In SF and throughout California, people with serious mental illnesses languish without treatment in prisons and hospitals


As public pressure mounts on San Francisco and other cities to force the mentally ill and homeless into treatment programs, many of those already confined under so-called “conservation” n have nowhere to go.

There are at least 56 people in regular short-term treatment hospitals such as Zuckerberg General Hospital in San Francisco, as well as six people in the city’s jails, who are under mental health care ordered by the San Francisco court but awaiting a long-term treatment bed to open.

A person at a local jail has been waiting for a treatment bed for nearly 1,200 days, according to Kara Chien, chief counsel for the SF public defender’s mental health unit.

The problem extends far beyond SF: In a statement, the California Department of State Hospitals said there are currently 99 people above its contract bed allocation for those under guardianship.

“Even though guardianship is the last level of care, there is no care available,” Chien said.

Guardianships give the courts or other guardians legal authority over a person who has been found unable to care for themselves. They have drawn new attention as the homelessness crisis explodes, with many calling for a more aggressive use of guardianship for people struggling with addiction and mental illness.

A new state program called court of care– created by the CARE (Community Assistance, Recovery and Empowerment) Act – could end up bringing even more people into conservatorship and worsening the backlog.

Health care providers, advocates and local leaders blame a shortage of intensive mental health facilities at the state level, as well as a lack of services to help people avoid guardianship altogether.

“No one at the state level is taking responsibility for these issues,” said SF supervisor Rafael Mandelman, who argued for increased guardianship. “We need another state psychiatric hospital […] and it wouldn’t even begin to scratch the surface of need.

SF supervisor Rafael Mandelman, during a press conference on Tuesday, September 6, 2022 in San Francisco, California | Paul Kuroda for The Standard

San Francisco primarily sends people to Napa State Hospital, one of six psychiatric hospitals in the state, which has about 1,255 beds. In SF, there are 94 city-contracted treatment beds for people under mental health care. Yet currently, the city retains nearly 600 people in various types of mental health guardianship, which are assigned based on the patient’s diagnosis and propensity for violence.

At a recent hearing, nurses at SF General Hospital described dangerous conditions in the city’s emergency units thanks to a revolving door of patients in serious mental health crisis. The Department of Public Health acknowledged in a statement to The Standard that the city’s long-term mental health facilities are generally at capacity, leaving mentally ill patients to wait in regular hospitals while vying for numbers. limited number of beds at the state level.

The California Department of State Hospitals highlighted Governor Gavin Newsom’s investments to help localities build more mental health infrastructure, including $2.2 billion in grants for new behavioral health facilities and $1.5 billion for “bridge housing” for homeless people with behavioral health issues.

See also

Governor Gavin Newsom speaks during a press conference Wednesday, Feb. 9, 2022, in Oakland, Calif. | Aric Crabb/MediaNews Group/East Bay Times via Getty Images

Alex Barnard, a New York University sociology professor who has written extensively on California guardianships, said the state needs to improve coordination among counties fighting over treatment areas.

In a general hospital, retained patients are at risk of infection and nurses trained to provide stabilizing care are not equipped to provide long-term mental health rehabilitation.

“An acute care hospital is not a place where people live,” Barnard said. “It’s demoralizing for the staff. Your training is to deal with acute crises and instead you have someone who just lingers.

Several nurses at SF General Hospital declined to be interviewed for this story due to the sensitivity of the issue. Dignity Health, a nonprofit that operates two hospitals in San Francisco, said in a statement they had seven patients on file this month.

“These patients typically stay with us for long periods of time as it is difficult to find a safe destination due to the shortage of custodial and long-term psychiatric care facilities,” the statement said. “When retained patients are committed to acute care hospitals but do not need acute care services, we lose the opportunity to help another patient in crisis.”


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