The
Castro’s shame: Addiction and mental illness devastate iconic SF neighborhood
Heather Knight
A woman referred to as "individual M" at Castro and Market
streets on Thursday, Jan. 30, 2020, in San Francisco, Calif. The woman is on a
list which San Francisco Supervisor Rafael Mandelman has created a list of 17
people who most need the city’s help.
Heading up Market Street the other day from City Hall to the Castro, we
spotted her: a woman sitting on a concrete median in the middle of Duboce
Avenue, her skinny, sore-covered legs and bright orange shoes hanging
dangerously into traffic.
Supervisor Rafael Mandelman pulled over, and we tried to talk to her.
But she just whispered incoherently. She’d strewn dirty clothes, chow mein
noodles and plastic utensils around the median. The situation didn’t seem
worthy of calling police, and she mumbled that she didn’t want an ambulance.
What to do?
That’s the question so many San Franciscans have as they pass people in
obvious distress — high out of their minds or coping with mental illness — who
desperately need help. But where does one get that help? Is there any real plan
for them other than, possibly, a police order to move along, a quick stay in a
jail cell or a brief visit to the overstuffed psychiatric emergency room at San
Francisco General Hospital?
These questions prompted Mandelman and his staff in August to create an
unusual list: the 17 most distressed and distressing people in his district,
which includes the Castro. The iconic neighborhood — a birthplace of gay
rights, the site of Harvey Milk’s camera shop, the place where the city’s giant
rainbow flag still flies — has lost some of its luster as it’s become dotted
with vacant storefronts, tent encampments, bicycle chop shops and scary street
behavior.
Part of the problem is the city’s inability to deal in any meaningful
way with those like the 17 people on Mandelman’s list. They’re the ones
neighbors see all the time wandering into traffic, passed out on sidewalks,
screaming into the air, flinging trash and harassing small business owners and
their customers. One man on the list regularly digs his filthy hands into the
pots of sweets at Giddy Candy and steals them. Another is often passed out
drunk in front of the now-shuttered Cafe Flore.
Of the 17, three are women and 14 are men. They range in age from 28 to
73. They’re homeless or in and out of precarious living situations. They’re
some combination of mentally ill, alcoholic or addicted to drugs.
The list is a mini-version of a longer one, totaling 237, that the city
is using to bring intensive attention and services to those in the most dire
need, to see whether their lives can improve along with the lives of everybody
forced to deal with their behavior. Because of tight patient privacy laws,
Mandelman doesn’t even know whether the 17 his office has identified are on the
city’s longer list. So far, the effort to help the original 237 has been mixed
— with 43 moving into permanent supportive housing, but scores still on the
street and nine dead from overdoses and other chronic health conditions.
Mandelman meets monthly with representatives from the police, public
health, homelessness and public works departments and representatives from
neighborhood groups to check in on the progress, or lack thereof, of the 17.
Can targeted, repeated outreach help them and the neighborhood at large?
On paper, the answer should be yes. On a recent visit with him to the
district, the answer was much more disheartening.
“We’re trying to coordinate a plan for each one,” Mandelman said. “But
I’m not convinced we know how to do that.”
Mandelman said the reasons for the city’s lackluster results are many:
the privacy laws that prevent even city supervisors from knowing any details
about the health of their most disturbed homeless residents, the shortage of
treatment beds and people to staff them, and the weak laws that prevent
counties from compelling everyone who needs help into treatment. Mandelman and
Mayor London Breed have pushed for stronger conservatorship laws, but other
supervisors and homeless advocates have fought them over civil rights concerns.
These issues are personal to Mandelman. He grew up with a severely
mentally ill mom, who’s since died, and essentially raised himself from age 11.
He said he knows firsthand that inside many of these sad souls are lovely,
coherent people struck down by bad brain chemistry.
“That’s not her best self,” Mandelman said of the woman with orange
shoes. “There’s another person in there who — if she was getting the right care
— might be able to emerge.”
