Last week, two police officers escorted a man to the emergency room at the UC Davis Medical Center. He had not been in a car accident. He did not have chest pain, shortness of breath, or any other symptom typical of a medical emergency.

While the officers spoke with our nurses, the man, whose first name was Bill, stood in the ambulance bay, shouting at the top of his lungs. He was impulsive, agitated, and hostile - very much in need of emergency treatment.

Bill was experiencing a manic episode, the cardinal feature of bipolar disorder. I later learned he had suffered from this chronic illness since his early 20s. Over the years, he'd been in and out of treatment, including several episodes at the Mental Health Treatment Center - the county hospital for patients with severe mental illness.

Bill was brought to the ER, in fact, because the treatment center was not accepting new patients.

Though there were two psychiatrists in the ER - myself and another resident - Bill would end up waiting several hours to be seen.

My colleague and I were busy helping to stabilize seven other mentally ill patients, each on gurneys in the hallway, waiting to be transferred to a psychiatric hospital.

Under normal circumstances, there is little need for psychiatrists in the emergency room. A patient like Bill would be seen briefly by emergency medicine doctors, who would assess his symptoms. Once stabilized, if necessary, he would be transferred quickly to a mental health hospital.

But lately, for patients with severe mental illness, the circumstances have changed. Over the past few months, budget cuts have decimated the public mental health system in Sacramento County.

Since July, 4,500 adults have lost vital services at clinics, and the number of psychiatric hospital beds has been cut in half.

Predictably, the elimination of these services has left thousands of adults in a precarious position. Many have had to forego regular treatment, allowing symptoms to worsen until, in an emergency, they can resort only to second-rate options, such as treatment in the local ER.

Over the past two weeks, I have seen the personal face of this crisis. Patients such as Bill - men and women who are so impaired by illness that they might harm themselves or others - may lie on a gurney in the hallway for days waiting for a hospital bed.

Against this backdrop, Bill's arrival in the ER was both a personal crisis and the predictable result of the collapse of the public mental health system.

There is not enough space in this newspaper to describe the many ways in which people with mental illness are treated as second-class citizens.

Imagine the outcry if any other group of adults with a common illness lost access to medications, doctors, and other vital services.

What would happen if people with heart disease, who depend on medications to treat congestive heart failure or to prevent a heart attack, suddenly lost access to treatment? Their symptoms would worsen, and they would appear in greater numbers at the emergency room. Emergency physicians would do what they could, but coronary care units, which are needed to provide life-saving treatment, would be closed.

As a result, patients with severe heart disease would remain on a gurney for days in the ER waiting for a hospital bed. For people suffering from heart disease, cancer, or lung disease, society would never allow this scenario to unfold.

Last week, several mentally ill patients were released from the ER, while under normal circumstances they would have been admitted to a psychiatric hospital. One woman with schizophrenia was discharged with her doctors fully aware that there was some danger she might hurt herself or deteriorate further. The doctors' only other option, though, was to keep her on a gurney in the hallway. She was given a short supply of medication and sent out.

What happens in two weeks when her medicine runs out?

To many readers, the collapse of the public mental health system may not sound like a Hurricane Katrina, or a major flood, or an earthquake. But for thousands of local adults like Bill and the other patients waiting in the hallway of the ER, "budget cuts" constitute a slow disaster that shamefully illuminates the ways we treat – and fail to treat – adults with mental illness.

Dr. Nathan Fairman, is a resident physician in Psychiatry and Behavioral Sciences at UC Davis Medical Center.