Santa Clara County Executive Pete Kutras will reveal his budget proposal for next year at a news conference Monday, and even he has termed the coming reductions "devastating."
Hardest hit will be the uninsured mentally ill.
Although county supervisors could still temper the initial proposal to cut the county's mental health budget by $34 million - far more than most other departments - mental health counselors already are advising clients that life could be very different, very soon.
"We've never faced anything of this magnitude," said Nancy Peña, director of the county's mental health department, who's been with the county for nearly three decades. "It is truly a crisis in the safety net for the whole county."
Nearly a third of the county's 387 mental health workers would be cut, on top of an additional 100 to 200 positions at non-profit agencies that contract with the county, if Kutras' budget proposal resembles the rough draft outlined in March.
And if the county decides to accept only a small percentage of uninsured clients for outpatient care, an estimated 8,000 people with mental health issues would be turned away next year, from the 18,000 currently receiving services.
Two weeks ago, hundreds of people stood before the board of supervisors to say, in voices sometimes shaking with fear or rage, that mental illness is a disease devastating to self and society.
One person, who had waited for nearly an hour for a chance at the microphone, told the board: "If you folks don't think Virginia Tech can happen here, you're wrong."
The county faces a $227 million deficit in its $3.7 billion budget. The board of supervisors, which will hold budget workshops in the coming weeks, will need to adopt a balanced budget by June 30.
Rippling effect
Almost every county department will be seeing cuts in funding. But reductions in mental health and alcohol and drug treatment programs threaten to cast a rippling effect throughout other county departments and the wider community.
"When people are not receiving the care they need, they access services through the most expensive doors, which is the hospital or the jails," said Navah Statman, a past president of the National Alliance on Mental Illness in Santa Clara County.
The severely mentally ill who need emergency and 24-hour care will still be treated at county facilities regardless of their ability to pay. But outpatient services - the target of the cuts - are always cheaper than hospitalization.
Keith Humphreys, a psychiatry professor at Stanford University who has provided consultant services to Santa Clara County in the past, said: "You can close services, they'll show up suicidal in the emergency room and you'll pay for it anyway." Cut treatment programs for a drug addict, he added, and "You'll pay when he wraps his car around a light pole."
The county's department of alcohol and drug services, with a $51 million budget, faces a cut of $10.9 million. That's separate from the proposed cuts to mental health.
After more than 30 years of working for the county, the last four as its CEO, Kutras doesn't need to be told that today's cuts only shift the burden to tomorrow.
"Does prevention save future costs? Yes, absolutely it does," Kutras said. "But I don't have current dollars to spend to save those future costs. I don't have it."
So it will be counselors like Steve Monte who will have to break the "We're-out-of-money, you're-out-of-luck" news to clients.
"It's very difficult for me to face the potential that I will have to speak with people on the phone, with clear mental health issues, and tell them that I don't know where they can go to get help," said Monte, who answers the phone when people call Community Solutions with problems ranging from sudden anxiety attacks to deep chronic depression.
"It's a difficult thing for them to hear," Monte said. "These people that want help and we're telling them we don't have any resources."
Community Solutions, a non-profit agency that provides a spectrum of services ranging from drug prevention and treatment to shelter and counseling, is among 20 community organizations at risk of reduced county funding. It's not yet clear how deep a cut those groups may be facing.
More fears
Jason Newman, a San Jose man who has been diagnosed with schizophrenia and bipolar disorder, said a county mental health official told him the clinic he uses could close by the end of the year.
"I got really scared and I cried," said Newman, who is 36 and cannot work regularly because of his illness. "This can't happen. This is absurd."
Newman has government health insurance that covers his treatment and the cost of the numerous psychiatric drugs he needs. But if the clinic closes, he worries about trying to find a physician in the community who will treat him. And he worries about people like him who don't have other options for care.
Law enforcement is also paying close attention.
"I'm extremely concerned for the welfare of the community, for people with mental illness and for my officers," said San Jose police officer Greg Sancier, with the department's crisis management team.
Just two months ago, Sancier noted, officers shot and killed a man who was armed with two butcher knives. The man was schizophrenic.
"Those officers and their lives will probably never be the same," Sancier said. "Certainly the family will never be the same."
Santa Clara County for years has been a leader in providing mental health and health care services above and beyond what the law requires. But Humphreys, of Stanford, said counties in crisis mode invariably cut back on mental health. Even in medical circles, he noted, "mental health has always been the least respected."
The spotlight on mental illness was fierce last month when Seung-Hui Cho gunned down fellow classmates at Virginia Tech, killing 33 people, including himself.
For about a week, communities near and far futilely probed the killer's mind and motive. But in time, the same communities returned to daily life, to the everyday issues of police, pensions and potholes.
A Nexis search of U.S. newspapers and wires showed the words "mental health" appearing 1,627 times in the week immediately following that bloody Monday, a 77 percent increase from the week before.
By week two, "mental health" had a 26 percent drop.