Patients Appear Before Supervisors : Pleas Made to Spare Funds for Mental Health

With tears as weapons, the mentally ill and those who care for them turned out more than 400 strong Tuesday to do battle on behalf of the $7.5 million that San Diego County is proposing to cut from outpatient mental health services beginning July 1.

The three-hour verbal barrage ended inconclusively, because county supervisors won’t act on any part of the 1988-89 budget until next week.

But, at an afternoon hearing on the mental health spending cuts, supervisors did offer their sympathy and, perhaps, a little hope that the cuts can be avoided.

“I don’t think there’s a one of us that wouldn’t like to--on a human level--reach out a hand,” Supervisor Susan Golding said to an audience of stragglers as the hearing drew to a close. Human services needs are great in many areas, she noted.

“I do not want to make them, and I’m going to look for a way to avoid them,” Golding said of the cuts. “But I hope that everyone understands that it’s not easy.”

Her appeal for compassion followed an afternoon in which patients and their families called forth that same emotion from a body used to dealing in dollars and cents.

“Don’t worry about us,” Chairman George F. Bailey reassured nervous mental patients as they stammered through speeches written out on bits of paper.

“You did well,” he added as they finished.

Protest Campaign

In cuts announced June 3, county administrators propose cutting services to about 5,000 people who use clinics, day care centers and other outpatient programs for the mentally ill. The cuts would trim $7.5 million from a mental health program that this year is spending $47.7 million overall, including on hospitalized patients.

Since the plan was announced, advocates for the mentally ill have mounted a protest campaign that brought out an overflow crowd Tuesday. Sporting “Say Yes to Mental Health” stickers, the partisans filled the supervisors’ chambers as well as three overflow rooms and the hallway outside.

The stories they told ran the gamut, from a young man who said he has been suicidal since age 6, to an abused wife who lost her three children after mental breakdowns made her unable to care properly for them.

All said the county’s outpatient mental services are a valued, last resource for mental health care.

“I would have been dead. I would have been a statistic if not for the South Bay Guidance Center,” said Deborah Powell, a patient at the Chula Vista clinic whose funds would be cut by 56%. “The (center) threw me a life rope. Please don’t cut it.”

Represented, too, were groups such as the Emergency Nurse Assn., whose spokeswoman pleaded with supervisors to consider how much more dangerous emergency rooms will be with many more violent, combative mental patients brought there by police.

“These patients are brought to our emergency rooms in handcuffs and they’re let loose out of those handcuffs, to be in the emergency room with other patients--possibly your husband or your children,” said Ramona J. Trebilcock. “Just as serious as the jail crisis, so is the issue of appropriate mental care for those in need.”

Increase in Problems

The witnesses were emphasizing points that county mental health officials have already conceded--that cutting back on drug therapy and psychosocial support services in low-cost outpatient clinics will land the chronically mentally ill in hospitals or jails. All those end points are much more expensive than outpatient treatment, witnesses noted.

Dr. Warren G. Gershwin said the savings from ending a year’s worth of weekly therapy at South Bay Guidance Center for just one person would be wiped out if that person were hospitalized for just six days for a mental breakdown.

The cuts also are likely to increase problems of homelessness, domestic violence and child abuse, they said.

Gregory Knoll, director and chief counsel for the Legal Aid Society of San Diego, warned the supervisors that they might face lawsuits if the cuts are implemented.

In a speech that prompted angry words from Supervisor Brian P. Bilbray, Knoll said the county is violating state law in its procedures for implementing the cuts. It also may be subjecting itself to charges of abandoning patients, of wrongful death and of denying mandatory treatment to the mentally ill, Knoll said.

“At least some of the proposed cuts will result in no access to mental health care for indigent residents with severe and even life-threatening mental illnesses,” Knoll said. “The county may not lawfully remove the safety net which these people now rely on, without ensuring that the necessary services will actually be available from alternative sources in this community.”

He urged the supervisors to follow San Francisco’s example and reinterpret the Gann spending limit to allow more county spending than is now planned. The county has blamed the failure of Proposition B earlier this month, which would have allowed extra spending, for some of the required budget cuts.

Although Knoll offered to work with the county to avoid suits, supervisors bristled at his suggestions.

‘Losing the War’

Bilbray pointed out that part of the county’s problems are brought about by extra spending on general relief and other services, ordered by courts as a result of Legal Aid suits.

“I just get frustrated because you fight your winning battles and you’re losing the war for the needy,” Bilbray said. “So I ask when your attorneys start picking lawsuits at the county, that you think about where the funds may come from.”

“My concern is that, every time we win a lawsuit on behalf of poor people, the reaction is that we’re doing something other than being your conscience,” Knoll retorted.

“This body does have a conscience toward people in need,” Bilbray said. “I don’t think any member here needs an attorney to act as our conscience.”

Later, Assistant Chief Administrative Officer David Janssen expressed doubt that reinterpreting the Gann limit would work. It also would make it politically impossible for the county to win voter approval for exceptions to taxing and spending limits, he said.