State Hospitals for Severely Mentally Ill Homeless Should Be Revived

Myth 1: Mental hospitals take away freedom. Aside from involuntary commitments for people who are a danger to themselves or others, loss of freedom isn’t necessary. A clinically informed approach respects patients’ wishes to leave the hospital. Staff and hearing judges can sometimes mistakenly overextend stays, but a hospital mission favoring and facilitating patients coming and going between their communities and their regional hospital can mitigate mistakes, even improve clinical outcomes.

Myth 2: State mental hospitals are snake pits. I have worked at state hospitals. They all had caring staffs. The myth derives from bestsellers of the 1900s that dramatically fictionalized actual neglect and cruelty that today’s safeguards can recognize. The real snake pits today are the city jails where people with serious mental illness are hospitalized after minor crimes because there is nowhere else for them to go. Treatment in jails is sham treatment.

Myth 3: State mental hospitals are too expensive. San Francisco haplessly cares for its homeless people who are ill at a cost of $360 million a year. This doesn’t include the cost to the city from residents and visitors abandoning its center. If 40 million Californians paid an average of $100 more in taxes, it would generate $4 billion, sufficient for residential care for all unsheltered people with serious mental illness in all of California. How does this compare with the cost of managing our sadness and guilt at witnessing people suffering on our streets and turning away from them? ■