The woman on the Duboce Avenue median wasn’t even on the supervisor’s
list of 17, but she might as well have been. She was missing teeth, her face
was smeared with dirt, and she whispered that she sleeps outside. It seemed
wrong to just leave her there to perhaps get her legs crushed by a whizzing
car.
“How in a civilized society do we have someone at this level of
distress just being left here?” Mandelman said.
He called an aide in his office for advice, and she gave him the phone
number for the city’s mobile crisis team, mental health experts who can respond
to homeless people in crisis.
Or that’s the goal anyway. A woman who answered Mandelman’s call
explained the team is based in the Bayview and wouldn’t be able to get there
anytime soon. When she took his name and realized who he was, the attitude
seemed to change. The team would get there as soon as possible, she said.
Social workers who interact with the same population, but not for the
city, told me the team is great, but is very understaffed and sometimes takes
up to seven hours to arrive. Jenna Lane, a spokeswoman for the Department of
Public Health, said the team has 14 people who also respond to other crises,
including homicide and suicide scenes, traffic collisions and police
negotiations with people in crisis.
Clearly, San Francisco, with its $12.3 billion annual budget, needs to
majorly beef up its crisis response and station the team more centrally because
a rapid response is essential. It also needs to beef up its Homeless Outreach
Team, which can also respond to women like the one on Duboce, but is similarly
stretched thin and often slow to respond.
Mental Health SF, a new City Hall plan to overhaul the broken mental
health care system, would create a new Crisis Response Street Team to help
people in crisis on our streets, but funding hasn’t been secured and the
changes are a long way off.
We stayed with the woman with orange shoes for a while. She eventually
left the median for a safer sidewalk. She talked about being from North Korea
and about being dead. Eventually she walked away, headed east down Market
Street.
Mandelman kept in contact with the mobile crisis team via text, and the
van finally found us about 45 minutes after he first called. He told the team
where we’d last seen the woman with the orange shoes, and they said they’d
drive around to try to find her.
We headed to talk to Mat Schuster, owner of Canela Bistro on Market
Street, who’d texted Mandelman’s staff that day in frustration. The night
before, a panhandler outside the restaurant had gotten angry that nobody was
giving him money and threw a patio chair at the restaurant’s front window — as
diners sat in the window inside. The glass shattered, but fortunately nobody
was hurt.
“The customer chatter was, ‘This is San Francisco now,’” Schuster said.
Which is the saddest thing I’ve heard in a while.
Across the street, Mandelman and his staff spotted Individual B on
their list of 17. He’s a tall, big man who’s often happy and smiling, but can
turn violent and aggressive. He’s known for being a hoarder, and he’d spread a
cushion, clothing, a bucket and trash around Jane Warner Plaza.
Individual B told us he’d been offered a bed at the Navigation Center
on the Embarcadero, but it wasn’t clear whether he was going to take it. He was
hard to talk to because he was almost entirely focused on staring at himself
preen and dance in the reflection of the window of Twin Peaks Tavern.
“I’m an American,” the man told me. “Aren’t you American? You’re my
cousin, aren’t you?”
Mandelman sighed.
“It’s been six to eight months, and whatever we’re trying ain’t
working,” he said, referring to the fact Individual B has been on the list
since its creation last summer. He shook his head as one neighbor after another
approached him to complain about needles or trash or whatever.
Mandelman said he understood the frustration.
“I’m the supervisor,” he said. “I’m the face of a city that’s failing.”
Mere feet away was Individual M on the list. She’s known for wandering
into traffic, and that’s what she was doing when we spotted her. She’d stand in
the street in front of cars trying to turn right and came within inches of
being whacked by a Muni bus. She’s known as “Princess Leia” in the neighborhood
for sometimes wearing her hair in two buns on the side of her head — held in
place at times with syringes.
She darted her eyes nervously and kept muttering to herself.
“I don’t want to talk right now,” she told me. “I’m really scared.”
People call 311 and 911 about her all the time, and yet she’s always
back there, darting into traffic.
