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.


If I here one more person refer to our lame duck mayor and his axe man Mitch Katz as progressives, I'm going to die. Thank you Guardian for letting the truth be known, about these bungling conservatives. colin

Posted by Guest colin campbell on Jun. 09, 2010 @ 7:45 am

Thank you for this thoughtful piece on the impact of these proposed budget cuts. I am shocked and saddened to hear that the city would plan to cut services to the most unstable residents -- a move which, as your article nicely articulates, is not only inhumane but is almost guaranteed to actually increase direct costs to the city as these patients start showing up in ERs, hospitals, jails, ambulances. Citywide/Community Focus is an essential piece in the complex fabric of city's services. I hope their funding is restored immediately.

Posted by Guest on Jun. 09, 2010 @ 5:09 pm

These cuts don't make any sense. Why lose sources of federal funding? The city should be made accountable for the decision making. It's a shame the Mayor's office did not respond.

Posted by Guest on Jun. 09, 2010 @ 5:45 pm

I suffer from PTSD and am treated at New Leaf by an excellent therapist. Last I heard the budget cuts are going to limit the number of individual sessions to 20/year effective FY2011! I have made great progress in the past 4.5 years due to regular weekly sessions, and only b/c my therapist could meeet with me regularly, was my disorder finally properly diagnosed. Since that time, we have implemented a treatment plan that is highly effective. The cuts in one-to-one sessions allegedly will be replaced with an aray of group therapy options. When I am ill, I get sicker when I am in groups. Thanks Mr. Lt. Governor Newsom, please god! The sooner you get the hell out of town, the sooner I'll feel safe in my own city.

Posted by Guest VIctor on Jun. 09, 2010 @ 8:32 pm

For a city that bags on LA for being a bunch of phonies. SF and Mayor Gavin Nuisance prides itself for being equal, pro choice, green, progressive blah blah blah blah, when it comes down to it's dirty secret the TL and the mentally ill, they're not any better than any other city. At least in LA they don't pretend to be shallow and fake by covering it up with food, gays, and smart cars.

So what happens to this population of mentally ill folks? Oh, more use of our county resources, stabbings, suicides, and hopefully a heavy migration to the Westfield mall or heaven forbid, the marina and Pac heights. Just because the mentally ill does not have a voice for advocacy doesn't mean they shouldn't be advocated for.

Citywide and community focus, thanks for doing what SF and it's politicians won't do. I'm sorry about your cuts, but it's obvious that San Franciscans rather spend their money on keeping our Victorian homes neat, our wealthy foodies well fed.

Posted by Viva Life on Jun. 10, 2010 @ 5:14 pm

Commenting of Bay Guardian is a waste of time. Write to your supervisors about this issue!

find out who is your supervisor by address:

Posted by dr_strangelove on Jun. 12, 2010 @ 6:20 pm

Obviously some of the people who have commented have serious problems and will suffer from these budget cuts. I don't live in the city, nor have I needed these services, but we are dealing with these issues everywhere as a result of unemployment and tax revenue losses. There will come a time when taxes must be increased, but first we should all clean house and get rid of any waste and inefficient programs. After that, are the tax paying citizens of the Bay area ready for a tax increase? How much is needed? Are programs like this a magnet for the people with needs? Will we ever really be able to cover everything we would like the city to provide? If not, what should be cut?

Posted by Guest on Jun. 15, 2010 @ 10:47 am