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Michael Wise spent his childhood in the Potrero Hill projects. His manic-depressive father, a Yellow cab driver, was in and out of state mental hospitals, where he was repeatedly treated with electroshock therapy. "My dad was not emotionally demonstrative," Wise says. "At home, he hid behind the newspaper, not saying much. He wanted to feel that he was better than a cab driver. When he was manic, he fancied himself as a businessman -- which he wasn't. He drove my mother crazy. After a while, our family fell apart."
Wise studied journalism at Washington High School, writing a column for the school newspaper called Wise Cracks. After graduation, his world went mad. "The times were schizophrenic," Wise remarks. "With political assassinations and race riots and Vietnam, people were paranoid. Drugs became popular. I did them to fit in."
But Wise did not fit in. When he used drugs, bad things happened. Voices commanded him to walk randomly for hours on end, to snatch purses, to break into houses. In 1968, he was diagnosed as a paranoid schizophrenic. Doctors at St. Mary's Hospital put him on neuroleptic drugs -- Thorazine, Stelazine, Haldol -- to control his hallucinations. The side effects, called tardive dyskinesia, were devastating. Wise's jaw locked up, his tongue lolled, his mouth sucked involuntarily, his body jerked.
Like many mentally ill people, Wise hated taking the anti-psychotics. He learned to medicate himself, instead, with street drugs. Occasional bouts with amphetamines, however, triggered episodes of bizarre behavior that landed him in jails and locked psychiatric wards. But during his terrible journey, he had moments of lucidity, and he used them to hook himself into San Francisco's welter of mental health treatment programs. He found a place in supportive housing for the mentally ill (that is, residences with social workers on staff). He received psychotherapy. He worked, off and on, as a mail handler for the United States Postal Service, which made him eligible for federal disability payments and medical insurance.
A few years ago, a psychiatrist hit on the right combination of psychotropic drugs; these particular "meds" produced no side effects in Wise, but reduced his level of anxiety, quieted the voices, allowed him, finally, to fit in. "My diagnosis got an upgrade," Wise chuckles, "from paranoid schizophrenic to schizoaffective, whatever that means." Like many recovering schizophrenics, Wise says his newfound ability to live in the world can be attributed to better drugs and to community care programs, especially self-help programs for the mentally ill.
As Wise, 52, tells his story, it is clear that he is a thoughtful man who is deeply committed to improving the lot of his fellows. And, indeed, Wise is doing his bit to raise public awareness about mental illness; he edits, publishes, and hand-distributes a four-page glossy newsletter, Voices at Bay, that is packed with news, views, poetry, and art made by and for the mentally ill. "I had a good idea, and I ran with it," says Wise proudly.
In ugly reality, though, Wise is a rare type of being in San Francisco's mental health universe, and because the city of San Francisco has in recent years made drastic, disguised cuts in mental health services, his type is becoming rarer by the month.
In the late 1960s, as part of a national trend, then-California Gov. Ronald Reagan "de-institutionalized" the state's mental hospitals. While these locked institutions generally kept the mentally ill out of society's sight, investigative journalists had reported that the hospitals were often hellholes that held sane people, such as conscientious objectors and rebellious teenagers, alongside untreated schizophrenics. When hundreds of thousands of liberated patients hit the nation's sidewalks, local communities, helped by state and federal funding, were charged with providing shelter and psychiatric treatment for them.
By many measures, adequate community support failed to materialize, which is the main reason why America's inner cities teem with mentally destabilized homeless people. In San Francisco, studies show that about 5,000 homeless people suffer from serious mental illness; half of them receive little or no treatment. The homeless are simply the most visible group in the mentally distressed population, which is much larger than most people think it is. The California Mental Health Planning Council estimates that San Francisco contains 65,000 very mentally ill people, of whom the majority are not receiving any form of treatment, public or private. The city-run mental health system currently serves 22,000 poor people (up from 19,000 when Mayor Willie Brown took office).
Dr. Robert L. Okin, chief of psychiatry at San Francisco General Hospital, says that the public mental health system is endangered, because city government keeps eliminating the jobs that are supposed to make it work. Public records and scores of interviews with mental health workers and patients show that, in fact, massive staff reductions ordered by Mayor Brown are edging San Francisco's mental health system over a health precipice. The city's psychiatric wards are overburdened because city money is being diverted from community mental health care clinics that help tether outpatients to reality.
The cuts in city mental health services are an extreme example of a secretive budget process the mayor has visited on many city departments. Every year since 1998, Brown has ordered all departments to submit "flat" annual budgets for his approval. Such budgets do not account for price inflation, and they also fail to account for the growing demand for services that results from a growing population. As if flat budgets were not bad enough, the ranks of city employees who treat the seriously mentally ill have been drastically thinned by use of a sharp bureaucratic knife known as "salary savings." Here is how salary savings work: A department budget appears on paper with (for example) $10 million for 200 jobs, at $50,000 each. To meet the mayor's order to create salary savings of, say, 10 percent, 20 jobs are budgeted on paper, but left vacant in reality, thereby freeing up $1 million. The million dollars "saved" might be used to increase pay for the remaining 180 jobs, or, depending on the politics of the moment, it might be returned to the General Fund for use at the discretion of the mayor and the Board of Supervisors. In any event, the department's official budget appears to be $1 million larger than it really is.