Easier Steps Urged to Hold the Homeless Mentally Ill

The American Psychiatric Assn. is urging states to make it easier for authorities to involuntarily commit for treatment mentally ill people living in the streets.

The recommendation is part of a package of reforms in an association task force report on the homeless mentally ill, which the association calls “one of the greatest problems of present-day society.”

Researchers said the problem resulted from communities not being prepared to accommodate the “mass exodus” of patients from mental health institutions closed in the 1960s.

Appears in AMA Journal

Drs. H. Richard Lamb and John Talbott wrote a summary of the report in today’s issue of the Journal of the American Medical Assn.

Lamb said government estimates on the number of single homeless adults in the United States range from 250,000 to 2 million. He said researchers have concluded that up to 40% of them may suffer from major mental illnesses such as schizophrenia and depression.

Some of the homeless mentally ill may commit crimes, but “more often they’re victims than victimizers,” Talbott said.

The report recommends that states take steps to make it easier for authorities to commit for treatment homeless people who are mentally ill, either for their own protection or for society’s.

State Criteria Vary

Lamb, from the University of Southern California School of Medicine, said current state laws require that a judge decide whether a person should be involuntarily committed. However, he said, the criteria used by the judges vary widely between states.

The most restrictive require a psychiatrist’s opinion that the person who is to be committed indefinitely poses a danger.

A second group of states allows involuntary commitment if the person is found “gravely disabled--can’t attend to the basic necessities of food, clothing, shelter,” Lamb said.

Recommends Model Laws

The least restrictive laws are in Washington, Alaska and Texas, which extend the definition of gravely disabled to include people who may have such problems in the future. Lamb said the report recommends that all states adopt standards similar to these.

Talbott and Lamb were among nine researchers nationwide on the association’s Task Force on the Homeless Mentally Ill. It spent a year compiling the report and has turned it over to the psychiatric association and the American Medical Assn. for lobbying at the state and national level, Talbott said.