MENTALLY ILL PEOPLE IN SAN FRANCISCO ARE CYCLING IN AND OUT OF EMERGENCY ROOMS by Heather Knight

Three people have forwarded this article to me. Heather Knight is a journalist who often writes about mental illness.

MENTALLY ILL PEOPLE IN SAN FRANCISCO ARE CYCLING IN AND OUT OF EMERGENCY GOOMS. ONE DOCTOR SHARES STORIES ABOUT OUR BROKEN SYSTEM.

Mentally ill people in S.F. are cycling in and out of emergency rooms. One doctor shares stories about our broken system

Dr. Scott Tcheng will never forget some of the people who come to his San Francisco emergency room in desperate need of help.

One man who arrived by ambulance looked like the Joker, his face and hands covered in animal blood. A 911 caller had spotted him eating a raccoon crushed by a car on a city street.

Tcheng has treated patients high on methamphetamines who are convinced a mouse is crawling inside their body or that someone has cut off their genitals with a sword.

One person on meth was treated after trying to steal a parked ambulance — with a patient inside. Another tried to captain the Pampanito, the floating submarine museum at Fisherman’s Wharf, but fell into the bay. He had hypothermia by the time a rescue team fished him out.

Just the other day, Tcheng treated a 31-year-old woman who is homeless, suffers from schizophrenia and has come to the ER about 150 times — usually to request pregnancy tests, but sometimes just for food and a place to sleep. This time, the pregnancy test came back positive, but the woman refused offers of hotel vouchers or a shelter bed. So the hospital released her back to the streets.

Other patients suffering from severe, untreated mental illness or meth-fueled psychosis have become violent toward hospital staffers, wrecked medical equipment, brandished knives and hurled their own feces. Some return to the ER shockingly often. Tcheng said one of his patients has visited emergency rooms around San Francisco hundreds of times in the past year.

What unites these patients, beyond their struggles, is their clear need for long-term care. But they’re usually not getting it. Not even in a rich city and a rich state that claim to be compassionate and caring.

The patients are often too sick to accept care. And frequently, there isn’t enough care, or adequate services, to meet their needs. Tcheng must send them back into the world, untethered, until the next ER visit.

“It’s so important that the people of San Francisco know about this,” Tcheng said, explaining his decision to go public about his patients. “They walk by it every day on Market Street and in SoMa, but the average San Franciscan doesn’t realize how deep it goes.”

Tcheng said he’s “cautiously optimistic” that a sweeping new proposal from Gov. Gavin Newsom could make a difference.

Called CARE Court, Newsom’s plan would require every county to provide needed treatment for people suffering from psychosis, whether due to mental illness or drug addiction, and would mandate that patients accept the help. Patients could be brought to the civil court because they allegedly committed a crime, because their involuntary psychiatric hold is ending or because they’re deteriorating on the streets.

If they don’t comply with a court-ordered treatment plan, a judge could turn them over to the regular criminal system, order additional involuntary holds or move toward conservatorship.

Newsom’s proposal suggests he has learned lessons since his time as mayor, when he dealt with recession-fueled budget cuts in part by slashing the number of psychiatric beds at San Francisco General Hospital. A dire bed shortage remains all these years later. He also cut beds in homeless shelters and closed drop-in centers where people could get help during the day.

San Francisco General Hospital is now the only hospital in the city with a dedicated psychiatric emergency room, but there are far more people needing its services than there are beds. So they’re often taken to regular emergency rooms for stabilization or because they also have medical issues that need to be addressed.

That sometimes means other patients — with strokes, heart attacks or injuries — must wait, Tcheng said.

“Someone coming in three and four times a day takes a toll on the system,” he said. “It’s incredibly dispiriting.”

He compared the fight against San Francisco’s threefold crisis — a lack of housing, mental health care and drug treatment — to building a three-legged stool. Addressing just one or two legs won’t work.

Tcheng, a 36-year-old Potrero Hill resident, works in four emergency rooms around the city, but couldn’t get permission from his bosses to name them. But really, they’re interchangeable — each one flooded daily with unsheltered patients suffering from psychosis who need treatment but aren’t getting it.

Rachel Rodriguez, a social worker in another emergency room in the city, confirmed the crisis exists at her hospital, too. She couldn’t talk for a while Tuesday because, as she texted, her ER was “bursting” with psychiatric patients. She said social workers are so strapped caring for psychiatric patients that they often can’t provide help to others who need it — such as domestic violence victims or those hurt in car crashes.

