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Photograph by Will Mosher
Drug Problem: Bonnie Jay, manager of the El Dorado Residential Treatment Center, displays a bag containing a single psychiatric patient's medications. She fears that if her program is closed, residents will be lost.

Slashed and Burned

A look at how $14 million in proposed cuts to county programs will play out for Santa Cruz County's most vulnerable residents.

By Steve Hahn and Will Mosher

Bonnie Jay is going over the budget in the kitchen of the El Dorado Residential Treatment Center, an eight-room psychiatric facility with 16 beds. This is the place where people go after being in lockup treatment centers, jail or Dominican Hospital. It's clean, but there are some cracks in the linoleum floor that have been patched up. Jay, who manages the center, says it costs about $700,000 year to run. The county budget unveiled last month would cut that in half and remove two of the three positions at the house. The El Dorado would have to close, Jay explains, because working conditions would become unsafe.

"Basically, we have three staff in at a time and maybe 16 residents. And if we tried to run it with that much money, we'd only have one staff member there at a time," she says. "If something goes wrong, then the residents would go unsupervised."

The county's budget crunch is affecting the county's mentally ill. Hit hardest are the mental health service providers who get their funding from county contracts. People in those programs say it's bad--really bad. Rick Zinman, president of the Human Care Alliance, calls the cuts the "worst since the Reagan administration."

If the budget is approved as is, three out of five of the county's residential treatment programs--the Darwin House, Opal Cliffs and the Paloma House--will close. The El Dorado, losing half its budget, will also be forced to shut its doors. That means only one of the residential treatment programs--out of five--will remain operative.

Jay says the El Dorado is a bargain. As of June 20, psychiatric treatment at Dominican Hospital cost $5,098 a night--just for a room, medication not included. El Dorado, on the other hand, costs about $119 a day per resident.

Jay says most of the residents at El Dorado aren't able to care for themselves. As an example, she points out that some have to be reminded to shower or they would forget to do it. She said that they often lack basic life skills, things that most wouldn't consider "skills," like being able to operate a washing machine.

She's worried that the residents at the El Dorado are going to find their way into emergency rooms and into hospitals, not only making their lives worse, but also ultimately costing the county more than it would save from cutting the nonprofit residential treatment programs.

The wave of cuts to services for the county's most vulnerable populations--$13.8 million between health and services alone--is just beginning to crest. The county has until July 1 to cement the budget, so there might be a reprieve in the few days between now and then.

If the cuts to mental health services are made final, then the residents of these programs won't be let out into the street, at least not immediately. There are laws that protect the mentally ill from being taken from residential treatment programs and thrown into the wilds of self-reliance: They'll have 60 days' notice.

Injection Drug Users: The Drop-In Center
The HIV Resource Drop-in Center on Front Street welcomes its clients with a comfortable couch, friendly staff, free advice on HIV prevention, clean needles and sometimes even free food. These services, offered at a center that had 35,000 visits last year, are being threatened by proposed county budget cuts. The county's 2009 budget proposes reducing payments to the drop-in center, which is operated by the Santa Cruz AIDS Project (SCAP), by $190,000. That's 50 percent of the center's funding.

The sudden move has sent SCAP administrators scrambling to keep the drop-in center open and its HIV prevention programs running. So far, the crisis has claimed only one casualty--the center's supervisor--but more could be on the way. Rob Sommer, development director for SCAP, is fighting with everything he's got to keep the remaining five employees on board, pay the center's rent and keep supplies, which range from clean needles to free condoms, fully stocked. It has required some financial gymnastics, but Sommer is confident the drop-in center will remain open throughout the year.

"We're doing what we can to not have to shut that drop-in center down," he says. "More positions are definitely being threatened. We might try to see if we can get cheaper rent or even move the drop-in center to a more suitable location. Maybe we can consolidate some of our operations to save costs, but you can only do so much of that."

SCAP administrators are also thinking about trimming costs in other services, such as food and housing assistance for HIV-positive clients, and redirecting any savings to the drop-in center. That could be tough, though, with high food and gas prices making deliveries more expensive and a growing HIV-positive population needing assistance. Last year, SCAP workers administered 38 percent more HIV tests than in 2006 and saw a 90 percent increase in positive test results overall. These additional cases push the number of Santa Cruz County residents diagnosed with HIV up to 126 (268 county residents are known to have AIDS). An average of 10 percent of these cases were spread by injection drug use, according to the County Health Services Agency.

To keep these numbers from growing, education and prevention services such as the drop-in center are crucial, says Sommer. The drop-in center houses the popular needle-exchange program, free pizza nights for at-risk youth, free HIV testing and educational services focused on reducing the transmission of HIV. The center also acts as a point of first contact for drug users and others who wouldn't normally go to the government for help. If these preventative services were to disappear, SCAP's mission would become a lot harder.

"We're fighting to keep as many front-line people active as we can," says Sommer. "It's becoming harder and harder for us to do that with the budget cuts."

