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Of Community and Quarantine 

A fight over mental health treatment blurs the line between civilization and discrimination

Wednesday, Dec 18 1996
On Harrison Street, just off Fourth, an empty two-story building has been echoing with the sounds of hammers and saws in recent weeks. Vacant for months, it was a little-noticed neighborhood blemish until February of this year when a huge banner was slung across its front: "Notice of Hearing for Mental Health Facility."

The announcement set off a neighborhood fight that one observer compared to the raging strife over school desegregation and left others equally shaken.

At issue, the South of Market Mental Health Clinic, which proposed in January to move from its longtime site at Jessie and Sixth streets to this building, at 760 Harrison, just four blocks away. The banner was then hung with the best of intentions, mandated by a little-known 1987 S.F. ordinance designed to ease neighborhoods' resistance to sharing space with the mentally ill. But the result has been just the opposite.

Face-offs between the stigmatized and the broader community are common in this era of reduced government dollars. But, ironically, the notification law exacerbates compassion fatigue. And it may even be illegal under newer federal anti-housing-discrimination guidelines.

The ordinance is very specific: Neighbors within a 300-foot radius of a proposed mental health or drug treatment facility must be notified. Hearings must be held by the Health Commission, which passes its recommendations on to the Board of Supervisors for final approval. Even then, community members may appeal to the commission and the board.

Social workers and legal experts argue that the ordinance violates the Fair Housing Amendments Act of 1989, which makes it illegal for landlords to discriminate against mentally and physically disabled people or agencies operating on their behalf. The FHAA also makes it illegal for cities to manipulate zoning rules or single out disabled residential facilities for special regulation.

"The ordinance ... implies there is a problem with our clients, and therefore a community review is needed," says Steve Fields. As executive director of Progress Foundation, a nonprofit organization that provides community-based housing for the mentally ill, Fields has been through the process a number of times.

"The toll it takes on the sense of community is pretty hard," he says. "You run into this unswerving opposition of people who don't want you there. People who've been through the system speak on our behalf, and they hear some of the most terrible things said about themselves. It's discouraging."

And not just for residents. Potential landlords are reluctant to wait out the lengthy review process. Jo Ruffin, director of the city's Division of Mental Health Services and one of the city's lead spokespersons for the city on behalf of the clinic's move, says an earlier site for the clinic had already been lost because of that. "The landlord couldn't put up with the amount of time it took," she says. (Clinic personnel begged off commenting for this story, out of fear they would stir up neighborhood animosities anew.)

"There are so many opportunities to slow down a project," Fields says. "Community attitudes have deteriorated rather than improved. People are more fearful, angry, and sophisticated in fighting."

The South of Market Mental Health Clinic has operated since the mid-'60s, providing counseling and medical services for approximately 80 people a day. The move was decided on in 1992, because the Jessie Street structure was deteriorating badly, and increased crime in the area threatened the safety of clients and staff alike.

But Harrison Street residents felt threatened, too -- by the new neighbor.
"This is predominantly a senior citizen community," says Jerry Clark, spokesman for the Yerba Buena Council, a community organization formed to oppose the clinic's relocation. "We don't want a flood of people in here who can't be helped."

Police statistics don't back up Clark's fears. Community perceptions "are a bigger problem than reality in these circumstances," says South Station Police Capt. Dennis Martell. "Our data showed no correlation between the high crime rate on Sixth Street with the existence of the clinic at its old location."

Such doses of reality have been lost in this debate. Relations between the two sides deteriorated rapidly over the course of six community meetings in March and April. Intended to provide information about the clinic and its clientele, they instead erupted into such vitriolic clashes that some participants remain upset to this day.

"Now I know what it must have been like being an African-American in front of a lynch mob," recalls Kinke Walker. "It was like a witch burning. I am a former mental health client with manic depression. I'm also an incest survivor, so I spoke as someone who received help. I was suicidal when I first entered the system. When I said I almost committed suicide somebody said I should have done it."

