The Externalities of Mental Illness

A stranger attempting to lure a three year old away from the child’s older sister with candy is odd, not to mention, bold. For the stranger to then follow the two children into their home and try to pry the younger child from her mother’s arms is unbelievable.  Although this might sound like a nightmare, this scenario actually took place last week in San Jose. The stranger is a woman whom suffers from mental illness and was subsequently arrested.

We come in contact with people suffering from mental illness every day.  Many people who suffer from mental illness can function quite well under medication and psychiatric supervision. However, there are others with mental illness who are unable to function well or cannot fit in under societal norms because they experience delusions.  For example, some people who have bipolar disorder can function and be fully employed and provide shelter for themselves and family. On the other hand, people who suffer from schizophrenia are usually unable to work but may be fortunate enough to be cared for by family or perhaps in a group home. Unfortunately, many mentally ill people are homeless.

In 1963, Pres. John F. Kennedy sent a special message to Congress to replace mental institutions with foster-home services. At the state level, Gov. Ronald Reagan was largely responsible for the deinstitutionalisation of facilities for the mentally ill. In my view, their decisions have contributed to the lack of care for mentally ill people in our society and have caused many to become homeless. As a result, we see many mentally ill people living in parks and creek beds within our neighborhoods.

Mental illness is a complex issue and a difficult one for police departments to deal with on the street level.  On one hand, we want to help those who truly cannot help themselves, which includes individuals with mental illness. On the other hand, like in the example I stated above, when a crime is being committed and/or about to be committed, and a call for service comes from a resident who sees someone doing something “weird” or “threatening,” police respond. These calls are risky and may require the use of physical force by police and sometimes deadly force due to threatening behavior from the suspect towards police.

I believe that if we brought back institutions for the mentally ill that many of these encounters would not happen. I am well aware that there is a cost to provide these services, however, the cost of not providing them is higher since there is the cost for police, ambulance, increased public health care costs, etc… Personally, I feel tax revenues that go to people who truly cannot help themselves is a good use of our tax dollars.  (Similarly, I view Social Security as a tax that I pay for existing retirees with no expectation of actually receiving the benefit myself.)

What has replaced a centralized institution for those that suffer from mental illness are disparate group homes often run as a business where proper supervision is not provided.  These homes often upset neighbors with the occupants’ strange behaviors, like talking to themselves and personal appearance, in part since proper medical supervision is not provided.

Those that are truly mentally ill are not people we should throw away but rather the challenge is how do help them even though they may decline assistance? How can someone who is unable to reason coherently be able to opt out of assistance that could help them?

Understanding that this is a state/county issue, as with most everything else, it all rolls down hill to cities. I remember one of the reasons I voted for Al Gore in 2000 was that Tipper Gore, his wife at the time, was an advocate for the mentally ill. Also, this issue can put partisan politics aside when Republican Senator Pete Domenici and now deceased Democratic Senator Paul Wellstone collaborated on federal legislation regarding mental illness. The side story is that both Senators had a brother that suffered from mental illness.

This blog is an observation of where state policy does not provide for the needs of mentally ill people and as a result, puts undo pressure at the city level.


  1. You titled the blog correctly.  But as usual, you fail to go all the way.  LANTERMAN ACT was a act that deinstiutionalized people calling for COMMUNITY MENTAL HEALTH PROGRAMS.  It was state law to close the hospitals, but to use community resources to find community centers.  Reagan erred by closing the hospitals and not funding the community programs, but Lanterman started the process with the law.  Try to do some homework for a change.  There are interesting and tragic forms of mental illness.  I believe it is tragic to have a guy address city councils in San Jose and other cities claiming to be God.  I think it is a form of mental illness to take a picture of little girl being shaken by an athlete with money coming out of her little purse.  I also think it is a form of mental illness to sit in front of City Hall and starve yourself.  These are examples of people who claim to be normal, but are crazy.  I think a woman who has several kids and is overwhelmed by it all, needs therapy and some lithium, not a snake put.  I think a guy who walks into meetings, begins to bully people with business cards and stares at them all night, is a sicko.  I think you should understand, that the baby goes out with the bath water once we open the hospitals up.  Why not create good hospitals for the severely developmentall disabled, these are the people who need state support.

  2. Pier,

    Have you ever seen or read “The one who flew over the cookos nest?”

    There was a reason we shut them down.  I’ll go through the laundry list.

    **Too many false positives
    Too often people would be locked away in these facilities for years.  Unlike the prison system where there’s a panel that weighs “cost of incarceration” to “danger to society” everything is left up to the discretion of the psychiatric staff.  In other words, there was no oversight to patient release.  No parole board.

    **Guards VS Orderlies
    The psychiatric profession was a stepping stone for correctional officers, but there was little to no background checking for Orderlies.  Tales of patient abuse (sexual, psychological, or exploitation) was common. 

    **Patient exploitation
    Remember that scene in Happy Gilmore where the Orderly (played by Ben Stiller) had his own little sweatshop in the retirement home?  Happened a lot in the larger state run hospitals (it’s starting to happen in China now)
    Another report shocked the nation last December when it was revealed that dozens mentally disabled men from Southwest China’s Sichuan province had been forced to work without pay for years in a sweatshop in Northwest China’s Xinjiang Uygur autonomous region.

