Viewpoint: Lack of Resources for Mentally Ill

By Dr. Stephen Read
Special to the Palisades News

(Editor’s note: The following letter was sent to Nancy Klopper, the author of “Rescuing the Homeless ‘Pretty Blonde’” in the August 9 News. We asked permission to print the letter because the information about resources for the mentally ill is something that will need to be addressed.)

I am a psychiatrist who completed residency at Harbor in 1982 and have since specialized in geriatric psychiatry. My sister also trained at Harbor and has stayed on as clinical faculty, with substantial responsibility for working with the resident physicians there, and Dr. Lesser deserves enormous credit for sustaining the program at Harbor.

Most of those words should be in quotes, representing that they are approximations, and increasingly distant approximations, to what is needed if we are in fact going to be able to take care of the chronically mentally ill in our country. And, from my perspective, the resources that are needed continue to be under attack.

Your dismay about the initial discharge from Harbor on 5150 is, in my opinion, very well placed, but in fact such discharges (of grievously impaired persons, easily recognized as such by, e.g., citizens of the Palisades) are the rule.

Why? Number one is the terrible paucity of resources. As you document, the lady in question was hospitalized for five weeks. The number of beds available is miniscule in comparison to the need, if all such homeless persons in L.A. County were to receive that level of care.

In addition, involuntary hospitalizations are routinely challenged by patients’ “rights” advocates, many of whom (in my experience) may not even believe in the concept of “mental illness,” and for whom a “victory” lies in extracting a person from mental health care.

Of course, key to the success in this case as well, were your amazing efforts to identify and locate family—and their dedication to taking this woman under their wing.

It’s not specified, but it is very likely from your description, that she will be in a country in which outpatient mental health care is provided and not stigmatized, i.e. that she will be able to proceed in treatment and thereby she and
her family will be saved the burden of relapse.

Such an outcome is much less likely had family not come. Even if she were from a local family, it is much less likely that treatment would be sustained [because of the lack of resources].

There are analogous issues in my practice in geriatric psychiatry—with a different type of conservatorship (heard in different courts—the Probate Court, where Judge Levanas previously was assigned), in which decision-making
capacity is the issue for when conservatorship is indicated. As it happens, that is the central part now of my practice, and I am an advocate for those criteria being made applicable to the issues of chronic mental illnesses in general.

But the main reason for this lengthy note is . . .to thank you for your concern and involvement.

(Dr. Stephen Read is a clinical, research and forensic psychiatrist with board certification in psychiatry, with added qualifications in forensic psychiatry and geriatric psychiatry. He has worked in outpatient care in private practice,
university and VA settings. He has worked in long-term care with Alzheimer’s Disease and other dementia. Read has worked as an associate clinical professor at UCLA.)

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