Starting last week, there have been stepped-up discharges from the MHRF. Staff feel that some of these discharges are appropriate. However, staff feels there are other placements that are inappropriate.

There have been discharges into Long-term locked ("L") facilities that are inappropriate because:

The discharges include cases where residents have definite potential to become able to live in the community, if they can be worked within the kind of rehab program the MHRF provides.

The rationale for the discharge is that these are "lateral transfers" to the same level of care, and that in some cases they will stay in the "L" facility until a community placement can be arranged.

This expectation is bogus because:

a. The "L" facilities don't have rehab programs which would help these patients continue to prepare to live in the community. The MHRF does.

b. The "L" facilities in general are not geared toward placing people in the community. For example, the ratio of social workers to patients is much lower than at the MHRF.

c. The "L" facilities have a financial incentive to keep the patients, because (unlike the MHRF) they get reimbursed by SSI for the patients' stay; and they need to keep beds filled to get the income.

Moreover, the "L" facilities that patients are discharged into are in San Jose, Vallejo, Stockton, etc. There are cases where the patients' families live in San Francisco, visit the patients frequently, and participate in their treatment-planning meetings. Staff agree that our experience shows that this family involvement has had very obvious and major positive effects on the patients' and families' state of mind, quality of life, and the patients' progress in recovery, rehab, and successful living in the community.

The importance of family involvement is especially true of the Asian residents. And most of the families are poor or low-income, many family members work more than one job, they don't have cars, and it would be pretty much impossible for them to visit the patients frequently in these locations.

Some staff reluctantly agree with discharging patients with "rehab potential" to "L" facilities, fearing that if the MHRF closes on July 1, we will have too many patients to find community placements. Others believe that even if that happens, the MHRF is slated to become a board-and -are home, which is the usual placement the MHRF discharges to, and those patients could just stay at the MHRF.

There is also evidence that patients will soon be discharged to independent living situations, where the staff feels clear that these patients are not ready to live independently, but could be if we could work with them longer.

We need to mobilize MHRF staff to help patients and their families be aware of their rights in these situations: They have a right to 30 days' notice before being discharged (and this can be enforced); they have the right to call "Patients' Rights" and/or the Ombudsman, two independent patients'-rights organizations who can help in these situations.

SOME PATIENTS HAVE ALREADY BEEN DISCHARGED INAPPROPRIATELY AS DESCRIBED, AND THERE ARE DEFINITE PLANS TO DO SO NEXT WEEK WITH MANY MORE. WE MUST PUT THE HEAT ON THE CITY TO STOP THIS IMMEDIATELY!