A hearing today on the prospect of a new criminal justice-mental health facility in San Francisco brought up a couple of key issues that will define the debate over how the city replaces the crumbing and unsafe Hall of Justice and its inhumane jails.
The first is that San Francisco is doing a scary bad job dealing with mentally ill people in the criminal justice system. The number of critical-care beds at SF General has declined from 87 to 22. Vastly larger numbers of people with mental illness are in the justice system – under arrest, in jail, going through court hearings, and to an alarming extent, not getting the care they need.
Sup. Jane Kim talked about visiting the mental-health facility at the SF County Jail and walked away deeply traumatized. Everyone agrees that people who are confined in a prison environment when they are mentally ill are going to get worse, not better.
In fact, Jennifer Johnson, a public defender who represents mentally ill people who are charged with crimes, often serious crimes, said that her clients can’t find space in community treatment centers. They have to go through a long series of interviews, many are rejected, and if they finally find a bed, they can be bumped by someone coming out of SF General.
Meanwhile, SF General is so overcrowded that is has been unable to take any new patients for the past two months.
It’s a terrible situation, and there’s no easy answer.
Johnson is part of a task force sponsored by District Attorney George Gascon that has proposed that the city replace the Hall of Justice, which has to come down, with a four-story mental-health facility offering four different levels of care, including a secure ward for people who would otherwise be in jail.
The center would have an intake facility on the first floor, open to anyone, and varying treatment options, run by health professionals, on the second and third floors.
But some of the people who led the fight to block the city from building a new jail now say that the proposal is just a new lockup under a different name. “They have described this center as just a different kind of jail,” Campos said.
The responses from the supporters and from community advocates reflect very different ideas about mental illness and criminal justice.
Johnson said that “it’s anything but a jail.” She noted that right now, there are no options – her clients are often accused of violent crimes, the most common being assault with attempt to commit bodily injury, and “no judge is going to release them to a program or the street.”
The only choice, she said, is a secure – that is, locked – treatment facility.
Sup Jane Kim raised another complex issue: Under what conditions would people be forced to accept medication or other treatment, and when would they have to consent?
Johnson noted that “the minute you are put in handcuffs, nothing is voluntary. We need these services, because my clients in the justice system get the short end of the stick.”
Kathleen Lacey, a social worker who handles mentally ill people in the justice system, explained that “these are not easy people to treat in the community.” Many are violent, and there are public-safety concerns.
I don’t think anyone disagrees with that.
But there’s a lot of disagreement about whether it’s better to build a centralized facility of this sort or to put the money – many millions of dollars – into community-based alternatives.
Among the questions:
Would the new center be run by the Department of Public Health – or by the Sheriff? At this point, nobody knows. Since it would be part of the criminal justice system, the courts would probably want the sheriff to be involved, which would shift the place further towards law-enforcement and away from health.
Who would get to transfer from the jail to the new Behavior Health Justice Center? Would that be voluntary? Would a judge (or the sheriff) decide?
Would people who are facing criminal charges get credit for jail time if they’re in treatment? When would they become patients instead of prisoners?
Would people in the secure facility have the same rights as prisoners (for example, family visits)? How would bail apply here?
How would people be released – after their sentence, or after (someone) decides their treatment is complete? And where would they go on release? What if they came in homeless?
“Fundamentally we have a capacity issue,” Roma Guy, a longtime health-care advocate and one of the leaders in the anti-jail campaign, testified. She noted that the plan calls for the new center to be a “bridge” – but a bridge to what? And is institutionalization the best solution to mental illness?
“I think we can do better,” she said.
But Sup. David Campos, who was one of the first to oppose the construction of a new jail, noted that “the status quo just isn’t working, and we need to do something different.”
What the city really needs – and what makes the most sense on every level – is to invest money now in community-based treatment centers that can intervene before people get so sick that they wind up getting arrested. Prevention is way cheaper, and everyone knows that.
Many of the people who are now getting put in handcuffs for violent behavior might not be in that situation if there were more options, particularly for homeless people with serious mental-health issues. As Guy noted, there’s no capacity right now; we continue to treat this as a crime issue, not a public health issue.
This is going to be a long discussion, and it’s going to involve a lot more than just a new building. San Francisco has a chance to set a new national standard for taking care of people who are mentally ill and in the criminal justice system – but it has to be more than a building.