How mental illness factors into San Francisco's homeless population

Michael Ornelas, 40, has lived with mental illness all of his adult life.

Diagnosed with anxiety panic disorder and severe depression as a teenager, Ornelas reached his lowest point in 2012 while homeless and living on the streets of San Francisco. He had already spent two years without a permanent home and was near his breaking point.

"I was suicidal," he said. "That actually really scared me because for the first time in my life, it wasn't just a thought; it was like 'I'm going to do this.'"

Ornelas, 40, checked into a psychiatric hospital and he says after five days doctors told him they were going to release him.  He knew that meant he’d be back living on the streets.

"The medication I was taking at the time made me really sleepy so I'm not going to take it, which is why I'm going to end up back in here,” he told his doctors. "And I'm going to be in the same position all over again."

For many who are both homeless and mentally ill, it’s a familiar story. And professionals cite mental disorders as a key denominator for many people who live on the street.

The city’s Homelessness Survey estimates that more than one-third of the city’s 6,700 homeless people suffer from psychiatric conditions.  Many of those patients end up at the Tom Waddell clinic in the city’s Tenderloin District, which specializes in the treatment of the homeless.

Dr. Pamela Swedlow is one of the staff physicians who treat homeless people with a wide range of mental issues, including schizophrenia, severe depression and suicidal tendencies.

"Mental illness (is) different from other kinds of illness," Swedlow said. "It's the illness itself that prevents people from knowing they have something that could benefit from help and then doing something about it."

Swedlow said the most she can do is to make a connection with a mentally ill patient and hope the patient decides to receive treatment.  

"If people just don't want to take their medication, then it's a matter of time and working with someone, trying to convince them that it's really worth a try,” Swedlow said.

The 1960s was a turning point

A sea change happened in California in the late 1960s when California closed more than half of its psychiatric hospitals and then-Gov. Ronald Reagan signed a law preventing the mentally ill from being forced into treatment except under the most extreme circumstances.

"People were released from the hospital without proper support in the community. And then when you had new populations sprung up who needed long-term care in a hospital setting, those beds were no longer available," said Anne Fischer, who works with the National Alliance on Mental Illness.

There are some new attempts to get patients with the most severe cases of mental illness into treatment.

San Francisco adopted Laura’s Law late last year, an ordinance named for Laura Wilcox, a Nevada County girl slain by a mentally ill man.

The law allows relatives of a mentally ill patient to petition a judge to order treatment for a person who has not sought treatment on their own. Since its adoption, 76 people in San Francisco have received treatment under Laura’s Law, officials say.

But ultimately, the law does not legally require the mentally ill patient to receive treatment; he or she can still refuse the help.

Former San Francisco mayor Willie Brown said the laws need to be revised to give the courts more leeway.

“The standard now is they must be a danger to themselves or a danger to other people, otherwise, you can't do anything about it," Brown said. "We need to change that law and make it more appropriate for the circumstances of individuals who will ultimately thank you for being of assistance."

Michael Ornelas said his breakthrough came when he finally realized he needed help and a case manager helped him get into a program.

"The pain, misery, loneliness, not having anything, that's what broke through (and) my mind opened up," he said. 

Once he was off the streets, into treatment and back on medication, his life changed dramatically.

He now owns an apartment, has a job, is engaged and has reconnected with his teenage son.  He also mentors psychiatric patients at San Francisco General Hospital through a program called Mentors on Discharge.

The program, run by the National Alliance on Mental Illness, allows him to meet with patients and share his success story. He said he hopes the patients are inspired to follow in his footsteps. The program just started in San Francisco, but is based on a pilot program in Alameda County, which organizers say has produced positive results.

Ornelas said many mentally ill patients feel like they are being judged which can hinder their efforts to seek treatment. "There's so much stigma around mental illness so we can open up a space and there's no judgment there," he said. "It's something I wish I had because I didn't have that."


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