    **Kickbacks from the pharm and insurance industries
    This still happens in the private sector, Pharmacutical companies spend an estimated 1bn a year trying to lure doctors to use their snake oils.  From high end kickbacks like trips to Hawaii, to the low end of having a scantily dressed “Sales Rep” come peddle their wares.

    This happened rampantly in the state run facilities.  Still happens in the privately run.

    During the six days Jeramy was held in the facility, he was drugged without his parents’ authorization and they were also refused permission to visit him. He was turned from a vivacious boy into someone with a glassy stare and dragging gait. The family’s health insurance was billed $11,000 (8,975) for this fraudulent “admission” and “treatment.”

    See.. The idea of giving these “quacks” state power scares me.  Building a large facility invites this abuse at a larger level.

    Let’s actually examine the things we could do to take care of these issues without having to dump billions into it ok?  Here are my ideas.

    1.  On a county level, give a substantial tax credit for anyone housing a family member with certifiable mental issues. I have a cousin that is schizophrenic, and his family takes care of him (he’s about 53 years old now) We love him very much, and without tax credit he’s taken care of, but not every family can afford to do this. 

    2. Reduce the cost of psychiatric medicine to something people can actually afford. 

    3. Create a “Therapy Voucher” system that any private sector therapist could benefit from.  Let the families decide on the best therapist for their ill family members, not the state.

    4. Form an evaluation board to determine a persons “mental health”  Why is it so many psychiatry battles end up in court?  It’s a waste of time/taxes.  Make something similar to a parole board..  Done.

    5.  Taking folks “out of their environment” can sometimes fix them.
    We all know when recovering addicts hang out with addicts that have access to addictive substances, chances are they’ll go right back to self medicating themselves.

    Keeping them with other addicts isn’t always the way to fix them.  We still have facilities “in the hills” around SJ that used to be used for semi-psychiatric uses (the old CYA camp along Mount Hamilton Road that’s now a fire station comes to mind) Building some monstrosity of a facility right next to the city will fix nothing for these folks.  Giving them a place to isolate for a time to get their heads straight will.

    Our current system of halfway houses and foster care is almost as bad as the old one, except now instead of psychiatrists keeping patients to bleed money from taxpayers/insurance, we have a bunch of slumlords doing the same. 

    Creek dwellers, depending on the type don’t bother me so much.  I can boil the creek dwellers into 4 categories.

    1. Migrant workers —These guys have the cleanest camps 30%
    2. Will work for fooders—mostly junkies, alcohol, meth, etc. 30%
    3. deranged and insane 20%
    4. Regular folks down on their luck and trying to keep a low profile 20%

    As you can see by my breakdown above, the deranged and insane only represent 25% of the total creekside population. (probably less, which is why I put down 20%)

    1. is an issue INS should deal with
    2. A lot of minors fit in here, pick them up and get a court order that they stay in a shelter
    3. Follow what I said way above about
    4. These are the folks that need the most help getting back on their feet.

    • Wow, you just don’t get it, do you? Outsourcing is not the alternative and has not been ever since Reagan dumped these people on the streets 30 years ago.

  3. The fastest way for San Jose to address this issue is to lobby Santa Clara County to implement Laura’s Law.  The law is already pass by the state legislature.’s_Law

    “As stated above the patient must have a serious mental illness plus a recent history of psychiatric hospitalizations, jailings or acts, threats or attempts of serious violent behavior towards self or others. The recipient must also have been offered an opportunity to voluntarily participate in a treatment plan by the local mental health department, yet fails to the point that, without a Laura’s Law program, he or she will likely relapse or deteriorate to the point of being dangerous to self or others. “Participation in the assisted outpatient program is the least restrictive placement necessary to ensure the person’s recovery and stability.” While a specified group of individuals may request an investigation to determine is a person qualifies for a Laura’s Law program, only the County mental health director, or his or her designee, may file a petition with the superior court for a hearing to determine if the person should be court ordered to receive the services specified under the law.”

    Longer term, we should advocate California adopt Arizona laws in this area that unfortunately went unused in the Jared Lee Loughner. 

    “Before Tucson Rampage, a Powerful Law Went Unused “

  4. I took PLO on a ride-along some months back and we toured some of the more problematic group homes in my district which purport to care for the mentally ill. I use the term purport quite deliberately and, after 11 years in law enforcement, feel that purport is, if anything, too mild a term. While there are some group homes which actually do take reasonably good care of their residents, the vast majority, in my experience, do an atrocious job of seeing to it that their residents are cared for in a way that would you or I would expect if we had to live in the same conditions. For anyone who thinks that group homes are the better alternative to a government-run institution, I challenge you to talk to a cop – especially one downtown where there’s a significant concentration of group homes – and ask what his or her experience is.

    In many cases, you will find that 6-12 (and sometimes more) people with varying degrees of mental illness are crammed into what used to be a single family dwelling. In once case with which I am uncomfortably familiar, there are about 30 residents crammed into a facility created by tearing down the fence between two SFD’s. In this case, the home has an elevator – presumably for the use of those who are physically handicapped. However, the elevator is absolutely awash in bird feces. In other cases, the homes are dim, dingy, reek of old food and unwashed bodies, and general filth.

