Mental Cruelty

San Francisco's ACT program follows a national model that has been shown to be the most effective treatment for impoverished mental cases. Front-line social workers say, however, that they are able to reach only a small percentage of people who are, literally, dying for attention. Ever-worsening staff shortages throughout the mental health system mean that even people who are reached are not likely to receive the comprehensive medical and psychiatric attention that they need for stability.

"Sara" is in her late 30s; she's blond and has a penetrating glance. Sara is typical of the all-too-few homeless women whom San Francisco's mental health system has been able to embrace. Sitting in an outpatient clinic at General, she tells her story. "I was the victim of a series of assaults; I disassociated, hallucinated, became homeless. I locked myself in the bathroom to sleep because I was very ... vulnerable ... in the shelters. I used drugs. I got 5150'd to General twice and, also, St. Luke's [Hospital]. Then I met my case manager."

Wes Draper

Wes Draper

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Sara's face glows. "I got better meds. I got a therapist. I got a room in a house. I learned budgeting and cooking. I learned to fight for my own life, to ask for help when I need it."

Time and again, ACT clients attribute the beginning of their recovery to the personal ministration of a trained social worker, nurse, or therapist -- the very clinicians being purged from the mental health system by salary savings.

"Martha" smiles sweetly. "I'm not particularly attached to people. I love frogs," she says. "See the frog art on the wall? I made that frog art."

A dozen people gather around a table under the frog art. Some are schizophrenic, some bipolar, some both. All of them are heartachingly distressed about the destruction of their day treatment center, the Bayview Clubhouse on Hyde Street in the Tenderloin. The program has lost 50 percent of its staff and cut back its hours by a third. Its clinic -- the busiest dispensary of psychotropic drugs in Northern California -- has lost two of its three psychiatrists. People are turned away daily.

The clubhouse is based on a treatment method geared toward vocational training. Members run a thrift store, operate a snack bar, assist the professional cook in preparing and serving breakfast and lunch, do janitorial and clerical work, act as security, and take computer classes. Counselors and members work together on these projects and engage in group therapy and social activities, among them poetry readings. The atmosphere in the clubhouse is very convivial, very safe.

Rudy Mason, the cook, says that clubhouse meals are the only source of food for some members. He used to feed 100 people a day. Now attendance is down by half because the club no longer has the staff it needs to operate at capacity, he sighs. There used to be a job placement person who got members half-day work in corporate mailrooms downtown. That position got zapped by the flat budget.

Mason frowns. "The worst thing was that for months the members had trepidation about the situation. When we were forced to close on Saturdays, they asked me every five minutes if it was the end. Now they have gotten used to the uncertainty and only ask every few hours."

The clubhouse and clinic are owned by a middleman organization, the nonprofit Bayview Hunters Point Foundation, which receives $6 million a year from the city to operate a dozen mental health and substance abuse programs. The current administration of the foundation has been sanctioned repeatedly by government auditors for serious financial irregularities. The U.S. Justice Department penalized the foundation last year after vials of methadone, a substitute for heroin used in addiction-treatment programs and abused on the street, went missing. But the foundation's executives remain, apparently, the darlings of the budget-slashers. For years, the executives have quietly gone along with Brown's budget cuts, refusing to fill vacant clinical positions, but giving themselves raises of as much as 24 percent.

The foundation's executive director, Karen Patterson Matthew, wrote a thank you letter to the Department of Public Health a few months ago: "[F]unds that were made available though our elimination of particular staff positions permitted rather impressive salary adjustments throughout our programs. Everyone is excited."

Perhaps not everyone. Public records obtained from the Department of Public Health are filled with plaintive letters from the Bayview Hunters Point Foundation's field workers literally begging high-ranking officials to restore funding for lost clinical positions. For instance, last December, Dr. Thomas Ryan, the Bayview Clubhouse psychiatrist, pleaded, "The clubhouse and other mental health programs are dying. Please do something."

In April, the Public Health Department sent a letter to its mental health contractors telling them to prepare for significantly greater cutbacks in next year's budget. This is bad news not just for the clubhouse, but for the entire mental health outpatient system, which is heavily dependent upon nonprofit contractors. For example, the Bayview Hunters Point Foundation's mental health program for children in the Bayview District has seen its regular clientele diminish from 100 children to 30 during the last three years. Program Coordinator Diane Scarritt says that since her staff fell from seven to two psychiatric professionals, suicidal children have been turned away for lack of counselors. The foundation's adult mental health treatment program, called Bayview Thunderseed, is also a shambles due to staff cuts.