She has started emailing the Department of Public Health every day with a tally of the people waiting for acute psychiatric beds in her hospital alone. One email from last month showed 15 patients ranging in age from 21 to 86, a few waiting a month or longer.

Rodriguez said she’s reserving judgment about Newsom’s plan. But her husband, Charlie Berman, a clinical social worker in San Francisco, said he fears it’s nothing more than “a political facade masking the ineffectuality of a rotten system,” and called the city’s emergency rooms “extensions of the Tenderloin with ambulances providing taxi service in between.”

Berman said the governor’s plan will fail without a major investment in locked psychiatric wards and beds designed for people with both mental illness and substance use disorder. Both are very expensive.

Tcheng is more hopeful — provided the governor finds the money to pay for treatment through CARE Court. Civil libertarians are already speaking out against the plan, saying that mandating care is inhumane and not as effective as providing voluntary services, but Tcheng said the real inhumanity is playing out in the city’s emergency rooms every day.

“I fundamentally reject the notion it’s more compassionate to let these people live on the streets and die in alleyways than to mandate that they get care,” Tcheng said. “I just think it’s appalling what San Francisco has allowed to happen to some of these patients.”

He cited Mary Botts, the San Francisco homeless woman dubbed “Princess Leia” for often wearing her hair in buns on the sides of her head, sometimes held together with syringes. She frequently walked into traffic at Castro and Market streets and slept in the gutter.

Tcheng said he treated her at least a dozen times — but kept releasing her back to the streets because she didn’t want help and there was nowhere to send her. She died of a drug overdose in November 2020 at age 28.

At a Board of Supervisors hearing last week, Superior Court Judge Michael Begert addressed the severe shortage of treatment beds. He oversees drug court, which aims to clear defendants’ arrests if they can prove they’ve successfully addressed the drug problem that led them to commit the crime. Begert said he has never been able to access a treatment bed for somebody who allegedly committed a crime and suffers from both mental illness and a drug addiction. Instead, such people often linger in jail — with one person waiting 264 days behind bars for a bed — until they’re eventually released, having further deteriorated while jailed.

“This is not treatment on demand, and they’ve been talking about treatment on demand for at least 25 years,” Begert said.

Two years ago, the Department of Public Health released a study stating the city needs 400 more treatment beds, but it’s added only 89 beds since then. And even 400 might not be enough, said Supervisor Hillary Ronen. She said the board hearing left her with “a mix of exasperation, sadness, frustration, but also a new resolve” to vastly improve the city’s mental health system.

Ronen said she doesn’t know enough about CARE Court to form an opinion, but hopes it’s not another “shiny new program” from a politician wanting to look good.

For now, Tcheng will keep seeing the same patients in his ER, and many will leave no better off than when they arrived. The man who tried to steal the submarine got released after he slept off his high. Tcheng doesn’t know what happened to him after that.

As for the man who ate a raccoon?

Tcheng said he asked a psychiatrist to evaluate whether he should be treated under an involuntary hold. But, he said, the man wasn’t deemed to fit the requirement of being “gravely disabled” under state law if he could secure his own food. Even if that food was roadkill.

Tcheng said he managed to get a different doctor to test the man for rabies, but he lost track of him after that.

“Hopefully, he got some sort of psychiatric care,” Tcheng said. “But knowing San Francisco, I doubt it.”

San Francisco Chronicle columnist Heather Knight appears Sundays and Wednesdays. Email: hknight@sfchronicle.com Twitter: @hknightsf

Dr. Scott Tcheng is an emergency room physician at several San Francisco hospitals.

Photo: Carlos Avila Gonzalez/The Chronicle

From the oldest

REMEMBERING ROSE KING by Dede Ranahan

Last night I lost a friend. A friend I never thought I'd lose. Someone as full of passion and fight and purpose is never supposed to leave. Teresa Pasquini called me this afternoon to let me know that Rose King passed away while undergoing emergency surgery. This is not supposed to happen. By my best estimate, Rose was around 82. The last time I saw her was January 16, 2014. We met for lunch and I wrote about our meeting in Sooner Than Tomorrow.

Rose was a giant (too small a word) in California mental health politics. She co-authored the 2004 Proposition 63 Act to fund mental health services for the seriously mentally ill. Or so she thought. Disappointed in its implementation, she turned around to become one of its fiercest critics saying that it needed more oversight, that it was losing focus, and it was being diluted from its original purpose. This was not kosher. Political interests began to take umbrage at Rose and her challenging the system. Again.

