“Why don’t they do something?”

“Why don’t they do something?” is what the kid asked his friend as I snapped a photo of the guy  pacing in front of the entrance to the Mission District Police Station on 16th Street at Valencia.

Why Don't They Do SomethingHe was aggressively agitated.

He screamed that he had been gang raped, that he was frightened, that he was in danger.

Some people crossed the street through traffic to avoid passing him.

“Why don’t they do something?” I thought when I noticed the green hospital tag that he wore on his wrist. He had a pen in one hand and folded papers in the other.

I wondered if they were his discharge orders. I wondered if he had signed his discharge orders and walked out the hospital with the pen.

His clothes looked dirty,  the shoes a bit large. He did look showered.

Why Don't They Do Something

If he arrived in my program in this condition, I’d have sent him right back to the hospital.

A discharge to an Acute Diversion Unit is almost the same as a discharge to the streets.

Acute Diversion Units can’t manage a patient this acute.

Patients are free to leave an ADU and many do.

I’d have assessed this patient as a danger to himself and/or others.

He begged anyone who dared to pass him for help.

He went from begging to rage to despair.

Why Don't They Do Something

One night while working an overnight shift at my program, I got call from a worried Mom in Michigan.

The so-called “Red States” practiced “Greyhound Therapy.”

That’s the answer to the mysterious and seemingly unsolvable question of why there are so many “crazies” in San Francisco.

Why is the simple corrupt truth so hard for us in the States to discuss?

Patients from Michigan, Kansas, Nevada, and points South are shipped one way to San Francisco.

We still have a barely functioning Public Mental Health System.

We pay for their tax cuts.

The worried Mom in Michigan was weeping.

Her son had just turned 20, was seriously ill, and had disappeared.

He got a free one-way bus ticket to San Francisco.

When he arrived in the City he said he was depressed and suicidal.

He had called 911 and had gone by ambulance to Psych Emergency.

He went from there to an in-patient unit at a local hospital.

He called his Mother in the morning when he arrived at the hospital.

His mother said that she called the unit at 11 PM her time because she wanted to tell her son that she loved him.

The nurse said that her son was discharged.

Mom asked to where and he replied to the street with the address of a shelter.

She had made calls to any program that might be a shelter.

That’s why she called me.

I thought no hospital was so callous as to discharge an acutely suicidal 20-year-old that had just arrived from Michigan to the streets of a City he didn’t know so I called and asked.

It had.

The nurse repeated to me that it had in defiant response to my sigh of disbelief.

Some people defend themselves with arrogance when they know that what they are doing is wrong.

I don’t blame the nurse for keeping his job in our nation of exalted selves that can’t be bothered with anyone else.

The price of colluding with barbarians is slavery.


Why don’t they do something?

Were I still working in the field of mental health, I’d describe this patient as acutely psychotic.

Perhaps he is bi-polar and manic.

But there is an edge of paranoia and an undertone of violence to what he says.

He is agitated and aggressively fearful.

He repeats that he was gang raped.

This may be true if he had a recent stay in jail.

Psychiatric Patients in jails and prisons are targets.

This may be a psychotic break brought on by recent trauma.

He states that his life is in danger and is doing so in front of a police station.

Why Don't They Do Something

I wonder if he wants to go back to the hospital.

Maybe he is confused because most patients associate discharge with better.

Maybe he doesn’t think he has a right to be sick.

Is there anything more confusing than having an entire system tell you that you are well when you’re not?

Mandatory hospitalization is for people who are in so much pain and confusion that they cannot think or make rational decisions.

He stands like a frightened child in front of a police station and wails his pain and rage like a siren.

Why Don't They Do Something

Why don’t they do something?

Good question.


(c) Rob Goldstein 2015 All Rights Reserved

Blog for Mental Health 2015mhwgmember2015