Downsizing Mercy copyright 1998 Bob Darby

The man in the soup line wore a hospital bracelet. His skin was gray and his eyes were yellow. He took his meal to a private corner of the park and sat down. I walked over to talk with him.

"Why are you wearing the hospital bracelet?"
He was pleased somebody cared. "I just got out of Grady."
"Why were you there?"
"I have cancer."

His discharge papers said that he had a malignancy of the liver. A Grady social worker gave him a list of shelters, and his monthly Social Security check for $400 could only rent him a week in a cheap motel. Food Not Bombs referred him to the Open Door Community for help with housing.

Once this man had a job with medical insurance, but his benefits ran out in a year. Then he lost his job and his home. If he couldn't get to a shelter in time and had to sleep in the park, the police would probably enforce the "Urban Camping" ordinance and put him in jail.

The Open Door Community and Food Not Bombs see hundreds of people every week who are homeless for no reason other than they are sick. People who are homeless because of cancer, AIDS, and other "physical" illnesses are just the second and smaller wave of America's abandoned sick. Little mercy is shown in this country for the mentally ill, and for a long time America's first and largest tidal wave of homeless sick people has been made up of discharged mental patients. One-third of all the homeless population of the United States is mentally ill. This means that there are five thousand mentally ill homeless people in Atlanta, and two million in the USA.

Mental hospitals have been shutting down in America for more than thirty years. This could be a humane and liberating event, but it isn't turning out that way. Drugs are now available to enable most mentally ill people to successfully live outside hospitals, but only with competent supervision in state-supported residential care facilities. Although such "group homes" are cheaper than hospitals, few are actually funded and maintained. The money saved by closing hospitals is being spent instead on jails and prisons, and the mentally ill are consequently thrown out on the streets to fend for themselves. Despite the fact that the violent crime rate for the mentally ill is the same as the rest of the population, many people fear them as being criminal and subhuman.

About one thousand beds in Atlanta-area jails are occupied by the homeless mentally ill, and most of these people are guilty of nothing more than loitering or sleeping in parks. Without lawyers, they will be kept in jail for at least a year, until such time as they are declared "stabilized" by jailhouse medication and their cases can finally be "cleared" by the courts. Then they are remanded to the streets and, eventually, another round of jail and neglect.

Many of Atlanta's mentally ill are in jail because there's no room for them in mental hospitals. Yet only 256 psychiatric adult-care beds are available at Georgia Regional Hospital-Atlanta (GRHA), and this is the sole state mental hospital now serving over three million people. Each adult-care bed at GRHA costs the state of Georgia $517 a day. Jail is much cheaper, at $50 a day, than hospitals or group homes.

Now the crisis over Georgia's homeless mentally ill has suddenly gotten worse. In June of 1998 the Georgia Mental Health Insitute (GMHI) permanently shut its doors, and now we have only one state hospital, Geogia Regional, serving all of metro Atlanta... over three million people. The Department of Human Resources (DHR) tells us that there is a "lessened need" for mental hospital beds because of "recent advances" in pharmacology," and that the money saved on closing GHMI will be spent on the "transfer of services to local communities." But what the DHR closure booklet doesn't explain is the limited applicability of, and the prohibitive cost of, these new drugs; and neither does it tell us exactly what new "services" they are planning to expand. We are expected to assume they are acting in good faith and on the public's behalf.
Truth is abused and evaded when the DHR says that new psychiatric medications have reduced the need for hospital beds. Most of Georgia's mentally ill aren't being served by these mysterious new miracle drugs because those who need them the most are homeless or in jail. With thousands of homeless mentally ill people in Atlanta, it is obscene for the DHR to say that we have a "reduced need" for hospital beds. And if there really are any "new services" planned by the DHR for local communities, it's a fair bet that these services will be delivered behind the bars of new neighborhood jails and prisons.

The sick and disabled of Germany in 1937 were scorned by their government as "useless eaters." Gas chambers and crematoria were pioneered on the grounds of mental hospitals, years before the Nazis used them against other populations. America should take warning. The abandonment of the sick and poor cultivates cruelty and downsizing mercy encourages murder. For as long as we abandon our sick and helpless to the streets our generosity is a lie and our riches are a curse.

Resources: "Trading Beds for Bars", by Stephanie Ramage, Creative Loafing, April 4, 1998. "Why are There So Many Homeless Mentally Ill?" by E. Fuller Torrey, M.D. Harvard Medical School Letter, August 1989. "A Plan to Close Georgia Mental Health Institute..." by the Georgia Department of Human Resources, 1998

Thanks to Jane Hannigan and Jon Farr for research assistance. Bob Darby has a B.A. in psychology and is a former employee of Georgia Regional Hospital. back