Someone is violently attacked or pushed in front of a subway train, prompting outrage and alarm about dangerous people on the streets - many of whom, it turns out, sought help for their illness but were turned away. Laws are swiftly passed (Kendra's Law) and funding pours in to fill a portion of the mental health program gaps (Major Mental Health Initiatives); this also makes news, usually with a photo of the Governor.
Smaller headlines emerge about the continuing incarceration of the mentally ill, where 15,000 to 20,000 people with mental illness are estimated to be in the criminal justice system. And there is the item about the mentally ill man, Gideon Busch, shot and killed by police last August. Commissioner Safir defended the officers, saying they acted in accordance with proper procedures. Or the item about the mentally disturbed Queens man, Alan Zelencic, shot and killed by police a few weeks ago. The officers didn't realize he was mentally ill, report say; if they had, they would have waited for the specially trained Emergency Services Unit. At the root of all these headlines is the old story of the deinstitutionalization of the mentally ill without community services to help them. There were 93,000 people in mental institutions in 1954; today there are under 6,000.
Absent from these headlines, though, are the people that go in and out of The Bridge, a day treatment program for the seriously mentally ill on West 108th Street, open 7-days a week, 365 days a year. About 250 people walk into The Bridge each day for activities that include daily living skills, therapeutic groups, creative arts and recreation.
According to Peter Beitchman, Deputy Director for The Bridge, deinstitutionalization was a disaster. "People were given a big bottle of pills and an appointment to go to an outpatient clinic. They were in the hospital for 10 to 30 years, with no independent living skills, and were expected to do well without support. They went into SROs or became homeless and went into shelters. It took the State many years to catch up. It still hasn't caught up."
What people at The Bridge found was most in need was not primarily the medical model of medicine and therapy (although that is certainly included), but the basics such as shelter, housing, income, food, clothing and safety.
"Once you take care of the basic needs," explained Beitchman, "by helping them get a beautiful place to live, a safe place, getting them social security or disability benefits or helping them get on welfare, having them participate in a psychiatric program, making sure they are stable through medication and closely monitored, once these basic needs are met, the next step is rehabilitation."
Rehabilitation doesn't mean a cure. "No one is cured of serious mental illness," says Beitchman. "But the effects and conditions that the mental illness creates can be effectively treated and dealt with." Rehabilitation means people gaining independence, perhaps moving to independent housing or reuniting with family and children. It can mean finding work.
The Bridge came up with the first such vocational training program in the City, again in response to their clients. "They asked us: what else do you have for us," said Beitchman. "We said, what would you like. They said, well, how about work?"
There is a danger that politicians will hear the word "rehabilitation" and think that means people can be taken out of the mental health system. "People with mental illness may not be able to go to full-time jobs or achieve total independence," Beitchman explained. "Some clients can work at a full-time computer job but still live in a 24-hour supervised residence. In that area of their lives, they are not able to function as well. We work with a client to achieve as much independence as possible."
Lynda Sounds Off:
In response to the outrage over violent attacks and the previous budget cuts, Governor Pataki recently allocated $125 million to community mental health programs. One of the flaws of this initiative package, according to Peter Beitchman, is that the majority of money earmarked for residential programs is for unsupervised living. "Yes, it is supportive housing for the mentally ill," says Beitchman. "But the housing is the cheapest and the lion's share of it is virtually unsupervised." Supervised residential housing, such as The Bridge provides in nine locations, has 24-hour staffing and is geared for people just out of the hospital and in need of assistance with living skills, learning to take their medication, and learning to become independent. "These are more expensive," acknowledges Beitchman, "but there are not enough of them. And there are none being developed."