Mandelman is tired of the city’s approach, which focuses mostly on
outreach workers trying to build a relationship with people over time in the
hopes they’ll eventually accept help. He wants the city to take stronger action
— and he wants the state to adopt more expansive conservatorship laws to compel
people into care. The state’s law was strengthened a little recently, but it’s
still a very high bar to force people into treatment if they say they don’t
want it.
The loud whir of Castro and Market streets — the clearly deranged
people and the incredibly frustrated neighbors who kept stopping to complain —
became too much for Mandelman. He held a finger up, as if asking for a pause in
our conversation, and his eyes filled with tears. He walked away for a while.
“It’s upsetting. There’s so much misery,” he said when he returned, his
voice rising in anger. “It’s insane that we cannot solve this. This is
solvable. The solutions are obvious to all of us.”
Obvious, maybe, but not easy. He wants stronger conservatorship laws
and more of the city’s money directed to treatment beds so there’s somewhere to
put those who are picked off the streets and mandated to accept care.
“She’s terrified,” he said, nodding to Individual M, still walking in
traffic.
“He’s off his rocker,” he said, motioning to Individual B, still
preening in the window.
“This is just wrong,” he continued. “This neighborhood is so important.
It’s where queer politics started. It’s an internationally known, iconic
neighborhood, and it’s suffering under civic failure.”
Mandelman was done. We walked back to his car. He checked with the
mobile crisis team. They had not found the woman with the orange shoes.
San Francisco Chronicle columnist Heather Knight appears Sundays and
Tuesdays. Email: hknight@sfchronicle.com Twitter: @hknightsf Instagram:
@heatherknightsf
Humanity
toward a struggling man and his canine companion
By Cynthia Tsai Feb. 6, 2020
A few years ago, I had joined the community forum, Nextdoor, on a whim
of curiosity. Often now, I follow the latest dog park happenings as a diligent
dog-mom to my poodle, Riley. I once needed a kitchen appliance I snagged at a
great deal from a neighbor. Sometimes, it is a guilty delight on a quiet
evening — I will scroll through the intense neighborly cyber squabbles about
the minutia of city dwelling.
At the same time, there are instances that sadly remind me that I still
live in a city of painful extremes. There are the neighborhood outcries about
homelessness, exclamations about the needles found near a children’s
playground, and descriptions of altercations between the residents of the
buildings and the residents of the peripheries. I do not dispute that these are
painful and concerning realities of our city; we have become a city of extreme
privilege interlaced with severe poverty. The words, though, that I come across
online that make my heart ache are the ones that label these issues as issues
not of people, of individuals, with nuanced challenges and circumstances, but
issues of various nondescript entities — the “drug addicts,” the “homeless,”
the “mentally ill.”
A few months ago, a post included a photograph of a man who lay
disheveled on the street, intoxicated and dazed, with a brawny white dog
splayed next to him. The poor dog, the community lamented. An individual
mentioned they left cans of dog food at the side of the brown and white pup.
The man was cast away as an addict, a “junkie,” another public nuisance.
I found this exchange disheartening.
I love my Riley pup to the end of the earth and back, and the dog in
the photograph pulled at my heartstrings — he needed a fresh bowl of water and
a silly romp in a green park with a brand new chew toy of his own.
Yet, too, as an internist, the man splayed on a street corner,
vulnerably alone save this steadfast furry companionship, pressed at my heart.
In my clinical practice, I see vast swaths of diversity in illness,
age, privilege and experience, and the greatest lesson in my work has been the
reminder, daily, that appearances always belie the deeper waters of self.
A few days after I saw this post, I started a clinical elective in
addiction medicine and spent a morning at a local methadone clinic. I saw the
patients that line up at dawn to take their dose of the pink liquid — a once
daily maintenance treatment for opiate use disorder — before their long days
ahead. I met patients who returned to the clinic after time away, eager to
start over, try again.
And, I met him and his brawny white dog.
He had come to start methadone treatment. In observing his intake
appointment, I learned that he was young and that he had only recently arrived
in San Francisco from his hometown in a suburban southwest corner of the
country. I learned that he first used heroin a few years back on a dare from a
high school mate, and I learned that that dare quickly spiraled beyond his control.
