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Treatment for Mentally Ill

August 28, 1994

My 10 years as an advocate for persons with mental illness taught me that it is not accurate to describe the problem of providing treatment to persons in need as a conflict between civil liberties and tough but necessary medicine ("Treatment Against Their Will," Aug. 18). Treatment can be provided and civil liberties respected if the treatment is available in the community and affordable housing provided to persons whose mental illness prevents them from working at certain times.

Public psychiatric hospitals, where almost all long-term patients are confined, are rightly feared by almost everyone, mentally ill or not. At their worst, the hospitals are snake pits, and some of these still exist. At their best, they are clean and patients are not abused, but treatment consists almost exclusively of psychotropic drugs, many of which cause powerful distortions of the mind, interfere with thinking and have serious (and sometimes irreversible) physical effects.

The deinstitutionalization of persons with mental illness was never intended by its advocates to result in dumping patients onto the streets; that result was imposed by politicians who saw opportunities for balancing budgets and saving taxes by closing hospitals without providing the needed housing and community-based treatment facilities. The legions of homeless persons who are mentally ill are the product of this shortsighted policy.

The solution is not to lock up those in need of assistance, but to provide the housing and needed care in the community, so that most will voluntarily accept the benefits along with the treatment. Surprisingly, it is also cheaper than the $50,000 or more it costs the taxpayers to lock someone into a hospital.

HERBERT SEMMEL

Los Angeles

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Your excellent piece on treating individuals with neurobiological disorders (formerly known as "mental illness") against their will missed one important change that has to be made in the law if we are to guarantee these people the human care they deserve.

In many states individuals receive one court hearing on whether or not they are "dangerous" and should be involuntarily hospitalized and a second hearing on whether or not they should be involuntarily treated. These hearings often occur weeks apart, resulting in the ludicrous and cruel proposition of having someone hospitalized but not allowed to receive treatment.

The law must be changed so the two hearings can be held at the same (earliest) time. This would prevent individuals with NBD from being warehoused unnecessarily, sometimes for months, while they wait for a second hearing on whether they should be treated. It will allow people to get on the road to recovery faster. Utah provides a good model for such a combined hearing at the time of commitment.

D. J. JAFFE, Board Member

Alliance for the Mentally Ill

New York

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