Authorities need more tools to help unhoused Californians who don’t want help

There’s a woman on the streets of San José who has spent a quarter of her life there. For the past decade she’s been cycling between the streets, the county jail, a shelter bed and the ER.

She keeps falling through the cracks. The specifics of her case are unique, but the pattern is ubiquitous and familiar in every city across California.

This woman in San José is nearly 60 years old. And without a change to state law, she could spend the rest of her life cycling through the same broken system. She could take her last breath on the pavement, in a jail cell or, if she’s lucky, receiving care in our public hospital.

Because in California, people are dying and we don’t have the political will to stop it.

I learned this constituent’s story when San José recently ran a pilot with our county focused on targeted intervention. She is one of the 60 most vulnerable residents living in our downtown — the “frequent flyers,” the people suffering on our streets and straining both emergency services and neighbors’ patience. The people who, frankly, we don’t know what to do with: They are too sick to remain in a shelter but not sick enough to be compelled into care.

We tried to get them help, including clinical evaluation. We offered all 60 people multiple housing options — a motel room, a tiny home, a permanent supportive housing unit.

Forty accepted. Twenty refused.

Of the 40 who came inside, 24 needed the county’s intensive behavioral health treatment, and 15 chose to immediately return to the streets.

We had less than a 50% success rate with the initial pilot.

By actually focusing on the hardest people to help, we confirmed a scary truth that should be obvious based on the state of our streets: We don’t have the tools to help more than half of the most vulnerable people living on our streets.

More than 1 in 5 Americans live with a mental illness.

Imagine going through a mental health crisis alone with no one to advocate for you. Imagine you are past the ability to recognize you need help. And no one is there to require the life-saving care you need.

In fact, in California, your right to remain ill and to overdose has a stronger legal foundation than your right to get well.

I’ve advocated to change this alongside state senators such as Susan Eggman and Catherine Blakespear, whose bills I’ve watched get watered down until access to care is essentially a suggestion.

We have to acknowledge that some of the people on our streets, often the ones who have languished the longest, are no longer able to make a rational decision regarding their own well-being.

Their addiction won’t let them say yes when offered services and care. Their psychosis stands between them and a treatment bed. And the end result is: We are allowing them to be controlled by chemicals in their brain telling them they are OK when anyone watching can see the truth.

So by taking the teeth out of initiatives such as the CARE Court, we’ve left people to face a much harsher bite: life and death on the streets.

It’s a philosophical question as much as a constitutional one: Where do we draw the line between personal liberty and moral responsibility? Especially when someone exercising their individual liberty is affecting our collective safety and quality of life. And even moreso, when our current policies allowed more than 30,000 people to die on our streets over the last decade, mostly from drug overdose, homicide and suicide.

We call 911 when someone is standing on a ledge. But when someone is slowly killing themselves on the sidewalk, we watch them deteriorate until they finally meet the legal threshold for intervention — or until it’s too late.

We have a collective responsibility to do better. And what we need to do next is clear to those of us closest to the system’s gaps: First, we need to significantly expand, by 50% or more, the number of treatment beds in California, including facilities capable of handling complex cases that involve both substance abuse and co-occurring mental illnesses. This also requires a significant investment in our healthcare workforce. Second, we need to create the legal tools to mandate care when those beds are available, including by allowing CARE Court proceedings to result in involuntary treatment.

I’m calling on our state leaders — our next governor and our leaders in the Legislature — to confront this moral failing head on. We can’t keep leading people to their graves while patting ourselves on the back for protecting the autonomy they are using to kill themselves.

Matt Mahan is the mayor of San José.