Rose lost her husband when she was a young mother of three children. He killed himself in their home. Later her son would take his life at approximately the same age that his father had taken his. In her 70s, Rose supported two grandsons stricken with the family illness. Then a grandson, well and thriving, died by electric shock while working on a construction job.

How much can one person take?

From Sooner Than Tomorrow:

January 16, 2014: Rose.

My friend Rose and I are meeting for lunch. She's 75 and such a trooper. She's still fighting the exhaustive fight for a competent mental health system. She's one of three co-authors of California's Prop 63, the Mental Health Services Act.

Disappointed in its implementation, Rose lobbied for an audit by the California State Auditor. The auditor reported that it wasn't possible to determine whether Prop 63 programs had been of benefit to those served, had improved community mental health delivery, or whether programs had complied with the requirements of the law.

In addition to the appalling number of untreated mentally ill, Rose, based on her continuing research, believes eighty percent of those in the system are not receiving adequate care. "Parity, she says, "we still don't have parity for physical and mental health."

Rose's husband and son always come up in our conversations. They both ended their struggle with mental illness by suicide. Two grandsons -- one is living with her -- also deal with the illness. We agree. If all the parents and grandparents housing their mentally ill children and grandchildren were to dump them on the street, there'd be major socio-economic fallout. Our health and welfare programs would be more overwhelmed than then already are. These family members, who've given up on the mental health system, are a hidden, unappreciated population.

We change the subject. We talk about Rose's 75th birthday party. We talk about my mother, my children, and grandchildren. We try to talk about everyday things like average folks. We hug goodbye and remind each other, "Take care of yourself."

Goodbye dear Rose. Take care of yourself, finally, and rest in peace. I love you, forever. Dede.

LETTER TO SENATOR WYDEN AND THE SENATE COMMITTEE ON FINANCE by Dede Ranahan

November 1, 2021

Dear Senator Ron Wyden, and other members of the Committee on Finance:

This is in response to your request for input from stakeholders to help you better understand how Congress can address behavioral health care challenges.

First, thank you, Senator Wyden, for keeping at it. I’m sure you don’t remember, but back in the late 1990s you intervened for my son who was delusional and psychotic in Oregon. He died in a California hospital psych ward in 2014. He never did receive the help he needed for schizo-affective disorder. In the interim, I became a mother bear and mental illness activist. I’ve written two award-winning books, Sooner Than Tomorrow — A Mother’s Diary About Mental Illness, Family, and Everyday Life (Nautilus Book Awards Gold Medal Winner, Memoir, 2019) and Tomorrow Was Yesterday, Explosive First-Person Indictments of the US Mental Health System — Mothers Across the Nation Tell It Like It Is (Nautilus Book Awards Silver Medal Winner, Social Change, Social Justice 2020). The second book includes stories from 65 mothers from 28 states, and a fifteen-point plan to address serious mental illness (SMI - schizophrenia, schizo-affective disorder, bipolar disorder, clinical depression, etc.). The plan was developed in 2019 by advocates/activists from across the country.

In January 2021, 150 Tomorrow Was Yesterday readers, from every state in the nation, volunteered to send a copy of the book to the White House (Joe Biden, Jill Biden, Kamala Harris, Xavier Becerra, and individual legislators) thinking 150 copies of the same book from every state might get someone’s attention. Five months later, we all began receiving form letters from the White House thanking us for our “gifts” and for welcoming Joe Biden to the Presidency. No mention of the topic. No reference to the books. It was hurtful and insulting.

The 15-part plan was prioritized by the participants. The number 1 priority on their list is to "Reclassify Serious Mental Illness (SMI) from a Behavioral Condition to what it is, a Neurological Medical Condition." Until we look at SMI through a biological/physical lens, the significant changes we users of the system need will not happen.

I’m not trying to specifically address the questions you’ve posed in your letter. The SMI Plan cuts through all of them. More significantly, it raises issues not included in your list. The suffering in the SMI community (11-13 million diagnosed individuals plus their families) is intense. We’re screaming to the heavens for help. So far, no one seems to be listening.

Summary from Tomorrow Was Yesterday:
“As it stands today, the US mental health/illness system is filled with political landmines and gut-wrenching divisions: parents vs. children, peer organizations vs. family organizations, voluntary vs. involuntary treatment concepts, psychiatrist vs. psychologist turf wars, state vs. federal jurisdictions, HIPAA restrictions vs. parental rights, lack of beds vs. incarceration, unions vs. providers, psychiatry vs. anti-psychiatry, civil rights vs. dying with your rights on, NIMBYism vs. housing, traditional medicine vs. holistic medicine, and funded advocacy organization vs. unfunded grassroots advocacy efforts. I watched my son Pat die because the system is tied up in bureaucratic and philosophical knots.”

