California Forum

Housing alone won’t solve homelessness. Let’s rethink how we treat mentally ill

As a young, motivated resident in internal medicine, I began to moonlight in a freestanding, full-service psychiatric hospital. I became fascinated with the medical care of the psychiatric patient and the management of substance use disorders. In time, I became a director of Medical Services and Program Medical Director for Chemical Dependency Services and spent the better part of three decades developing expertise in the care of psychiatric patients.

This is why I support a mental health reform bill, Senate Bill 640, by state Sen. John Moorlach (R-Costa Mesa).

Never did I imagine I would live in a state which would systematically allow patients with massive mental health needs to languish and deteriorate in the most unconscionable, abject circumstances. It was unthinkable to me as a young physician that, decades after I began my career, leadership in the State of California would –in the name of some abstract, misplaced notion of compassion – literally position the symptoms of major psychiatric illness as a guiding principle to be protected.

The very symptoms causing desperately ill patients to spill into our streets are being protected in the name of compassion. This is dialing back to a Medieval understanding of psychiatric illness and is absolutely outrageous, particularly in the era of effective treatments which can restore patients to stability.

As I have seen repeatedly, the patients themselves, when their thought disorders are stabilized, become furious that anyone allowed them to languish in abject conditions in the name of compassion. Paranoia, hoarding and the distorted motivation to seek and use powerful narcotics are elevated to protected status under California laws. The very symptoms that lead to progressive misery are privileged above the ability to step in to help. Every civilized society knows to intervene in spite of these symptoms to restore people to health.


It is anathema to the basic needs of civilization to allow the current situation to continue. Summer is approaching and I am terribly concerned about the continued deterioration of these ill individuals. The complete sanitation breakdown, rodent infestation and vector explosion are going to result in an infectious disease crisis. In Southern California, typhus is going to be even worse than our recent epidemics. Tuberculosis is going to massively expand. I predict we will see Yersinia pestis – the plague. And it won’t be just the homeless who are stricken.

This is not a housing or homelessness crisis; this is a mental health crisis. It is a deplorable insult to continue to see this glossed over in the press as somehow the result of expensive housing. Housing does not cause our communities to need to rake the grass in parks before children play to pull up hundreds of needles. Housing is not going to help the paranoid, poorly clothed manic or paranoid schizophrenic. In fact, the symptoms of these illnesses will cause the homeless to refuse to remain indoors and to accept help or treatment. To hear politicians maintain the rhetoric of a housing crisis is tantamount to reckless negligence and materially contributes to the misery and death of untold numbers.

Dr. Drew Pinsky

If we are going to show true compassion for these patients, we must have the tools to combat their symptoms. The symptoms of brain disease must lose their protected status and the ability of our highly trained mental health professionals to help must be supported.

As an enlightened approach to solving these problems, SB 640 would provide a more accurate and compassionate definition of the gravely disabled. Doing so would allow mental health professionals to better deliver services to patients whose psychiatric symptoms would otherwise be allowed to drive a wedge between the patient and their ultimate wellness.

Lack of insight, distorted thoughts and beliefs, hoarding, agitation, lack of trust, paranoia, difficulty remaining indoors, driving toward substances that overtake all other priorities and delusional distortions about current conditions – all are symptoms that must be contended with so that, ultimately, a chronically mentally ill patient might accept housing and vocational rehabilitation.

I would also urge the California State Legislature to look at finding ways to increase funding and access to conservatorships for patients with chronic symptoms that prevent them from certain decision making about their wellness, and interfere with their ability to participate in care. Combined with passing SB 640, such reforms are crucial to helping the least among us in this ongoing crisis.

Dr. Drew Pinsky, M.D., Board Certified Internist and Addiction Medicine Specialist, hosts Dr. Drew Midday Live with Leeann Tweeden, noon to 3 pm on 790 KABC