Mental Cruelty

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.

In an interview, Dr. Mitchell H. Katz, San Francisco's director of health, said that he is working with the foundation to address its problems. Katz said that the Community Mental Health Services' large salary savings were put in place by previous Health Department administrations. He said he spends all the money he is given by the mayor and the Board of Supervisors.

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The home of Spiritmenders, a self-help group run by and for the mentally ill, is located at the far corner of a damp basement in the Mission District. Furniture in the dingy office is worn and saggy. An old television screen is filled with electronic snow. The place can grow on you, though. Hot coffee steams next to a clutch of cups. People sit comfortably around the space, chatting about who's in the psych ward, who's sleeping with whom, how to get into a homeless shelter, where to eat for free. There is little room for pretension here.

Membership in Spiritmenders, a nonprofit group funded by grants and donations, is open to "all people who have suffered emotional turmoil through the firsthand experience of mental health services." There are a few basic rules: No drug or alcohol use on the premises. No fighting. No cursing.

Democratically elected leaders of the group, such as Voices at Bay Editor Wise, strive to set good examples of behavior for the membership, which includes people who are hallucinating because they can't get appointments with a psychiatrist to get medication, people who are tweaking on crack, people who are lonely, hungry, ready to end it all. Then again, some of the members have part-time jobs, go to college, live in their own apartments, serve on community boards as representatives of mental health consumers.

The sense of social ease in the room can be traced to the good work of clinicians and case managers in San Francisco's community mental health network. The stable people here are hooked up with therapists, regular medication, affordable housing, and monthly checks.

Susan Owsley, who wears black half-moons of eye makeup, illuminates her world. "I'm a raccoon. That's what some of us like to call ourselves," she confides. "Many years ago, I was a nurse's aide, a single mom with two kids. I had a nervous breakdown. I got schizophrenia with anxiety and depression. I was homeless for two years. Now I'm in supportive housing. I'm on Benadryl, alprazolam, nortriptyline, Librium. I stay out of the psych wards because I take my medication.