Brain Storms

A City Hall plan to downgrade S.F.'s only long-term-care facility for the severely mentally ill has critics up in arms

"Reduced cost was not the issue [in 1987]. The budget, or the economy, was at a boom time," says Program Director Henley. "And the generosity of the citizens of the City and County of San Francisco prevailed."

But Prop. C provided money only for building the MHRF, not running it. City officials claimed that its operating costs could be made up largely from sources other than city funds.

"The facility would pay for itself, with Medi-Cal and private insurance payments," argued then-Director of Public Health David Werdegar in the 1987 voters' guide. He was wrong, however. Medi-Cal, the joint state-federal program that pays for health care for the poor, doesn't reimburse skilled nursing facilities, as the MHRF is classified, with more than 16 beds.

To make matters worse, not long after the MHRF opened, its residents were notified that they were no longer eligible for federal Supplemental Security Income payments, since they were already under publicly financed care. The bottom line: San Francisco had to bear nearly the entire cost of running the MHRF itself. And it wasn't cheap: The facility cost $13.2 million in the most recent fiscal year. Now, city officials have decided that San Francisco simply can't afford a dream mental health facility any longer.

Housing the 42 sickest residents in out-of-city facilities like the Crestwoods will cost only $759,400 a year, officials say. (MHRF staffers charge that the Crestwoods provide "warehousing" rather than proper care.) And patients who are transferred to board and care homes and other less restrictive residential settings in San Francisco will be eligible for SSI and Medi-Cal reimbursement.

Still, such financial fixes are not balm for people whose lives have been touched by the MHRF. Piers McKenzie, a San Francisco fine art appraiser, didn't know anything about the mental health system until he and his wife watched their 22-year-old daughter descend into dementia last year. Behavior they had written off as "flaky" -- dropping out of school, disinterest in having a job -- deteriorated into something nightmarish. McKenzie says his daughter became violently agitated, hearing voices, yelling, and breaking things.

After a trip to San Francisco General Hospital, McKenzie's daughter was placed in the MHRF, where McKenzie and his wife have visited her every day for the past seven months. McKenzie says his daughter's improvement there has been marked. She now takes her medications, can hold a conversation, and has given her parents hope that one day she will be able to live a normal life again. She is slated to move to a board and care soon.

"But if you don't have the MHRF, there is no place for people to go," says McKenzie. "If it hadn't been for MHRF, I don't know where my daughter would be."

With any luck, his daughter will remain well, and he'll never have to find out.

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