A Prescription for Helping the Homeless

I am an employee of the Los Angeles County Department of Mental Health’s Santa Monica West Clinic. I am responsible for clinical evaluations for persons with mental health problems. In the course of my duties, I encounter many of the homeless who have settled in Santa Monica. I am writing in response to the Homeless Task Force meeting that was held on Sept. 23.

It appears that there are two basic viewpoints on this issue: that the homeless are victims of Reagan-era social spending cuts, and that Santa Monica has become a more dangerous place to live because of the large homeless population. Both points seem valid. My concern is that neither side is willing to listen to the other.

A large majority of the homeless mentally ill--those who have been diagnosed with a major psychiatric condition--are more of a threat to themselves than to others. If such a person finds himself homeless, that tells me that long-term inpatient treatment is required because that person can no longer care for his needs. Anything else is a shortcut, which can have tragic consequences--for example, the fatal stabbing of social worker Robbyn Panitch in 1989.

However, most of the homeless are not mentally ill at all. Some are on the streets due to economic factors, but others are not. They are ex-convicts, substance abusers and those with other behavior problems (as distinguished from mental illness, a genuine medical condition). It is this group that causes most of the problems. What is therefore needed is a method of determining who is truly mentally ill and who is not.

Unfortunately, the county has subjected our department to severe cutbacks and has contracted out many of our functions to volunteer agencies. Professionals who are trained to make these judgments are replaced by staff who cannot diagnose and treat mental illness. The results, I think, speak for themselves.

While some volunteer agencies serve a purpose, they do not substitute for well-paid, clinically trained personnel. Furthermore, because so many resources are concentrated in one area, the homeless--mentally ill or not--drift here from all over the country. If they do not come on their own, they are given “Greyhound therapy”--a one-way bus ticket from other states, cities and counties.

Those with mental health problems need mental health treatment. Those with substance abuse problems need drug and alcohol treatment. Those who pose a serious threat to the community need to be in jail.

I would propose the following:

* Reduce contracting-out, and replace it with expanded public-sector services such as clinical day treatment and outpatient psychotherapy. Stop funding contracted programs that are not doing their job.

* Use the outpatient mental health system for those who are stable and can care for themselves. Provide inpatient treatment for those who need it.

* Put the homeless who are able to work in community service jobs--such as cleaning parks and beaches.

* Provide relevant job training.

* Make affordable housing available nationwide.

I’m aware that this costs money. But keep this in mind: You could fit two Los Angeles County mental health department budgets into the price of one B-2 bomber. It’s all a matter of priority.

JOSH BORENZWEIG

Venice