Budget Cuts Sever Lifeline to Sanity : For Some, More Than Money Is at Stake With Proposed County Mental Health Cuts

“Ithought I was going to kill my baby. One day I was taking a bath with him and I thought I was going to drown him. I was really scared.”

Tyler, now 10 months old, squirms in a stroller as his mother describes the incident last October that took her to a county mental health clinic. As he lets out a wail, Nancy stretches out a comforting hand.

That day last fall wasn’t the first time she had found herself unaccountably depressed and anxious since Tyler’s birth, she says. This episode of depression was so severe, though, that she knew it was time to go back to UC San Diego’s Gifford Mental Health Clinic for help. She had last been there in 1981.

She began taking anti-depressants, saw a therapist, and brought her husband and 8-year-old son in, too, to help them understand her extreme depression.

“They covered all bases, basically, and really got us to functioning,” Nancy says of the psychologists, psychiatrist and social workers she saw. “We were really going down the tubes. Because when one person in the family is going down, the rest just kind of go down, too.

“For the last six or seven months, there are bad days, but I’ve been able to carry on the household and take care of the baby.”

Nancy is among the 11,000 San Diegans who may pay the price of the $7.5 million in cuts to the county’s mental health care system that are proposed to begin July 1.

It is a cost that even San Diego County officials acknowledge will be extracted not in dollars, but in human pain and misery.

While the mental health treatment community raged last week over the cuts, patients began their own silent battles with the anxiety that comes with realizing how tenuous their lifeline to sanity may become.

For the low-cost clinics--from central San Diego to El Cajon and San Ysidro--are the mentally ill’s last defense against demons that can haunt their every waking minute. When these people talk about the budget cuts as a life-and-death issue, you believe them.

In a gesture that says more than words ever can, Anne hides her face in her hands.

“People are afraid of you,” she says. “I don’t tell anybody I’m a paranoid schizophrenic.”

Vaguely, Anne--who does not want her real name used--remembers the bizarre

behavior that brought her to Gifford two years ago.

“I was Alice in Wonderland or I was Dorothy in ‘The Wizard of Oz.’ I had to find the looking glass, because I had to go home. And I walked from El Cajon to Point Loma, looking for the Good Witch of the North.

“Now see, I’m telling you this, whether I actually did all this--well, my shoes and my clothes and everything showed it.

“I got to the airport. When I got there, everybody was getting out of the cab, going into the airport, yak-yak-yak-yak, going in, and put their luggage down and then leaving. The same people. And they kept doing this.

“And I looked up at the road signs, and they were brown with yellow writing. Now, I’m a Californian all my life, and I know our road signs are green with white writing. So I thought, ‘Where am I? I’m not at Lindbergh Field.’ ”

A frantic call to someone who had helped with her alcoholism yielded the clinic phone number that “saved my life.”

Two years later, Anne, 50, speaks with a slight slur from the drugs that keep her condition under control, even while coping with the stress of a dying mother. The drugs also make it possible for her to live independently.

But the county budget cuts bring a quaver to her voice. What does that mean?

“It’s panic. It’s just real panic. Because where am I going to go? Who’s going to administer my medicine?”

The proposed cuts in mental health and several other programs, announced June 3, are needed to allow the county to maintain overall services and also to add new spending, such as $6 million to operate two new jails, said David Jannsen, assistant chief administrative officer. The mental health cutback is more than twice as large as any of the others.

The voters’ rejection Tuesday of Proposition B, which would have allowed the county to spend more of its revenues, means the mental health cuts cannot be avoided, Jannsen said last week.

Because of state constitutional limits, San Diego County’s revenues and spending can rise only $71 million next fiscal year, and $55 million of that is state revenue over which the county has no control, Jannsen said. That leaves $16 million to cover both new programs and inflationary increases in county programs.

But the cost of operating new jails, plus state-mandated increases in programs such as general relief, welfare and indigent defense, add up to $20.5 million. General workload increases in county departments would have required another $55 million, but were trimmed to about $6 million, he said.

Faced with that prospect, the county began looking last fall at its $32 million in discretionary spending--money spent in excess of state requirements on programs such as mental health. The largest chunk of this money, about $22 million, is in health care (though critics and officials alike note the irony of labeling as “discretionary” any of the money in a seriously underfunded health care system).

Chief Administrative Officer Norman Hickey decided that health services would have to take $5 million in cuts, and consultations with Health Services Director Dr. J. William Cox resulted in the decision that the cuts would come from mental health, Jannsen said. Another $1 million intended for other health care is also being withdrawn from outpatient mental health care, and $1.5 million in patient revenue would be lost, bringing the total mental health cuts to $7.5 million.

‘Policy to Take Whole Cloth’

The philosophy behind the decisions: Set priorities, then cut out a few programs entirely rather than nibble away at a lot of them.

“It is a county policy to take whole cloth, not across-the-board cuts,” said Kathleen Armogida, deputy director for policy in the health department. And mental health had the largest share of discretionary funding dedicated to it.

In this case, the priority was put on caring for only the worst cases of mental illness, those in need of immediate hospitalization at the County Mental Health hospital in Hillcrest. Cuts there would have taken the hospital backward to a time a few years ago when it provided substandard care, officials feared.

So mental health clinics, social support centers and other outpatient services were cut by more than half. A few were abolished altogether.

