To the Editor:

Ronald Reagan’s callousness toward the mentally ill is mainly responsible for the large numbers of them who live on the streets in California. That is a fact which I have rarely seen mentioned by any writers on the subject of homelessness. Thus, although Susan Wiviott, in her review of A Nation in Denial by Alice S. Baum and Donald W. Burnes [Books in Review, February], points out that great numbers of homeless are not just ordinary folk who lack housing but sick people, she does not mention Reagan’s role in creating that situation. Many, if not most, of the homeless may indeed be people who need professional help, and they make the streets of our cities unpleasant, even dangerous, because they are not getting either professional help or housing.

Prior to the summer of 1967, when then-Governor Ronald Reagan used his line-item veto to destroy California’s mental hospitals, the mentally ill, and many alcoholics, were getting help within the state hospitals. Those institutions were not idyllic places prior to 1967, but under Pat Brown’s Democratic administration, as well under the preceding Republican administrations, the state mental hospitals were being upgraded into effective and humane treatment facilities. . . .

Furthermore, plans were well under way to establish community-based mental-health facilities with adequate budgets so that patients could be closer to their families and friends. The key to the success of that program was to be the transferring of funds from the state hospitals to the community-based facilities.

I saw all this as a state employee who often had occasion to visit state hospitals on official business, and later as a union representative. Frequently, I was panhandled by patients who wanted a little change to buy some item at the hospital canteen. I learned to distinguish a patient from a staff member a block away.

One of the first things I noticed in 1967, after Reagan had used his line-item veto to destroy the mental-health system, was the number of former state-hospital patients on the streets of San Francisco. As before, I could recognize them a block away. As before, they panhandled me for spare change. The big difference was that they did not have a regular place to eat or sleep, and they were not getting much, if any, treatment. The money Reagan took from the state hospitals did not go to community-based facilities; it went somewhere else.

We cannot go back to the old mental-hospital system, but for their sakes and ours, let us do something to help the mentally ill (including drug addicts and alcoholics) who are making our city streets such unpleasant places. After we care for the mentally ill, the ordinary folk who are homeless because they are down on their luck will become more visible.

Hugh Sheehan
Fremont, California

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Susan Wiviott writes:

I agree with Hugh Sheehan that we need to provide long-term residential care—be it in larger facilities or small community-based settings—for the severely mentally ill who are homeless. Although I am not familiar with the specific history of deinstitutionalization in California, the process described by Mr. Sheehan has been going on, in roughly similar fashion, throughout the country for the last 35 years.

As the authors of A Nation in Denial point out in their book, 442,000 beds available nationwide in state institutions for the mentally ill—80 percent of the total—were eliminated between 1955 and 1985. New York State, for example, had about 93,000 inpatient psychiatric beds in 1955. By 1980, the number was down to approximately 22,700; and by 1992, the number had been further reduced to about 11,500 beds. Plans call for cutting the number of remaining beds by almost half by the end of the century. Thus, even after it became apparent that there were not enough community-based facilities to meet the needs of the mentally ill, and that without a place to go, many of these people would become homeless, the cuts continued. These cuts have taken place under both Republican and Democratic administrations.

The reason for this wave of deinstitutionalization was neither primarily political nor fiscal. Rather, it resulted, in good part, from the discovery of psychotropic drugs, which have made it possible for large numbers of the mentally ill to live outside highly structured hospital settings, and from court rulings, which made it legally difficult to institutionalize even the very ill against their wishes. In other words, large institutions for the mentally ill became both medically and legally obsolete.

Unfortunately, in many parts of the country, including New York and, according to Mr. Sheehan, California, the less-restrictive community facilities meant to replace the state hospitals have never materialized in numbers sufficient to meet the needs of the homeless mentally ill. As a result, as Mr. Sheehan rightly points out, large numbers of people, many also abusing drugs and alcohol, have been left to fend for themselves.