For the past two months my wife and I have lived in downtown Seattle, WA. I have lived in seven different cities, sometimes in urban neighborhoods. But this is the first time I have lived in a downtown district.
In the frequent walks that are now a daily feature of my city life, I encounter homeless people who appear to be mentally ill. Many talk to themselves (no Bluetooth devices) and are, I assume, psychotic. After forty-five years in Psychiatry, I find this very sad. These poor souls are at profound risk: of assaults, accidents, hypo- and hyperthermia, malnutrition, and overall poor health. They reflect the unintended consequence of the deinstitutionalization movement at the start of my career, a movement nobly intended but poorly thought out and implemented. I also believe that mentally ill people on city streets represent an imbalance in the tension between civil liberties and compassionate care for the vulnerable—a balance that is gradually being restored as more states adopt outpatient commitment statutes.
Seattle’s mayor recently described receiving letters from visitors to our city, who complain about the mentally ill wandering the streets. As the city grows rapidly and the downtown becomes more vibrant, he is appealing to business leaders to support improved funding for care of this population.
I have been in partnerships between advocacy groups and psychiatric organizations that have sought increased funding for mental health care. Even after horrific crimes committed by a few psychotic people, and despite front-page press coverage and statements by politicians, proposed legislation to improve public mental health systems typically languishes. The public attention and concern flags, and the mentally ill are forgotten—until the next public outrage.
What I find appealing and encouraging about our mayor’s call is the potential confluence of interests: an improved quality of life for visitors and residents, a better climate for business and commerce, and—as a moral dividend—a potential benefit for those who are often forgotten, disdained, and dismissed. Here’s hoping.
-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Editor-in-Chief, Journal of Clinical Psychiatry
Professor Emeritus, University of Arizona