“We are not saying that the mental health dollars are not needed,” Jannsen said. “There is only so much money in the pot. It is always necessary to take care of the institutions first, even though you know that in the long run, it is prevention dollars that will solve the problem.”

However, clinic officials say the past few years of steady budget cuts have already forced them to screen out the simplest cases. Now their clientele consists of the hard-core mentally ill who need drugs and regular supervision, but cannot afford to get it anywhere else.

Perhaps half of these 11,000 people would receive continuing care under the cutbacks. The rest apparently would have to do without. County officials as well as their critics predict the unmedicated mentally ill will become a bigger problem for police and hospital emergency rooms, and will swell the ranks of the homeless in San Diego County.

“The first response of one of our patients when he heard about this was, ‘Well, I might as well go slit my throat.’ And that’s not an idle threat,” said Penny Dublin, program manager for Gifford.

Mike, Donna and Barbara are a study in contrasts.

Depression and anxiety hide easily behind Mike’s friendly face, which is framed by a neatly trimmed beard. Barbara, a bright scarf draped over the neckline of her dress, sits so meekly it is hard to believe she is a manic depressive, prone to wild mood swings.

Then there is Donna: tanned, her face well made-up, a little over-assertive, but nothing too extraordinary. Except for the uncontrollable twitching. Her legs jerk from side to side in the chair. They only stop to allow her whole body to bounce up and down.

She insists on talking first.

“If I don’t get help and the proper medication, I will get suicidal. I will not be able to function,” she blurts in a staccato. Two months ago, she was hospitalized at CMH.

As calm as Donna is jittery, Barbara quietly tells a story of losing her job when she was hospitalized at CMH 2 1/2 years ago, and of needing help from the clinic ever since. “If it weren’t for coming here, I would be out on the streets,” she says.

Then Mike, a well-educated professional sunk into depression after losing his job more than a year ago, begins a careful analysis of the “myopic vision” behind the budget cuts. They would eliminate treatment for people like him, “people who are living lives of quiet desperation,” he says.

The more his well-constructed sentences run on, the more agitated and aggressive Donna becomes. Barbara’s composure degenerates. She begins ducking her head to the side and fidgeting with her glasses.

Mike, who does not want his real name revealed, thinks it was his negotiating skill that got him into the clinic at all, and he knows that others find their own ways to demand help.

“In two months in the mental health community, I’ve met several people who have faked suicides so they could get immediate therapy,” he said. “And that’s only under the present system.”

With little discussion, the county Mental Health Advisory Board, a state-required body of private citizens that advises the county on mental health matters, declined Wednesday night to even consider the proposed cuts. It endorsed a letter urging the Board of Supervisors to continue funding mental health at least at the current level.

“The system as it is today cannot meet the needs of some of the most severely impaired persons. Therefore, we respectfully advise the board of supervisors that a cut of this magnitude would be devastating in this community,” the letter says.

Using words such as criminal to describe the cuts, psychiatrists and other mental health community leaders also are mobilizing a massive effort to pressure, cajole or, if necessary, go to court to prevent the cuts.

Supervisors were inundated with phone calls protesting the cuts. So many people have called asking to testify at the June 21 budget hearing on mental health that officials gave up on trying to schedule them and doubled the time allocated. The county expects at least 300 people to jam the chambers.

Not an insignificant part of the lobbying effort will be the personal testimonials that mental health clinics are urging their clients to give on how the cuts would make their lives literally unbearable.

Four years after trying to kill herself, Carol’s wounds are still fresh in her mind.

“I was taking an anti-depressant, and my doctor told me that it would take a couple of weeks to take effect,” she says. Her voice cracks and the words become halting. “But I thought that it didn’t take effect . . . because I wasn’t trying . . . hard enough to get well.”

Sobs emerge, too, as Carol describes her anguish a year ago when the support group she had been attending to obtain her medication was discontinued. Now she sees a Gifford doctor for 20 minutes a week to get the medicine, which her psychotherapist cannot give her. She cannot afford a private psychiatrist.

Remembering that difficult adjustment, she voices the worst fear that all of Gifford’s clients seem to have.

“If the mental health clinics vanish, I would be another person just out on the street,” Carol says, the hoarseness of tears once again in her voice. “I don’t have a car. I take the trolley downtown and catch buses from there, and I see those people on the street.” She sobs quietly for a time.

“I don’t want to wind up like that.”

“Yesterday in the support group that we had, we were talking about this issue,” Dr. Margaret McCahill, a psychiatry resident, said Thursday as she and other Gifford staff members discussed how the budget threat is affecting their 1,400 patients.

“And, as it happened, quite unrelated a woman returned after an absence of several visits--very psychotic and threatening to the people in the group. She had admitted to the group she had stopped her medication, she had been absent from group for about a month, and so she was a living example to them of what happens when you don’t have treatment. And the police had to be called.

“These are all patients with schizophrenia, who are barely making it in the community, and who have all been hospitalized at CMH in the last couple of years,” McCahill said.

“So the patients were faced with the anxiety of, ‘I might lose my group, and look what happens when I stop taking medication and stop going to group.’ It was right there before their eyes,” she said. “This is a woman they’ve known for a year, and care a lot about. This woman was really coming apart right in group. And it was real hard for them.