It was my parents' first visit to San Francisco, maybe 15 years ago. We were walking down Market when we saw a man standing on a traffic island, brandishing a book and preaching at the top of his voice. He wore nothing but a well-used pair of brown oxfords. No socks, even.
Later that day, my Dad, who was 75, was telling somebody else about what we'd seen. That's when I learned that it wasn't the orator's nakedness that Dad found remarkable. It was the fact that nobody was paying any attention to him.
Looking back, I realize it wasn't all that funny. It was too accurate a metaphor for the political plight of the mentally ill: the difficulty of getting anyone to pay attention.
As this is written, the network news is clucking worriedly about the Sydney flu, a brutal virus headed this way bearing nausea, fever and related miseries. It is Page One stuff, as it overcrowds the nation's emergency rooms.
Mental health isn't on the front page today, despite the fact that mental illness kills and disables more people than the flu -- and all the other infectious and parasitic diseases together.
Where is the news hour teaser about mental illness: "More people die and are disabled by mental illness than by cancer."
As many as 80 percent of the people with severe mental illness are treatable, but the majority end up with chronic, often disabling symptoms -- because in fact they aren't treated.
President Clinton took a step toward fixing the problem recently when he ordered health insurers who do business with the government to provide mental health benefits on a par with those for so-called physical ailments. We'll soon know the response of the insurers.
Some states, like California, are also considering legislation to make it easier to commit mentally ill patients against their will.
It's a tough ethics question. To some, it's is a step back to the days when it was easy to deprive patients of their liberty. But proponents argue that the pendulum swung too far. The bill, they say, would make everybody safer, including the patients. We'll see.
In the 1950s and 1960s, well-intentioned legislatures freed the majority of people living in mental hospitals. If they were no danger to themselves and others, the idea was to treat them in environments as permissive as possible.
As you well know, most states turned out the resident patients, but never arranged for the pharmaceuticals, therapy and half-way houses so glowingly pictured in the original plans. The rest of us made them invisible by not seeing them. They're like Patient J.
J, age 30, lives with his parents because the county ran out of money for the halfway house where he lived before. There they made sure he took his medicines for schizophrenia, and had the staff to handle him when he turned mean..
J hadn't been taking his medications recently, and had spent three days in bed, fully clothed. When his 68-year-old father came in and stood beside the bed, J's booted foot shot out and caught him in the ribs, breaking two of them.
"We love our son," his father says. "But I'm in no shape for that kind of thing. He was doing fine in a halfway house. When the county ran out of funds it was come back here or live on the street.
"It left just 23 halfway-house beds in this whole city of 150,000 people."
Elvira Gonzalez lost a daughter and two grandchildren to the weaknesses in our treatment for the mentallly ill.
For five years, Gonzalez had been trying to get her daughter into a treatment facility. But the laws now make it almost impossible to get help for the daughter, Julie Rodriguez.
Gonzalez told a Sacramento Bee reporter that Julie's behavior had been increasingly erratic since a brother died in 1994. Julie invited her extended family for a Father's Day dinner, and just as people were sitting down, angrily dumped all the food in the garbage. She moved out on her husband and accused him of tampering with her car. She said he was harboring strangers in the attic.
She moved in with her mother, and then accused her of putting something in her food to make her angry.
Her mother urged her to seek help,, but she refused. When Gonzalez talked to police, social workers and county mental health workers, they said state law prevented them from hospitalizing Julie against her will.
She had never threatened anyone, they said. She had a home, food and clothing, so she wasn't gravely ill. Sometimes Julie would gather up her four-year-old son and two-year-old daughter and go for fast drives, with all the windows open, along the river. The mother called police each time this happened. "Something terrible is going to happen." But Julie seemed quite normal when interviewed by the police.
Late in May, Julie took the children for one of her rides along the levee. Witnesses watched in horror as the car swung off the levee into the river. Police found no skid marks.
Three days later they found the three bodies. The deaths were ruled murders and a suicide. California is talking about spending $350 million to make mental health treatment as available as the care for other illnesses. And commitment will probably be made easaier, but not too much easier.
That offers hope to thousands of very sick people -- but probably little comfort to Elvira Gonzalez.
