Anyone walking around San Francisco is likely at some point to catch a glimpse of people who suffer from a mental illness or have a psychiatric problem. And though there have long been anecdotes about an increase in people with such issues, there is evidence that the number of those brought to hospitals for involuntary psychiatric holds has indeed increased in recent years.
The problems surrounding this issue are multifold and nuanced. The quest for solutions should involve multiple stakeholders coming together in search of a holistic approach.
In 2009, 5,837 patients were admitted to San Francisco General Hospital's Psychiatric Emergency Services unit. That is The City's primary site for psychiatric patients — basically the equivalent of a medical emergency room for mental health services.
In 2012, admissions for psychiatric holds increased to 6,293 — and that is just a slice of the issue, since other hospitals in San Francisco also treat psychiatric patients with lower-level needs.
Officials at S.F. General say that even after losing six beds in recent years, their hospital has the resources to treat these acute patients. But problems arise once such patients are out of care. Many of the patients need longer-term support of some sort, including hospitalization.
And officials say there are not enough long-term and outpatient services to meet this increased demand. And for the ones that do exist, there are long waitlists.
So while the hospitals continue to admit and treat such psychiatric patients, there is no follow-through for ongoing care. That can leave patients to fall back, especially if they lack a strong social network of friends and family. The most visible manifestation of this population is those unfortunate people who end up living on the streets of our city.
In fact, the homeless count recently conducted in San Francisco bears out that there has been an increase in the percentage of people living on the streets or in shelters who report having a mental illness, addiction or debilitating physical condition. Sixty-three percent of respondents reported having such a condition, an increase from 55 percent just two years before.
Although people who live on the streets are the most visible of those who need help for psychiatric or mental health problems, an untold number of others continue on after their emergency is over without the proper followup to recover fully or prevent a relapse to the break that landed them in the hospital to begin with.
The many hospitals in The City need to create a working group with neighborhood clinics and various San Francisco nonprofits to create a model in which patients of every income level can be properly routed to the lower-level psychiatric care that they may need after hospitalization. This group should create the model of followup care and, if need be, go to San Francisco for funding.
Psychiatric issues and mental health problems are not a failing at the personal level. But we need to stop letting the treatment be a failure at the societal level.