Finally, a Cure for the Homeless
Torrey, E. Fuller
FINALLY, A CURE FOR THE HOMELESS: BUT IT TAKES SOME STRONG MEDICINE by E. Fuller Torrey, M.D. C ynthia* joined the legions of homeless on Washington's streets on March 26, 1985, when she was...
...But most of the homeless who could benefit from medication will not accept it...
...She feels safe there from the Israeli agents who she believes-inject her with special medicine- while she's sleeping...
...Elizabeth's continue to dump disturbed patients into the community, while the CMHCs show more interest in patients with mid-life crises than in those with serious mental illness...
...Then, in her early twenties, when she developed E. Fuller Torrey, M.D...
...She likes clothes and hangs onto them by wearing several layers: She is a familiar site around Lafayette Park, which-is across from.the White House, and _the Smithsonian museums, happily-talking to herself andcarrying her bags...
...There are also, of course, many homeless at the other end of the educational spectrum and at all points in between...
...Rather, it is that everybody acknowledges the fact, but does nothing about it...
...Now, in most states, no one can be involuntarily hospitalized and treated unless . he is a danger to himself or to others...
...Yet when schizophrenia jumbles the brain's chemistry, we insist that the person has the right to remain sick even when he has a history of getting well on medication...
...In New York City, 50 percent of those in public shelters have been either deinstitutionalized from mental hospitals or denied admission because no beds were available...
...If the patients stop taking their medication (as determined by blood tests) then they can also be returned to the hospital...
...One month later, in a historic special message to Congress, Kennedy proposed a network of CMHCs as "a bold new approach" When carried out, "reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability...
...In- Washington, one-third of the men and- a smaller percentage of...
...It was clear from the beginning, however, that neither NIMH nor the CMHCs had any interest in the severely mentally ill...
...Their voices whisper that medication is poison...
...Ever since, she says she must-watch for people following her or trying topoison her food...
...Their brains tell them there is nothing wrong with them...
...Low-cost housing must also be developed and made available to the homeless...
...The lithium and antipsychotic medication do not cure mental illness, they control the symptoms...
...Her family_lost track of -her for several months until one of her daughters,.when catching a flight back to college, ran into her...
...She is eligible to receive $359 each month as Supplemental Security Income because of her schizophrenia, though she denies there is anything wrong with her...
...Because she didn't believe she was sick, she stopped...
...She had been on medicine in the past and was much better, even able to hold a job...
...In it he said: "In some of the wards there were scenes that rivaled the horrors of the Nazi concentration camps—hundreds of naked mental patients herded into huge, barnlike, filth-infested wards, in all degrees of deterioration, untended and untreated, stripped of every vestige of human decency, many in stages of semi-starvation...
...Nobody would advocate returning to the 1930s when someone could be hospitalized involuntarily for an indefinite period on the strength of a single psychiatrist's signature...
...If they have any possessions, they must take-them wherever they go during the day...
...Stores in California sell "troll buster" T-shirts to honor youths who beat up helpless men living under bridges...
...So Mary now has the right to sit at National Airport, safely evading the Israeli agents...
...And we now have a wonderfully free collection of individuals congregating in the nation's parks and streets...
...Most days she hides from them in the public- libraries and art galleries: How many homeless people are -there...
...A homeless woman in New York was raped and killed by three teenage boys, and in Hyannis, Massachusetts, two street people were beaten to death...
...she refuses all entreaties to take medicine...
...The District of Columbia, for instance, has more mental health professionals per capita than any city in America—five times as many psychiatrists and four times as many psychologists per capita as the national average...
...Nancy has lived at this shelter for mare than two years...
...In 1972, internal NIMH memos complained of CMHCs that abused federal funds by building swimming pools or by allowing psychiatrists to hospitalize their private patients...
...And she was out the door after one hour's notice...
...The rest have lost their jobs, housing, and hope, and are-drifting...
...Susan ran away from home when she was 13 because of what her father might do when he learned she was pregnant...
...President John F. Kennedy spoke of "the abandonment of the mentally ill and the mentally retarded to the grim mercies of custodial institutions" in his 1963 State of the Union message...
...Passersby glanced at Cynthia and her odd footwear, and walked past this latest graduate of St...
...schizophrenia, she went from irascible to unlikable...
...Elizabeth's, , she may have wondered too...
...The nursing staff had been subtly pressuring the ward psychiatrist for weeks to discharge her...
...Troll busters The biggest tragedy is that many of these lives are salvageable...
...In fact, there has been a broad consensus for several years that deinstitutionalization is a major cause of homelessness...
...But unofficially everyone knows...
