DO NOT GO GENTLE INTO THAT GOOD NIGHT,
RAGE, RAGE AGAINST THE DYING OF THE LIGHT"" - Dylan Thomas
Community Behavioral Health Services is the alias of The Department of Mental Health of San Francisco. It is the city agency that provides mental health services to those who cannot afford private treatment. It got this bizarre, ambiguous appellation about a decade or so ago when, for budgetary reasons, the Department of Mental Health decided to subsume treatment for the mood disordered under treatment for substance abusers. Since there is disagreement as to whether substance abuse in a legitimate mental disorder, they changed their name to omit the word, ""mental"". (It's true. I swear it.) Suffice it to say that the inane title reflects CBHS's status as the homely stepchild of the Department of Public Health.
Mental health care has evolved dramatically in the past five decades but not in the civic bureaucracy. Rather than developing treatment modalities to reflect advances in medical knowledge, CBHS remains immured in the past. Position equals power/money in civil service, and the rulers of established CBHS fiefdoms do not want to hear of any theories or practices that might detract from their status. Ergo, the only way that novelty squeezes into San Francisco Public Mental Health is as a subset of an already-existing category of illness.
The effect of this can be seen in the unfortunates with mood disorders who fall within the orbit of the CBHS. Mood disorder is a recently established diagnosis and has no vested bureaucracy within the DPH. However, substance abusers, (Drunks and Hypes), is an historic civil service fiefdom. Hence, all mood disordered clients are treated as de facto substance abusers despite the fact that only about 30% actually are. These unlucky folks are made to undergo pointless substance abuse therapy led by zealous, take-no-prisoners, former substance abusers that not only is irrelevant to their condition, but makes it depressingly clear that no one cares.
Another untouchable class is adults with AD/HD. The only drug that successfully treats AD/HD is amphetamine hcl, a less potent family member of methamphetamine hcl. God forbid that the media should find out that the CBHS is giving its clients SPEED! How much more politically expedient to pretend that anything-other-than-speed works. At 18 yrs. of age, speed is removed from the formulary for all clients. (Have a happy life. Goodbye!)
Imagine the case of a mood disordered client with AD/HD and chronic fatigue syndrome. The Holy Office of the Inquisition was less effective when it broke sinners on the wheel. The exclusion of needed drugs creates a permanent underclass medicated into a state of lethargy that renders them too enervated to act out and disturb the public but whose underlying psychological problem remains untreated.
Predictably, millions of dollars in Prop. 63 money (intended, by statute, to extend mental health care to the untreated and undertreated [e.g., the Mood Disordered & Adults with AD/HD and Chronic Fatigue Syndrome]) has been sopped up by the CBHS bureaucracy to no therapeutic effect. But the payroll is up!
Finally, there is the city budget. At the best of times, CBHS is inadequately funded since the Director of the Department of Public Health is not particularly interested in mental health. [Edit (Dec. 30, '10): Mitch Katz will be gone in two days. Praise the Lord! Maybe his replacement will TREAT the mentally ill rather than just try to keep them out of sight (and off the books).] This accounts for the plethora of non-profit private mental health agencies that have arisen in San Francisco principally to assure that the damage caused by inadequate and inappropriate treatment by the CBHS is minimized. When times are bad, the CBHS is pared back to maintaining its infrastructure for when times become good again. Patient care becomes even more notional (which has its pluses and minuses.)