In the past, the solution to this paradox was compulsion. The state took custody of the “gravely disabled” and treated them in long-term residential institutions. However, with the exposure of civil rights abuses and the release of Ken Kesey’s 1962 novel, “One Flew Over the Cuckoo’s Nest,” the United States gradually dismantled its mental health system, reducing the number of mental health beds per capita by an astonishing 95% between 1955 and 2016. Today, California has fewer beds per capita than the national average, with San Francisco having only 219 adult psychiatric beds available at a given time — drastically insufficient for the number of people in need.
Although Mayor Breed has tentatively moved towards a return to short-term “conservatorships,” a form of involuntary commitment for individuals who present a grave danger to themselves or others, the plan has neither the scope nor the force to significantly reduce the numbers of the perilous trifecta. Because of pressure from disability activists and the ACLU, which have called conservatorships “the greatest deprivation of civil liberties aside from the death penalty,” the plan is limited to individuals who have had eight or more involuntary psychiatric holds in the past year, which, in practice, would mean less than 100 people citywide.
The writing was on the wall when I left San Francisco in the mid-’90s, and politically the city has moved far left from even where it was back then.