City Cuts Psychiatric Beds – Taking the “Public” Out of Public Health

by Ed Kinchley on July 13, 2007

This year’s budget process has taken the public out of public health. Both in terms of encouraging an open, public debate about how best to serve the health care needs of the people of San Francisco, and the harm that is being done to the public’s health.

One case in point is Health Director Mitch Katz’ proposal to “save” $130,000 by shutting down 14 locked psychiatric beds at S.F. General Hospital for the acutely mentally ill, and to transfer the funding to a community-based program to provide an alternative for people with mental illnesses before they need hospitalization. The program would be run by the Progress Foundation, which already provides a number of Acute Diversion Units (ADU) programs in the City.

This proposal comes in the context of a precipitous reduction in the number of acute psychiatric beds at San Francisco hospitals over the past few years, with the result that SFGH’s Psychiatric Emergency Service (PES) has been on diversion 30% of the time since December 2006. In October 2005, Sutter Health closed 40 locked psychiatric beds at St. Luke’s Hospital. Sutter has announced it will close 28 more psychiatric hospital beds in 2008.

When PES is on diversion, people who are put on a 5150 legal hold for being a danger to themselves or others are taken to any of the city’s medical emergency rooms – where they are treated alongside car accident victims and people who suffer from heart attacks and other medical emergencies. There is no specialty psychiatric care. Acutely mentally ill patients sometimes wait for days to get into PES or a hospital psychiatric unit.

The Progress Foundation plan for a Community Urgent Care connected to 14 new ADU beds is a good one. But to assume that the new plan – modeled on programs that existed in the 1980’s – will reduce the need for locked psychiatric beds in a hospital setting is bad public policy. It makes every bit of sense to get the Progress Foundation program up and running – and then assess the impact on the need for inpatient, locked psychiatric beds.

That’s why it is important for the Board of Supervisors to reinstate funding for the inpatient psychiatric beds at SFGH, so that both programs will be funded for this fiscal year.

Instead, Dr. Katz and the Mayor have used the budget process – rather than a forum that promotes both public input and public understanding – to pit these two programs against each other.

The Health Director has a responsibility to foster public input and understanding of public health programs. How does the Progress Foundation plan relate to thee need for in-patient psychiatric care? Will police officers and others responsible for putting people on a “5150” psychiatric hold know when to take people who are freaking out to PES – rather than the new Progress Foundation program?

As the Health Care Chair for SEIU Local 1021, the union that represents all the City employees who work in the hospital psychiatric care units and the workers at the Progress Foundation, I know our meembers want to understand how the changes will work. But so far we – and the public – have been left in the dark … with the “politics” in City Hall substituting for a necessary, and public, discussion.

Our goal needs to be figure out what is best for the people of San Francisco. Public opinion seems to be clear that we should do what we can to keep the dangerously mentally ill off the streets. We believe this is also best for the individuals suffering from psychiatric ills. Yet the “policy” being pursued by the Health Director and the Mayor will, in fact, result in more acutely mentally ill people on the streets.

EDITOR’S NOTE: Ed Kinchley is a social worker in the Emergency Department at San Francisco General Hospital, and is the Health Care Chair of SEIU Local 1021.

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