Mayor Darrell Steinberg, long an advocate of better psychiatric care, draws an apt analogy: If you see someone bleeding on the street, you’ll call 911. If you see someone on that same street who is suffering from mental illness, you’ll probably walk a little faster.
We as a society do the same, often leaving it to law enforcement to handle the problem. Too often, people with severe mental illness end up behind state prison bars.
A report by the nonpartisan Stanford Justice Advocacy Project finds that 30 percent of California state inmates receive treatment for serious mental disorders, a 150 percent increase since 2000. At least in prison they receive care, though no one truly believes prison is the appropriate setting for severely mentally ill people.
In California’s prison system, mentally ill inmates numbered 32,525 in 2013, or 24.5 percent of the total. As of February, the number of inmates with a mental illness diagnosis increased to 36,800, while the overall prison population had declined.
Sen. Jim Beall, D-San Jose, one of the few current members of the Legislature to take an interest in the issue, is carrying Senate Bill 142 to require that judges consider a defendant’s mental health history when imposing sentences and provide counties incentives in the form of payments if they can find ways to reduce the number of mentally ill felons they send to state prison.
The profound lack of housing for psychiatric patients has increased ER visits, mentally ill prison populations and, most tragically, suicides.
Beall’s bill is supported by the ACLU, public defenders and country district attorneys. Republican and Democratic lawmakers have voted for it. The Senate Appropriations Committee will consider the measure on Monday. We hope it doesn’t stall.
For the bill to work, however, there must be places to house people in need. Too few humane options exist.
In December, the Journal of the American Medical Association reported that there were 22 psychiatric beds for every 100,000 people in the United States. Compare that to Germany, which has 127 beds per 100,000; Switzerland with 91 beds; and France with 87 beds per 100,000 population, the article noted.
In California, researchers have reported, that number is 17 psych beds per 100,000. Clearly, it’s not enough. Twenty-five of the state’s 58 counties have no psych beds.
At a symposium last week at the UC Center Sacramento, Dr. Aimee Moulin of UC Davis School of Medicine provided data showing that between 2009 and 2014, 24.6 percent of emergency room visits in San Francisco were for patients who had a mental illness diagnosis. In Fresno County that percentage was 22.1.
Many people struggle until they give up. The JAMA article noted that from 1998 to 2013, as the number of psychiatric beds fell from 34 to 22 per 100,000, the suicide rate increased by 24 percent to 13 per 100,000 population, significantly more than in other developed nations. In this most advanced of nations, there were 42,773 suicide deaths in 2014, up from 29,199 in 1999.
Gov. Jerry Brown last year signed the “no place like home” legislation, Assembly Bill 1618, to distribute $2 billion to finance housing for homeless mentally ill people. State officials continue to plan how best to spend that money.
Deciding how and where to spend taxpayer money wisely takes time. But it cannot happen soon enough. Lives depend on it. Without safe shelter, people will decompensate on the streets, turn to emergency rooms, end up in jail and prison, and take their lives, while most of the rest of us walk a little faster and avert our eyes.