(Courtesy photo)

Mental health issues require the right level of care at the right time

By Vivian Imperiale

Mental health has been in the news, with several arenas receiving recent media and City Hall attention. As an advocate for over 40 years I offer some insights:


Some citizens have an unjustified fear of people on the street with odd behaviors. While being alert to those around us is always prudent, it is important not to summarily judge others. Someone ranting in public does not necessarily mean that person is dangerous. In my travels around the city there have been numerous touching occasions where strangers with seemingly psychotic behaviors stop when they see me. They feel a connection. One man got tears in his eyes because for that minute with me he felt safe. Another time I walked up to a man who was loudly ranting. His eyes met mine and focused and he engaged in a normal conversation. On a bus a passenger’s loudness and gesticulation led to people moving away from him. I sat across from him and made eye contact. He immediately stopped and was quiet and calm the rest of his ride. Experiences like these make me happy while they are happening, but then make me sad because I have to leave. We need mental health workers who can do this, but don’t have to leave.


People with mental health challenges are far more likely to be the victims, rather than the perpetrators, of violence.


Otherwise good people I know speak with derision when I mention my bonding with people living on the streets. I told a homeless man I wanted to write an article because I was tired of the disrespect people felt about people who are homeless. And then I realized, “Oh, I don’t need to convince you!” and we both laughed. Another street friend — who was the key contact in locating my missing friend— graduated from Haas Business School but fell apart when his young wife died. Another is an amazingly talented artist. I offered one man $1 but, when I told him I was facing a big tax bill, he refused to take my money. People are people who thrive on connection rather than having people turning away and shunning them.


Putting people into forced treatment in the hope that will have good results can be futile and demoralizing. People do far, far better when they are voluntarily using services. Matching the right worker with a person in distress and establishing rapport is key.

New Statewide Peer-run Warm Line

This month the state legislature recognized the effectiveness of the Mental Health Association of San Francisco free peer-run Warm Line 1-855-845-7415. Through the good work of state Sen. Scott Wiener, Assemblymember Phil Ting and Assemblymember David Chiu, the state is funding the Warm Line to be statewide and soon expand to 24/7. Keep the number handy for those days you have moments of uncertainly, vulnerability, self-doubt, or confusion or know someone who would feel better calling as often as they want.

Need for a Changed System

Our behavioral health system is hardly a functioning system when it is bogged down and people are stuck at one level of service or are released with no treatment options. Keeping people in a locked room for months because there is no bed available elsewhere is unjustifiably jailing them. Supervisors Hillary Ronen and Matt Haney’s MentalHealth SF overhaul plan — developed with a working group of community members — would provide timely appropriate help. But now a competing plan has been introduced by the Mayor: UrgentCare SF.

Just by the names alone the difference is clear. The Hillary Ronen/Matt Haney MentalHealth SF proposal provides services for people all across the spectrum of needs. Early intervention is the key to preventing the need for expensive, and often traumatic, urgent care. The premise is simple: appropriate care at the appropriate time. Unlike UrgentCare SF, MentalHealth SF doesn’t have a limited focus. It is a plan to help people at any level when they need help. The Mayor’s UrgentCare SF plan lacks insight and sensitivity to the trajectory of mental health challenges. People do not suddenly present with overwhelming symptoms. Much is going on between a first bout with depression or frightening psychotic thoughts and the need for urgent care. It is incumbent on this city to provide the proper level of care when it is needed. To do otherwise is like expecting a person with a physical infection to wait until it is festering and life-threatening to be able to get help.

Vivian Imperiale is president of the Mental Health Association of San Francisco and past president of the National Alliance on Mental Illness (NAMI) – California and NAMI SF.


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