...There must be checks and balances available in the system, of course, such as court hearings and specified review periods...
...On the day Cynthia was released from St...
...She walked down Martin Luther King Avenue holding a list of the city's public shelters and one week's worth of medication, wearing a light sweater and bedroom slippers because, as her hospital chart phrased it, "she refused to wear her sneakers...
...Marion also lives-there...
...The weatherman had said the temperature would drop into the thirties...
...The defenders of civil liberties may be proud of that, but they don't have to live on the streets...
...Elizabeth's...
...She refused to meet with her occupational therapy group, and was then told she had to attend or she would be released...
...Earlier this year, the New England Journal of Medicine described "dumpster-diving injuries" suffered by the homeless searching for food...
...she doesn't like any of it...
...The Department of Health and Human Services-says 33 to 66 percent'of all shelter residents are severely mentally ill...
...So for -several months she h-as slept on the mezzanine of National Airport...
...She came to the United States in her twenties as an immigrant from Eastern Europe...
...Republicans point out that deinstitutionalization began under Presidents Kennedy and Johnson...
...Mary's family tried several times to have her involuntarily hospitalized and treated...
...Adequate community mental health services are clearly essential as well...
...Elizabeth's...
...Officially, no one is certain where they will go...
...Another part of the solution is to provide enough beds for patients in need of hospitalization...
...Mental health professionals should also take an interest in public patients as well as their private ones...
...These solutions, however, have been opposed by the American Civil Liberties Union, and others who say that involuntary treatment infringes on an individual's autonomy and right to make his own decisions...
...The program that had originally been set up for patients with schizophrenia, manic-depressive psychosis, and other severe mental disorders, became instead a program for married couples having difficulty communicating, young adults concerned about their relations with the opposite sex, and middle-aged individuals undergoing existential crises...
...For the past three years he has run a clinic for mentally ill homeless women...
...Although the law once said that people could be hospitalized against their will if they were "in need of treatment" or "gravely disabled," wellmeaning lawyers, concerned about the patients' civil liberties, have changed that...
...Perhaps it is time to require professionals in the District to spend a small amount of time doing public service each month as a condition of their license to practice...
...A patient is supposed to have housing arranged and a follow-up appointment at a community mental health center...
...The crisis of the mentally ill among the homeless is certainly not news...
...The news, then, is not that there is a clear relationship between failed mental health programs and the number of homeless mentally ill...
...She was hospitalized years ago but hated it...
...C ynthia* joined the legions of homeless on Washington's streets on March 26, 1985, when she was precipitously discharged from St...
...As early as 1969, an internal NIMH study showed that one-third of patients with schizophrenia released from state hospitals were given no referral for further care...
...the guards leave her alone as long as she is quiet...
...Hospital regulations do not sanction such hasty discharges, of course...
...Meanwhile, the numbers of homeless increase...
...Recently in New York City, Juan Gonzalez, a homeless man with schizophrenia who told authorities that "Jesus wants me to kill," was not admitted to the hospital because of a lack of beds...
...President Reagan, of course, says that those living on the street have elected to do so and denies that his safety net is inadequate...
...Homelessness is truly an equal opportunity employer...
...In 1980, studies in New York showed that 42 percent of the homeless were severely mentally ill, and in 1981, the Times editorialized: "The state's deinstitutionalization program has yet to develop adequate community service for discharged mental patients, yet it has also tightened up admission requirements to state hospitals ." A 1983 Senate hearing showed that 30 to 50 percent of the homeless have severe mental illnesses, and congressional hearings in 1985 drew a Washington Post headline: "Experts Decry Dumping of Mental Patients: Streets Called Asylums of the 1980s...
...It seems that hospital beds are available by the hundreds—but not for psychiatric patients who don't have private insurance...
...Virginia has a master's-degree in English from- the University of Wisconsin, Joan graduated with high honors from Washing-ton University in St...
...Gentrification of the inner city and the- demolition of low-rent housing has compounded an already bad situation: Mary says she has .been looking for affordable housing for more than- a year...
...Mary is not the only well-educated member at the homeless club...
...But, -she says, somebody put electric wires into a chair she was sitting in, causing voices in her ,brain to talk to-her...
...It is difficult for her to keep things...
...In 1986 the "shame of the states" has become the "shame of the streets...
...If they are fortunate enough to have an extra 50 cents, they may rent a public- locker at the bus station, but.that is a luxury few can afford...
...Release from a hospital should be made contingent upon the the patients' agreeing to continue to take medication...
...schizophrenia is capable of making intelligent decisions regarding his or her own needs is like assuming that a person with heart disease has normal cardiac function and can run a marathon...