    It is not uncommon that my team respond to one or more of these group homes several times a week because one of their residents has walked away and not returned for 12 hours or more. Sometimes that person has been missing for a day or so and, more often than not, that person doesn’t have the medications they need so that they don’t destabilize. Furthermore, when these residents are at their group home they frequently are living in conditions which might generously be described as squalor. Their clothes are shabby and/or filthy. They are about as filthy as your average long-term transient. Their teeth are disintegrating out of their mouths from lack of proper dental care. In many cases, their medication regimens are so poorly monitored that these folks destabilize often.

    For those who point to ‘One Flew Over the Cuckoo’s Nest’ as a reason for not financing large institutions, I’d like to point out that it’s a work of fiction. Did it accurately describe conditions in some institutions? Probably, but it was not universally accurate. Certainly, our mental health care system needs oversight, but it’s far easier to perform that oversight with a comparatively few larger facilities than the hundreds of individual group homes scattered throughout the county. And, certainly, San Jose bears the brunt of the cost in terms of dealing with all the problems which arise from using these institutions. Lastly, keep in mind that the several thousand dollars per person per month which goes to these institutions is only one aspect of their cost. Police and EMS response is another and there are many more costs besides these.

    I have to think we can do a better job caring for our mentally ill than the present system manages.

    • This was one of the best, most informative, and most autoritative comments I’ve ever read in PLO’s blog. Thanks for taking the time to write it. Hopefully it will have more influence than the facile rants posted elsewhere.

  5. Pierluigi,
    Your remarks are all true enough. The only point (and the most critical one) that I’d disagree on is where you make the judgment call; “there is a cost to provide these services, however the cost of not providing them is higher…”.
    No. The cost of providing them WOULD be higher. I think you’re underestimating the inefficiency, waste, incompetence, and lack of focus that is inherent in every government endeavor. Letting the State back into the mental health care business would not only cost way more than anybody predicts, it would have destructive side effects and there would STILL be mentally ill people who are not being helped. “We’re not doing enough”, would be the inevitable cry from mental illness lobbyists after billions spent and billions wasted and a new, lumbering, politically powerful, self serving bureacracy is firmly entrenched in Sacramento.

    The only thing that might be helped is the consciences of liberals. Well we’re already going broke trying to appease the consciences of liberals.

    • John Galt makes a very good point.  As usual someone is making money off the unfortunate. There is no real oversight on the millions the Mental Health system receives now. Top officials and “consultants” make big bucks and very little of that money actually makes it to those its intended to help. I think there needs to be a serious investigation into where all this money goes, and why programs helping these people aren’t getting the funds they need. Mental Health officials claim there are too many hoops to jump through and tons of red tape to do what is needed so I say let’s bring on an investigation to clear up the problem. 

      On another note: Officer D is correct. Our Police Department ends up taking care of many of these people because most “group homes,” throw these people out during the day, and locks the doors. (I know this first hand because I volunteered at one years ago.What I saw was sickening.)

      Also, our jails are full of mentally ill people because there’s nowhere to house them. I find this very disturbing given that they don’t belong there in the first place.

  6. Just another reason why police officers deserve their pay and pensions. Nobody wants to deal with the mentally I’ll, call the cop’s they will take care of the problem, just like everything else. Stay safe.

    • I would welcome funding more police to clean up the Guadalupe Creek area and urban downtown of the mess that is now there.  I am not a cop, but believe they earn their pay and benefits.

  7. Just a funny quote I heard today that fits this story.

    Before you diagnose yourself with depression or low self-esteem, first make sure you are not, in fact, just surrounded by assholes. ~ W. April Gibson

  8. Treatment modalities change over time, based in part on trial and error.  The institutional system of shutting away the mentally ill was highly criticized by advocates.  It also proved, like our correctional system, not a treatment or cure, but more of a warehousing of problems out of sight for a time.

    Another thing happened also, the medication got a lot better.  I know we like to cap on the medical/pharmacuetical cartel but they came through with some pretty good medications for severe psychiatric disorders that made some folks nominally capable of self-care when before they were helpless wards of the state.

    All that said, I’ve come to realize that a modality of treatment isn’t a one size fits all solution.  Working with homeless veterans, the current VA mantra is housing first (special Section 8 vouchers) and I realized this works great with some and horribly with others (the addict who’s been on the creek or under the bridge for a long time will just bring the creek scene indoors and flame out tragically, going to jail or prison or overdosing.)

    So, I agree that there’s a place for instutional care as one of multiple modalities of treatment.  Not everyone in group homes or half-way houses is really doing well so maybe something akin to the old Agnews.  The mentally ill on the street and under the bridge, some do need more care.  Not all, not most, but some.  In terms of costs/benefit – what does it cost to house a state prisoner?  What’s the perceived and real benefit?  Is prison a vacation from “the life” or a real path to rehabilitation?  Recidivism rates (90% suggest its just warehousing the problems our of sight for a time but that most go back to crime as soon as they are released (while still on parole.)  We might want to explore prison reform at the same time we start talking about mental health reform.  There’s probably some better approaches that will work better on some.

  9. Considering the two insane fanatics in Santa Clara, one screams anti stadium stuff at the CSM library, and the other bullies people with 211 cards, I can see your point.

  10. Another point on this subject:

    There are all kinds of costs associated with how we deal with the mentally ill. Some costs are more transparent and easy to calculate than others. On one level there’s the up front cost to shelter, clothe, feed and medicate someone who is mentally ill and so disabled as to be unable to care for themselves. On another level, there are all the costs associate with the additional public services which those people often require: an increased medical costs brought on by inadequate personal care and hygiene and a need for emergency services that seems to be disproportionate to their representation in the population are just two examples which come readily to mind. Depending on the source, experts estimate that between 7% and 15% of all calls for police service involve someone who is mentally ill.

