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The dark side of community-based care

The story "Crucial case for mentally disabled" (April 21) strongly presents the argument that a history of ill-treatment of those diagnosed with mental illness must be addressed by community-based warehousing. California used such arguments to close most of its mental hospitals and push the mentally ill into private residential care facilities. Before Georgia, or any other state follows this lead, it would do well to examine the California experience.

The best laboratory is San Francisco's Haight-Ashbury district. It's a half-square-mile patch within the the city's 49-square-miles that supports more than a third of the city's residential care facilities. Its Golden Gate Park panhandle and the eastern entrance to the park provide sleeping grounds for most of the city's homeless. About a third of these homeless people have spent time in hospitals for the mentally ill or under care for various forms of mental disability.

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Advocates for the disabled present a simplified picture of the mentally disabled as able to care for themselves, but trapped in gothic mental institutions. The private residential care facilities and other components of "community-based programs" are viewed as neighborhood homes providing freedom and loving care.

In reality, community-based programs are often strapped for cash, even in wealthy states such as California. Private residential care facilities may be "mom and pop" businesses, or nonprofit facilities run by $100,000-per-year directors, but minimizing the cost of care is the name of the game everywhere. Care facilities are crammed into welfare ghettos like Haight-Ashbury. Oversight is limited by the city's budget. Welfare developers have learned that massive amounts of Federal HUD money, combined with compliant city planning by the cash-hungry community, make for easy pickings.

More than three-quarters of San Francisco's homeless are caught up in a cycle of mental illness, alcohol, and drugs. The outcome, sooner than later, is death from exposure, overdose, chronic illness, or violence.

The Americans with Disabilities Act, which facilitates the path from institution to care facility to the streets, makes it almost impossible to break the cycle of death on the streets. Homeless people brought into hospital emergency rooms with erratic behavior may be diagnosed as mentally disabled. Unless this diagnosis is combined with certification that the person is dangerous to themselves or society, they may refuse medication and discharge themselves. The advocates are ready to assist in fighting the certification.

Freeing people from mental institutions has left them free to die on the streets.

Wayne Lanier San Francisco

Teachers' vigilance is not enough Regarding "Tangled roots of school violence," April 23: Teachers usually do make reports on troubled students, but frequently nothing happens. Public schools are probably careful about what kinds of intervention they use, because if it involves psychiatric evaluations or other services the district doesn't currently provide, they may have to pay for the services.

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If there was a hot-line number where teachers could make anonymous phone calls to an agency that acted as an intervention source, I suspect a lot of these kids would be receiving help.

We must pledge, as a country, that we are willing to finance the costs of addressing our troubled youth. If we need to hire additional counselors, place students in private psychiatric facilities, or hire more teachers, there must be a financial commitment. And teachers can't be treated as whistle blowers for going outside their districts to place referrals on students whom the district has ignored.

Diane Payne Tumacacori, Ariz.

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