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County Cuts Beds for Acute Mental Cases : Budget: Flouting warnings, supervisors trim space for the costliest of the county's wards and to eliminate 143 county jobs. Some of those released will end up on the streets, a public danger, advocates for the mentally ill say.


Amid warnings that their action would result in "tragedy," county supervisors approved a money-saving reorganization of the public psychiatric hospital Tuesday that will sharply cut the number of beds available for acutely mentally ill patients.

The reconfiguration of the San Diego County Psychiatric Hospital would save the county about $4.5 million, eliminate 143 county jobs and replace public employees with a private contractor in a 62-bed unit devoted to patients receiving longer-term care.

The 3-1 vote, with Supervisor Susan Golding dissenting and Supervisor Leon Williams absent, represents a step toward balancing the county's budget for the fiscal year that begins July 1 and reorienting the mental health system toward longer-term care, said Board Chairman George Bailey.

"While no one really wants to see budget reductions in mental health services, economic conditions and other state and county budgetary problems leave us no choice but to make these cuts," Bailey wrote in a memo to his colleagues.

But advocates for the mentally ill said the cutbacks would force the hospital to turn away even larger numbers of acutely and chronically ill people than it does now, some of whom will pose a danger to themselves and the public.

"We (already) put people out into the community who we're not comfortable with," said Marianne Prince, a nurse at the psychiatric hospital. "This is going to put us in an even more difficult situation."

Kraig Peck, an official with the labor union that represents most of the county's employees, predicted the "the decision will result in some tragedies, and the supervisors will re-examine this decision at a later point when the public becomes aware of its impact."

The vote was the culmination of budget wrangling that began last summer, when county officials proposed to close the entire hospital--and later, parts of it--to cope with a yawning gap in the budget.

A last-minute cash infusion staved off the cuts for this year, but staffers were ordered to develop a plan to trim the hospital's budget for the fiscal year that begins July 1, eliminating most county funding for the facility.

The response was the plan approved Tuesday, which reduces the number of costly "acute care" beds from 62 to 34 and increases the number of beds for longer-term patients with greater chances of recovery from 34 to 62. A private contractor will be selected to provide mental health services to those patients.

A 13-bed unit of acute-care beds for the elderly would be downgraded to 13 long-term care beds operated by the county. The hospital's emergency room would remain unchanged.

Primarily because acutely ill patients require intensive service by a higher number of staffers, each acute-care bed costs the county more than $182,000 annually, according to a report to the supervisors. The longer-term patients, who are not as prone to violence or other outbursts, cost more than $28,000 annually.

Assistant Chief Administrative Officer David Janssen said the hospital averages about 34 acute-care patients now.

But Peck and Prince said the rest of the current acute-care beds are occupied by people with severe, chronic mental problems who are not "acutely" ill but are far too dangerous to be transferred to the lower level of care provided by the long-term beds.

They are people like the patient who hears voices urging him to run into traffic, and the man who has chased schoolchildren with a razorblade, Prince said.

Between the two categories, Peck contended, the county psychiatric hospital is turning away more patients than the national average, many of them more severely ill than already admitted patients considered too sick to release to a lower level of care, he contended.

Further cuts will make the problem worse, particularly with the number of homeless mentally ill people on the streets, Peck said.

"The current number of acute-care beds is already at an irreducible minimum," Peck said. "They are already turning away people who need acute care."

Golding said she voted against the plan because she could not be assured that the hospital would be able to handle the people on the streets in need of acute care.

Administrators will begin phasing out acute beds as they seek to hire a private contractor by June 1, and will fully implement the reorganization by July 1, said Steve Harmon, acting director of the county's Mental Health Services program.

About 35 staffers, from psychiatrists to nurse's aids, are at risk of being laid off, Harmon said, but the county will make efforts to place them elsewhere during the intervening months.

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