cian to advocate more funding for programs that incarcerate the severely mentally ill rather than outpatient programs that provide care and treatment at a much lower cost. Lots of fear mongering helped restore funds to the Sheriff’s Department. I support public safety, but I think public health programs and social services are taking a disproportionate share of the cuts.
The Disappearing Safety Net
If we are not careful, all urgent and emergent care of the mentally ill will be shifted to our local emergency rooms, which is just about the worst place for this service to be delivered.
4
By now you have all heard that our public safety net has had several more holes torn in it — perhaps it would be more accurate to say that there are only a few threads left of the net. The Sacramento County Board of Supervisors recently voted to cut public health services to our most vulnerable citizens, severely mentally ill patients, medically ill indigent patients and patients prone to abuse and neglect. These cuts will get us through this year, but most experts are not predicting an economic recovery for one or two more years. That means more cuts are likely next year and much of the money “found” this year comes from shifting funds around and delaying paying debts. This could lead to a lower credit rating for our county, which is what happened the last time we did this. Many cuts seem short sighted: the closure of the Sacramento Boys Ranch, further cuts to mental health, primary care clinics closed or cut (prior cuts led to SSVMS’ MD volunteers serving nearly 50 percent fewer patients this year), less tuberculosis tracking. According to a recent article in the Sacramento Bee, there may be more beds closing at Sacramento County Mental Health. Although plans call for other beds to be added in the future, we cannot permit beds to be closed until the future beds are signed, sealed and delivered — and opened. All too often, cuts in services are sold to the public based on promises that never materialize. If we are not careful, all urgent and emergent care of the mentally ill will be shifted to our local emergency rooms, which is just about the worst place for this service to be delivered.
Sierra Sacramento Valley Medicine
In addition, some very basic services with potentially huge medical cost savings as well as better patient outcomes are being cut. STD (sexually transmitted disease) prevention and treatment will be virtually eliminated by the new cuts. Luckily for Sacramento, an organization created over 20 years ago by our four hospital systems and the county is stepping in to help fill this gap. CARES, The Center for AIDS Research, Education and Services will be providing a much needed health care service. The April 27 edition of the New England Journal of Medicine has an article entitled “AIDS in America — Forgotten but Not Gone.” Most attention on HIV/AIDS is focused on the global epidemic. But there are places in America where the rates of infection have grown to rival that of Sub-Saharan Africa. CARES is tackling the HIV/AIDS epidemic to make sure it doesn’t get out of control in this area. It is leading the community-wide initiative known as “Are You the Difference?” which aims to significantly reduce, if not eliminate, new cases of HIV over the next 5 years. This is an ambitious goal. CARES is using a strategy gaining traction among those who plan HIV prevention: control infection transmission by keeping the viral loads low among all those infected. This means aggressive testing to find those unaware of their HIV status, finding those who aren’t in medical care but know they are HIV positive, and, finally, keeping people in medical care so that they will be more likely to take their medications. Nationally this is known as Test & Treat or Testing & Linkage to Care, Plus. As physicians, we can help Sacramento put a huge dent in new HIV infections by testing everyone for HIV, especially anyone with an STD and anyone in a high risk group. In Sacramento, that currently includes gay men, African-Americans and Latinos. By taking these steps, we can be the difference. SSVMS is also stepping in to help fill some gaps. Through our 501(c)(3) organization, Community Service, Education and Research Fund (CSERF), we are expanding the SPIRIT Project (Sacramento Physicians’ Initiative to