    However, there is a more severe human cost involved: one that is borne largely by police officers and, to a lesser degree, firefighters and paramedics. According to one article I read (, “The FBI study found that two types of personality disorders were very common among people who had killed officers. Fifty-six percent had antisocial personalities and twenty-three percent had dependent personalities.”, “A person who has an antisocial personality knows the rules that govern society, but do not accept the fact that the rules apply to them. The most common types of antisocial personalities involved in officer deaths are sociopaths and psychopaths.”, “While the antisocial personality disorders have contributed significantly to the numbers of officer deaths, other psychiatric disorders have been identified as well. In recent years the number of police officers killed by deinstitutionalized mental patients that refuse to take medication has been on the rise.”, and finally, “However, even with the impressive success rate of the new medications, under the current system of releasing patients without implementing a way to ensure they take their medicine may be the root cause of up to a thousand homicides a year just in the Washington D.C. area.”

    There is also the human cost in terms of violence – or the threat of it – committed against police officers wherein the officer survives the encounter. Suicide by Cop is an example of this. Don’t think for an instant that the cop who shot and killed a mentally ill person is going to walk away from the encounter feeling good about it. There was no winner, no positive outcome – just a survivor who will contend with bone-deep mixed emotions and who will likely replay the incident for the rest of his or her life. There are also the officers who are attacked by the mentally ill and who are injured or who are injured while taking someone with mental illness into custody. My dad is one of those. So am I.

    We all need to understand that mental illness cannot be cured. Let me reiterate for emphasis: MENTAL ILLNESS CAN NOT BE CURED. It can ONLY be treated and with varying degrees of success. Blair Whitney suggested that institutionalizing some ore many mentally ill persons might be the equivalent of ‘a warehousing of problems’. While not necessarily inaccurate, it also doesn’t quite capture the potential benefits of institutionalizing at least some of our mentally ill patients- particularly schizophrenics. Properly implemented, the result would likely be a decrease in calls for police service, an improvement to the general health of the patients in question and an overall improvement to public safety. I don’t believe that there’s any ideal solution for the issues surrounding mental illness. I’m not even sure there are any particularly good solutions. However, I am certain that there are better solutions than the system currently in place.

    • >>We all need to understand that mental illness cannot be cured.

      Citation needed otherwise you’re spouting BS.  Sure, there’s folks that will never be cured, but at the same time there’s plenty that can be cured, and plenty more that are stuck in the system because as you said earlier..

      >>In once case with which I am uncomfortably familiar, there are about 30 residents crammed into a facility created by tearing down the fence between two SFD’s.

      These aren’t people treating people, these are corporate entities (slumlords) looking to make a profit.  There is no treatment happening, and THAT is the reason you think:
      >>We all need to understand that mental illness cannot be cured.

      • In the sense that I use ‘cure’, I mean in the clinical sense, in the same sense that a person can be ‘cured’ of cancer or a disease brought on by something like a micro-organism. The term means to restore health in such a way that it is no longer present in the body and exhibits no further symptoms. In the vast majority of cases, mental illness is a genetic condition or the result of something like traumatic brain injury. While these conditions can be treated medically, and a person afflicted with mental illness can often fully function in society, the medical community generally accepts that these illnesses can’t be cured. However, you asked for citations (which, incidentally 20 seconds worth of searching on Google would have afforded you): “Which brings me back to the question — how do you cure mental illness? The answer — you don’t. You help people understand what it is, learn and engage new ways of coping with its symptoms, and help them do the best they can with the resources they have available. Right now, there’s no “cure” for mental illness. I hope within my lifetime, I can answer this question in a very different way.”

        And many more.

        Mr. Cortese, while I often appreciate the special insight you bring to various discussions I would like to know what special knowledge you have that would allow you to factually dispute these assertions. Understand that the manner in which the mentally ill are ‘warehoused’(as Blair Whitney described it) is a completely separate issue from whether or not they are curable. The ‘warehousing’ issue is very much a quality of life issue and a public health and safety issue, but finding genuine cures for mental illness is something which, sadly, eludes modern medical science.

        • >>Mr. Cortese, while I often appreciate the special insight you bring to various discussions I would like to know what special knowledge you have that would allow you to factually dispute these assertions.

          Sigh.. You’ve backed me into a corner here…

          I came from abusive parents.  One physically/mentally abusive, the other suffered some form of Munchhausen Syndrome by proxy (never diagnosed, but the pattern fits)  They divorced when I was 5, and the Munchhausen parent spent their life trying to hurt the other, even at the cost of us kids.

          In 1982 the police found out about parent “A”‘s abuse.  CPS pulled me from school, took pictures of the welts running up and down my back, buttocks, and legs.  I was 10 at the time, and this had gone on for the worst part of 5 years.

          Parent “B” leveraged this to feed their Munchhausen, and to get back at parent “A” so they had me committed on falsified police reports.  The doctor who’s care I was under was pretty insane himself, it would come out years later that he was molesting underage girls under his care. 

          Sorry for the large link, but google cache is all I could find of the article.

