Editorial column by Susan Nielson of The Oregonian, October 7, 2012

A disheveled man boarded the Hawthorne bus one morning last week and sat near the front, agitated and in some kind of pain. The debris on the back of his coat suggested he slept outside the night before, and perhaps many nights before that.

Ten minutes later, the bus driver kicked the man off the bus. The rest of us made it downtown, but he didn’t. Though nothing terrible happened, there’s nothing like sharing a bus with someone in poor mental health to raise some hard truths about his journey.

The bus that morning was like any other day, crowded with office workers and Portland State students. Two women came aboard and said a man at the bus stop had been harassing them. The man boarded and announced that he needed to reach the hospital to have some sutures removed. Then he eyeballed the rest of us.

The commuters got very interested in their reading material. No eye contact: It’s the first rule of thumb when in an enclosed space with an unsettled stranger.

The man sat there vibrating with discomfort. Before long, he punctuated the air with random remarks and expletives that triggered a warning from the bus driver. A few riders moved farther away. Meanwhile, a bridge lift brought traffic to a halt and made the bus’s interior feel more confined. What happened next is fuzzy in my mind, but the man got into a short but tense exchange with a fellow passenger that ended with each of them threatening the other at close range.

At some point, the bus driver warned that a police car was nearby and officers could be summoned. It never came to that, thankfully. After several deft attempts to help the man stay calm, the driver asked him to leave — and then just like that, the man was gone.

A couple riders briefly applauded. Like a big jerk, so did I.

When you live in a city of any size, social problems are part of the urban landscape. People who appear to be homeless and mentally ill are passing time in the city parks, scavenging for cans in the neighborhoods and panhandling near the transit lines. You forget that these people are not extras in the movie of your life, adding some interesting grittiness to the background. You forget that many are suffering in ways you don’t understand.

But sometimes, people with visible problems aren’t on the other side of the park, but four feet away, right in front of your face.

This is doubly true during an economic downturn, when long-term unemployment and housing problems push more people toward the margins. Oregon’s rate of homelessness is third highest in the nation, according to the Kaiser Family Foundation, and homelessness raises the risk of minor and manageable mental health problems developing into major and chronic ones.

You see this in Portland and in cities across the country, said David Hidalgo, director of Multnomah County’s mental health and addiction services. Each person in obvious distress brings up some uncomfortable questions, he added.

“What do we do to get this person help? Who is responsible for this guy?” Hidalgo said. “We go to work, we go home to our families, and who knows where he goes?”

Multnomah County, like the rest of Oregon, is trying to strengthen its safety net. Through more outreach and better coordination of health care and social services, the goal is to keep more people out of crisis, on their medication, in stable housing, out of the emergency rooms and, ideally, employed. A secondary goal is to live up to the promise of deinstitutionalization, which was supposed to move people out of psychiatric wards and into the community, where they could thrive with enough support.

The safety net does save lives, but it’s nowhere near meeting the needs. As a result, we have police officers responding to endless mental health calls and bus drivers doubling as counselors.

The next morning, I asked the bus driver if the incident was stressful. He shrugged, all nonchalant in his mirrored sunglasses.

“It comes up, and you have to deal with it,” he said.

He’s right, of course. It comes up, and you deal with it. This confrontation on the bus was minor in the scheme of things. This particular man was likely harmless, like the majority of people in poor mental or physical health.

What sticks with me now is that this man said he needed to get to a hospital. He probably needed to reach his destination more than anyone else on the bus, yet he lacked the capacity to ride without getting kicked off. Maybe he reached the hospital eventually, and maybe he was connected with social workers and housing specialists who will help him transform his life. But I fear he got on another bus, and another bus after that, without going anywhere at all.

Multnomah County’s 24-hour crisis line number for people who need help, or are concerned about someone in crisis, is 503-988-4888.