to have mental illnesses or were in psychiatric
crisis when they died at the hands of law enforcement from Stolen Lives (a
book pulled together by the October 22nd Coalition).

Here are some of their stories:

Solano Sivano 47, Latino, Nov. 9, 1997, San Francisco
shot by police 
Police Shot and killed Mr. Sivano, who lived in a homeless encampment.
Police claim he had fired a 20-gauge, double barreled sawed-off shotgun at
them from the shadows of a Highway 101 on ramp. A SFPD officer allegedly
asked him to drop the shotgun in English, which the Spanish-speaking Mr.
Sivano may not have understood. There are reports that the gun was never
found.  Mr. Sivano had sought mental health treatment for paranoia at five
different SF programs in one month just seven months before his death.

Hue Truong, 38, Vietnamese, Aug. 3, 1997
shot by police 
Hue, a homeless man, was shot in the chest and killed after allegedly
pulling a knife out of a bag.

Mark Garcia, 41, Latino, Apr. 6, 1996
 pepper-sprayed or maced by police
Mark was robbed and standing in the middle of the street, calling for help
and in need of medical attention. The police responded by pursuing him. He
was beaten, pepper sprayed, and slammed to the ground, with a foot grinding
into his back for 5 minutes. The ambulance called to the scene was diverted
to a non-injury accident, and he was thrown into the back of the police van,
hog tied and on his stomach. After emptying several cans of pepper spray
into his eyes, Mark had a massive heart attack and died the next day.

David Boss, 42, June 14, 1995
shot by police 
Police said he had a knife and they shot to death. It turned out Mr. Boss
had a steak knife. 

Henry Quade, 56, White, Oct. 16, 1990
shot by police 
Called "a fat Howard Hughes" and a kind recluse man by those who knew him,
Henry was gunned down by a SWAT team after he refused to allow a
court-ordered Health Department inspection of his home.

Demand #1


Police Crisis Intervention is a concept that was developed by various
community organizations including Caduceus Outreach Services, Ella Baker
Center for Human Rights, Office of Citizen's Complaints, Coalition on
Homelessness, and Mental Health Board back in 1996.

Community members were responding to the fact that police are often the
first to respond to the scene when individuals are in psychiatric crisis.
Today, one in four police calls fall into this category.

At the same time, the way in which police have been trained is to utilize a
"command and control" strategy when they approach individuals.  This has led
to further trauma of those unfortunate enough to be experiencing psychiatric
crisis, and in extreme situations, injury or death on the part of both
police and people with mental illnesses.

Community members designed a program to train one police officer on every
shift at every precinct on how to respond to calls which were coded as
"individuals acting bizarrely" by 911 in a more humane and safe manner.
Memphis, Tennessee Police Department has enacted almost an exact, and highly
successful model in their community.  Since then, many more communities
around the country, including San Jose have enacted similar programs.

While the police commission approved the program, a proposal that the police
department submitted was never funded.  At the same time, there was
continued resistance among the police departments top brass to this

In fiscal year 1999/2000, the San Francisco Board of Supervisors funded the
project at $180,000.  SFPD representatives started meeting with community
members to work on designing the curriculum and implementing the proposal.
The curriculum was complete in August, 2000, with forty hours of training.
Police department concerns were met, such as the need to train all officers,
given the high number of calls, and to have police trainers along side
consumer and community trainers.  The police department responded with a
counter proposal to cut the training time in half, and to use half that time
for weapons training.  Community members strongly oppose this.

To date, this extremely critical training has not been implemented.  We are
demanding full implementation of Police Crisis Intervention, with
comprehensive training.

Demand #2

All individuals in California, including individuals with psychiatric
conditions, have a right to refuse medications.  This right to refuse
treatment exists even if the person is in a psychiatric hold.  Existing
California law has been in place for 30 years, under the Lanterman-Short
Petris Act.  It is a sensible compromise between civil liberties and social
policy.  Current law permits the detention of individuals with psychiatric
conditions when they are threatening, violent or suicidal.  Individuals who
cannot attend to their personal needs or who are dangerous to themselves or
others, because of their psychiatric conditions, can be involuntarily
detained for treatment and stabilization.

