Thread by @ShellenbergerMD

Corey is homeless & addicted to fentanyl

He could OD & die as nearly 90k Americans did in 2020

No psychiatrist thinks fentanyl is good medicine for mental illness & yet we enable its use

Here's why Californians should be ashamed of ourselves

THREAD

michaelshellenberger.substack.com/p/why-californ…

In the fall of 2019, someone posted a picture of a homeless man to a Facebook group called “BART Rants and Raves,” where people share photos and videos of the often upsetting things they see while riding BART, the San Francisco Bay Area’s subway system.

The photo was of 30-year-old Corey Sylvester. He was passed out and looked very sick. His clothes were ragged, his hair and beard matted.

“They were saying some hurtful things,” said Jacqui Berlinn, Corey’s mother, who raised him and lives in Livermore, a city on the eastern edge of the San Francisco Bay Area.

She wasn’t sure whether or not to respond. "It just kept weighing on my mind,” she said. “I used to hide my story out of shame. But I realized a few years ago that that didn’t help my son or myself.”

And so Jacqui posted a comment. “This is my son,” she said. If you see him, she said, “Just say a kind word to him. Tell him, ‘Your mother loves you. She wants you to be healthy.’” Jacqui then posted a photo of Corey when he was sober. “May he return there soon,” she added.

It worked. After that, “People were a lot kinder,” she said. And people talked to Corey on the street. “I don’t know what you did,” Corey told Jacqui, “but so many people are coming up to me and saying, ‘Call your mom! Go home! You are loved. Please, we want to help you.’”

On Halloween 2019, Corey came home, and said he wanted to stay sober. “We’re at a critical moment,” Berlinn told a reporter. “We need to get him the help that he needs.”

An addiction specialist agreed. “Most likely [Corey’s] going to need a level of residential care because spending that much time out on the street, you’re going to come to a lot of challenges.”

Jacqui got Corey on a waitlist for drug treatment & a room at a halfway house to stay at until the spot opened up. “It's a sober living facility,” she said, “but he didn't have any tools to stay sober.” He would've benefited from an opiate substitute but wasn’t given one

“He stayed sober for about a week,” said Jacqui, “but then he slipped back into it because he was allowed to just go out on the streets. We had a program lined up but when it came time to take him, he had already gone back [to the streets] and he refused to go to the program.”

The streets have been hard on Corey. “My son has also been hospitalized twice from being stabbed,” she said. “One time he almost died. I didn’t even know he was in the hospital until he was well enough to call me....

"....After that I bought him a medic alert bracelet with my info on it. He eventually lost it, of course. So I planned to have my phone number tattooed on his chest—he agreed, but because of COVID, tattoo parlors are closed.”

When I spoke to Jacqui yesterday, she said Corey was about to get surgery for a deep, infected wound on his hand, but left the hospital before it could happen, likely because of he was experiencing withdrawal from fentanyl.

“He called me from the hospital and started crying because the last time he was under general anesthesia was because of the stabbings,” she said. “But he checked himself out against the doctor’s orders and I’m really upset and worried.”

Jacqui had just read the article on homelessness that I wrote, and agreed to let me describe what was happening. “I read your article, and in the right circumstances he should have had to have stayed so he could be clear-headed and make the right decisions,” she said.

“Now he could lose his hand or his life if he doesn’t deal with the infection.”

The responsibility for fixing our homeless crisis lies with Gov @GavinNewsom His mental health advisor, Thomas Insel, said he agreed the state needs to take over psychiatric & addiction services, but that the state lacks “leadership… leadership… leadership.”

Why is that?

Part of the reason may be that the governor is out of touch. In 2011, after he was done serving as mayor of San Francisco, Newsom moved to Marin, one of the most affluent counties in California, on the other side of the Golden Gate Bridge.

“When you’re in a city, as Gavin [Newsom] used to be,” said Stanford University addiction specialist Keith Humphreys, “the cost of this stuff is more evident to you than it is from fifty thousand feet...."

