Mental Health Cuts Ride Fiscal Seesaw : Over Half of $7.5-Million Budget Trim Is Tentatively Restored by Supervisors

Softening proposed cutbacks in mental health services, the San Diego County Board of Supervisors on Friday tentatively restored about $4.2 million of a $7.5-million budget reduction originally recommended by county administrators.

But the supervisors, faced with budget constraints that county officials describe as the most severe in a decade, reluctantly acceded to proposed reductions in other vital areas, including child-abuse prevention programs and services for seniors.

“Child-abuse programs strike at the heart of everything I’m on the board of supervisors for,” Supervisor Brian Bilbray said. “But I can’t make money that isn’t there.”

Bilbray’s colleagues expressed similar laments on a day on which they confronted some of their toughest decisions to date in their review of $10 million in cuts that Chief Administrative Officer Norman Hickey proposed in order to balance the county’s $1.3-billion budget, as required by law.

Adding and Subtracting

Before Friday, however, the supervisors had added about $1.4 million to the budget in areas ranging from parks to more staff and equipment in county departments, widening the gap between projected revenues and expenditures.

“No one wants these cuts . . . but we can’t keep adding numbers on a page,” Bilbray said, capturing the tenor of a meeting in which the supervisors repeatedly emphasized that their policy preferences were overwhelmed by economic realities.

Of the major county services debated Friday, only mental health programs ended the day in markedly better financial condition, as the board took actions that--assuming they are affirmed when final budget decisions are made later this month--would reduce a prospective $7.5-million cut by more than half.

With the county’s mental health director warning that the proposed cuts would produce “a great deal of human suffering,” the supervisors--who last week heard the same theme during nearly three hours of often emotional testimony from mental health patients and advocates--voted unanimously to transfer $1.6 million from the county’s contingency reserve fund to mental programs. The supervisors also adopted Hickey’s recommendation to add $1.4 million to the mental health budget to provide a three-month transition period during which certain services will be scaled back or eliminated by Oct. 1.

The extra $3 million in county funds will, in turn, generate about $1.2 million in Medi-Cal payments and other revenue, county administrators explained.

In May, Hickey had proposed a $5-million cut in health services that would have reduced overall funding for mental programs by $7.5 million during fiscal 1989, which began Friday.

Strained System

Although Friday’s actions could reduce that potential cutback by 56%, Mental Health Director Areta Crowell emphasized that the remaining $3.3-million cut will exacerbate the strains on a $50-million-a-year system in which “we’re only able to provide service to about half of the people we should.”

Under Hickey’s original budget proposal, county officials estimated that as many as 5,000 of the 11,000 San Diegans now receiving publicly financed mental health care could go without treatment and medication. After Friday’s vote, Crowell said that the board’s decision could enable about three-quarters of those persons to continue receiving treatment.

However, Crowell added that the $3.3-million reduction will lead to reduced service in outpatient programs and residential treatment, as well as cause the closing of at least two clinics.

“Obviously, this helps . . . but $3.3 million is still a very significant amount,” Crowell said.

Hoping to further bolster funding for mental programs, the board, at Supervisor Susan Golding’s urging, instructed county administrators to examine a number of potential cost-cutting ideas. Those include consolidating services and clinics and contracting with private firms to provide services now operated by the county.

Although those suggestions hold the potential for long-range savings, Crowell said that, even if the ideas are deemed worthy, they cannot be implemented in time to alleviate this year’s fiscal woes. Moreover, the mental health director stressed that, even if any of those proposals were to be enacted, the county would have to use the savings to “keep from cutting more . . . instead of strengthening” mental programs.

A measure approved by the Legislature could provide San Diego with another $1.1 million in state funding for mental health programs this year, Assistant Chief Administrative Officer David Janssen said Friday. However, county officials, anticipating a gubernatorial veto, emphasized that they doubt that those funds will ever reach San Diego.

But, if mental health administrators gained only partial satisfaction at Friday’s meeting, that still left them ahead of some county officials associated with a number of other high-profile programs.

Aware that some of their earlier decisions had left them farther from a balanced budget than when they began their deliberations, the supervisors approved Hickey-recommended cuts in social services affecting children and seniors.

Perhaps the most notable is a $2.7-million reduction in child services that county officials concede will seriously curtail their review of child-neglect and abuse cases.

Richard Jacobsen, director of the county’s Social Services Department, told the supervisors that, although state funding will rise from $22 million to $28 million this year, that increase is insufficient to keep pace with a rapidly growing workload now averaging about 5,700 cases monthly. As a result, hundreds of children who previously would have had a face-to-face meeting with a county social worker to assess their situation no longer will, Jacobsen said.

Conceding that that prospect is unsettling, the supervisors, reiterating an oft-heard theme, argued that the county’s budget problems left them with little alternative but to approve Hickey’s cutbacks.

“It’s painful,” Bilbray said. “But we can’t just print money.”