More from our inbox:
To the Editor:
Re “A Fatal Shove on the Subway and a Broken Mental Health System” (front page, Feb. 6):
The woeful inadequacies of our mental health systems are legion: universal underfunding; no overarching system to provide consistent individualized care over time; insufficient hospital and residential beds, leading to too short revolving-door hospitalizations; too few intermediate care programs; waiting lists for mobile crisis intervention teams; virtually nonexistent housing for the mentally ill, leading to homelessness and imprisonment; and on and on.
There is one underlying theme in all these inadequacies — our unwillingness as a society to spend the money necessary to adequately meet the needs of mentally ill people. Just one example: Since the earliest days of deinstitutionalization, the number of psychiatric hospital beds in America has declined relentlessly, so that it is rarely possible to treat the full episode of illness in hospital. It is not unusual to be discharged after three or four days, even when hospitalization was prompted by a suicide attempt or a psychotic episode.
Despite all the talk and the intermittent media coverage, our attention spans are short. We return to this conversation repeatedly, especially following a random act of horrific violence, but make no systemic change. We seem to be OK with the homeless mentally ill wandering the streets.
There are no words for this. It is inhumane, disgraceful. We should be ashamed.
Harold I. Schwartz
West Hartford, Conn.
The writer is psychiatrist in chief emeritus at the Institute of Living, Hartford Hospital.
To the Editor:
Martial Simon’s story — confessing to an act of violence after an “endless circuit of hospitals and jails, outpatient psychiatric programs and the streets” — will continue to repeat itself unless we do things differently. Adding another program, no matter how good, won’t move the needle enough. The system is too fragmented, with entities acting in silos, creating the cracks through which people fall.
This is a systems failure, and we need systems solutions. Stewards — people who are or can be change agents across the mental health system — must be brought together to develop shared goals and collaborative approaches. And we need to address vital conditions for health and well-being, like housing and employment.
Mr. Simon, according to your story, was asking for housing and was clearly food insecure; he didn’t have the medication he needed and wanted; and he was shuttled from one institution to another. The outcome of his story is as unsurprising as it is tragic. It didn’t need to be that way.
Becky Payne
Morristown, N.J.
The writer is executive vice president of the Rippel Foundation, which aims to rethink health care.
To the Editor:
Deinstitutionalization is a program that has gone terribly wrong. Initially conceived and developed to erase the ugly past of psychiatric hospitalizations, hospitals are now a place where patients are discharged almost as soon as they are admitted, into a community that is dismally unprepared to accommodate them.
Outpatient clinics in the state system, woefully understaffed, are forced to take on the care of patients who are not ready for discharge. These patients often have psychiatric, substance abuse and criminal histories, each of which requires a specific type of treatment in a safe and nurturing environment. Patients who are discharged before they have been given appropriate treatment and care will act out their problems, to the detriment of all.
Many members of this population have schizophrenia, and two common symptoms of schizophrenia are paranoia and anger. Often these two symptoms become entangled and can result in violent acts. If a patient is discharged from a hospital before he is engaged and compliant in his treatment, he is likely to stop his medication, and this can lead to violence.
We are a highly evolved society with many ills. This is one ill, one broken system, that needs to be addressed sooner than later.
Arlene Shegerian
Queens
The writer is a licensed clinical social worker.
Times Columnists Are Too Downbeat on Biden
To the Editor:
Times columnists seem to have made up their minds about President Biden. Witness these headlines in recent weeks:
“What’s Biden Thinking?” (Ross Douthat)
“More Mojo, Joe!” (Maureen Dowd)
“Biden Can Still Rescue His Presidency” (Bret Stephens)
“This Presidency Isn’t Turning Out as Planned” (Ezra Klein)
These opinion pieces go on to describe Mr. Biden’s first year in the White House as “hapless,” “flailing” and “failing.” To be fair, some of these writers also tout Mr. Biden’s achievements — but to the casual headline scroller or essay skimmer, the messaging feels downbeat and dire.
As an activist, I fear that many of my fellow citizens on the left are absorbing and repeating the notion that Mr. Biden is failing us, and in turn expressing pessimism about Democrats’ chances in the midterm elections. But this doesn’t have to be a self-fulfilling prophecy. We need to be pragmatic, focus on Mr. Biden’s achievements and continue to engage in saving our democracy from the forces that threaten it.
A president is not Santa Claus, granting us every item on our wish list. Instead, a president operates within a complex system of government.
In 2020, millions of us wrote letters and postcards, made calls and voted for a new president, despite our fatigue and despondency caused by the Trump administration. We need to show up again this year with that same energy, to elect more Democrats to the House and the Senate who support Mr. Biden’s agenda.
Lotti Pharriss Knowles
Burbank, Calif.
The writer is a board member of Swing Left San Gabriel Valley.