          I could go deeper into some of the other atrocities I suffered if you like.  Being force fed psychotropic medications, being locked in restraints for over 20 hours.  The big one, being molested while in there. The quack ask me about it, then moved the conversation to how he’s going to send me to a state facility to have a lobotomy. (Thinly veiled threat that if I talk, I’d be a goner)  I kept it bottled in for 4 years before I’d talk to anyone about it.

          Family “A” fought “B” and the quack.  Parent “A” did not want to authorize their insurance to keep me incarcerated. The “quack” said I was “Cured” when the insurance ran out.  Shortly after I was release, parent “B” tried again to have me committed, but the SCC system was already wise to her, so I spent another 6 months in the SCC childrens shelter on 1440 Roberts Road.

          My grandmother from parent “A” petitioned the courts to take me in.  I never really got over all the crap my parents put me through, I put her through hell, but I didn’t wind up like so many who went through what I went through.

          The courts decided to put me back with parent “A”..  Grandmother says she really wishes she hadn’t let that happen.  The only difference between the abuse I suffered as a child, and the abuse parent “A” tried to inflict on me at 15 was I was bigger and could fight back.

          At one point I got so scared of parent “A” and their meth fueled rages, I slept with a shotgun under my bed (I wouldn’t find out that meth was the culprit here till I got into my 30’s)  We got into some fights, and I wound up living under the Hamilton Av Bridge by the Delta Queen Car wash for 2 weeks.  Parent “B” took me in with promises of things would be different, and 5 months later, on my 16th birthday parent “B” tried to pull the same crap again.  This time though, I wasn’t going back into the system, I ran. 

          I outran 5 of your officers and a dog that night. I went back to my “bridge house” I lived there for 2 months, in one of the coldest February’s on record.  I shined shoes to make enough bucks to sustain on a diet of Taco Bravo bean burritos, the handouts of canned foods my friends would give me, and when all that ran out I resorted to eating out of dumpsters.

          With my shoes worn to the point of having holes in them, I went back to the only person I knew would help me, my grandmother.  I never really got “back on track” after all of this, but I managed to figure out I was good with computers, found a nice girl, got married (still married) bought a house and had a couple of kids.  Got my GED, but never completed any college.

          During this whole time, Parent “B” collected child support. Parent “B” (Munchhausen parent) repeated this with 2 of my relatives.

          My parents were from that whole “Cocaine is awesome!” 70’s and 80’s generation.  What they put me through, and the disgust at their inability to be parents is what keeps me on track with my own kids today.

          When you’re 12, scared, locked away from all your friends and family, prohibited from talking to anyone not on the “call list”…

          Before all this I was doing OK.  I wasn’t the best student, but the schools recognized I was bright.  I was in the GATE program in Los Altos.  I would score in the 98th percentile on some scantron test they gave us.  in 4th grade I was tested to have an IQ of 138.

          I don’t know what else to tell you, Try going to Jr High right after you’ve been released, or try going to HS when all the kids know you’re living under a bridge (I actually tried to keep going, but the rumbling of trucks overhead kept me awake at night)

          Is that good enough to be considered an “expert” in the subject OfficerD?

        • Robert, this has, as so many controversial topics often do, into a bit of a hydra. On the one hand, having backed you into a corner and you having disclosed a bit of your history, I think you’ve actually made my point for me. On the other hand, I think this is a much of an indictment of Childrens’ Protective Services and the Mental Health Care system as they existed when you were a juvenile as anything else. What you described with respect to the Mental Health Care system is anecdotal in nature and may or may not describe a larger more pervasive set of conditions then. Personally I’d like to see some documentation that your experiences were consisted with the overall set of conditions. Otherwise, it is entirely possible to argue that your experiences (along with, perhaps, those other molested children)were largely anomalous in nature and not representative of a more general malaise in the system.

          Interestingly, as I read your post, I noted two additional omissions. First, nowhere in your post do you say that either of your parents were ever ‘cured’ of whatever for of mental illness it was that afflicted them. Certainly, Munchaussen by Proxy Syndrome is a recognized form of mental illness from what I’ve been able to discern, but you don’t say that your MBPS parent was treated or cured which might tend to support your earlier assertion.

          The other omission I noted is that you never stated that you, personally, were diagnosed with any mental illness. In fact, I would tend to guess that whatever developmental issues you suffered were caused by the abuse of your parents, but did not, in fact, create a situation in which you, yourself, became mentally ill.

          Lastly, in an oblique sort of way, you bring up one of the central issues surrounding the use of illicit drugs: that they tend to create significant mental health issues themselves. In particular, methamphetamine, ecstasy (MDMA) and the psychoactive compounds in certain mushrooms have been shown to have neurotoxic properties which over a period of time can cause symptoms quite similar to various mental illnesses. This is one of the reasons why long-term users of methamphetamine often present as paranoid schizophrenics, when, in point of fact, they are not and can’t be treated in the same manner. Nonetheless, many of the behavioral traits are the same and a tweaker can be just as dangerous as a paranoid schizophrenic who is destabilizing.

        • Officer D:

          Come on, you and I both thought Cortese was going to say he knows a lot because he has lunch with Cary Andrew Crittenden. 

          Damn.  He has more then that.  Back at ya. Back at me. 

          Cortese sorry for your pain.

        • OD.

