The San Francisco General Hospital (SFGH) department of psychiatry has won its war with the city and county of San Francisco’s Department of Public Health (DPH). The psychiatry department won’t have to eliminate 22 of its 87 award-winning beds after all.

Under an agreement brokered by San Francisco Mayor Willie Brown, the DPH will accept an alternative plan, put forward by the psychiatry staff at SFGH, to help reduce inpatient stays and increase revenues.

The plan, proposed by Robert Okin, M.D., chief of psychiatry at SFGH, and his staff, calls on the DPH to create alternatives for patients who no longer need acute care in a locked psychiatric unit, but who are not appropriate for release or unsupervised residential programs. These so-called "decertified" patients will be moved out of inpatient beds, allowing the admission of new Medi-Cal and Medicare patients. This will result in a net increase in revenues to the hospital.

DPH Director Mitchell Katz, M.D., had proposed the closure of the 22 beds as a way of reducing budget outlays in an effort to balance the DPH budget, which was facing a $45 million shortfall. The cut would have required the psychiatry department to close one of its four unique cultural-competence focus units. Katz’s proposal required the hospital as a whole to cut expenses roughly 10 percent. The department of psychiatry, however, would have lost 25 percent of its beds and 25 percent of its staff.

"I could not allow psychiatry to be the victim—again," Okin told Psychiatric News. "The reductions ordered were unfairly aimed at psychiatry; they were not based on an evenly distributed, across-the-board model, or even a needs-analysis basis."

As soon as the proposed budget cuts were announced by DPH, Okin decided that he and his staff would fight the proposal, and fight it "all out."

The psychiatry staff enlisted every friend and coworker they could muster to help mount a highly visible media campaign to inform the public of the threat to psychiatric services at the hospital. The public responded with outrage, deluging the DPH, the San Francisco Board of Supervisors, and the mayor’s office with strong objections to the proposed closure of the beds.

The victory is a sweet one indeed. Most of all, said Francis Lu, M.D., director of the Cultural Competence Program at SFGH, the victory belongs to the patients. "It was a hard fight, but one well worth fighting."

The victory is also one for cultural competence, preserving the first such program (founded by Lu) in the United States. SFGH’s "award-winning model programs serve the diverse culture here in San Francisco," said Lu.

As the population of the United States continues to diversify in the 21st century, the SFGH units will continue to serve as models for setting up units all over the country. According to the U.S. Census Bureau, California no longer has a "majority" race or culture. It projects the same will be true for the United States as a whole by the year 2050.

"By then," said Lu, "cultural competence should no longer be unique; it should be the norm."