1. Star Tribune (Minneapolis, MN), March 25, 2001, "Commitment; Saving
minds, saving money"

The bridges of Hennepin County have stories to tell, and not all of them
involve traffic. Some are about troubled people who huddle under overpasses,
hobbled by mental illnesses. Their trouble could be eased but for two
problems: They're too sick, and they're not dangerous enough. That means no
court can step in to insist they get treatment. It means they'll stay under
the bridges until they die.

Oh, the story doesn't always end that way. There's always a chance a
bridge-dweller might be found half-frozen and taken to the hospital for a
gentle toasting. At the hospital, no one will insist the fellow must be
fully frozen to qualify for defrosting. No one will ask him whether he
really wants to be thawed. And if he starts snarling that he prefers the
chill, no one will toss him back into the snow. That's because it's
generally assumed that half-frozen people sometimes can't think straight,
and that warming them up is always worth a try.

Which raises a question: Does a frosty body really deserve more attention
than a disordered brain? Minnesota's hospitals seem to think so. Their
association _ the Minnesota Hospital and Healthcare Partnership _ is among
the few foes of a bill to enable earlier court-ordered treatment of people
with mental illnesses. Sponsored by Rep. Mindy Greiling, DFL-Roseville, and
Sen. Don Betzold, DFL-Fridley, the bill would revise the state's
civil-commitment law to permit community-based treatment before pain turns
to peril.

It's hard to see why the hospitals object. When they're accused of
neglecting the mentally ill _ as sometimes happens after a rejected
treatment-seeker leaves a hospital to look for a gun _ they often point to
the state's strict commitment law as the reason they couldn't do more.
Allina did precisely that last year after a man turned away from one of its
hospitals _ Mercy in Anoka _ went on a killing spree. You'd think that
tragedy would spur Allina, the largest member of the hospital association,
to lead the reform quest.

No such luck. At a hearing last week before the House Health and Human
Services Committee, the hospitals' lobbyist argued vehemently against
changing the law. Echoing warnings from the Church of Scientology _ the only
other group fighting the bill _ the lobbyist claimed that it would violate
patients' rights to refuse treatment.

This is nonsense, and the hospitals know it. Mental illness is often
characterized by irrationality _ an inability to recognize that one is ill
and in need of help. Indeed, the state's civil-commitment law was written
expressly to assure treatment for those too sick to seek it. Most thoughtful
groups _ from the League of Women Voters to the Minnesota Medical
Association _ favor refining the law to help nip psychiatric crises in the
bud.

Advocates favor this change for reasons of compassion. But they could back
it as well for reasons of economy. Many studies show that psychiatric lapses
caught early are cheaper to treat. Some analysts predict a change in
Minnesota's commitment law could save this state several million dollars a
year.

What keeps the hospitals from supporting this step toward decency and
thrift? After all, it's hard to imagine a more brutish and wasteful "system"
for managing mental illness than the one we've got. The current commitment
law virtually guarantees that handling mental illness will cost a fortune.
It withholds treatment until patients are desperate and dangerous, keeping
the revolving doors of psychiatric hospitals in a wild and expensive whirl.
It propels people with mental illnesses out of work, away from love, toward
violence, behind bars and under bridges.

Who wants that? Minnesota's hospitals? How could they?
*******************************
2. The Washington Post, March 30, 2001, "Mental Health: A Stronger System
for D.C."

I agree with E. Fuller Torrey and Mary T. Zdanowicz [Close to Home,
March
11] that legal barriers to treating the dangerous mentally ill should be
removed. In the District, a step in the right direction would be a more
effective use of the enlightened involuntary commitment laws already on the
books. But to do so would fly in the face of the policy of reducing costly
inpatient care.

I am a former psychiatrist at St. Elizabeths Hospital. I can attest that
committing a patient to involuntary care can be burdensome. Mental health
hearings without benefit of legal representation for the psychiatrist
facing
aggressive lawyers, lengthy delays, continuances and cancellations make the
process unpleasant and take time from patients. Thus, doctors are tacitly
encouraged to avoid the commitment process by allowing patients to sign
voluntary admission forms that give them the right to sign out of the
hospital.

A process known as "gatekeeping," which makes it difficult for patients
to
enter the system, further reduces the possibility of receiving care. In
addition, hospital staff members are under pressure to discharge patients
who
may have improved but are not sufficiently motivated to continue treatment
on
their own.

Fortunately, dangerousness in the form of violence to others is
relatively
rare. Far more people with untreated mental illness are dangerous to
themselves
because they are unable to care for themselves. These are the people who
end up
in jails, on the streets or who commit suicide. Unfortunately, policymakers
deem
their protection to be too costly.

HENRY SKOPEK
Mclean