Psychiatric patients increasing in S.F. hospitals, putting a strain on the system

Police Commissioner Thomas Mazzucco was driving past a San Francisco hospital with his wife last year when he spotted a blanket in the middle of a busy roadway.

“My wife said, 'Oh my God, there's a person in there,'” Mazzucco said during a Police Commission meeting in May.

When Mazzucco circled the block to assess the situation, he saw the man under the blanket being escorted back into the hospital by Police Chief Greg Suhr, who happened to be in the area.

“That person still had the hospital band on and had just gotten out of the psych ward,” Mazzucco said.

The incident highlights an increase in people who suffer from a mental illness or psychological problems living on the streets of San Francisco. Officials say this growing problem is creating a strain on the system.

San Francisco General Hospital is admitting more patients on 72-hour psychiatric holds, in which patients can be involuntarily held for up to that length of time if they are considered a threat to themselves or others.

In 2009, there were 5,837 patient admissions to S.F. General's Psychiatric Emergency Services unit, The City's primary site for psychiatric patients, director Dr. Melissa Nau told the Police Commission. Last year, the number of admissions for psychiatric holds rose to 6,293, she said. Patients are sent to other San Francisco hospitals too.

But the lengths of the stays at the hospital have been decreasing while staffers attempt to free up beds.

“If you see people getting discharged earlier, you're right, that is happening,” Nau told the Police Commission.

Residents and police alike say they are noticing an increase in the number of people on city streets who exhibit signs of having mental illness.

“You just walk down Market Street in any given morning and within a block you see two or three people in crisis,” Mazzucco said.

Troy Campbell, the executive director of the Fisherman's Wharf Community Benefit District who also sits on the Police Department's community advisory board, agreed that there are “a lot more aggressive people” on the streets. The difficult matter is not isolated to one part of The City, Campbell said.

“Society as a whole has dropped the ball on this issue,” he said.

San Francisco's recent biannual homeless count also reinforces the anecdotes. According to the survey, 63 percent of the people interviewed in shelters and on the streets reported having a mental illness, addiction or debilitating physical condition.

That is an 8 percentage point increase from two years prior, when the last count was conducted and 55 percent reported having one of those conditions.

One problem, Mazzucco said, is that too often these people end up in the criminal justice system as opposed to the mental health system.

“We've got a volatile situation,” he said. “It's dangerous.”

Another problem facing The City as funds dwindle is where to treat the patients and for how long. Six months ago, Nau said, S.F. General lost six beds in its Psychiatric Emergency Services ward — the equivalent of the medical emergency room — despite seeing an increase in the number of patients. The lost beds were reportedly due to a nursing shortage and hiring freeze, she added, and it's unclear whether they will be reinstated.

Once patients are out of emergency care, a bigger problem is where to send them if they need long-term care.

Dr. Mark Leary, deputy director of UC San Francisco's Psychiatry Department at S.F. General, said the capacity in the emergency services and the inpatient beds at S.F. General can meet the needs if there are increased options for short- and long-term patients who need them. Right now, there aren't enough cheaper, less-intensive care options to continue monitoring patients. There are currently long wait lists for outpatient clinics.

S.F. General's acute beds also are expensive, Leary said.

“Frankly, in years past, we were keeping people in the hospital longer than was absolutely necessary to keep them in a hospital,” Leary said.

Hospital staff have been in a “constant battle” to determine when to release a patient to save on cost, Nau said.

“Doctors and nurses struggle with not wanting to discharge someone that's unsafe to discharge and not wanting to single-handedly sink the hospital,” Nau said.

S.F. mom says 5150 a misunderstanding, seeks records wiped

Amid a rise in mental health cases in The City, one woman told the Police Commission last week that officers mistakenly arrested her on a 5150 psychiatric evaluation hold.

In January, Diane Carpio said, she had a disagreement with a restaurant manager and he called police. Officers booked her on a mental health hold — a black mark she wants to have expunged from her record.

“I know my credibility is going to be attacked,” she said. The 46-year-old San Francisco mom is worried the 5150 will affect future employment and a custody battle for her daughter.

The incident happened at a Papa John's pizzeria in Parkmerced. Carpio said she could understand some confusion on the part of police, as there were different versions of what happened.

“Cop cars showed up, and they're standing around trying to figure out what to charge me with,” she said. “One of them was like, 'Oh, how about a 5150?'”

“He told me that means you're crazy,” Carpio said.

She was brought to San Francisco General Hospital, where she was placed under a 72-hour involuntary hold, called a 5150 after the corresponding section of state legal code.

On Wednesday, Carpio asked the Police Commission to help her obtain the incident report of her detainment, which the records office at 850 Bryant St. refused to give her, she said. The report is needed to make a filing with the Office of Citizen Complaints; her deadline is today.

— Joe Fitzgerald

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