A REAL COMMITMENT TO MENTAL HEALTH SERVICES
by Ronald Rucker
As of April 1, 1998, California has mandated a single standard of care for all mental health services. That means that all mental health clients will be treated the same regardless of their ability to pay.
This is good news for those homeless people who struggle with mental illness. Approximately 40% of the 12,000 - 14,000 homeless people in San Francisco are mentally ill, and most are not receiving treatment.
San Francisco has clarified what mental health care in our City will look like by committing to provide services to those without medical insurance at the same level as those covered by MediCal. According to the Department of Public Health (DPH) annual budget request to the Mayor's office, the expansion will cost $8.5 million. Despite a budget surplus of over $100 million, the Mayor's budget contained only $1 million for the expansion, a paltry sum by anyone's estimation. The Board of Supervisors Finance Committee added only $279,000, to bring the total to $1,279,000.
Now it doesn't take a genius to do the math on this one: it adds up to underfunding and total irresponsibility. Since its initial budget request, DPH has changed its funding amount a number of times, from $8.5 million to $5.8 million (let's just flip the number around), to $1.9 million, to their most recent request of 0 -- that's right, 0 additional dollars to fund the expansion of services.
Now I don't know about you, but it's a long leap for a simple guy like me between $8.5 million and 0.
The new figure of 0, according to Dr. Katz, is based on an assumption that only 65% of those eligible for treatment will ever show up, as the record seems to bear out in two other counties, San Mateo and Solano.
Well here is a bit of information that Mr. Katz may have overlooked. Since April 1, 1998, when the State mandate went into effect, SF's central mental health access line has received between 70 and 100 calls per day. At the current rate, 14,754 new clients will have entered the mental health system by the end of Fiscal Year 98-99, and 8,225 of them will be underinsured or uninsured. Dr. Katz has stated that the $0 additional funding figure would cover approximately 2,000 of them. Well, here again we can engage in a bit mathematical genius: what about the 6,225 other eligible clients who go untreated?
Needless to say, a coalition of advocates, consumers, and service providers resolved to fight the funding cuts. Their strategy was to ask the Board of Supervisors to submit a Supplemental Appropriation to make the concept of single standard of care a reality.
On October 22, 1998, thanks in no small part to Supervisor Sue Bierman, the Board of Supervisors' Health Family and Environment Committee heard testimonies from advocates, consumers and service providers on the need for additional mental health funding. The Coalition on Homelessness' Substance Abuse and Mental Health Workgroup delivered compelling testimony and submitted for Board consideration a more comprehensive Supplemental Appropriations request of $2,461,123 which would ensure that uninsured mental health clients get the same care as Medi-Cal clients. Of that amount, $1.3 million would fund outpatient visits for 7,475 new clients, and $1.1 million would pay for pharmaceuticals (including the new generation of drugs with fewer side effects) for uninsured mental health clients currently receiving services.
At the hearings, Supervisors Sue Bierman, Tom Ammiano, and Leslie Katz voiced their continued support for the Supplemental.
Of the more than 20 individuals who testified, a number deserve special mention here.
Marykate Connor, Director of Caduceus Outreach Services, gave a testimony filled at times with vitriolic rage concerning the treatment on the street of homeless people with mental disabilities by the SF Police Department. Many of these individuals are routinely incarcerated; many have lost their lives at the hands of the SFPD. Ms. Connor further went on to say that the SFPD is currently not in compliance with the Americans with Disabilities Act and must be monitored strictly in the future.
Also on hand was Jan Kahan of the Mental Health Association who stated that the hearing was a "significant victory for the mentally ill!"
While the testimony was very powerful and convincing, let us not forget that the Supplemental still must be voted on by the entire Board of Supervisors. And if our guess is correct, the Mayor will do everything in his power to prevent its passing.
I think his position on homelessness was best characterized by one of the testifiers who exclaimed, "The Mayor is willing to sacrifice an entire population in order to ensure that his agenda for the city goes uninterrupted." I say let's hope that this time next year we won't even have to consider the man and let's get out the vote -- the city is counting on us!
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