Cutting from the bottom - Page 2

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


Citywide, at 982 Mission St., boasts the facilities, network, and location to serve one of San Francisco's most vulnerable populations. The typical Citywide client suffers from schizophrenia, bipolar disorder, borderline personality disorder, or severe depression. They are likely homeless, grappling with substance abuse, and many have posttraumatic stress disorder.

Citywide employees, doctors, and administrators, as well as physicians from outside the clinic, speculate that cutting outpatient mental health services in a city with one of the highest per capita populations of mentally ill homeless people will ultimately cost the city more money than it saves now. Use of expensive city services like psychiatric emergency rooms, jails, police, and ambulance could all rise.

"Frankly, a lot of these budget cuts do not seem to be very well thought out in terms of what the real cost is going to be," Woodard said. "If you look into the not very distant future, you're going to incur costs that are probably much greater than your savings were initially by making the cuts."

Cabaj said that past funding cuts haven't resulted in higher use of psychiatric emergency services because the DPH prioritizes funding for the most severe cases and screens for those who could possibly be moved into cheaper services. Citywide clients are consistently high users of San Francisco General Hospital acute inpatient psychiatric care, at an average cost to the city of $1,200 per patient, per day, if they don't have insurance or Medical benefits.

Many end up in costly in-patient psychiatric care facilities or are arrested and land in the city's Behavioral Health Court, which hears cases in which defendants have been diagnosed with a mental illness that is suspected of being a factor in their crime. More than 70 percent of the Behavioral Health Court's mandated treatment slots are at Citywide.

"We can manage behaviors that get people thrown out of every other clinic in the city," Fariello said. "Where is that capacity going to be picked up? These are not clients who, if they don't get treatment, maybe their doctor will give them some medicine and it'll be OK. These are clients who are going to continue to be high users unless we intervene."

Citywide figures show a 40 percent decrease in violent reoffenses for clients referred to their clinic from the Behavioral Health Court. Nearly three-quarters who were homeless are able to maintain housing, and more than 25 percent of clients who were frequent users of inpatient psychiatric services have stayed out of the hospital.

"Citywide really is one of the best," said Woodard, who works with Citywide's Linkage Team to stabilize patients from SFGH's psychiatric emergency room. "They provide excellent care for these really fragile, very ill patients. I would say of the community programs, they're really at the top of the list."

Fariello estimates having to reduce the 1,035 clients receiving treatment at his clinic by 400 if the cuts are finalized. He may have to scale back some of his clinic's innovative and successful categories of service — such as employment support and dialectical behavioral therapy, a highly specialized form of therapy with proven success in treating borderline personality disorder. Citywide has the largest DBT team in San Francisco.

Citywide administrators are baffled by DPH's decision-making process, given that it serves the city's sickest, poorest, and homeless — characteristics that should have reduced its cuts, according to the department's priorities outlined in its budget reduction proposal.


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