...Profiles that discourage Deinstitutionalization was conceived in idealism and implemented with the best of intentions...
...Elizabeth's in October 1987, it will discharge 500 patients into the community...
...The local newspaper editorialized that it was like having "rabbits forced to live in the company of dogs" Liberty and cruelty have become confused...
...President Kennedy's "open warmth of community concern and capability" was not readily apparent...
...In 1979, The New York Times ran a three-part series headlined, "Mental-Patient Release Program Leaves Many to Face Harsh Fate...
...Hospitals like St...
...Lawyers and politicians have objected on civil liberties grounds...
...It has not been implemented, however, and New York continues to live with the irony of using part of Creedmore State Hospital as a public men's shelter...
...Cynthia often believes people are trying to kill her...
...More frustrating still, Cynthia and others like her could lead normal, productive lives if they would take certain medications...
...When diabetes causes a person to go into a coma we do not defend the person's right to remain in a coma...
...Dan's • life is especially poignant to me...
...In 1974, the Health Research Group, a public interest organization based- in Washington, published a scathing study-on the' CMHC program that concluded: "the deficien-cies of the program- are now too glaring to be brushed aside?' Meanwhile,' seriously ill patients continued to be dumped from state hospitals into the community despite clear indications that CMHCswere not following up with treatment...
...A 1985 survey by- the Health Research Group found that almost two-thirds of the women and one-third of the men had schizophrenia...
...Housing must certainly be assured for patients discharged from state hospitals...
...In- addition to shelter residents with schizophrenia, there is another large group of homeless...
...Occasionally he calls me when he is in Washington, hoping I can explain why the FBI is doing this to him...
...He has absolutely no insight into his illness...
...Homelessness lends itself nicely to political posturing...
...Just six days later Cynthia was released from St...
...Yet for 20 years he has roamed the nation, living in public shelters and sleeping in the woods, trying to escape the voices and messages he says are beamed to his brain by the FBI...
...There is nothing wrong with her,- she says, although it is sometimes -difficult _to get her to focus on .your questions, which compete with the several other inaudible voices with which she -is carrying .on conversations...
...Packing was easy, for she had come with nothing...
...But she lived alone, with no one to force her to keep taking her medication...
...Nine days later, a New York Times headline stated: "Hospital Occupancy Drops to 20-Year Low in City...
...Schizophrenia is a disease which affects the brain's chemistry so that its sufferers can no longer think clearly or logically...
...The writer heard state hospital doctors frankly admit that the animals of nearby piggeries were better fed, housed, and treated than many of the patients in their wards...
...Two days later he fatally stabbed two people on the Staten Island Ferry...
...Some hallucinating shelter residents are sleeping in the same rooms they slept in when Creedmore was a mental hospital, only now there are no nurses and no medication...
...Like most shelters in Washington, the church sends the_women out at 7:30 in the morning and- doesn't allow them to store anything...
...While this solution is medically simple, it is politically and legally difficult...
...But the present state of affairs is unacceptable...
...They work the same way that insulin does in diabetics...
...Psychiatric services should be available in public shelters, and mobile vans should reach out to the mentally ill living on the streets as they do in Philadelphia and New York...
...It has been demonstrated that two out of three schizophrenics—our largest category of mentally ill—can be treated and released within six months .. . . If we launch a broad new mental health program now, it will be possible within a decade or two to reduce the number of patients now under custodial care by 50 percent or more...
...Gentrification of the inner cities benefits some, but not those who have been displaced into the streets...
...Homeless people frequently freeze to death in the winter...
...In that same year, a report of the American Psychiatric Association claimed that "some centers [CMHCs] consciously discriminated against poor and chronically ill patients who came to them for help...
...She had had difficulty getting along with other people even as a small girl...
...Where state and federal officials thought these disabled people were going to get care is a mystery...
...But tell that to a homeless mentally ill person who cannot afford $100 per hour on upper Connecticut Avenue...
...Medication, of course, is not a panacea for homelessness...
...Washington is not unique...
...Nobody really knows, but . it is estimated there are more than 3,000...
...He majored in history and wrote his senior thesis on a complicated aspect of nineteenth century economic history...
...They sleep, importune strangers, gesture to imaginary accomplices, shout angrily at the wind, forage through cans, and sit quietly with glazed eyes...
...But since homelessness among the mentally ill persists—despite the agreement on its causes—it is time for society to take a seemingly distasteful step: force many of these schizophrenics to take their medicine...
...jail and St...
...I remember him as a varsity athlete, a member of one of the most prestigious eating clubs, and a class leader...
...You barely notice her sitting in the airport during the day, apparently waiting for a plane to arrive...