          Our mental health system resembles our corrections system.  Neither system is geared towards rehabilitation, just lock them away and get the blight out of the light of society.

          Blair Whitney makes a great point about this below..
          It appears that mental disorders are contagious in that negative environments and disordered social contacts can promot mentally unbalanced thinking and behavior. 

          Again, both mental health facilities of the past (and present) just stuck a bunch of mentally unhealthy people together, and like nuclear fission causes this caused the numbers of cases to grow.

          It’s insanity to try and reopen Agnew, or build another facility based on it when the goal should be to actually cure people so we DON’T have to house them for life.

          Granted, there are people like the woman Pierluigi was talking about, that are an actual danger to society.  Was she always this way?  What was her life like before she lost it, and how do we get her back there without destroying what little self esteem and dignity she has left?

          I would put these folks to some kind of work, while removing them from society in a non-incarceration setting.  I’d create a model for mental health that resembles Bastoy Island in Norway.  Here’s a video if you’ve never heard of it.

          Just simple quiet time away with goals. Some time to think about your situation, and what you can do to get out of it.  Show them, “Hey, shit might suck but guess what, you have a choice to straighten out” 

          Santa Clara County has a lot of land isolated in the hills that could be setup to be like Bastoy Island.  Far enough away where they’re not going to walk back, far enough where dope dealers won’t bother coming (1 road in and out security) and serene enough settings to let them see what life is really all about.

          But not like Agnews.. Already a proven failure.  This is self evident by the constantly repeated banter that when it closed, “ALL THESE PEOPLE WERE RELEASED ON THE STREET!”  Had Agnews been working, we wouldn’t be complaining about them now.

        • >>Cortese sorry for your pain.

          Thanks anon.  Maybe one of these days we can sit down to some pancakes.  For some reason breakfast food at a diner with coffee always makes great kindling for sparking discussion on political or social topics.

          I’m pretty much over any pain caused.  The only pain I have now is knowing that the majority of mental health is a profit industry. 

          I’ve lived a pretty good life so far.  I had 10 years doing corporate IT work before being laid off in 2001, even had some temp stints at a few fortune 500’s. Spent the last 10 developing karaoke jukebox software under the guise of being a doorman. I watch my kids during the day(I just baked cookies for em too), and at night deal with everything from drunk to mentally ill at bamboo, and not once have I ever thrown a punch at any of them.

          Not bad.

          I can attribute my “moving on” to 3 people in my life.  My grandmother, my 8th grade English teacher, and my wife.

          My grandmother because she took me out of this situation.  Parent “B” and Dr Quackers wanted to have me put in a state facility, to “wash their hands clean” so to speak.  At the time, state facilities were the last places to authorize lobotomy and electroshock treatment.  I think their master plan was to completely erase any will to fight back, or any memory of what had happened to me in order to reduce their own liability.

          Mrs Keller (now Potter), my 8th grade teacher recognized that I had a talent to write. Being one of only 3 Caucasian kids at Sheppard was rough, I got into fights with my bullies daily there. I already had an appreciation for the sciences, but she gave me an appreciation for what some teachers can do to students.  When my grandmother first got me, I was doing terrible, but between her and Mrs Keller they turned that around, and by the end of the year Mrs Keller was taking her personal time out to take me to extra curricular writing classes taught by TA’s at local JC’s. .  It’s why I can just flow somewhat decent English here.

          My wife because I always had ideas of how I wanted to be better than my parents, and she’s 1/2 of how I’m here now. 

          Here I am today.  No need for a lifetime of psychotherapy or medication.  Just 3 people in my life who actually cared enough to give me the guidance and space I needed to grow.

        • I go to the dentist regularly.  I brush my teeth daily.  I even floss fairly regularly.  I’ve tried many toothpastes, gels and mouthwashes. 

          That does not make me an expert on medical dental issues. 

          Sorry guy but you’re grabbing at straws with your expert ranking.  You lost credibility when you self diagnosed your parent’s afflictions and referred to it as absolute after you did that.

          The Councilman’s original article is right on the money.  Mentally ill walking the streets unmedicated, uncared for cause more danger and expense to the local community.

        • I talk to people regularly. I listen to them daily. I even joke around with them fairly regularly. I’ve tried many telephones, VHF radios, and much letter correspondence.

          That does not make me an expert on judging a person’s expertise from their blog posts.

          Sorry guy but you’re grabbing at straws with your expert ranking. You lost credibility when you self diagnosed Mr. Cortese.
          Mr. Cortese might be right. Mr. Oliverio might be right. It’s impossible to tell who’s right until we are blessed with the opinion of a bonafide expert. You sir, are no expert. You’re just a guy with 3 different pseudonyms over a 14 minute period. Until you produce a credential verifying your expert ranking, your opinion on this, or any other matter, counts for nothing.
          Show me your papers!

        • >>You lost credibility when you self diagnosed your parent’s afflictions and referred to it as absolute after you did that.

          So wait, you’re telling me that 0% are in that system by mistake?

          You beat a dog, the dog will roll over and piss on itself when you try and give it love.  Is it the dogs fault that they pissed themselves?

          You lock a person up without due process, medicate them and tell them “they’re crazy” with no hope their entire life.

          And you expect this system to cure them how?

          I don’t give up on my parents, or people in general. Real sociopath tendencies you have there “expertise” when you think they’re just animals that deserve to be rounded up off the street.