"...And he would endure great political blowback from lots of people who support him who don’t see the downsides and feel very good about the current policy.”

Others agree that the underlying problem is that Newsom doesn’t want to cross traditional Democratic Party interest groups. “Gavin is a check-the-box kind of Democrat,” said a lobbyist in Sacramento.

One of Newsom’s homelessness advisors, Philip F. Mangano, told me that the governor feared lawsuits by the American Civil Liberties Union if he sought to expand mandatory treatment of the mentally ill and addicted.

It seemed in 2019 like Newsom was trying to build consensus for change. He convened a homelessness task force. He declared himself “homelessness czar.”

But now, two years later, the governor and his task force have still not built agreement around a real solution. I asked Jeff Bellisario from Bay Area Council, who was part of the governor’s task force, if Newsom or the task force had developed a plan to end homelessness.

“No,” he said.

What about a proposal to just shelter people?

“There’s a lot of power in Sacramento on the Housing First side,” said Bellisario, “and few people talking about shelter. Housing First has taken over a lot of what happens on the ground whether in the nonprofits or cities and counties. In the end we ended up with nothing.”

According to Housing First homeless people should be given apartment units with no requirement to address self-destructive behaviors. As a result, the evidence suggests that Housing First may be increasing addiction & overdose deaths by making drug use easier, & recovery harder

In 2020, California’s independent Legislative Analyst’s Office reported, “We find the Governor’s budget proposal falls short of articulating a clear strategy for curbing homelessness in California.”

The confusion was apparent at the Governor’s press conference on Tuesday. “Shelters aren’t the solution to homelessness,” he said, repeating the mantra frequently repeated by California’s elected leaders, “housing is.”

Newsom then held a showy press conference where he could be seen participating in the clean-up of a homeless encampment.

But Newsom has done little to build new housing. Newsom campaigned and was elected on a pledge to build 500,000 new units of housing every year from 2019 to 2025. Instead, California’s housing production declined in both of the years Newsom has been in office, 2019 and 2020.

New housing construction in 2020 declined 10 percent with just 100,550 new building permits issued, one-fifth of what Newsom promised.

“I think that it’s no secret that Gavin’s administration has not followed through on what would have been necessary to actually achieve the housing goals that he set forth when he was running for office,” said Laura Foote, the head of San Francisco YIMBY, a pro-housing group.

“He didn’t put a lot of pressure on the state legislature to pass some of the packages that needed, and they needed a governor to push and usher them through.”

Newsom threatened to withhold money from the counties that did not build more housing, but didn’t follow through. “He has the inherent legal authority,” said a different pro-housing leader who asked to remain anonymous. “He just lacks the courage to use it.”

At this point, the person started laughing

“Why are you laughing?” I asked

“Because there is no other way to say it than the rude way! He is being a coward about it. I'd be the same if I were running for president. It takes a certain kind of leader to raise his middle finger"

"I don’t know if Gavin is the kind of leader to do the right thing when it’s unpopular. He’s more reactive & transactional. I don’t know why he has that political strategy. I would categorize it as, ‘He doesn’t because he’s afraid to,’ and it’s not more complicated than that.”

We Californians are intensely proud of our record as progressives. In the 1960s, California birthed humanistic psychology, which fiercely rejects the notion that we are limited by our genetics, our families, or our societies.

In the 1970s, California gave rise to the gay rights movement. And in the 1980s, California’s cities generously extended health care to previously stigmatized populations suffering from mental illness, addiction, and HIV-AIDS.

But over the last 10 years, while California has been governed by a super-majority of Democrats, & as progressives became more powerful in San Francisco, Los Angeles, and other cities, the homeless addiction and untreated mental illness crisis worsened dramatically.

Between 2010 and 2020, homelessness rose 31 percent in California but declined 18 percent in the rest of the U.S.

As such, we Californians should be ashamed of ourselves, not proud of ourselves.

