Death at the Clinic

A dedicated psychiatric social worker, Robbyn Panitch, has died a violent death on the job at a Los Angeles County mental-health clinic in Santa Monica. She knew the dangers of working among the damaged members of society, but she continued to help--as those in her profession feel called to do. For that service and the horrible sacrifice that it has entailed, her family and friends deserve the public’s sympathy and respect.

Random killing is common today in many urban areas, including Los Angeles. Murder can occur anywhere--in a schoolyard, a Skid Row alley or a suburban home. But the social worker died in a mental-health clinic, and that means taking stock of the system to find some meaning deeper than the shock of the moment.

The central problem is that the state of California has backed away from its responsibilityto the mentally ill, one that neither it nor any state has handled particularly well. For decades states met the responsibility by putting the mentally ill in warehouses that they called hospitals. Community-based clinics were supposed to be an improvement, but, because there is neither money nor political leadership to support such programs, many of the mentally ill rarely receive help. Many also wind up living on the streets.

It is the chronically mentally ill who need care most desperately. Some can function without risking harm to others or to themselves if they receive regular treatment. But they live in limbo, neither so gravely disabled that they can be committed for more than a few days to state hospitals nor legally entitled to care anywhere else.

The California Psychiatric Assn. is proposing legislation to make outpatient treatment mandatory for people in this group who respond to treatment but who lapse into old patterns of behavior unless they are in an organized, required program.

For many people, though, even treatment that would come close to matching the original concept of community-based care in clinics will always come too late unless the state also provides a comprehensive, and costly, treatment and counseling program. The best time to begin treatment is in early stages of mental illness. But the people who need this early treatment, many of them teenagers, are the very ones who will suffer if several local mental-health clinics are closed because the state will not make the extra effort to come up with the $18 million that it will take to keep them open. Their illnesses will not necessarily get worse, to be sure, but the familiar, reassuring people who have helped them in the past will not be there when they encounter their next crisis.

Vastly expanded public support for county mental-health programs is required to ease caseloads for therapists so that they can give the required attention to all patients instead of spreading themselves too thin trying to provide at least some help to all of them. No society can ever protect its every member from harm, but more money might allow local clinics not only to expand their ability to help but also to increase the security of those in charge of helping.

The pressures on both the people treated by the mental-health system and those who work in it are tightening. For both professional and patient, increased public support can be a matter of life or death. Providing care for citizens unable to defend themselves from the private demons that they encounter day by day is a basic obligation of government. Since it has not been met, Sacramento must change--or face the demons of basic failure.