          They’re human beings like you and me.  They have a name, they have a history.  Tell me, how many of these homeless do you know by name, if any?  Do you just toss em a buck and pat yourself on the back?

          How many have you served meals to?  How many have you helped get off the street and become productive?

          I can name at LEAST 1 guy who you probably would have cast off as “hopeless” that I got off the street and back into being somewhat normal. I can name at least 10 that I talk to on a regular basis in my neighborhood.  I don’t look down at these people.

          I feel sorry for you.  You’re more screwed up than they are obviously.

      • Robert,
        I respectfully disagree with you. Mental illness is not cruable, but it can be treated. It is a medical condition that often times needs medication, and therapy to keep the person functional.

        I do however agree that the way these people are treated and “warehoused” is horrific.

        • >>Mental illness is not cruable,

          Depends on the condition and the patients will to be cured.  Medication is nothing more than a crutch.  Sometimes medication is abused by caregivers to keep their “patients” glassy eyed and catatonic so they can continue saying that they still require care.  (gotta love those state checks with no oversight)

          Read what I wrote to officerD above.  I lived it, I think my experience living it puts me head and shoulders above anything you or D can attest to.

        • Robert, while I completely agree with you that your childhood and upbringing were horrific and that the ‘system’ failed you in numerous and unconscionable ways, I still don’t see anything in your above post which suggests that either of your parents were successfully treated in such a way that they no longer needed treatment or that you, yourself, were mentally ill and now are cured.

          One thing I do agree with you is that the lack of oversight is a central issue which needs to be resolved. This, however, is true whether the treatment facility is a residential care home for the mentally ill or an institutional facility of some kind. I can tell you this: the agencies responsible for monitoring residential care homes is far more overworked and understaffed than the CDC parole offices and therefore even less capable of monitoring the literally hundreds of residential care homes scattered throughout San Jose. I’m not saying that residential care homes aren’t or can’t form one possible treatment solution, but that for many mentally ill patients, they are inappropriate and unsuccessful in providing the highest quality of life possible to their patients. If you don’t believe me, I can point you to probably a half dozen examples just in the district in which I work.

    • Officer D,
      Would you be so kind as to break down how much work the PD does in assisting mentally people when called to the scene? Do you run them to the ER, and transport to jail? Please educate us on that as I know you guys have a long drawn out policy for this and hours of paperwork too.

      Thank you!

      • There are a number of different possible scenarios for temporarily resolving an incident involving someone who is mentally ill. Broadly, the options and time involved, generally for each solution are as follows:

        1. Leave the individual in question in their present situation. Many times, the conditions/actions which initiated the call for service have resolved prior to police arrival. Obviously, this is the ideal solution. (10-30 minutes, usually.)

        2. If the patient is still not stable for one reason or another and presents a danger to self or others, but has not hurt anyone or is not injured him/herself, the patient is transported to EPS and placed on a 72 hour hold for observation. However, the 72 hour thing is nominal at best. The reality is that EPS is sometimes something of a revolving door. I have actually transported someone there on a 72 hour (5150 W&I) hold and had to deal with the same person the following day. (1.25 – 2 hours.)

        3. If the patient is destabilized and has hurt someone or committed a crime, they can be booked at jail and simultaneously placed on a 72 hour hold. The jail has mental health professionals on site. (2-5 hours, depending on the time it takes to book the individual and the complexity of and time involved in writing the report.)

        4. There is also the absolutely worst case scenario where, for one reason or another, the officer(s) who respond are forced to use deadly force. (Literally hundreds, if not thousands of man-hours.)

        Understand that dealing with someone who is mentally ill can be every bit as dangerous to a police officer as dealing with someone who is out of their mind on meth or PCP. I know this to be statistically true and have certainly experienced it firsthand.  I was the first responder who provided initial first aid to Daniel Pham’s brother. One day, I’d like to be able to speak in public about what I saw and what Brian Pham told me about his brother. Unfortunately, that will have to wait until after the civil suit against the city is resolved. Furthermore, I have been in physical fights with both mentally ill persons and people high on PCP, for instance. One of the last fights I was in with a schizophrenic person was the catalyst for the two most recent job-related surgeries I had this year. My dad had his ACL blown out in a fight with a mentally ill patient he was trying to take into custody back when I was a kid.

        • 2. If the patient is still not stable for one reason or another and presents a danger to self or others, but has not hurt anyone or is not injured him/herself, the patient is transported to EPS and placed on a 72 hour hold for observation. However, the 72 hour thing is nominal at best. The reality is that EPS is sometimes something of a revolving door. I have actually transported someone there on a 72 hour (5150 W&I) hold and had to deal with the same person the following day. (1.25 – 2 hours.)

          There’s also the 2 week assessment, which can be followed by another 72 hour hold, and another 2 week assessment.

          If so, the person may be offered a voluntary admission. If it is refused, then another hold for up to 14 days, the 5250 (WIC-5250), must be written to continue the involuntary confinement of the person.

          The facility can do a “revolving door” with the paperwork and keep someone incarcerated indefinitely.

        • Police officers never place anyone on an involuntary confinement outside the parameters of a 5150 WI hold. Any hold longer than 72 hours must be written by someone other than a law enforcement officer.

          Since Kathleen asked about the actions/policies with respect to police officers, I answered in kind.

    • I’m neither a physician nor clinical psychologists, but I do have some notions developed from working with some folks in the behavioral mental health field.