This past year, California legislators considered an expansion of current
law that would permit involuntary detention of persons who are deemed by a
psychiatrist to face "serious risk of substantial deterioration" because of
mental illness.  The proposal offered no definition of "substantial
deterioration," nor any objective guidelines for the psychiatrist to apply
in concluding that the individual meets the standard.  Virtually anyone with
a psychiatric condition or label could be subjected to involuntary

The proposed legislation would have eliminated the constitutional right to
refuse treatment, including medications, for a single group of California
citizens.  Persons with mental health issues are as likely as persons with
other chronic conditions such as diabetes or heart disease to take
prescribed medications, despite the onerous side effects associated with
many psychiatric medications.

This legislation, brought forward by State Assemblymember Helen Thompson,
and put forward from Pharmaceutical corporations, family members and
organization such as the National Alliance of the Mentally Ill, was never
passed.  Forced Outpatient Treatment has been recently implemented in a
majority of states.  It is our sense that this legislation may be brought
forward again next year.

Experience shows that the vast majority of individuals with severe mental
illnesses choose to use these services when they are funded and available
(which they are not now).  Involuntary treatment does not result in better
outcomes than simply providing access to comprehensive voluntary services.

We are demanding that San Francisco resist all efforts to expand involuntary
treatment, and form a sanctuary from this violation of civil rights.

Demand #3


By definition, people who are homeless live in public.  A lack of housing
forces them to do in public what everyone prefers to do in private.  This
indignity is one of many reasons we seek to end homelessness.
Unfortunately, it has also become the battleground for the most fundamental
defense of people who happen to be homeless; the right to exist.

Since 1993,  San Francisco police officers have issued over 100,000
citations to homeless people for such so- called crimes as sleeping or
sitting in public.  San Francisco mirrors a national trend to criminalize
homelessness.  Police continuously misapply and selectively enforce existing
laws in order to harass people who are homeless and move them from parks to
neighborhoods to alleys and back into parks.  This strategy demonizes poor
people and feeds negative public sentiment to target people who experience
homelessness, rather than address root causes of homelessness itself.

The flaws in this effort to criminalize homelessness are as numerous as they
are obvious.  Though no one should ever have to sleep in a park or beg for
food, making those acts into criminal offenses does not help the people
driven by desperation to commit them.  These city ordinances are misguided
because they seek to hide homeless people, not end homelessness.  They are
unjust because they seek to punish people for being poor.

1 in 4 calls San Francisco police officers receive are in response to people
in psychiatric crisis.  At the same time, it is estimated that 40% of people
living on the streets have mental illnesses.  Homeless people with mental
illnesses are at increased risk of police harassment.  When they are cited,
it is less likely they are able to follow up with court dates, and because
of that are more likely to become incarcerated.  Interactions with the
police and incarceration have a disproportionate traumatizing effect on
people with mental illnesses.

We demand full protection of the civil and human rights of those living on
the streets.

Demand #4


Mental health services located in the community have been eroded over the
past three decades, and the result is thousands of people with mental health
issues being denied services and living on the streets.  In fact, last year
the City of San Francisco stated in public documents that only one-half of
those seeking treatment and qualified for treatment actually received it.

For the past several years, in spite of a budget surplus, the city has
continued the erosion of mental health services, by making deep cuts and
expanding services only for the very few.  In budget year 1999/2000, the
Department and the Mayor's office conceded and started to build back up the
mental health system by expanding outpatient services.  The following year
they cut millions of dollars from anticipated revenue coming into community
mental health services to help put a dent in the deficit at San Francisco
General Hospital.  

Community mental health services are needed on every level, in every
community.  The need for outpatient treatment, residential treatment, board
and care facilities, supportive housing, and peer services are overwhelming.
In addition, there are no crisis services available in the community after
hours.  Waits for residential services exceed nine months, we have half as
many board and care facilities as we had in 1984, only 2% of community
mental health clients can be housed in supported independent living, and
people are being discharged from the hospitals onto the streets.

Mental health consumers in San Francisco are not just demanding a major
expansion of the mental health system -  they want major reforms.

In our report entitled "Locked Out", a survey of over 300 homeless people
with mental illnesses, we found that not only did 92% of those surveyed want
treatment, but they knew exactly what that treatment should look like.  More
then half found that the system failed more then it succeeded - mostly
because of the bureaucratic access process.  They wanted staff that was
caring and respectful, and they wanted programs that helped them be more
productive members of society - whether that was jobs, recreation activities
or a way to give back to their community.

We demand full consumer directed mental health treatment on demand.