Hospitalizing the Mentally Ill

As usual, Fleming’s general consensus is right on the mark, with few points on which one could take issue. But there are a few.

The fact that the Los Angeles County Department of Mental Health operates with normal office hours is irrelevant to the care of the mentally ill. Those offices are charged with the responsibility for administering the funds that permit both contract and county-run facilities throughout Los Angeles County to care for the mentally ill. Those facilities that receive special funds for care of the homeless mentally ill are open seven days a week, oftentimes with extended hours each day depending upon the need in their area.

As to psychiatrists being more involved, and paraprofessionals less, this depends upon the context of Fleming’s point. If what is meant is acute care (i.e., hospital care) it should be realized that this is the most costly, albeit necessary, care during a mentally disabled person’s crisis. The Mental Health Department is funding acute care beds at the present time at over $400 per day. This does not permit day care by psychiatrists, so psychiatric technicians and paraprofessionals may be utilized for day care during hospital confinement. Psychiatric attention is always available not only on a scheduled basis, but also as needed at anytime.

To expect the inward anger of most homeless mentally ill persons to permit them to “ . . . report regularly to mental health centers so they can be monitored and required to stay on their medications” is a simplistic approach that, for the most part, doesn’t work. It is necessary to have community facilities in the areas where they congregate that provide services they need and can understand. That last point is at least one of the reasons the Skid Row Mental Health Center is so successful. It’s in their area . . . it’s recognized as a place meant for them. Outreach activities to social service facilities in the area have also figured importantly in reaching the mentally ill homeless.

But of equal importance are social service activities that aid in obtaining entitlements, shelter in a supervised facility that may provide food, if that preparation is beyond the capability of the mentally ill person, as well as rehabilitative programs.

Unfortunately, for any mentally ill person, it is simply not enough to provide “stability” through medication. It is necessary to follow through with habilitative, rehabilitative and vocational rehabilitative programs that give that person a fighting chance for as close to a normal life as capabilities of the person permit. Those aspects of care for the mentally ill are just now being addressed on a programmed basis. They are just as important for the homeless mentally ill.

Halfway houses without relevant programs have also been found to be fruitless for the mentally ill.

GEORGE F. HAMILTON

Member, L.A. County

Mental Health Advisory Board