Don Hesse, a 20-year staff member with the city Human Rights Commission, which works to resolve conflicts between community groups, likened the meetings to "hearings at the school board regarding integration. I hadn't seen anything like it in 20 years. The behavior of the people was outrageous beyond any description. Clients of the clinic were mocked and hooted at. One woman who spoke of her schizophrenic son regaining his health and starting a family was told he should be castrated."

At one point, neighborhood children were brought into the fray when Circe McLeod, then acting principal for the nearby Filipino Education Center, had 10 of her students show up at a hearing. They wore signs whose messages included: "The children of SOMA are not dispensable," "We are afraid," and, the most grisly, "Let us not repeat the Scotland Massacre," a reference to the murder of 16 children in a Scottish grammar school by a mentally deranged gunman last spring.

"My mom told me there might be a clinic a few steps from my school, for mental [sic] ill patients," one 9-year-old girl testified, according to a hearing transcript. "Some of those patients may wander around looking for the clinic and may end up coming to the school. They will also wait for the bus ride in front of my school. Isn't this scary?"

McLeod's tactic led Health Commission President Dr. Edward Chow to criticize the use of children at the hearing. In an interview later he noted, "It comes to be a problem when the young express a viewpoint they could not arrive at on their own. It's problematic when children speak adult perceptions. That's not the way to instruct the young on what mental illness is." (McLeod has since taken a medical leave of absence and could not be reached.)

Despite the protestations, the clinic's relocation was approved by the Board of Supervisors in November. But only after community insistence on repeated neighborhood meetings, which led to delays in the commission's consideration of the issue, caused the decision to drag on for nine months. Now, the dust has settled, and the clinic is set to open once renovations are finished. But scars still remain.

Because they're stereotyped as prone to form gangs, "do we put up signs calling a public hearing because African-Americans are moving in?" notes Bill Hirsh, executive director of the nonprofit Mental Health Association of San Francisco. "Then why the mentally ill?"

The answer to that question harks back to the closing of state mental hospitals in the 1960s and 1970s, says Steve Segal, a professor at the School of Social Welfare at UC Berkeley. The failure of "deinstitutionalization," he explains, was caused when states didn't shift hospital dollars to community programs. Consequently, the mentally ill were left to fend for themselves on the street. These days, "If you can survive on the street for three months, then you've been able to provide food, clothing, and shelter for yourself, and that's enough," says Segal. "Twenty-five years ago that wasn't enough. We had a commitment to care for those who couldn't care for themselves."

The Department of Public Health estimates that among San Francisco's 6,000 to 10,000 homeless, 30 percent are in need of psychiatric services. At $975 per person held overnight at San Francisco General Hospital's Psychiatric Ward, delays in finding suitable programs can cost the city dearly. Some $4 million annually, according to A Place to Be, a 1987 report by the Housing Task Force of the San Francisco Mental Health Association.

"Communities shoot themselves in the foot when they reject housing for the mentally ill," says Tim Iglesias, a lawyer with the nonprofit Housing Association of Northern California, a membership organization for agencies providing affordable housing. "People will be homeless or live in substandard housing without services and become more of a drag on the social service system."

But that point rarely persuades neighbors, and their hostility toward a project often remains even when the hearings end.

"People who live [in the facility] learn about it when they get in," Fields explains. "We tell them there're people watching us." If firetrucks pull up in an emergency, it becomes politicized, "instead of 'the poor neighbor down the street having a fire.' "

The Health Commission approved a recommendation to the Board of Supervisors on June 6, 1995, that the supes should repeal the 1987 ordinance. Not surprisingly, the board still has not acted on such a politically sensitive proposal.

"It is difficult, policywise, to remove a law that purports to alert the public to land use," says Jim Morales, a staff attorney with the S.F.-based National Center for Youth Law. "The better approach is to keep some review process but to carefully state what factors the city can consider."

Resistance to community-based mental health programs will not disappear if the ordinance is repealed, but it would be a start, advocates say, toward reasserting the rights of the disabled.

"We have a law that allows NIMBY-ism to be civic policy," says Hirsh. "A process designed to promote community participation has instead given license to discrimination. Rather than determining the best way to meet people's needs, we spend an inordinate amount of time healing wounds.

About The Author

Malcolm Garcia


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