      It appears that mental disorders are contagious in that negative environments and disordered social contacts can promot mentally unbalanced thinking and behavior.  Add the chemical stew of street drugs that many claim to use for “self medicating” and there’s definitely a cycle where funtional people become anti-social, dysfunctional and destructive.

      Look at the CAT scans on brain function on a meth addict, crack user, chronic alcoholic or whatever and you’ll discover that brain function is substantially diminished.  With treatment and abstinence, there’s some restored brain function in damaged areas, but other areas are either permanently damaged or rewired in ways that affect emotional health, behavior and cognitive ability.

      I think emerging research is suggesting something similiar might be occuring with soldiers suffering from TBI and PTSD.

      The medical model has been used for nearly a century in treating addiction disorders as it makes it into “disease” that folks are genetically predispoded for.  Actually, both mental illness and addiction works both ways, genetic predisposition (nature) as well as aquirable though environmental factors (nurture). 

      So in talking about new models for dealing with mental illness, you need to realize that its not just the presribed medication at play here.  The issue of street drugs is a factor, sometimes a huge one with mental health implications.  Also, presription solutions for behavioral mental health problems are usually handled in a shotgun approach where a provider will prescribe freely and frequently to treat symptoms of mental illness. In a way, the pharmacuetical industry is a predator as much as the street pusher in pushing providers to prescribe expensive medication (which public health providers pay for with tax dollars for indigent or low income residents.)

      I believe there is a role for institutional care, just like there is a role for prisons, but I’m wondering if we can do better with both than in the past.  I really do think criminal justice issues and mental health issues are more inter-connected than you might think at first glance.

      • >>It appears that mental disorders are contagious in that negative environments and disordered social contacts can promot mentally unbalanced thinking and behavior.

        Which is why we shouldn’t lock them all up together.

  11. Officer D, Kathleen, Blair and Robert C.: Thanks for your contributions to one of the more interesting, insightful and respectful threads I’ve read here in a long time.

    • You’re right Reader. It has been an interesting and enlightening thread. The problem is, it’s exactly this sort of discussion among ‘stakeholders’ and ‘experts’ that too often gets misinterpreted as proof of the necessity for governmental involvement.

      The expertise of professional therapists, counselors, former patients, policemen, psychiatrists, etc. should most certainly be relied upon to administer programs and institutions.
      But before that, in the political discussion regarding whether to initiate such programs and institutions in the first place, their testimonies and opinions should carry no more weight than that of the average voting, taxpaying non-expert citizen.

      At this stage it’s just talk- a good natured, mutually beneficial discussion in which everyone interested should be welcomed to offer their opinion and nobody should be demanding credentials or the citing of sources.
      It’s the arrogance and haughtiness of ‘experts’ steamrolling through legislation with the meek compliance of the layman, whose pocketbook is valued but whose opinion is sneered at, that has brought about our gigantic, dysfunctional, mostly bankrupt government.

  12. Thank you, Reader, for the kind words. I think that the interesting thing about this whole thread is that it’s pretty clear we all care about the issue. We may have different experiences and different ideas about how to resolve the problems in the mental health field, but we are all in agreement that the current system simply isn’t working.

    Personally, absent a genuine cure, I don’t think there’s any ideal solution, only solutions which might be less bad than others. With respect to the whole ‘warehousing’ issue, I think that the ‘institution’ vs. ‘group home’ debate is really a question of figuring out which set of conditions is less objectionable than the other. And, frankly, I think that the current one size fits all solution that presently predominates truly isn’t working. The lack of oversight of board/care homes is, frankly stunning, and I think that, considering the thousands of dollar per month per patient that are dispersed to these care homes, the patients themselves deserve far better than what most seem to get.

    Finally, with respect to Blair’s closing comment above about the interconnectedness of mental health issues and criminalism, I tend to agree to an extent. On the other hand, I also think there are alot of people out there who are criminals simply because they choose to be that way or have made choices which have indirectly led them to criminalism. For that latter group, I don’t have much sympathy, since I am a firm believer that people ought to experience consequences for their bad choices. No matter how you slice it, it’s a complicated set of issues with no easy or ideal answers.

    • Part of the reason I found the thread so interesting has to do with my student days at San Jose State. At the time, and I am not sure if this is still true, there were a number of so-called “halfway houses” concentrated north of the campus. As a student, this was my first brush with the problems associated with the mental health system.
        It was sad. I would see the patients idly shuffling along the street, sometimes panhandling or loudly talking to themselves. They were treated as pariahs by others in the neighborhood and often harassed. When I worked at the SJSU bookstore we were told to call security if a “Halfway” even came into the store. No such rules existed for other people. 
        Other than providing a roof and a few meals it seemed that nobody was doing anything to really help these people. I doubt if any of them ever “got better.” While a “cure” for some forms of mental illness may be elusive, I can’t help but wonder if these human warehouses did more to exacerbate the problems than to help. 
        Sadly, judging from the posts here, it seems that little has changed in the intervening years.

  13. Reader, based on what you’ve written, I can assure you that things have most certainly not improved for the mentally ill housed near SJSU. Their living conditions are poor, the care they receive is largely sub-par and, if anything, there are more mentally ill patients populating downtown than in the past.

    All in all, it’s an overall appalling set of conditions, with no end in sight.

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