COME AS YOU ARE: Mental Health Care (and drug treatment) Prop C style

Make a left from Harrison onto Merlin Street in San Francisco’s South of Market neighborhood and you enter another world. Past two low-slung, industrial buildings and under a noisy freeway is a scene that has come to define San Francisco: Tents line the sidewalks, and a collection of household items tumble out onto the street. There are cardboard boxes, coolers, overflowing garbage bags, containers of food, grills, chairs, and a pile of bicycles. A huge clock is attached to a chain-link fence and on top of it sits a red toy truck. A makeshift clothesline dries shirts and pants in the dusty air. An elderly man sits in a wheelchair. Parked on the street is a black pick-up truck and several large, rusting RVs. Merlin Street is a mini homeless community just one block from luxury condos that cost millions. The streets of San Francisco tell a brutal story of wealth, poverty, and the pursuit of profit over the housing needs of human beings. 

Thanks to the advocacy of the Coalition on Homelessness which worked to pass Proposition C, a low-threshold drop-in harm reduction mental health center operated by the Harm Reduction Therapy Center (HRTC) will soon open to serve the homeless folks living on Merlin. While HRTC does not have Prop C funding yet, it has managed to secure a site in SOMA. While there will be a competitive process to decide who gets the funding, the hope that Prop C funding will be secured provided the final impetus to open the site, which is a dream come true for HRTC’s founders, Jeannie Little and Patt Denning. People in need of high quality therapy will be able to walk in and feel welcome.  

HRTC’s harm reduction services coordinator, James Pollet, provided a tour of the cinder block building. From the outside, it looked like just another abandoned warehouse with a garage door next to an entrance with a locked iron gate.  But as I stepped inside, I saw a huge, modern space. I was immediately struck by the amount of light bouncing off the white walls from several skylights. Part café arthouse hangout, part living room, and part “maybe get some help because it looks like there are some therapy offices here” vibe, Merlin, as the staff like to call it, was welcoming and intriguing. Pollet, who is also an architect, used his skills to create a beautiful and inviting space, and installed acoustic panels that hang from the ceiling to dampen sound and create intimacy. In the main living room area large, comfortable couches and chairs rest on Persian rugs surrounded by lamps that spill butter-colored light. Around the perimeter are private therapy offices, meeting rooms, a kitchen, computer workstations, and an accessible bathroom. A second-floor mezzanine holds admininistration and harm reduction supply assembly spaces. Art is everywhere, murals are dreamed-of, and a timeline depicting the history of the harm reduction movement, HRTC, and its staff occupies an entire wall. Although the space is still under construction, it projects a sense of dignity, respect, freedom, and comfort.    

 “Merlin is the physical embodiment of HRTC’s vision to provide mental health services to all people who suffer emotionally, physically, and who are stigmatized and excluded because they use drugs,” Pollett said and he showed off the space.

A New Kind of Mental Health Treatment

People might believe that therapy is a luxury, that other needs should be met first for people who are homeless and marginalized. That is just wrong. Harm reduction therapy was created for people who have multiple issues, overwhelming life demands, and a strong desire to make their own informed decisions about how to cope with stress and live their lives. HRTC brings together a sophisticated understanding of mental health, total acceptance of drugs and drug use as a way of living and coping, harm reduction, case management, and other necessities – food, harm reduction supplies, massage (from the non-profit Care Through Touch Institute), and love – in a therapy package that can happen sitting on a sidewalk chatting or in a private office having your typical 50-minute session. You can have therapy and work all the other things you need and be actively using drugs, all at the same time.

“Our job is to let people know that they are loved and that they matter.”

Corey Drew, HRTC therapist. 

This is the heartbeat of harm reduction therapy, to do ANYthing and EVERYthing to make sure people know they are loved and valued. From there all else flows.

Readers of Street Sheet might recognize HRTC as the group behind a couple of therapy vans, weekly pop-up drop-in centers, and a mobile kitchen in 5 SF neighborhoods in 2019.  While they had to downsize their pop-ups when COVID hit, they’re still there – at Victoria Manolo Draves Park off Folsom, at 15th and Mission, at Armstrong in the Bayview, and walking the TL with Street Medicine – just smaller. Some staff went to work in Shelter in Place hotels and Safe Camps and are still there, too. Readers might also know them as the therapists at Hospitality House and at Homeless Youth Alliance’s Needle Exchange. Every week HRTC’s therapists can be found in 20 different locations.  

Coming in 2022

Prop C has provided the inspiration—and hopefully soon the funding—for HRTC to open its own drop-in mental health center. Once funding is secured, HRTC will open that garage door to everyone who wants harm reduction therapy. When that happens you will find our harm reduction services around the city as well as “at home” at Merlin.

So why is HRTC’s mental health treatment different?  

We’re different because you don’t have to apply to benefit from our programs.  No intakes, no waiting lists, no diagnosis necessary. We welcome people who use drugs with open arms and no conditions at all. You decide what you need, you decide how much and for how long, you tell us what mental health care means for you.  

The HRTC mantra is:

Come as you are

Take what you need

Leave when you want

HRTC on Merlin Street is taking a stand for the right to unconditional, truly client-serving, and time-unlimited mental health care for people who have long been denied these services.