At-Risk Youth: Community Counseling Center
Clare Wesley is counting her blessings and hoping more are on the way. Wesley, who serves as the director of Youth Services for the Santa Cruz Community Counseling Center (SCCC), was facing a $2.5 million funding cut at the beginning of this month under the county's 2009 proposed budget, but thanks to a mix of compassion and fiscal deck-shuffling in the county's mental health services program, the cut was almost completely reversed: she's now looking at a reduction of just $348,000.

In these tough budgetary times, the one-time transfer of funds that turned a 50 percent funding cut into a 6 percent nick is a rare story of disaster averted. It has to do with the way the county, state and feds split up responsibility for some programs. In this case, in order to recoop $2.1 million in funding, the county had only to chip in $210,000; state and federal sources came up with the other $1.89 million in a 10/90 split.

However, that doesn't mean that the various programs under Wesley's watch are safe forever, or that this year won't bring some pain.

"This is only one-year funding," she says. "What the county is saying is, 'Here's a year, let's all put our heads together to find some long-term solutions.' As soon as we land somewhere on a budget this year, we must immediately begin to look at what we are going to do next year. Across the board we're just keeping our noses above the water."

It will still be a tough year for an organization that serves the county's youth in a variety of ways--whether it's helping teens recover from substance abuse, sending counselors to schools, working with juveniles on probation or providing housing for runaway and foster kids. Five employees will be lost, drug and alcohol counseling services will have less money to serve patients not covered by Medi-Cal, programs serving youth on probation will be scaled back, the foster home Crossroads will be running "leaner than ever before" and counseling visits to county schools could be less frequent.

Wesley was relieved she was able to take this year's budget cuts without having to eliminate any programs altogether. Next year, she might not be as lucky. Wesley is quick to mention that all her partners, including the county, are working on keeping the services in place.

"No one wants to cut services to children," says Wesley, adding that next year, absent a fix, reductions could once again reach the $2.5 million mark--meaning some programs would have to be cut completely.

"We're looking at a potential reduction next year of half our services, which would mean some programs just couldn't survive," says Wesley. "It's hard to say which programs would be affected, but some could definitely disappear. All of our partners are working on finding funding for next year in as many ways as we can."

The Poorest: Homeless Services Center
Declining revenues also mean that the Homeless Services Center on Coral Street might be forced to limit its hours of operation while serving cheaper food.

It's another part of the cuts going on across the county.

Ken Cole, the center's executive director, calls the county a "critical funding source." "To have the county talking about a 10 percent cut in our contracts is very disturbing," he says. "We're expecting an increase in the demand for services. It isn't a good time for the county to be in the position it's in."

The day program, which serves anyone who decides to come in off the streets, gives food to the homeless. Though Cole doesn't know what the cuts will affect, since the program will have to respond to the cuts only after they're made, he says they'll likely be similar to the type made in 2001, which resulted in the center serving cheaper food less often. Cole said the center was just recovering from those cuts and now was going to have to go back to its previous level of service.

"The dust has yet to settle and it's difficult to predict how we'll react if it comes to be," he said. "We need our programs to be healthy and viable."

Cole, though frustrated, doesn't blame the county.

"We're not angry with the county," he says. "We're angry with the state. The other nonprofit organizations have all the same problems."

The Elderly: Adult Protective Services
Santa Cruz County's Adult Protective Services is getting hit too; it's losing half its staff.

Francie Newfield, the division director of Adult and Long-Term Care Services, is worried about what the cuts will mean for the program's clients--people over 85 and the mentally or physically disabled who are vulnerable to financial exploitation, physical abuse and neglect.

"We're the people who intervene early to make sure that these things don't happen," says Newfield. "But in terms of Adult Protective Services, if we have this reduction, we won't be able to respond to as many reports."

So far the program has been able to respond to about 55 referrals a month within the state-mandated time frame of 10 days, but that's only with the staff it currently has. Newfield points out that the state created mandates for the program, and then didn't make funding for it.

"We don't have projections for next year because we're not sure what the state is going to do," she says. "We do know that reducing us by 10 percent will result in reducing our capacity by 50 percent."

Newfield says the reduced funding creates false savings in the budget because the neglect and abuse that APS would normally stop will carry over into emergency rooms.

"In the long run, people might be using publicly funded programs like Medi-Cal in-house support services, or they might be calling the police," she says.

She points out that the Adult Protective Services has an edge over the police and paramedics when it comes to bringing care to older adults: they create relationships with their clients in order to help them, which is important because some of the elderly who are unable to take care of themselves are also legally protected from being forced into care or receiving medical treatment.

She says her program most often deals with cases of neglect and self-neglect, where either someone fails to take care of an older adult or the older adult becomes unable to care for himself or herself due to dementia or other disabilities.

"It takes a lot of time to build these relationships," said Newfield. "Each one is important."

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