"Most of the patients I see as a psychiatry resident at the Zuckerberg San Francisco General Hospital are very ill," Alison Hwong, a psychiatrist in her residency at UCSF, writes in an op-ed piece for the Chronicle. "It doesn’t take a medical degree to determine that jail is not a therapeutic environment for people with severe mental illness and that it will prolong behavioral and legal problems." The dilemma: 35 to 40 percent of San Francisco jail inmates are receiving treatment for mental illness, and presumably more ought to be. Hwong implores the city to "invest in more psychiatric beds, community-based mental health support, and housing rather than jails."
The report whose numbers she cites: "Justice That Heals: Promoting Behavioral Health, Safeguarding the Public, and Ending Our Overreliance on Jails." Its authors are UC Santa Cruz Psychology professor Craig Haney, Ph.D., J.D., San Francisco Behavioral Health Court co-founder Jennifer K. Johnson, J.D., UCSF Citywide Case Management Forensic Program director Kathleen Lacey, LCSW, and Stanford Law School Justice Advocacy Project director Michael Romano, J.D. The group claims that according to those percentages of mentally ill inmates, county jail is the city's largest mental health facility. As such it proposes the creation of a "Behavioral Health Justice Center," an institution "providing mental health services designed to interrupt the cycle of homelessness, addiction, and criminal activity."
Hwong notes that such a facility has backing from the DA's office, and though it's "promising," notably, "psychiatrists have not been part of the discussion." More generally, Hwong proposes providing alternatives to incarceration, which she feels the need to argue is the "moral" thing to do. Of course it is, and to imply that others in the liberal city of San Francisco might disagree is vaguely insulting. But a more practical argument is her last one: It's simply cheaper to create incarceration alternatives. "It is estimated to cost roughly $50,000 per year to incarcerate someone at 850 Bryant, versus $7,000 to 10,000 to provide safe, supportive housing plus mobile treatment teams for people living with chronic mental illness," Hwong points out.