In 1975, my father appeared as Billy Bibbit in the film “One Flew Over The Cuckoo’s Nest.” Though he didn’t know it at the time, in just a few years the frustrations of mental healthcare in America would become extremely personal to him, when it would come to affect his second wife — my mother, Joni. My mother was a brilliant and singular woman who was failed, again and again, by a system which operates under the best of intentions, yet leaves the most vulnerable among us to suffer and die in the streets.

When my mother lined the windows of her apartment with tinfoil, and allegedly attacked a neighbor’s friend, the police were called to arrest her. But before that, before she was tackled to the ground and sedated, and before she was later evicted, she had been in that particular apartment just three months. My mother had been diagnosed with Delusional Disorder, a kind of “fixed” schizophrenia.  She needed desperately to be hospitalized and put on an antipsychotic, options which are unavailable unless, somehow, she decided to choose them.

In jail, she explained the “mind-control battalion” had surrounded the apartment. I asked her where she would go when released, and she said they terrorized her wherever she went. When I mentioned checking in to a hospital, she asked who I had been talking to. When the police released her that time, she was gone for weeks. It would be two years until they found her dead on the floor of a drug house, overdosed from the heroin, meth and probably Fentanyl she had been using to cope.

The rooms of gatherings of NAMI, The National Alliance of Mental Illness, are filled with stories like this. Mothers and partners and siblings of mentally ill people, wringing their hands over not knowing what to do. In support groups, we hugged and cried and railed against the broken system that barely exists. How is an apartment supposed to keep my son alive? Where are they now? Is it okay that I was too scared to let my kid in when he knocked on my door at 3 a.m.?

The unspoken truth at the center of the homelessness epidemic is that a large portion of this population need greater care than just housing. It is estimated by the Stanford Institute for Economic Policy Research Center that 52% of the homeless in California are either severally mentally ill or addicted to hard drugs. It’s important to note that these are self-assessed polls; the actual number is believed to be higher. It’s obvious if we stop to think about it: what person not dealing with a debilitating illness or late-stage addiction would decide to pitch a tent on a street corner, surrounded by addiction, psychosis and violence, rather than go to a shelter?

Our current solution is the “Housing First” model for everyone, which means having people live on the streets until we place them in apartments (in Los Angeles where I live, at a staggering price tag of $740,000 per unit). Some in-treatment options are available, but that requires the mentally ill person to choose this option, and there are gaping holes in this logic. When a social worker explained my mother would have to want treatment, I wanted to say, “She wants invisible men in trees to stop following her around. She wants me to buy a camera she can tie to a street lamp. What planet do you live on?” Even if the plan was viable, and no one has a reasonable plan to build enough units — it wouldn’t solve the problem if we could.

A Spring 2021 Harvard research study found that after ten years, only 12% of the people placed in a housing-first apartment remained housed. In 2018, the National Academy of Sciences concluded, “The committee found no substantial evidence that [permanent supportive housing] contributes to improved health outcomes, notwithstanding the intuitive logic that it should.”

I am writing this now because I wonder if there is hope. Gubernatorial candidate Michael Shellenberger, whose aunt suffered from schizophrenia but received good care in a group home, advocates an alternative system, which already exists in Switzerland, The Netherlands and Portugal. He correctly identifies our current so-called “harm reduction” models as “addiction maintenance,” and with good reason; with no mandated treatment, no required hospital care, these well-meaning programs of clean needles and anti-overdose drugs only serve to keep people sick. My mom, too, was delivered food, shelter, and clean needles to inject the heroin that killed her. What harm did that actually reduce?

Portugal’s “housing earned” model outlaws camping on the streets, instead providing the option of expanded shelters, mandated treatment, or if nothing else, jail. These systems incentivize recovery and lead to less jail time than our current jail-to-streets revolving door. For California, Shellenberger also proposes a centralized, state-wide Cal Psych agency which would provide psychological counseling, support groups, job training and placement, over the course of not months, but years.

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My mother received only a taste of the supportive services which could have saved her life; a brief hospitalization under a 5150 order gave her some relief, but she was released days later without word to her family. In California, a state which spends $7 billion a year on mental health services, that type of treatment is ubiquitous and is its own sickness. We have to move past our “Cuckoo’s Nest” fears of group care and embrace a model which already works in nations around the world.

A few days after my mother’s death, one of her many social workers called me sobbing, apparently having just found out my mom died. She kept crying “Not Joni! Not Joni!” As I listened to her, I thought, Of course Joni, what did you think was going to happen? I have no doubt that her good intentions were real, but our good intentions have never been enough. It’s time to stop working to “reduce harm” and actually help. It’s time to give Michael Shellenberger a shot.

Fiona Dourif is an actress and California resident.