Crossing state lines, a man arrives alone in San Francisco, having traveled by bus on a 1-way ticket provided by a psychiatric hospital in his home state. He is disoriented, with few possessions, lacks medications and medical records, and calls 911 as he was instructed. He is brought to the county psychiatric emergency service, which, hectic and often over capacity, treats nearly 6000 patients annually (of which 39% are not San Francisco residents). The patient needs housing, a psychiatrist, case manager, primary care provider, and transfer of Medicaid or general assistance—a package known colloquially as the San Francisco Special. Placements are challenging—the county hospital reduced its acute inpatient psychiatry capacity 50% in the last 5 years owing to budget shortfalls—yet out-of-state visitors are not turned away.
Das S, Fromont SC, Prochaska JJ. Bus Therapy: A Problematic Practice in Psychiatry. JAMA Psychiatry. 2013;70(11):1127–1128. doi:10.1001/jamapsychiatry.2013.2824
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