It’s true that shaming is badly abused. Nothing is more common than to blame addicts and their mothers. But they are not responsible for the refusal of @GavinNewsom to take over psychiatric and addiction services. Nor are they to blame for the California’s open air drug scenes

What happened to Corey is unremarkable. Jacqui and his father divorced. Corey was bright. “He played football. He played baseball. He played saxophone,” said Jacqui. “He graduated from Livermore High School and got his actual diploma.”

But he also started getting into trouble around 18 or 19, “breaking the rules of the house and then he wasn't being safe.” He ended up on the street, and using increasingly hard drugs.

Corey compared the Tenderloin neighborhood of San Francisco to Pleasure Island in the Disney film Pinocchio. “On one side of the street are people giving you food and clean needles,” he told Jacqui. “On the other side of the street are all the drug dealers...

"It’s like getting all the treats you think you want. You think you’re having fun. But little by little it’s taking away your humanity and turning you into something you were never meant to be, like how the kids start turning into donkeys in Pinocchio and end up trapped in cages”

“We watched the movie when he was a boy,” said Jacqui, “and so it totally made sense to me that he felt like one of the poor donkeys trying to break free, with the drug dealers giving them treats and enslaving them and taking away their humanity and they had no way to escape.”

Matt Haney, the San Francisco supervisor who represents the Tenderloin, and is considered a promising mayoral candidate, told me, “Undoubtedly there are some people who come here because they are sick with addiction. This is a place where you can access drugs more easily.”

The overdose crisis is much worse in San Francisco than other cities. In New York and Chicago there were 16 and 23 overdose deaths per every 100,000 people, respectively, in 2020. In San Francisco, there were 50. Overdose deaths rose from 179 in 2015 to 713 in 2020.

Just over half occurred in the Tenderloin, the Inner Mission, and South of Market. A preliminary report estimates that 203 people died of overdoses in the first three months of 2021 alone, a 54 percent rise from the same period in 2020.

Jacqui believes that for Corey to survive he must be mandated drug treatment. “I get a lot of pushback,” she said. “It’s the old adage of, ‘You can’t force them,’ and to some extent I believe that. But honestly everybody’s different and my son’s rock bottom is death.

Unless he’s sober and thinking clearly, he is too scared of withdrawal. He needs to be able to focus in a controlled environment so he can think straight. As long as he’s on the street he can’t think straight.”

No mainstream psychiatrist in America thinks fentanyl and meth are the right medicines for schizophrenia, bipolar disorder, and depression. No serious addiction specialist denies the importance of coercion in helping people overcome their substance use disorder.

And yet at the state and local level, we Californians are enabling the use of fentanyl and meth by growing numbers of people in open air drug scenes that deprive people of their dignity and strip cities of their civility.

Last night, after I had written this, Jacqui emailed. “Corey just called me!” she wrote. “He said the hospital gave him antibiotics when he left and that he is doing better because he also lanced it. He said he will still go to the hospital though.

He said so many people die out there from sepsis because they are saving up to get enough of their drug so when they go into the hospital they don't get drug sick.”

What we Calfornians are doing to the weakest and most vulnerable people in our society is unconscionable. The issue is “not shame or don’t shame,” it’s “what should we shame and what should we value?”

Over the last fifty years, California progressives have shamed any amount of coercion to address addiction or treat mental illness, whether in the provision of housing or in the issuing of sentences for crimes committed. The results are visible on the street.

As such, the blame belongs not just on Newsom and state and county elected officials, but on us, the people of California who elected and re-elected them over the 30 years when their policies made homelessness much, much worse.

It’s time to take responsibility for our actions, which includes our political leaders accountable for their unwillingness to respond forcefully to the crisis.

Californians can hold Gavin Newsom accountable this fall and next year, when he is up for re-election.

But the situation for Corey and 100,000 other unsheltered homeless in California is precarious and urgent. We need to find ways to support mothers like Jacqui, in their quest to save the lives of their children, before it’s too late.

/END

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