Alameda County plans to close intensive outpatient mental health programs at Highland Hospital in Oakland, pictured in 2021, and Fairmont Hospital in San Leandro.

On March 9, in an attempt to balance its budget, Alameda Health System plans to shutter two of the only intensive outpatient treatment programs in the county available to indigent people with serious mental illness.

If the system takes this step, it will dramatically worsen a public health crisis for Alameda County. 

The intensive outpatient programs at Highland Hospital in Oakland and Fairmont Hospital in San Leandro serve a vital need in our community. They ensure that people with chronic mental health conditions who require consistent treatment receive the necessary support they need to maintain stability. Access to consistent treatment greatly reduces their likelihood of inpatient hospitalization, homelessness and incarceration.

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Until last year, I spent every weekday with the patients at Fairmont’s intensive outpatient program. During my 2½ years as a therapist there, I often heard from my patients that the program had literally saved their lives.  

As someone who lost a brother to mental illness — in part because he never found the kind of treatment he needed — I understand the gravity of those words. For years, as my brother struggled with schizoaffective disorder, I scoured the country looking for a program that would offer him the kind of support that Fairmont offers: A program that elicits and builds on patients’ strengths. A program that creates a warm and caring community, addressing the isolation and stigma that cause so much pain to so many people who struggle with chronic mental illness.

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At the Fairmont and Highland programs, patients’ symptoms and well-being are closely tracked by a team of skilled and caring professionals. Clinicians respond quickly when patients become psychotic, manic or suicidal. They can take the necessary steps to help patients avoid hospitalization, if possible, or to encourage hospitalization when necessary. 

For individuals struggling with chronic, acute mental illness, the consequences of closing these programs will be devastating. They will suddenly find themselves without the consistent support of a therapy team dedicated to helping them manage their symptoms. Just as critically, they will find themselves severed from their community — a community of people who understand and accept them.

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Without these anchors, clients at Fairmont and Highland’s outpatient programs are at great risk of decompensating and all that that entails. 

Many will wind up cycling through inpatient psych wards — if they can even get a bed, given the significant and well-documented shortage. And what will become of the unlucky ones who are turned away for lack of space?  Some will join the throngs of unhoused individuals on our streets. Others might wind up in Santa Rita Jail, which has become a de facto repository for individuals struggling with acute mental illness in Alameda County. A 2021 Department of Justice report noted that almost half of the inmate population at Santa Rita suffers from a mental health condition. A 2022 report by the county’s Mental Health Advisory board referred to the jail as “the county’s primary locked mental health treatment facility.”

In response to abuses documented in the 2021 Justice Department report, a “Care First, Jails Last” task force was created to investigate and address the deficits in Alameda’s mental health system. In June 2024, the task force presented 58 recommendations to the Alameda County Mental Health Advisory Board, many of them focused on shifting resources from incarceration to community-based mental health services. The plan includes creating preventative mental health care and post-crisis mental health care. But the programs at Highland and Fairmont already do both. With a system that is clearly over-stretched, it’s unclear why the county would choose to eliminate two existing services that fulfill the same needs that the task force is seeking to meet.

Alameda County does not have any other treatment options equivalent to Fairmont and Highland’s intensive outpatient programs. If clients are prematurely discharged in March, most will not have alternatives. The county may be counting on full-service programs to care for the clients whose services will disappear in March. However, full-service programs primarily provide case management, not therapeutic treatment. In fact, they rely on the outpatient programs at Fairmont and Highland. What’s more, the full-service programs fall woefully short of the existing need: In 2021, the county had the capacity to serve 850 people, while the estimated need was 4,000-6,000 individuals.

The county’s other Plan B, wellness centers, are not authorized to accept clients with acute symptoms.

Let’s put the needs of people with acute mental illness aside for a moment and consider the economic impact of cutting these programs. Treatment in inpatient facilities is by far the highest cost in the behavioral health care system — approximately $2,000 per person, per day. A 2020 study revealed that Fairmont’s intensive outpatient programs reduced inpatient hospitalization by 73% annually. The study estimated that Fairmont’s program saved the health care system approximately $28.7 million in higher-level services over a period of 12 years. 

It’s true that Trump’s pet bill, HR1, is slashing Medicaid, and this has resulted in significant cuts to the already strained public health system. But other California counties, including San Francisco, Fresno and Sacramento, are finding ways to retain their essential outpatient psychiatry treatment. 

Guest opinions in Open Forum and Insight are produced by writers with expertise, personal experience or original insights on a subject of interest to our readers. Their views do not necessarily reflect the opinion of The Chronicle editorial board, which is committed to providing a diversity of ideas to our readership.

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When Fairmont and Highland’s programs close in March and these safety nets are snatched away, the people they serve will most certainly end up falling through the cracks, and costing Alameda County even more. These closures will amplify an already acute public health crisis.

It’s imperative that we try to find a solution that does not cause irrevocable harm to the most vulnerable people in our community and that doesn’t increase the economic burden on everyone.

Kimberley Sevcik is a therapist specializing in treating chronic, serious mental illness. A former journalist, she has written for the New York Times Magazine, Rolling Stone, Mother Jones and the Guardian.

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