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Schizophrenic. Killer. My Cousin.

It's insanity to kill your father with a kitchen knife, but it's also insanity to close hospitals, fire therapists and leave families to face mental illness all on their own.

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"No one ends up in jail rotting," Summit ADAMHS chief clinical officer Doug Smith promises me, dismissing the very notion of that happening here with a shake of his head. "We don't have those problems here, like they have in California."

Ah, California. No. 1 in the amount of mental-health funding cut from 2009 to 2011, No. 7 in cuts as a percentage. Home to one of the largest jail/psych facilities in the nation, the LA County Jail. Where visitors can't believe how many bat-shit-crazy homeless we've got. Where deinstitutionalization was pioneered under Gov. Ronald Reagan with the 1967  Lanterman-Petris-Short Act, which made it vastly more difficult to commit people, and where the rate of mentally ill in the criminal-justice system doubled just one year after it took effect. Where, often, the severely mentally ill live in jail for three to six months because they're waiting for a bed to open up in a psychiatric facility. California: where, says Torrey, the psychiatrist who warns about "predictable" violence like my cousin's, "they led the way in [deinstitutionalization], and they've led the way downhill. They're certainly leading the way in consequences."


The Tendeloin, a neighborhood on the western edge of San Francisco's downtown, has never been quite as infamous as New York City's skid row once was, but it is no less deserving of its own depressing show tune. Emerging from the Civic Center subway station—with a guy stalking behind you barking, "Bitch. Bitch. Bitch"—you can generate a tour of movie-drama levels of abandoned humanity by simply doing a 360-degree spin. See a guy in a camo jacket selling four boxes of Kraft Macaroni and Cheese, cursing at unsellable mac and cheese. A guy rubbing his hands and smelling them, rubbing his hands, smelling them. A guy with a skateboard and chatty invisible friend to his lower right; another guy earnestly preparing a crack pipe; a filth-covered gal sitting and staring intently at nowhere; a lady with one shoe, no bra, a high ponytail, and a confused face, weeping and glancing around, lost in the broad light of day.

"This is not a ghetto," says Cindy Gyori, executive director of  Hyde Street Community Services, one of the city's underfunded community mental-health centers. "Nobody is born here. They're looking for the end of the rainbow," and they end up here because San Francisco has "a reputation for being open." Of the 1,000 individuals the clinic sees per year, 44 percent walk in the door homeless. Fifty percent admit to substance abuse. From wherever they came, "they bring their problems with them."

Gyori, a petite white-haired lady with an exuberance you wouldn't expect to last 20 minutes, much less 40 years, in this neighborhood—its 35 square blocks host 6,000 homeless people and 72 crimes on any given day—joined the civil and patients' rights movement that had helped a cost-cutting Gov. Reagan pass Lanterman-Petris-Short. As a social worker, she experienced deinstitutionalization shake out; she's had to call the police, invoking LPS's Section 5150, on "lots of people" who "didn't know how to take care of themselves" and were a threat to their own or others' safety. But she still disagrees with those who think it should be easier to get people committed, medicated, or treated against their will. Whether they're in their "right mind" or not, she says, mentally ill people should be able to do whatever they choose until they're a danger—just like non-mentally-ill people. That violence has often already occurred by the time someone gets 5150'd is, Gyori says, a necessary "complication of our rights in America." 

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