I would be happy to send you a copy of Tomorrow Was Yesterday which includes the 15-point plan to address SMI. My hope is that you, and others on the committee, might read our stories, take the plan seriously, and pursue some of its recommendations. It’s a beginning. It’s from the people in the trenches -- the sufferers, the families, the folks the system is supposed to help.

Thank you for reaching out. Let me know if/where I should send a copy of Tomorrow Was Yesterday.

Sincerely,
Dede Ranahan

Available on Amazon

HOW DO WE GET A NATIONAL PLAN FOR SMI? by Dede Ranahan

Just downloaded the White House National Strategy for the COVID-19 Response and Pandemic Preparedness (198 pages). It lays 7 goals out in detail. To date, 24 million Americans have contracted COVID and over 400,000 have died. Hopefully this will be a time-limited health crisis.

Right now, between 11-13 million Americans (and by extension 11-13 million families, maybe 44 million more Americans) suffer from the ramifications of SMI each year. This crisis isn't time-limited.

The country is being crushed with multiple crises, but our on-going SMI crisis needs to be added to the crises requiring immediate attention -- a National Plan. It's way past time to ask for a National Plan.

From Tomorrow Was Yesterday: “As it stands today, the US mental health/illness system is filled with political landmines and gut-wrenching divisions: parents vs. children, peer organizations vs. family organizations, voluntary vs. involuntary treatment concepts, psychiatrist vs. psychologist turf wars, state vs. federal jurisdictions, HIPAA restrictions vs. parental rights, lack of beds vs. incarceration, unions vs. providers, psychiatry vs. anti-psychiatry, civil rights vs. dying with your rights on, NIMBYism vs. housing, traditional medicine vs. holistic medicine, and funded advocacy organizations vs. unfunded grassroots advocacy efforts. I watched my son Pat die because the system is tied up in bureaucratic and philosophical knots."

There will never be a better time than now to ask for what we need and deserve. How can we make this request?

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GOOD AND BAD IN 2020 by Dede Ranahan

I’m pleased to report that Tomorrow Was Yesterday — Explosive First-Person Indictments of the US Mental Health System — Mothers Across the Nation Tell It Like It Is — is doing really well. Thank you to those of you who have already purchased and read our book (65 mothers from 28 states). Thank you to those who have left reviews on Amazon. Reviews help spread the word.

Some exciting new connections are developing from the publication of this book. Too soon to talk about, but more good things might be coming. Keep fingers crossed…

Click on this link to the book’s page on Amazon:

Meanwhile, goodbye 2020. What a year! A friend, just diagnosed with Covid says, “You don’t really have a bubble because people are careless.”

Please stay safe and well in 2021. Over and above surviving, may the new year bring you and your families many blessings. Love, Dede

Please stay safe and well in 2021. Over and above surviving, may the new year bring you and your families many blessings. Love, Dede

ALL THE BEST FROM ME TO YOU by Dede Ranahan

Thanks to my new kitty, Detective Lucas Whiskers, being sick, and getting old/er, I’ve “set up” my simplest Christmas tree ever. In this chaotic 2020 year, simple feels comforting to me. So I'm sending simple wishes to all.

MERRY CHRISTMAS1 HAPPY HOLIDAYS! STAY SAFE AND WELL.

MERRY CHRISTMAS1 HAPPY HOLIDAYS! STAY SAFE AND WELL.

TOMORROW WAS YESTERDAY - INTRODUCING THE AUTHORS (4) by Dede Ranahan

Introducing authors of the 65 stories in Tomorrow Was Yesterday - Explosive First-Person Indictments of the US Mental Health System — Mothers Across the Nation Tell It Like It Is.

This book is now available on Amazon
: Click on this link.

FROM NORTH CAROLINA
Gwendolyn Bartley: “It’s Kind of like a Daily ‘Sophie’s Choice’”
Gwendolyn is the mother of five (now adult) children through the blessing of adoption and natural birth. She is the founder and executive director of Amazing Grace Advocacy, a non-profit that supports families raising children with brain disorders in Concord, North Carolina. Gwendolyn serves on several community, state, and national initiatives to advocate for access to appropriate services for children with serious emotional disturbances (SED).

Sherri McGimsey: “What Would You Do?”
Sherri is a wife, mother of two sons, grandmother, business owners for 39 years, and a national advocate for SMI. Her eldest son, Matt, has schizophrenia. Sherri’s a member of NAMI South Mountains, North Carolina and serves on the NSSC (National Shattering Silence Coalition). She’s a trainer in NAMI’s Family-toFamily class and in the Crisis Intervention Team (CIT) for police and law enforcement. “A Mother’s Prayer for Mental Illness” guides her on this journey.

