S.F.’s largest mental health facility — the jail

It is disappointing to acknowledge in 2016 that San Francisco’s largest mental health facility is the county jail. At any given time, 35 to 40 percent of San Francisco jail inmates are being treated for mental illness. Most of the patients I see as a psychiatry resident at the Zuckerberg San Francisco General Hospital are very ill. It doesn’t take a medical degree to determine that jail is not a therapeutic environment for people with severe mental illness and that it will prolong behavioral and legal problems.

We need the city to invest in more psychiatric beds, community-based mental health support, and housing rather than jails.

Individuals with mental illness have little insight or judgment about their actions, and many require hospitalization for short-term stabilization. Since 2008, the number of acute psychiatric beds at the General was reduced from 87 to 44. As a result, we end up turning away people who in other cities and communities would be admitted, and who need treatment.

For the past 11 months, the city’s Work Group to Re-envision the Jail Replacement Project has met to develop a plan that works toward the closure of the county jails at 850 Bryant St., after the Board of Supervisors unanimously rejected funding to build a new jail last December.

During this time, the No New SF Jail coalition, a collective effort of more than 10 organizations, has pushed for community-based alternatives as viable solutions.

The coalition released a plan in October, the “San Francisco Community Health Initiative: A People’s Plan for Shifting Reliance Away from the Criminal Legal System and Toward Community-Based Solutions,” with the support of Public Defender Jeff Adachi and community advocates. The plan outlines ways the Work Group can take immediate action to fund and support community-based health alternatives to incarceration.

On Thursday, the Work Group will advance recommendations to the Board of Supervisors. These include bail reform, housing, and expanding inpatient psychiatry beds at the General. Yet despite months of discussion and public input, the Mayor’s Office is still wanting to build a new jail facility.

The District Attorney’s Office has proposed a Behavioral Health Justice Center, with four levels of care, including a locked unit, dual-diagnosis treatment, and emergency mental health beds. This proposal has promise, but, notably, psychiatrists have not been part of the discussion. Still, there are many more interventions that can prevent people from ever reaching arrest and placement at such a center.

Mentally ill individuals too often end up in the legal system as a result of untreated mental illness exacerbated by homelessness. Individuals with mental illness languish in jail — waiting an average of 120 days for a bed in a community-based residential treatment program even after they are deemed clinically stable.

There are three main arguments for alternatives to incarceration:

1. It is the right thing to do. The moral thing is to treat individuals with mental illness as you would wish your daughter or father to be treated — humanely.

2. It is more sustainable. Putting someone in jail temporarily locks them away, but that person will return to the community with fewer options for housing and employment. This hurts us all if fewer of our neighbors can be housed and have jobs.

3. It’s cheaper to provide stable housing and mental health treatment than having people cycle in and out of emergency services and jails. It is estimated to cost roughly $50,000 per year to incarcerate someone at 850 Bryant, versus $7,000 to 10,000 to provide safe, supportive housing plus mobile treatment teams for people living with chronic mental illness.

Directing funding to mental health and housing services rather than more criminal justice facilities is a first step in the right direction, but clinicians and consumers must be part of the process. If we dare, we can develop innovative solutions for mental health care — ones that allow people to live with the kind of dignity and justice that we all deserve.