I learned that inpatient rehab and methadone maintenance therapy pulled him out
of the swell of opiates for a year. I learned that his family relationships
were chaotic before and after treatment, and I learned that in this fractured
environment, he relapsed. I learned that he made his way to San Francisco in
order to leave this environment. I learned that when he relapsed, he chanced
upon that brawny white pup — stray, dumped on a street corner — and that his
dog’s jolly spirit pulled him along and motivated his decision to take an
Amtrak train to this restart.
I followed up his progress a few weeks later — he missed methadone
dosing once or twice a week, but he continued to come. He continues to move
forward; his story continues to evolve. He had a job interview last week.
He is a son, a dog dad, a bassist, a poet. He proved himself in our
brief encounter to be witty, kind and insightful. He struggles with opiate use
disorder, and he strives daily to overcome a challenge born not out of fault
but out of a constellation of genes, upbringing and sad happenstance. In our
common humanity, his spirit and story cannot be captured by the soulless image
of a “drug addict”; he has a name, a spirit, a soul — he is a human with a
story and a struggle beneath it all.
Cynthia Tsai is a resident physician in internal medicine at UC San
Francisco. She practices clinical medicine at UCSF, the San Francisco Veterans
Administration and Zuckerberg San Francisco General Hospital, and she is a Bay
Area native and proud dog mom. The views expressed here are her own and not of
her employers. Some minor details have been changed to protect the identity of
the patient.
That's California and illegal immigration. The state has squandered hundreds of billions on illegal immigration in the 20 years since I've been gone. They could use that money today. They desperately need it back to pay for the hundred-billion-dollar job of upgrading and modernizing their electric grid.
Census: Number of ‘majority Hispanic’ US counties doubles
by Paul Bedard
November 21, 2019
In the latest evidence of the effect Latin American immigrants are having on the United States, the number of U.S. counties that have turned majority Hispanic has doubled.
New Census Bureau data analyzed by the Pew Research Center found that from 2000 to 2018, the number of majority Hispanic counties jumped from 34 to 69.
What’s more, the overall number of U.S. counties that turned majority minority-based, mostly Hispanic or African American, also surged to 151 from 110 in 2000. Most of those counties are in Southern California and along the Mexico-U.S. border.
“Overall, 69 counties were majority Hispanic in 2018, 72 were majority black and 10 were majority American Indian or Alaska Native. The majority American Indian or Alaska Native counties are unique in that most have experienced overall population declines since 2000, even as the share of American Indian or Alaska Native residents in these counties remained fairly flat,” said the Pew analysis.
Other reports have shown that the share of immigrants, mostly Hispanic, have continued to break records due to legal and illegal immigration and the baby boom among new arrivals.
The majority black counties are also in the South, though mostly from Louisiana and to the east.
“While the black share of the total U.S. population has not changed substantially over the last two decades, the number of majority black counties in the U.S. grew from 65 to 72 between 2000 and 2018. One contributing factor may be migration of black Americans from the North to the South and from cities into suburbs,” said Pew.
Census Bureau: Immigration Driving Half of U.S. Population Growth
JOHN BINDER
Immigration to the United States is now driving nearly half of all population growth in the country instead of increased birth rates, the U.S. Census Bureau finds.
The latest Census Bureau estimates on the U.S. population reveal that about 48.5 percent of all population growth is driven by the country’s mass illegal and legal immigration policy, where more than 1.5 million foreign nationals are admitted to the country every year.
Americans Must Destroy Surburbia to Benefit Immigrants, Says New York Times Author
5:00
Americans must abandon their ambitions to raise their children in suburban greenery because the country is getting too crowded, says a pro-immigration immigrant at the New York Times.
“Let’s Quit Fetishizing the Single-Family Home,” said the headline to an op-ed by columnist Farhad Manjoo in the February 5 edition of the New York Times.
