
                         THE VIRGINIAN-PILOT
                 Copyright (c) 1994, Landmark Communications, Inc.

DATE: TUESDAY, June 28, 1994                    TAG: 9406280006 
SECTION: FRONT                     PAGE: A14    EDITION: FINAL  
SOURCE: Medium 
DATELINE: 940628                                 LENGTH:

TIME FOR A NEW LOOK AT MENTAL HEALTH\

{LEAD} When states reduce spending to confine people with severe mental illnesses and courts make it increasingly difficult to keep them from hurting themselves or others, who wins: the mentally ill or society in general? Both lose - those who are released to the streets even though they are unable or unwilling to care for themselves, and those whose lives are endangered or unnecessarily complicated by their freedom.

It's a sad state of affairs when prisons and jails become the nation's new ``mental hospitals.'' But that, says Farrell Fitch of the National Alliance for the Mentally Ill, is precisely what's happening. Liberals hell-bent on freeing people from institutional confinement - and there's no doubt that some patients were detained wrongly - and conservatives eager to save the money put into taxpayer-funded mental institutions share the blame.

{REST} The basic premise of releasing some patients is that they will take the medication that regulates their behavior and thus function as normally as possible among society. Little thought apparently was given to dangerous side effects of some medications or to the availability of alcohol or other drugs that counter the drugs and exacerbate conditions that put the patients in the hospital.

Courts further complicated matters with the requirement of ``clear and imminent danger'' - holding a gun or knife - to justify commitment to mental-health facilities against one's will. While no one would have police, mental-health workers or others round up people just because they act strangely, there clearly should be authority to protect people who have a history of mental illness.

Yet a walk on the streets of practically any area, but particularly cities like Norfolk, will demonstrate the growing population of people who have been pushed out of protective environments to the care of the ``community,'' which often means no care at all.

In a story Friday, Staff Writer Joe Jackson detailed 13 violent crimes involving former mental patients from Hampton Roads. These horrors reflect a deplorable national trend: as more are released from institutions, more also end up in court or jail or dead after confrontations with police.

Many blame inadequate followup of released patients. But without the economies of scale that used to be available within a hospital, there is no way to have enough community care workers at a cost taxpayers would find reasonable.

As a result, downtown streets often serve as substitute mental hospitals. Shoppers and strollers stay away to avoid confronting mentally ill, often homeless, people.

It might be time for a wholesale re-examination of the deinstitutionalization experiment. As with so many public policy issues, there are no real ``solutions,'' only trade-offs. The issue is whether the trade-off of giving mentally ill people more freedom has been worth it to society as a whole, and whether it has been fair to the mentally ill themselves.

by CNB