NEW YORK — As he muttered incoherently on a busy downtown sidewalk, Frankie was not a threat to anyone, except perhaps himself. The gaunt, disheveled man was homeless, turning purple on a bone-chilling afternoon and lost in a bizarre world all his own.
"I just got back from Warsaw," he mumbled to the passing crowd, his eyes darting up and down the street. "I got gold mines in South Africa. By now, the priests and rabbis in this neighborhood know me pretty well."
One day last month, as a freezing wind began to blow, New York City psychiatrist Neal Cohen gently persuaded Frankie to visit Bellevue Hospital. There, Cohen told him, he could have a checkup and "feel better." Frankie heaved a sigh, tossed a paper cup reading "I love New York" to the sidewalk and climbed into Cohen's van.
It was all part of a controversial New York program to round up a small group of mentally ill homeless people and bring them to a mental hospital for treatment, if necessary against their will. Local officials have called it a first step toward helping street people, but critics say it is a drop in the bucket, given New York's nearly 50,000 homeless.
Regardless of the debate, New York is one of the few cities trying to do something about the estimated 250,000 mentally ill people who have become fixtures on the street corners of the nation's big cities. Although the majority of street people are not mentally ill, federal surveys estimate that more than 20% show signs of such illness.
A recent survey of the Los Angeles Skid Row population, for example, disclosed that 28% to 33% of those surveyed were mentally disabled. In other areas, the estimates run as high as 50%.
As cities such as New York and Los Angeles grapple with the problem, the federal government has been slow to respond. Congress, which funded some innovative programs to treat the homeless mentally ill earlier this year, has now cut back on such efforts. Given the nation's fiscal difficulties, there is no indication that such funding will be expanded anytime soon.
"Washington has failed terribly in providing funds for hospital care, as well as community facilities for the homeless mentally ill," said Jill Halverson, who directs the Downtown Women's Center in Los Angeles, which helps mentally disabled street people.
"And the sad thing is these are the people most in need, the people on our streets who clearly can't take care of themselves," she said. "There is so little really being done for them."
In the absence of a national strategy, several cities have devised short-term programs to help the homeless mentally ill, including drop-in clinics on the street and mobile outreach programs. But, in New York, Mayor Edward I. Koch decided to try something different.
Last summer, during a meeting of the American Psychiatric Assn., he announced plans to round up about 500 of the city's most seriously disabled homeless people and rotate them through a newly created 28-bed psychiatric unit at Bellevue Hospital.
Debate Goes On
Similar ideas about extended hospitalization are being debated in Los Angeles and other communities. But New York is the only city that has actually taken such action.
"Enough is enough," said Koch, who initiated the program after visiting the streets to see some of the city's most severely disabled people. "We are going to take care of these people. Someone has got to show some leadership on this issue."
Koch brushed aside objections by American Civil Liberties Union attorneys and expanded the city's interpretation of a state law setting conditions under which people may be kept involuntarily in a hospital.
Previously, mentally disabled street people could not be kept in medical custody for more than a few days unless they posed an imminent danger to themselves or others. Under the new plan, New York is also committing people who are a danger to themselves in the foreseeable future.
As a result, New York now has "legal latitude" to bring in selected persons and treat them in the special ward at Bellevue for at least three weeks, Koch said. Patients may later be sent to state hospitals, halfway houses or city shelters, or they may simply be discharged back to the streets, depending on the assessments of their physicians.
Those confined are entitled to a court hearing within five days, if they request it.
Some Extreme Cases
In recent weeks, the city has rounded up some extreme cases: a woman who slept on the street, defecated in her clothes and tore up dollar bills given to her by pedestrians . . . a lice-ridden man who lived on a rock in Central Park inside a plastic bag filled with rats . . . a nearly blind woman who lived on a sidewalk and screamed at passers-by.
Not surprisingly, Koch's plan has drawn fire from critics in New York and across the nation. Many of them believe that simply rounding up street people and putting them in overcrowded mental hospitals is unconstitutional and does not address the real problem: the lack of low-cost housing for the homeless.