The Specter Haunting America : How the problem of the unattended mentally ill erodes societal order

What we expect from government, if we expect nothing else, is law and order: the enforcement of the laws and the preservation of order. The second of these duties, far more than we sometimes realize, requires basic care of the mentally ill. Unfortunately, as the director of Virginia’s state mental health department commented earlier this year: “The mentally ill are not a popular group. If you have to choose between children and the mentally ill, or senior citizens and the mentally ill, the mentally ill will lose every time.”

Nationwide, the mentally ill have lost again and again in recent years. The end of revenue sharing meant that what had been a burden shared by the federal government became one borne by state and local government alone. De-institutionalization--a cost-cutting remedy that seemed, for a time, to have a clinical rationale--transferred the burden to the families of the mentally disturbed. Increasingly, and alarmingly, however, that burden has simply been transferred to the mentally ill themselves. These are the spectral creatures who, utterly unable to care for themselves, now haunt America’s parks and streets. There is scarcely a more visible or more disturbing symbol of the national decline.

The early promise of de-institutionalization was that outpatient care could make many of the mentally ill socially functional. Far too idealistic for the most severely disturbed, this vision has in any event been destroyed by funding cutbacks. Suffolk County in New York sought earlier this year to eliminate 44,000 outpatient consultations per year--a 50% cut.

The same process--first we sink the boat, then we confiscate the life rafts--has taken place in Los Angeles County. The county now has access to only 1,700 acute- and subacute-care beds for the mentally ill--compared to 5,000 such beds for a similarly sized population in New York City, according to Dr. Maurice Weise, medical director for adult services for the Los Angeles County Department of Mental Health. But outpatient care has by no means taken up the slack. Full-time staffing dropped from 900 to 600 between 1987-88 and 1990-91, and--no surprise--the number of patients treated dropped from 90,000 to 71,000.

The money just isn’t there, we are told. But madness in the streets is scarcely a less serious problem than crime in the streets. And we can no more expect free preservation of order than we can expect free enforcement of the laws.