As government budgets tighten across the nation, local mental-health service providers and advocates say steep cuts may cost The City far more in the long term than the price of maintaining services.
They worry recent progress made on San Francisco’s homeless problem could quickly regress if funding for mental-health services is further slashed.
The City’s Public Health Department has yet to put forward its proposed budget for the next fiscal year, as it waits to see what state and federal funding may come down the pike. However, in the past three years, cuts have been made across the board, killing a handful of day treatment programs, reducing beds at San Francisco General Hospital and cutting staff at almost all service programs.
Hospital psychiatrist Dr. John Rouse said these cuts can make a dramatic difference for some patients, and can mean the difference between success and failure of the treatment.
“It means more people in jail, it means more people pushing shopping carts down Market Street, it means more wasted resources because it makes it hard to intervene early and cheaply,” Rouse said. “That’s a tragedy for patients, who get sicker and do things that will wreck their lives. And it’s a fiscal tragedy because we lose the ability to intervene quickly and cheaply and effectively.”
At a recent hearing on mental-health budget cuts, Carrie Gustafson, a director of San Francisco’s Jail Psychiatric Services, said the jail is treating more people for mental illness and seeing them come in with more-severe mental illness. She said that from 49,900 units of service in 2007 — defined as hours of treatment or other services provided — demand increased to 54,600 units in 2009.
“That’s an awful lot of contact in a situation where it shouldn’t be at all,” Gustafson said.
San Francisco police Lt. Mark Solomon said budget cuts to mental-health services during the past three years have “gradually increased our workload.”
“One of the problems our officers are dealing with is when they 5150 an individual, [the individual is] discharged quickly,” Solomon said, referring to when a person is placed on an involuntary psychiatric hold for 72 hours. “And more often than that, prior to [the officer] finishing his report, the individual has already been released from services. This makes it very difficult for everyone.”
It’s still unclear how deep this year’s cuts will be, said Dr. Bob Cabaj, director of behavioral health for the Public Health Department, noting that if federal and state money comes through, the department may not have to make the 20 to 30 percent cuts they have been asked to prepare for.
“We’re going to have to wait to see what happens at the end of April,” he said. “We’re trying to do innovative things and rearrange the funding so we don’t have to make cuts.”
General Hospital fears more cuts to psychiatric staff, patient beds
The number of psychiatric staff and available inpatient beds at The City’s public hospital has been reduced drastically in recent years. Three years ago, the department had 87 beds available for acute psychiatric patients; today, it has 42, according to Mark Leary, deputy chief of San Francisco General Hospital’s psychiatry department.
A midyear budget cut that again would have trimmed the number of acute beds in half was taken off the table at the last minute, but Leary said he worries it will be back in the mix later this year.
Meanwhile, the number of inpatient psychiatrists at the hospital has decreased from 12 full-time positions in 2007 to seven in 2009, according to data provided by UC San Francisco.
The result of the decreasing availability is that patients spend less time at the hospital than they once did. In 2007, the average psychiatric patient stayed 14 days in the hospital; today, they stay 10 days, Leary said.
Not everyone agrees the budget cuts are resulting in a lower quality of care. Dr. Bob Cabaj, director of behavioral health for the Public Health Department and one of the people tasked with taking a red pen to the department’s budget, pointed out that so far, the decrease in beds has not resulted in more repeat patients.
He said it’s possible patients were staying at the hospital too long.
Cabaj said the increased interaction between police officers and mentally ill patients may have to do with the mental-health training police have been receiving in recent years.
— Katie Worth