...is a Washington psychiatrist and writer...
...Given .a regular supply of lithium, a standard medication that restores a proper chemical balance in the brain, Donna was transformed from a shelter resident to a GS-5 in the Department of Commerce and has worked steadily for two years...
...Assuming, however, that someone with Given a regular supply of medication, Donna was transformed from a shelter resident to a GS-5 in the Department of Commerce, while Lily is holding two jobs and has moved from a shelter to her own apartment...
...When the District of Columbia takes over St...
...Mayor Edward Koch of New York is one of the few leaders who have proposed a housing program specifically for the mentally ill homeless...
...The names of the homeless have been changed...
...Pleasant and intelligent., she is a college graduate with three children...
...Elizabeth's Hospital...
...There are no housing plans for them...
...They are daily reminders of the massive failure of one of the Great Society's premier programs: the deinstitutionalization of mental patients out of state asylums and into local Community Mental Health Centers (CMHCs...
...The laws need to be changed so that obviously disabled individuals can be hospitalized and treated before they become a danger to themselves or others...
...alL of them had been in mental hospitals like St...
...But Cynthia was, everyone agreed, a difficult patient— "very demanding" and "not cooperative at all," as the nursing staff wrote on her hospital chart...
...In states such as Mississippi, where mental health officials have tried to gear the centers more toward the seriously ill, the staffs that run the clinics have rebelled, claiming they are not equipped to treat such patients...
...Despite having had four federally funded CMHCs, the District of Columbia ranks near the bottom nationally for such services...
...The only people with improved lives," said one memo, "appear to be the professionals who run the program ." In 1973, further NIMH studies showed that there was no relationship between most CMHCs and the ongoing release of patients from state hospitals, and the American Journal of Psychiatry published an...
...Cynthia told the nursing staff what she thought of their threat...
...He refuses all offers of help, for he trusts no one...
...On antipsychotic medication, Lily is holding two restaurant jobs and has moved from a shelter to her own apartment, while Ann supports her teenage son by working as a nurse's aide...
...In Boston, 36 percent of shelter residents were diagnosed • as schizophrenic, and in Philadelphia, 37 percent...
...article titled, "Care of the Chronically Mentally A National Disgrace...
...Four years and six hospitals earlier she still owned some things—pictures, clothes, bagatelles of a private past—but now they are all gone, forgotten on some park bench or locked away in the unclaimed luggage room of another state hospital...
...Cynthia joined the homeless who live on the streets and park benches of downtown Washington...
...Louis, Denise was trained in law at Howard University and was one of 'the first black lawyers- accepted by a prestigious Washington -firm, John is a fully-trained psychiatrist, yet often sleeps in the woods in northern Virginia, and Dan- was a classmate of mine at Princeton...
...women are alcoholics...
...the voices in her disordered brain distract her...
...Governor Mario Cuomo of New York says that "homelessness is by its nature a crisis in housing" and implies that the reduction in federal funds for low-cost housing has exacerbated the problem...
...Andrea dropped out of school in the fourth grade and occasionally turns to prostitution to support her fondness for alcohol...
...I would estimate that one-fourth of the women I have known who live in public shelters could be returned to at least part-time employment if they took medication regularly...
...Set up for the suffering sick, Kennedy's program was instead coopted by the worried well...
...Partial conservatorship or guardianship, and similar legal mechanisms for ensuring treatment have all been shown to work...
...NIMH wrote its regulations so loosely that the local centers soon geared themselves to people with "problems of living" who could not afford the fees of private psychiatrists...
...In 1948, Albert Deutsch, a crusading newsman, investigated state mental hospitals and wrote The Shame of the States...
...At congressional hearings on enactment of the CMHC legislation in March 1963, Health, Education, and Welfare Secretary Anthony Celebrezze testified: "It is clear that huge custodial institutions are not suited for the treatment of mental illness . .Therefore the national program for mental health [CMHCs] is centered on a wholly new emphasis and approach—care and treatment of most mentally ill persons in their home communities ." The CMHC program was passed by Congress and turned over to the National Institute of Mental Health (NIMH) to administer...
...She can tell- you what is available for that income level and...
...If they are gravely disabled and refuse help because they can't understand their illness, then psychiatric staff or the police should be allowed to take them—involuntarilyto a hospital for evaluation...
...Elizabeth's...
...in Washington...
...Elizabeth's...
...Most of the women's shelters were full, but she.was finally accepted at a small church shelter where the women sleep on mats on thelloor...
...Homeless women are frequently raped...
...And Richard lives at a shelter between stays in the D.C...
Vol. 18 • September 1986 • No. 8
