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AM-HOMELESS 2takes
By PHILIP M. BOFFEY
c.1984 N.Y. Times News Service
    WASHINGTON - The American Psychiatric Association said Wednesday
that the practice of discharging mentally ill patients from state
hospitals into ill-prepared local communities had been a failure and
''a major societal tragedy.''
    In its first comprehensive report on the homeless mentally ill, the
association said the concept of shifting the chronic mentally ill
from large institutions to community treatment facilities was
''basically a good one'' but that its ''implementation was flawed.''
    The association, the nation's chief professional organization for
psychiatrists, said a ''disastrous'' failure to provide adequate
mental health care in the community, or even such basic needs as
shelter and food, had left tens of thousands, perhaps even a million
or more, of the mentally ill ''cast adrift under conditions that most
persons think can no longer exist in this country.''
    The association blamed virtually everyone involved in the care and
treatment of the mentally ill or the homeless for some aspect of the
problem.
    It charged that federal, state and local governments had failed to
provide enough money for adequate health care and social services,
that ''patients' rights'' lawyers had been more interested in getting
patients released than in insuring that they are cared for, that
mental health professionals had sometimes shied away from dealing
with the most severely ill patients, and that psychiatrists
themselves were slow to wake up to the dimensions of the problem.
    In New York State, which is ''considered to be in the forefront of
the nationwide de-institutionalization movement,'' the report said,
state and city officials have consistently allowed ''the blame to be
shuttled back and forth.'' But the chief underlying problem in New
York City, the report said, is that there is simply not enough
inexpensive shelter or housing available, a need that must be met
before mental health care can succeed.
    The concept of removing the mentally ill from overcrowded
institutions began 30 years ago, according to the report. It has
since cut the number of patients kept in large public mental
hospitals by three-fourths, from a peak of about 559,000 in 1955 to
about 132,000 in 1980, the association said.
    The movement began with ''little preparation or planning,''
according to the report, and was propelled by at least four major
factors. New drug treatments allowed patients to be treated outside
of institutions; a new mental health philosophy concluded that most
individuals were better treated in their home communities than in
warehouse-like mental hospitals; legal and legislative pressures
called for granting more freedom and dignity to patients, and
financially pressed state governments hoped to save money by
shrinking or closing their mental hospitals.
    The association's views were presented in a 313-page report notable
for its blunt language and at a news conference Wednesday. The report
was described as the first major effort to determine who the homeless
mentally ill are, how sick they are, what services they might need
and what sort of plan might help them. It was the outgrowth of a
yearlong study by a nine-member study group, which operated with a
''sense of urgency'' because ''the problem was so serious'' and ''the
plight of the homeless mentally ill so desperate.''
    ''Hardly a section of the country, urban or rural, has escaped the
ubiquitous presence of ragged, ill and hallucinating human beings,
wandering through our city streets, huddled in alleyways or sleeping
over vents,'' the report said.
    ''This rapidly growing problem of homelessness has emerged as a
major societal tragedy,'' it added. ''The individuals affected are
now regarded as an eyesore at best and the victims of a moral scandal
at worst.''
    The report gave no firm estimate of the number of homeless mentally
ill. It cited studies estimating that the total number of homeless
individuals might range from 250,000 to 3 million, and it cited
somewhat firmer estimates that 25 percent to 50 percent of these
homeless individuals suffer serious, chronic forms of mental illness.
These illnesses include schizophrenia, manic depressive psychosis and
psychotic depression, among others, according to the association.
    The patients are often so ill, mentally, that they are incapable of
making wise choices for themselves or of following a consistent
program of treatment, association officials said at Wednesday's news
conference.
    (MORE)
     nn
    
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n095  1901  12 Sep 84
AM-HOMELESS 1stadd
NYT WASHINGTON: news conference.
    Although the officials refused to criticize either major political
party and urged a bipartisan approach to ''caring for the sick,''
their judgments appeared to differ sharply from those of President
Reagan, who argued in a January television interview that many people
sleeping on grates were homeless ''by choice.'' However, the
president also blamed ''new laws'' for requiring that disturbed
people be released from institutions when ''they have no place to
go.''
    Wednesday's report said the movement to treat the mentally ill as
out-patients, rather than in institutions, was a major factor in
causing the population of homeless mentally ill to swell. Other
factors include a general increase in the whole population, which
naturally increases the number of mentally ill, plus greater mobility
and exposure to street drugs.
    The report acknowledged that the old mental hospitals had some
strengths that are not currently provided in community treatment
programs, including the provision of ''asylum and sanctuary'' for
patients who are incapable of functioning in the community and a
complex array of treatment services, however poor they might be, in a
single location where the patients had no trouble finding them.
    Indeed, the report said the small number of patients who are
''dangerous or gravely disabled'' must still be given long-term
asylum, either in the old hospitals or other appropriate facilities.
    However, the report also warned that professionals who talk of
sending all the patients back to the state hospitals are
''exaggerating and romanticizing'' the care the patients are said to
have received there. Moreover, it said that the movement toward
community care had not been ''a universal disaster'' because some
patients had benefited greatly while others had suffered.
    John A. Talbott, president of the association, said a dozen or more
studies comparing reasonably good programs of community care with
institutional care found that the patients in the community were
often better off, and in no cases worse off, than those in the
hospitals. The association has long supported de-institutionalization
when adequate alternative services are provided and it continues to
do so, a spokesman added.
    The report called for a ''revamping of the mental health system''
with ''markedly increased funding'' to provide the homeless mentally
ill with food, clothing, shelter, medical and mental health treatment
in a varied array of facilities. It urged that a single person be put
in charge of each patient to insure that all services are tapped and
coordinated. The report gave no estimate of the total cost and no
recommendation as to who should take the lead in revamping the system.
    
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