We Need To Reopen Asylums

My brother has nowhere else to go

Anyone can see our social fabric is frayed. Walk around San Francisco, and you meet mentally ill people and drug addicts everywhere you go. Some are begging. Some are threatening. One is taking a crap on the street between two parked cars in North Beach. Another is shooting drugs into his neck on the courthouse steps. Most are dirty and weathered and at least a bit desperate. All are aggressively ignored.

One is taking a crap on the street between two parked cars. Another is shooting drugs into their neck on the steps of the Hall of Justice.

If you call the police (or the Homeless Outreach Team) about one of these lost people, they may come, or they may not. If they show up, they will probably tell you the obviously insane person doesn’t qualify to be taken to the hospital. That’s because laws say he must be “a danger to himself or others” before he can be taken into custody against his will. In other words, if he isn’t brandishing a gun, he can’t be helped. Great plan!

Now let me ask you, hypothetically, is someone who’s lying half naked on the sidewalk and shooting heroin into his neck a danger to himself? YES!!! YES HE %$#*@&% IS!!! Any child could tell you that. Just not any public officer.

But let’s put aside our frustrated outrage for a moment and imagine that some kind of miracle occurs, and your person with a major mental illness in the throes of a psychosis agrees to go to the hospital voluntarily.

Chances are, after all your nervous coaxing and his paranoid acquiescence, he won’t get help there either. The psych ward door will shut in his face. Why? Because Medicaid doesn’t reimburse hospitals if they have more than 16 beds in their psych wards. And more than 8 million Americans need those paltry few beds.

The bald fact is we’ve lost 96 percent of the last-resort psych treatment beds that we had in the 1950s. Funny thing, though, we haven’t lost any of the psych patients.

Why would politicians pass such an idiotic law, limiting needed treatment? Fear of the dreaded asylums we’ve seen in horror movies. They say that in the 1950s and 60s, mental patients were being abused in asylums. So what did we do about it? Fire the abusers? Get more oversight? No. We closed the asylums and turned the patients out onto the streets. Another great plan!

One consequence is our prisons are now de facto asylums, except the huge percentage of inmates who have a mental illness — anywhere from 15–73 percent, depending on the facility — are treated much, much worse in prison, and there is no hope for recovery there.

Other consequences include upset, fear and disgust.

I have a favorite waitress, Luan at the New Spot on Polk, who is considering moving back to England after 15 years in SF — even now, when some English people are stockpiling food in fear of Brexit — because she’s upset by the homeless people she encounters here.

Tech companies located downtown offer self defense classes for their employees who are frightened to walk in to work; and President Trump tweets that we should clean up our “disgusting” streets.

I love San Francisco, and I don’t like to hear it disparaged. But the real reason I feel so strongly about this issue is that my little brother has been put in locked psych wards multiple times over the past 14 years.

And guess what? My brother has never been taken into custody when he didn’t need serious medical attention. The fear that inspired that law about needing to be “a danger to yourself or others” — the fear that we might be cavalierly detained by evildoers trying to take away our civil rights — appears to be entirely manufactured, probably because the healthcare industry makes more money when it doesn’t have to treat people who are chronically ill.

And guess what else? On those lucky occasions when we are able to overcome substantial obstacles and get him into treatment, he prefers a larger mental hospital—he prefers an asylum. Because with a larger patient population, it’s more likely he’ll find someone he wants to hang out with. It’s like preferring to live in a city vs. a small town.

Webster’s Dictionary defines asylum as “a place of retreat and security,” and that’s what we need to provide for our lost citizens. As 2020 looms, and candidates announce they are running for president, many problems come to the fore. Climate change, immigration, wage stagnation and foreign policy all need our attention. And so do our neighbors with mental illness.

I hope London Breed, Speaker Pelosi, Senator Dianne Feinstein, Kamala Harris, Scott Wiener, DavidChiu, Aaron Peskin, and every other politician in our country wake up and do the right thing.

We must let hospitals expand their psych wards — no, require them to expand — reopen asylums, and throw out the “danger to yourself or others” laws, or at least interpret them with common sense. Only then will we be able to mend the rich American fabric that warms us all in our dreams.

Postscript: Just last week, police told my friend Ana that her brother didn’t qualify to be taken into the hospital. Then on Wednesday, he stepped in front of a train. This column is for him, and his family, and all of us still out here who are crying and trying and fearing the same.

**For more by Patsy Fergusson, visit Fourth Wave.