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Mental Health Woes

June 26, 1988

We are writing in response to the proposed cuts in the San Diego County Mental Health budget.

As you know, the county is legally obligated to provide care for individuals who present a clear and imminent danger to themselves or others. While the present mental health system in San Diego County is flawed, incomplete and underfunded, it does maintain thousands of patients outside the hospital. These patients are very seriously ill and yet voluntarily receive treatment in non-hospital settings. The difference between voluntary and involuntary status is often a fine line that is stabilized only by existing mental health services.

The Hillcrest hospital is functioning at full capacity and beyond. The new county psychiatric hospital will be at full capacity the moment it opens. The crisis residences are functioning near maximum capacity and are unable to accommodate involuntary patients. The jails and the streets are already serving as "overload psychiatric units."

The situation will deteriorate dramatically if these cuts are adopted. Many current consumers of low-cost outpatient and residential care will decompensate and require hospitalization. Limited bed capacity will preclude admission to patients who are legally entitled to hospital services for their own safety and the safety of the community. The results will likely be far more expensive than the current cost of services to be cut. Recent experience with the Hillcrest hospital demonstrates that the human and monetary consequences of our actions may not be as "discretionary" in the future as they seem in the present. Thirty extra locked hospital beds at $450 a day is nearly $5 million, and it is questionable whether 30 extra beds could adequately address the increased demand.

We urge rejection of this proposal. It represents more than a budget cut as it will shift the direction of mental health services away from community-based treatment and back toward the hospital. The damage to our already fragile system will take years to repair. Adoption of this plan would likely result in a significant increase in the incidence of suicides, mental health-related homicides, homelessness and criminal activity. The fiscal "savings" are an illusion, the human suffering is not.

To date, the news media have been alarmingly restrained in covering this unfolding tragedy. This mental health crisis needs to make the news now before catastrophe or scandal makes it a more sensational story.


Executive Director


Chief Administrative Officer

Community Research Foundation

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