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Wrong Answer

December 04, 1987

Some people want to sweep the homeless mentally ill off the streets. These wretches shuffle along streets like Broadway in downtown Los Angeles and Montana Avenue in Santa Monica, hair matted, belongings under their arms, muttering at private demons. They are a national tragedy, but tougher commitment laws alone are not the answer.

By now, most caring Americans understand that only part of the well-intentioned program to change the focus of care for the mentally ill was carried out in the 1960s. Horrified at conditions in mental institutions, officials closed them. But the promised resources for community mental-health centers never materialized.

The first priority must be a basic commitment to help the homeless who are mentally ill. The state of California has avoided facing up to that.

The second step is actually to start treating them. About 40% of the homeless are mentally ill. About half that number are schizophrenic. Medication can help some at least to deal with the business of living. But they must take the medicine, and most are wary of doing so in any place that smacks of the institutions where once they would have been sedated into virtual oblivion.

They are more easily persuaded to accept help once their basic human needs--food, shelter, a hot shower and a friendly helping hand--are met. But few community mental-health centers exist that make the people who use them feel comfortable; fewer exist that have effective outreach programs. The state, at the Legislature's initiative, is financing projects that have provided this humane treatment, including programs in San Mateo, Yuba and Sutter counties that use former street people to communicate with the homeless mentally ill.

Finally, there does need to be some change in commitment laws, but only in combination with renewed emphasis on community care. The mentally ill may be held against their will only if they are considered dangerous or gravely disabled. The existing definition is already sufficiently broad to accommodate the most troubled among the homeless who cannot care for themselves, but the definition could be made even clearer if it allowed longer involuntary treatment for someone on the verge of permanent harm or disintegration.

Any change in the law, however, must be accompanied by the paying of more attention to the mental-health courts that rule on competency. Given better facilities and better pay, judges and county attorneys might want to serve in those courts; that is far from the case today.

Assemblyman Bruce Bronzan (D-Fresno), who has emerged as the Legislature's leader on mental-health issues, estimates that it would cost more than $2 billion a year to reinstitutionalize the existing homeless mentally ill. Even if Sacramento had the money, going back to the old ways would not be the answer. The answer lies in community mental-health centers that work as they are supposed to work. Even that is not likely unless someone, either the governor or the Legislature, leads the way to a formal commitment.

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