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Reinstate the Single Standard of Care Now!

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Single Standard of Care refers to the long-standing policy that uninsured people get access to the same level of care as insured people in San Francisco’s mental health system! It was arbitrarily reversed in the mid- year budget cuts as an ill-conceived plan to save money.


Why Current Policy is Bad and Must be Reversed!

Hurts Large Number of People

  • 1,700 medically indigent individuals lost their city funding for mental health treatment as of January 1st, 2005.
  • Up to 20% of the total number of people served in SF mental health system are impacted by this policy change.
  • Clinically Problematic

  • Medically indigent Individuals with adjustment, anxiety, minor depression and mood disorders are no longer eligible for treatment under this policy change.
  • Current policy does not take into consideration severity of disorder, nor functional impairment.
  • This arbitrary policy change does not take into consideration the accuracy of the diagnosis and does not include secondary diagnosis. Clinicians may not want to label new monolingual patients, for example, with more severe diagnosis to start with.
  • Policy change encourages mis-diagnosis of individual into a reimbursable category.
  • Encourages clinics to serve insured people in order to pull down more MediCal reimbursements.
  • Encourages clinics to turn down treatment for people with other co-occurring issues, such as addictive disorders.
  • Negatively Impacts Vulnerable Populations

  • As this policy denies services to medically indigent adults, new immigrants and ethnic minorities are disparately impacted. The agencies that are hit the hardest are those who serve these populations. These are individuals that are very difficult to engage in treatment, and once engaged, it makes no sense to discontinue them.
  • Homeless people are also disproportionately hit with these cuts. This population is already vulnerable and unstable; losing their treatment will be devastating.
  • Untreated mental illness is dangerous – it can cost lives! With the loss of treatment, individuals are at increased risk for suicide.
  • Contrary to Current City Policy

  • SF is currently moving towards an integrated model of service. This policy change flies in the face of integration.
  • The City is currently trying to create exits off the street for homeless people, and this policy change will exacerbate homelessness. Untreated mental illness leads to longer stints of homelessness, and individuals have a more difficult time navigating their way off the streets.
  • City policy currently dictates an emphasis on linking individuals to entitlement programs such as MediCal. This policy change will make it more difficult for individuals to garner benefits as they are unable todemonstrate their disability without treatment, and their related instability makes it harder to follow the bureaucratic maze public benefits require.
  • City is trying to promote idea in mental health services that “any door is the right door.” With this policy, a whole lot of wrong doors are being slammed shut.
  • This policy does not prioritize prevention.
  • Moves away from city policy of “Treatment on Demand”.
  • Reversed Without Proper Community Process

  • This was a top-down decision that was made without input or support from the rest of the Department, community organizations, contractors or the community at large.
  • There was no regular community process to discuss the ramifications of such a major policy change. In fact, even the Bielensen hearing did not take place.
  • The criteria did not even get developed until after the policy was put in place.
  • Just Plain Bad Policy

  • Do we really want a two-tiered system in San Francisco, where people’s health is determined based on insurance status?
  • In this policy change, health care is not the priority-insurance is!
  • Policy can result in explosion of immigrants, homeless, and ethnic minorities in the hospitals.
  • Public policy should be developed by having a vision first, then instituting policy that implements that vision.

The ongoing campaign to reinstate the Single Standard of Access and Care scored a recent victory. It was assigned to the government Audits and Oversight Committee on June 27th, and it passed with flying colors due to the expert testimony of community members and the support of Supervisors Daly and Peskin. Now it goes to the full Board of Supervisors on July 12. It is very important to contact your supervisor and demand that they reinstate the Single Standard of Care. People’s lives and mental health depend on it!


Author: Street Sheet Editor

The STREET SHEET is the oldest continuously published street news paper in the United States. Organizationally, it is the public education and outreach tool of the Coalition on Homelessness. Every month, the STREET SHEET reaches 32,000 readers through over 200 homeless or low-income vendors. Our vendors are charged nothing for the papers they receive, and keep all money they earn through STREET SHEET distribution.

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