The decimation of public health

Pub date January 14, 2009
SectionNews & OpinionSectionOpinion

OPINION Crisis seems omnipresent these days.: it’s hard to find a newspaper that doesn’t carry the word in a headline at the top of the business section, or even on page 1. But a liquidity crisis seems a lot less solid when compared to the kind of crises faced by people in a society without health services.

San Francisco has developed a strong mental-health infrastructure, with respect for mental health consumers’ viewpoints and rights.

As an alternative to confinement — a coercive practice that can alienate patients — this city has acute diversion units: houses that serve as recovery centers for people in psychiatric crises. Psychiatrists manage medication, and nurse practitioners conduct health screenings, as you’d expect, but this is just the beginning of a broader approach to mental health. Residents work with professionals to develop their own treatment plans. They meet for discussion groups and trainings on topics that affect their ongoing mental health, like relapse prevention, symptom management, and medication education.

Participants help cook and clean to prepare themselves for independent living. Every year, 1,400 San Franciscans use these units.

We also have created culturally competent services. In immigrant neighborhoods and at San Francisco General Hospital, we have services in Spanish and Asian and Pacific Islander languages — services that help prevent the problems that can occur when native-language support is unavailable.

And the city has embarked on a grand experiment: Healthy San Francisco is designed to provide health care — before things get to crisis level — for any city resident who lacks insurance.

Unfortunately the crises have collided. These programs, along with dozens of others, are slated for closure next month as part of the city’s emergency rebudgeting response to our economic crisis. Half our acute diversion units will close. Hundreds of monolingual San Franciscans will lose services in Chinatown and the Richmond District, and General Hospital may lose half the Asian languages with which it can communicate with mental health consumers. New Leaf will cut therapy for 50 gay clients with combined mental health and addictive disorders. The sexual assault trauma recovery center will close.

Healthy San Francisco will be gutted. Staffing has not increased sufficiently to provide high quality care for all patients, and SF General will downgrade service by replacing skilled nursing jobs with less-skilled positions. Some RNs will be eliminated, LVNs will be replaced, certified staff will be replaced by noncertified staff, and clerks with medical training will be reduced to clerical work.

These are just examples. Cuts were made so hastily that nobody yet understands their full extent. But budgets — for all those digits and decimals that smack of hard economic truth — exist in the nebulous apparition of What May Be. And what may be, may yet be changed.

This month, the Board of Supervisors has the opportunity to change this future, and to protect the health and, in some cases, the lives of thousands of San Franciscans. Public health will receive cuts: that’s a sad truth of a faltering economy. But these cuts need be neither as numerous nor as deep as the current plan.

By reallocating funding from less essential programs to our most vital services, and by giving San Franciscans the option to vote on new revenue in June, the supervisors can respect the priorities of a city that cares about the well-being of its ill, its injured, and its uninsured.

Alysabeth Alexander works with La Voz Latina. Jennifer Friedenbach works with the Coalition, and SEIU Local 1021 activist Ed Kinchley is a member of the Coalition to Save Public Health.