True Treatment Can Turn the Tide
Part of working with poor people in the ghetto is learning to read the rhythm of the neighborhood as it ebbs and flows. An important but unfortunate part of that rhythm in neighborhoods like the Tenderloin is recognizing the prevalence of self-medication and addiction.
Waiting for the elevator on my way to the office, today, I ran into a neighbor I’ve only managed to say, “Hi,” to on two prior instances in the 15 months I’ve lived there. Her once-pretty face peered up from her emaciated frame to ask me, “Do you have some crack?” I demur politely, but she persists, “I have two dollars. I thought I could buy just a hit.”
She is far from alone among my neighbors: Most of them have co-occurring disabilities of every description. A third of them are seniors. More than half have HIV. Another half of my neighbors have prison records.
In other words, they represent a true cross section of my neighborhood’s demographics.
San Francisco’s Treatment on Demand campaign began in 1996, after we discovered more than 1,700 people were on waiting lists for substance abuse treatment while local emergency room mentions for both methamphetamine and heroin overdoses topped state and national rankings. At that time, a few fatal drug overdoses would typically occur daily in San Francisco.
Addictive disorders are medical conditions recognized by the DSM IV, a manual used by professionals to define and categorize psychiatric conditions. Often addictive disorders will mask other psychiatric illnesses when patients self-medicate with illegal drugs, alcohol, or addictive medications.
Untreated addiction is costly, both in human terms to individuals, families and communities it impacts, but also in fiscal terms. Studies have long shown for every dollar invested in treatment, $7 in social, criminal, and health care can be saved.
Treatment on Demand, however, is a solution that works. Since 1996, Treatment on Demand efforts have led to tremendous improvements in service accessibility. From a few fatal overdoses per day, we’re down to about 100 per year. But there’s still a long way to go:
Currently more than 500 people are waiting to access treatment in San Francisco. Proposition T, the Treatment on Demand Initiative, would require the city to provide immediate access to both residential and medical based treatment because these two treatment modalities have the longest wait lists, at a cost about $7–$13 million annually.
Repeatedly, we’ve seen unkind proposals hiding behind the promise of treatment—be it yet another aggressive panhandling ordinance, or the highly touted Care Not Cash.
With the latest such example—the Community Justice Center—these punitive initiatives have no treatment attached to them and frequently lead to increased jail time. Why? Because all of them fail to reconcile the availability of voluntary treatment opportunities with the ongoing demand for these life-saving medical services.
That Center will slum it with Treatment on Demand on the November ballot as Propositions L and T, respectively. The Community Justice Center has already been funded by the City, and its inclusion on the ballot is little more than a political ploy to convince voters to green-light the further ghettoization of one of San Francisco’s poorest communities. But Prop T gives that Tenderloin demographic above real services to help stem the tide.
Yes on T, No on L
True Treatment, Not Lies
- Prop T would require the City to provide real mental health and substance abuse treatment in San Francisco.
- Prop L would create a poverty court further ghettoize one of San Francisco’s poorest neighborhoods. While service is a good alternative to incarceration, the poverty court will require a guilty plea for access.
- Prop T would cost about $7–13 million that could come from the City’s general fund. National studies have shown that every dollar spent on treatment saves about $7 on medical, judicial, and social services. Prop T will cost money its first few years, but will save money in the long run.
- Prop L has no attached funding for services. Current expectations are that the City will reduce mental health and substance abuse budgets by 22 to 30% next year. A poverty court will be a further drain on already limited resources.
Chance