“The reign of the single-family home is over. Whatever its habitable charms and nostalgic appeal, the single-family home is out of step with the future,” Manjoo writes.
That future — according to Manjoo — is the continued immigration of millions of people from India, Africa, China, and elsewhere.
Manjoo writes about his childhood in the “California Dream [of] sun-drenched suburbs” that his father provided in the less-crowded 1980s. “That dream now looks prohibitive: Houses with backyards in my neck of the woods require tech-I.P.O. levels of insane wealth,” he complains.
He cannot afford to give his own children what his father gave him, so he beats his sunny memories into a progressive sword:
And yet, wistful though I may remain for my suburban-sprawl childhood, these days I find myself continually amazed and befuddled by my state’s insane fetishization of an anachronistic model of urban development. Why — when the case for some better way of living has become so painfully obvious — can’t California quit propping up its endless rows of single-family houses? Why can’t so much of America?
Manjoo is one of many young status-seeking progressives who want to abolish the ideal suburbia because they cannot afford to buy housing in fashionable districts. So he wants government to help investors fracture, diversify, split, and subdivide ordinary Americans’ suburbia into affordable mini-homes, duplexes, four-unit apartments, and parking lots.
His demand for suburbia’s death comes after he helped to make suburbia expensive by urging more immigration.
Most migrants are clever and hard-working. So their intense competition for jobs and housing lowers wages and inflates housing prices. The resulting housing crisis is most obvious in Manjoo’s high-migration state of California:
California's poverty rate is worse than Alabama & Mississippi, says Census Bureau. The major cause of this huge change is immigration policy which spikes housing costs & shrinks wages -- and delivers huge gains for investors in real-estate & corp. shares. bit.ly/2mgvBlW
Manjoo does not entirely break the media taboo against mentioning the harms caused by mass migration. But he gets close by blaming California’s crisis on “too many people”:
In an era constrained by sustainability and affordability, a big house with a backyard should be a rarity. Much of California is straining under its own success: We have too many people and too few places for them to live, offered at too-high prices, in too many areas touched-by-climate-change-related menaces, like wildfires, all too far from where people work. And the solution is so painfully obvious it feels almost reductive to point it out: Make it legal to build more housing that houses more people.
Manjoo is one of the open-borders progressive pundits who helped spike housing prices. “My family came to the United States from our native South Africa in the late 1980s,” Manjoo wrote in January 2019 as he argued for open borders:
Economically and strategically, open borders isn’t just a good plan — it’s the only chance we’ve got. America is an aging nation with a stagnant population. We have ample land to house lots more people, but we are increasingly short of workers.
Manjoo’s self-defeating views are perfume for investors, real estate owners, and employers — including Democrats Tom Steyer and Mike Bloomberg. They have the wealth to profit from any inflow of immigrant consumers, renters and home-buyers, and workers.
A booklet by the investor-funded Economic Innovation Group says:
The relationship between population growth and housing demand is clear. More people means more demand for housing, and fewer people means less demand.…As a result, a shrinking population will lead to falling prices and a deteriorating, vacancy-plagued housing stock that may take generations to clear.…The potential for skilled immigrants to boost local housing markets is clear. Notably, economist Albert Saiz (2007) found a 1% increase in population from immigration causes housing rents and house prices in U.S. cities to rise commensurately, by 1%.
But Manjoo is a clever pundit who can parlay his self-defeating politics into pleasing rationalizations:
Single-family zoning was one of the many ways white homeowners and politicians kept African-Americans out of suburbs.…I don’t feel so bad. Our attached townhouse, on a piece of land a small fraction of the size of a single-family home, is less of a burden on the environment, and it is just the right size for the four of us. It’s also just as loving and pleasant a place for my kids to grow up in as my own suburban manse was for me.
Democrat & billionaire investor Tom Steyer says he will give cheap housing to many illegal migrants (plus jobs etc) - so raising Americans' housing costs.
His private house looks down on SF's Golden Gate bridge. Maybe he is just oblivious to housing costs?bit.ly/2sjnsjV
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