UPDATE / HOMELESS EXPERIMENT : Vans Still Pluck Mental Patients From N.Y. Streets : But the controversy has cooled. Physicians say valuable lessons have been learned.

When New York City began seizing and involuntarily hospitalizing its most seriously mentally ill street people 32 months ago, civil liberties organizations objected vigorously.

Today, the controversy has died down, legal challenges by patients are rare and physicians say some major lessons have been learned from the closely watched experiment.

Psychiatrists and social workers still travel the city in a Project Help van, searching for the homeless who pose a serious danger to themselves or others. Latest available statistics show that out of 2,145 homeless people evaluated by the city teams, 902 were hospitalized. Of these, 864 have been discharged or transferred for longer term care to a special homeless unit at the state-run Creedmoor Psychiatric Center in Queens, from which significant numbers rejoin the community.

Judged against the severity of the illnesses they have encountered, physicians are pleased with results so far.

“Given the fact these are some of the most difficult cases psychiatrists will see, the results are encouraging,” said Dr. David Nardacci, director of the psychiatric homeless unit at Bellevue Hospital. “ . . . I think that there are definite positive results, not with every patient, but with enough so it is clearly rewarding and should be expanded.”

“I think the one thing we have learned is the aggressive outreach component that is represented by Project Help is a necessary component of any citywide effort,” said Richard C. Surles, New York State’s commissioner of mental health.

“I would also contend that . . . people that we have at least touched, the ones we have been able to help stabilize, are a hell of a lot better off than they were.”

Project Help expanded the criteria that allows the city to commit a homeless person. Physicians and social workers who travel the city searching for highly disturbed homeless people interpret self-neglect as self destruction, broadening the parameters for hospitalization.

Physicians at Bellevue found several factors contribute to homelessness among the mentally ill: schizophrenia, or having schizophrenic related symptoms coupled with lack of affordable housing, childhood spent in foster or broken homes, and the disintegration of families.

Some civil liberties organizations still view Project Help with suspicion.

“We’re still very skeptical and suspicious of their activity. Our experience is that they do not affirmatively give people viable options,” said Norman Siegel, executive director of the New York Civil Liberties Union, who stresses the need for low-income housing, drug and alcohol treatment and community mental health facilities.

Project Help’s staff agrees that additional options are badly needed. But they say the present mechanism, which gets the most seriously mentally ill homeless into treatment, also is important.

“These patients . . . find their own psychotic delusions comforting and safe because there is no responsibility,” said Nardacci. “There is no challenge. A lot of people have failure experiences, and you have to give them success experiences over a long period of time to sell them on basically our version of a small fraction of the American dream.”

The physicians learned that the homeless patients often require medication and a high level of supervision, and can’t be pushed too fast into group activities designed to build socialization skills.

Over half the street people brought to Bellevue’s special homeless unit showed a history of alcohol or drug abuse in addition to symptoms of major mental illness. Placing these patients has proven especially difficult. Physicians at Bellevue observe with gallows humor that it is easier to get someone into law school than to get a dual-diagnosed person admitted to the proper post-hospital setting.

“It’s very difficult to place patients who are substance abusers,” said Dr. Michael Silver, head of the homeless unit at Creedmoor.