Photograph of a mentally ill man raging in front of a police station on Valencia Street

“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



20 thoughts on ““Why don’t they do something?”

      1. I know… Love God, Love Neighbor… Isn’t that what Jesus taught? And it comes straight from the law the Pharisees loved to warp and evidently their descendants still do today…

        Liked by 1 person

      2. Thank you.

        Everything I say below is based on personal observation and experience.

        This means I may be completely wrong.

        My Father was an Orthodox Jew and I was raised in both the Orthodox and Reformed Traditions.

        I think the difference is between the two is that reformed Judaism emphases that aspect of Judaism that gave rise to Christianity.

        More pointedly, the teaching that mercy is the heart of the law and the soul of faith.

        Jesus is the light of the World which suggests that the world he entered lived in spiritual darkness.

        For me, the gospel sheds light on an evolving God that felt he/she/it had to incarnate under the worst possible conditions to learn from the creation that he came to heal.

        I do not believe in an absolutely perfect God.

        I believe in a perfect God in a perfect universe that is in a process of endless evolution and self discovery.

        (not to be confused with Candide :))

        Liked by 1 person

    1. Individually we can’t do anything…that’s why we have or had a government. Our job is to make wise choices when we vote. If we demand that our governments fund mental health and vote out anyone that stood in the way we would get people like this guy off of the streets and out of the prisons and into the treatment he deserves as a member of the human race…I may be a fool but I’ve seen our culture change in surprising ways just because people worked together to make the changes happen.


    1. I have to disagree. I have worked in the San Francisco Mental Health System.

      The failure of deinstitutionalization has been publically discussed for over forty years and for over forty years we have elected to cut the mental health system to the point that it doesn’t work at all–

      This article on the NIH server dates to 1985: Build a better state hospital: deinstitutionalization has failed.

      This article in the New York Times also dates to 1985: MENTALLY ILL HOMELESS: POLICY AT ISSUE

      This article in the Los Angeles Times is dated 1990: The Madness of Deinstitutionalization : OUT OF BEDLAM

      This article in the New York Times is also dated 1990: Lost Lesson of Mental Health

      This statement to Congress by Patrick Moynihan is dated 1999: Deinstitutionalization Hasn’t Worked

      I can offer you thousands of articles and editorials. They not only discuss the failure of this egregious mistake in public policy, they offer solutions.

      We know what we must do…but we do not.

      And certainly, the police officers in that station know what to do. Their job is to protect the public and keep the peace.

      This poor man easily met the criteria for a 5150, which is the code for mandatory hospitalization.

      But that would require the use of expensive emergency services, an ambulance, and an expensive stay in a public hospital.

      My guess is that they were waiting for him to assault someone or do property damage because jail is cheaper.

      Liked by 1 person

  1. Sigh. You get them in England too, mostly I am guessing homeless though. I don’t think it’s as bad as in the States. These are the people that if I meet without my kids with me, I always go and give them a hug and speak to them. But that’s the limit of what I can do 😦

    Liked by 1 person

    1. As individuals we can do nothing. As voters we can use the government to take action.

      Part of the problem is that we don’t make the connection that choosing to vote is also choosing to take back the government. There are powerful forces
      that seek to convince us that voting doesn’t matter…My understanding is that the UK has a public health system–The Affordable Care Act is the closest thing we have in the U.S. to your National Health Service which you’ve had since 1948.

      Liked by 1 person

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