FROM OHIO
Nikki Landis: “Nikki and Kevin”
Nikki is the mother of five and homeschools her children on a small farm in rural Ohio. She loves to read and learn new perspectives. Her childhood dream was to have a large family, live in the country, and write. She continues to pursue her dreams despite how SMI has affected her life and she encourages everyone to do the same.

FROM OKLAHOMA
Audrey Adams Auernheimer: “For Now I’m Thankful Adam is Alive”
Audrey is the mother of four children, three of whom have been diagnosed with mental illness. Her son, Marty, was diagnosed with schizophrenia at age 22. Her only daughter Candace was diagnosed with depression with suicidal ideation at age 12. Marty died at 28 and Candace died at 26 to suicide. Her 30-year-old son, also diagnosed, lives with her. The youngest son remains untreated and barely functional, mostly due to anosognosia.

FROM OREGON
Carole McAfee: “A Mother’s Fight”

Kecia Bolken Speck: “I’m Never Calling the Crisis Team or the Police Again”
Kecia is the mother of two adult children and currently lives in rural Oregon. She works in pediatric occupational therapy and takes care of her 29-year-old son full-time. Her dreams for the future are to change the education of first responders, to ensure the funding of skilled crisis teams, and to decriminalize serious mental illness. “My family’s lives depend on it. Nobody should ever have to go through this alone.”

Sharon Underwood: “Why Is This Okay?”
Sharon is a single mother of four. Her mentally ill son Tim is her youngest child. Sharon’s been a caregiver for the elderly for over 25 years.

FROM PENNSYLVANIA
Holly Alston: “Mommy Please Clear My Name”
Holly’s son suffered from schizophrenia and other mental health issues. He was in prison for over seven years while his mental health was ignored. When Terrell was in isolation, he would scrape his eyebrows off and pluck out his eyelashes. “He was released from prison 8/8/16 and by 8/20/16 he was dead.”

Mary A. Butler: “Let’s Talk About hopeful Voluntary Admissions”

FROM TEXAS
Joyce Berryman: “Stuck in Texas”

Channin Henry Williams: “I See Change Coming”
After 14 years of giving so much of herself to meet her daughter’s special needs, Channin is now focusing on her husband, hobbies, and finding her way. “Raven left the institution on her 18th birthday. Soon all communication stopped. My greatest nightmare came true. How should a mother like me grieve or even feel? It is my supportive family and faith in Jesus Christ that has given me strength and hope that change is coming.”

FROM UTAH
Heidi Franke: “I Am Livid. Shaking”
Heidi is an RN. She’s been living through the diagnosis of her youngest son’s pervasive mental illness and struggles with addiction. Her goal is to empower parents to speak up to help overcome obstacles to care for their children. “By telling our stories, we give permission to others to start telling theirs.” Heidi makes mending herself a personal daily engagement project “as we must put on our oxygen mask first to help those beside us.”

FROM VIRGINIA
Pat Wood: “Our Son’s Preventable Death”
After his first year of college, Pat’s elder son was diagnosed with bipolar disorder. “His death by suicide at age 38 was the outcome we’d fought against for years and was our worst nightmare come true.” Pat’s younger son also has a mental illness. “There have been many medications, hospitals, therapists, psychiatrists, and less-than-successful battles to get the services my children needed. My younger son’s uncertain future remains my concern and focus now.”

FROM WASHINGTON
April: “Helping Mr. K.”
April is a wife, retired direct marketing creator, and sibling to Mr. K. Her mother died seven years ago with no plan in place for her brother’s care other than the designation of “Social Security Payee.”

Jerri Clark: “My Goal Is Not Happiness but Human Understanding”
Jerri advocates for treatment access in Washington State where she started Mothers of the Mentally Ill (MOMI). She and her husband (married since 1994) have a daughter and two grandsons. Their son Calvin died from suicide March 1, 2019.

Jerri Clark with son Calvin

Jerri Clark with son Calvin

TOMORROW WAS YESTERDAY COMING TO AMAZON NEXT WEEK by Dede Ranahan

So Excited!

Tomorrow Was Yesterday authors great news! Our book will be available on Amazon the end of NEXT week. Be bold. Be proud. Be comfortable in what we're doing — getting our stories out to the unknowing public. I know we'll make an impact. Thank you and love to all of you. Dede

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