Thread by @ShellenbergerMD

The chaos, violence, & drug death crisis in California worsen

The open drug scene in San Francisco yesterday was worse than anything I’ve seen in over 25 years here

Violence, chaos, death

There is a solution. Shelter First. Treatment First.

But that requires new leadership

California spends more on mental illness per capita than any other state & has the worst outcomes

Most everyone on the street suffers addiction and/or mental illness

Many were recently released from prison

They need psychiatric & addiction care

People can be found lying face down on sidewalks across cities

Open drug scenes are crowded and spreading

Our leaders including Gov. @GavinNewsom admit they don’t know what to do

But every nation handles open drug scenes the same way. Shelter First. Treatment First. Housing Earned.

Call it “Cal-Psych”

I went to SF yesterday to promote this plan to Newsom & with @Kevin_Faulconer

Our mental health care system is both fragmented and duplicative, which is part of the reason why we spend the most and have the worst outcomes

When people leave prison or drug treatment they have nowhere to go and end up on the street, back in prison, or dead

There’s strong support for Cal-Psych among everyone from experts to the homeless themselves

Cal. counties were overwhelmed by the addiction crisis & de-incarceration

They’ve proven incapable of solving the problem

Nellie, homeless, says Cal-Psych should deploy mobile units

Everyone has expressed openness to Cal-Psych, even Gov. @GavinNewsom who I button-holed yesterday in San Francisco, and who put me in touch with his aide

(I am obviously skeptical, but I feel an obligation to keep trying )

In the video above, Nellie described different kinds of homeless, including the people who want to be homeless, and the mentally ill

Here she describes why we need Cal-Psych vans to provide psychiatric & addiction care

Cal-Psych could place people in the facility right for them

Former San Diego Mayor @Kevin_Faulconer told me he supports “Shelter First, Treatment First”

Faulconer has the most experience, the most comprehensive plan, and the clearest thinking, which is why I endorsed him, even as I push others, including Newsom, to embrace Cal-Psych

I have now met all the major gubernatorial candidates in person, save Larry Elder, who I interviewed over email

To all I have emphasized the need for a Shelter/Treatment First & Housing Earned policy, centrally organized, as in other developed nations

Cal-Psych can do it!

I wore scrubs as a Cal-Psych costume. I am not a doctor or nurse & have never claimed to be one!

@shellenberger @ShellenbergerM & @mshellenberger were not available

My bio for years has said “MD” in my *handle* not *name* = my initials

I have updated my bio to emphasize this

“Low drug prices, lack of law enforcement and lack of social control attract drug users towards the open drug scene & the increase in problems appears to have been more rapid than the increase in the population of addicts”

In video, a man in a red coat arrives & buys drugs…

The man in red coat has smoked the fentanyl he bought & is now high

“The scenes are often found in city centres… users may be in poor physical & mental condition & the locations will often serve as a focal point for drug dealing. The situation might grow out of police control”

Open drug scenes “attract less socially stable adolescents & others who have problems fitting in… Homelessness is often prevalent as different types of dysfunctions are prevalent & increased rates of crime may be found in the neighbourhood.”

California’s response to open drug scenes has been strictly harm reduction, but the most important study on them warns that “although harm reduction might decrease the health harms it does not decrease the size & seriousness of the open drugs scenes.”

bmcpublichealth.biomedcentral.com/articles/10.11…

Progressives insist the problem is lack of housing, but giving away free housing in the Tenderloin neighborhood is what created, and sustains, the open drug scene

By contrast, in Portugal, “The open drug scene areas were literally destroyed and rebuilt”

bmcpublichealth.biomedcentral.com/articles/10.11…

“All the cities describe open drug scenes that tended to grow out of control. These scenes were regarded as destructive to individual drug users and as a problematic nuisance to society

“None of the cities succeeded by treatment and medical and social support measures alone.”

“Provision of increased helping measures alone seems to have been unsuccessful and when provided within the open drug scenes, may even have increased their attraction.”

Sound familiar?

“A common theme was that on-going political and ideological conflicts seem to have prevented solutions and effective measures for several years. Only when consensus had been reached at sufficiently high political and administrative levels, has real progress been achieved.”

San Francisco & other progressive cities are making the same mistake that Amsterdam and other cities made in the 1980s with “helping only” (Housing First/harm reduction) policies. In truth, both carrots and sticks are always required

michaelshellenberger.substack.com/p/the-reason-t…

Former San Diego Mayor @Kevin_Faulconer and me

Cal-Psych. Treatment First. “Peace of mind for peace in the streets”

Bonus: I’m not wearing scrubs 🤣

#CalPsych #TreatmentFirst