Cutting from the bottom

Newsom's mental health budget would trigger federal funding loss, reducing treatment to the most severe cases by a third


By Alex Emslie

When Mayor Gavin Newsom unveiled his proposed city budget on June 1, he downplayed the severity of cuts to the city's Department of Public Health, noting that they amounted to less than 2 percent. But if Newsom's uneven program chopping becomes a reality, critical social services for some of San Francisco's poorest and most vulnerable residents will be cut by almost one-third.

The DPH was able to shrink its budget by nearly $31 million, according to a budget proposal currently before the Board of Supervisors, in part by slashing community nonprofit clinics providing outpatient mental health services to some of San Francisco's most difficult to treat mental health cases.

"It's very possible you could see more people who are homeless, people who are homeless not getting as much care — they'll be sicker," said Dr. Eric Woodard, medical director of psychiatric emergency services at San Francisco General Hospital. "And you could reasonably expect more deaths on the street to occur."

State and federal matching funding to the DPH dwarfs the amount of money the department receives from the city. What isn't spelled out in Newsom's budget is that every dollar cut by the city results in more than another dollar lost in federal funding for social services.

The DPH proposed a nearly 9 percent cut to outpatient community-based health services, and an 11 percent cut to residential inpatient services to meet the mayor's request that all city departments submit a 30 percent budget reduction to his office. Newsom reversed the proposed cuts to residential services but kept the outpatient cuts.

"I believe in the efficacy of residential [treatment]," Newsom said during his budget unveiling. "I believe there are a lot of question marks around outpatient drug treatment."

But the cuts affect more than just outpatient drug treatment. While many of the clinics that were cut focus on treating mental illnesses, they are funded through the DPH category that includes substance abuse treatment. Newsom's office declined to answer our inquiries about the reasons for and implications of his cuts, referring us to DPH.

Walden House CEO Vitka Eisen, whose organization serves people suffering from mental illness and substance abuse in inpatient and outpatient clinics, said she was relieved that residential funding was added back. However, she is concerned about the proposed $4.1 million cut spread across several nonprofit outpatient services.

"There's a very large cut to outpatient services citywide, and that's obviously problematic because outpatient services are an important part of our system of care in the city," she told the Guardian. "You can't really cut one or the other."

DPH Community Behavioral Health Services Director Dr. Robert Cabaj is hoping the Board of Supervisors will restore some of the cuts to outpatient clinics. "Unfortunately, they [the Mayor's Office] left these in," he told the Guardian. "I'm not sure why — I'm not sure what the mayor was thinking at the time."

Citywide Case Management and Community Focus, an outpatient clinic serving some of San Francisco's most severely mentally ill, is one of the hardest hit nonprofit clinics in the mayor's proposed budget. The agency will lose $1.22 in federal funding for every $1 cut from the city, division director Dr. David Fariello said.

That's how its 15 percent, $1.3 million cut proposed by the DPH and accepted by the mayor, ballooned into a 33 percent, $2.8 million loss for one of the city's most comprehensive and best-performing community behavioral health services.