When Donna Mateer was 14, she walked into a Whittier department store, put on a wedding dress, and strolled out. Store security quickly detained her for shoplifting. It was her first arrest, and an early sign of the mental illness that has afflicted her ever since.
When Mateer was in her 20s, she worked at McDonald’s for a month, according to her sister Debbie Gish. It was the only job she ever had.
In 1994, when she was in her 30s, Mateer moved to San Francisco to live with Gish. Nearly a decade of chaos ensued. The sisters recalled Mateer hammering away on the piano in the dead of night. But it wasn’t just loud music — deep in a depressive episode, Mateer tried to take her own life by swallowing pills. At the hospital, she had her stomach pumped and was diagnosed with bipolar disorder. For the next 10 to 15 years — neither sister quite remembers the timeline — Mateer cycled through filthy board-and-care facilities and single-room occupancy hotels.
Then, sometime in the 2000s, she arrived at the Behavioral Health Center at Zuckerberg San Francisco General Hospital and, for the first time, found stability. Mateer said the BHC staff truly care about her. They make sure she takes her medications and eats during her depressive episodes, but they also play guitar for residents and make them laugh.
But soon, Mateer, 66, and the facility’s 81 other residents will have to move. As part of Mayor Daniel Lurie’s plan to tackle the homelessness and drug crises, the Department of Public Health is converting the center into a mental health rehabilitation facility to treat people in crisis and moving current residents to facilities outside the hospital, including two in Hayes Valley that have yet to open. Unlike the current center, in which one floor is a locked ward, the new center will consist completely of locked beds for patients who need round-the-clock psychiatric care.
No residents will need to move before the fall, city officials said. People on the second floor will likely move near the end of this year, while those on the first floor will move next year. Of the two planned Hayes Valley sites, the city has acquired only one; the Board of Supervisors will vote this summer on buying the other.
City officials recognize that the move is unsettling — numerous hospital and city employees uttered the phrase “Change is hard” — but argue that the need for locked beds is paramount. Residents and their families, though, are scarred by past experiences at outside facilities and are loath to leave.
Sitting on her walker outside the BHC, Mateer recalled her suicide attempt 30 years ago.
“I might come down again, and where am I going to hide?” she said. “I need this place.”
Board-and-care nightmares
Relatives of BHC residents uniformly describe the facility as safe, orderly, and professional, in contrast to places their loved ones lived before: dirty board-and-care facilities with uncaring staff, where patients were allowed to wander away or go days without eating.
Elmer Conde, 65, has lived on the second floor of the BHC for about five years. His sister Antoinette said he was previously in a Mission facility that was shut down due to unsanitary conditions. And that wasn’t the only place Conde, who has schizophrenia, had problems.
“My experience and his experience were not good at all,” Antoinette said. “[The facilities] were poorly managed, and the staff were mean.”
In 2019, Conde had to leave another home, the South Van Ness Manor, when it closed, contributing to the loss of dozens of residential beds in recent years.
Rozelle Trizuto’s daughter Angela, 41, lives on the first floor of the BHC, which is known as the Adult Residential Facility, or ARF. Like Mateer, she cycled through small facilities before landing at the center and achieving stability.
“My daughter and I have had vast experience with these psychiatric board-and-care places,” Trizuto said. “They’re horrible. Absolutely horrid, every single one of them.”
Trizuto described one Mission facility that had bedbugs and another “rathole that looked like it should have been a storage closet.”
Angela, who has schizophrenia and a history of violence, also spent time on the streets and in jail. But the nightmare ended when she moved to the BHC.
“ARF has saved my daughter’s life,” Trizuto said. “She has done wonderfully. She goes out during the day sometimes, walks around, comes back, they make sure she takes her meds, they make sure she eats, they make sure she does the things a 41-year-old woman should do to take care of her health.”
Antoinette Conde said the same of her brother’s experience.
“I swear to God, this is the safest place he’s been in. The safest and the cleanest. The hospital is just next door, if something happens,” Conde said. “This is perfect for this type of people. Why are you trying to move them?”
Acute bed shortage
According to the Department of Public Health, the facility at SF General is the perfect place to add 57 locked beds. The top floor of the three-level building is already secure, and the structure was built as a locked facility. Additionally, the department has received $21 million in state funding to renovate the BHC and can double the number of locked beds in the city by doing so. (There are currently about 100 across several facilities.)
“The BHC is a unique opportunity because it’s this confluence of situations,” said Angelica Almeida, who oversees behavioral health services at the hospital.
Kate Brady, board director for the National Alliance on Mental Illness San Francisco, said there are not enough locked beds in San Francisco to accommodate the need.
“Everybody is getting shipped outside of the city,” Brady said. And when doctors determine that patients are no longer a danger to themselves and others, they’re turned loose, even if nobody is there to pick them up.
That’s only the people lucky enough to get a placement at all. Others are waiting in psychiatric emergency rooms, hospital hallways, and county jails for beds to open up.
“Jail is not the right place for them,” said San Francisco Superior Court Judge Charles Crompton, who oversees the court’s behavioral and mental health diversion departments. “It should be, ‘What does this person need?’ But instead it’s, ‘What’s available?’ And if there’s no viable alternative to jail available, that’s the answer.”
In addition to the potential for harm, placing such patients in jail contributes to crowding and the bottleneck in the courts. Psychiatric beds in hospitals are choked with people who need long-term residential care, restricting access to those experiencing acute mental health crises on the street. In short, it’s a mess — a mess that can be solved only by introducing more locked beds for residential care.
None of that is much comfort to BHC’s occupants, some of whom protested the conversion last month at a Board of Supervisors meeting. DPH has assured the residents they’ll receive the same level of care at their new homes. But they and their families remain skeptical.
“They’re stabilized because of the environment of [the BHC],” Trizuto said. “You want to take a mini-community full of schizophrenic, bipolar people and move them around. That’s how you destabilize them again.”
If you or someone you know may be struggling with suicidal thoughts, call or text “988,” day or night, to reach the Suicide and Crisis Lifeline, or chat online.