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Instead of emptying out, state hospitals are just as crowded—but with a higher percentage of untreatable patients. Many of these hapless people, in addition to their mental problems, are poor, infirm or alone and without any basic social skills to survive in the outside world. The drive to empty the hospitals may have gone as far as it can go. The readmission rate is up from 25% in 1960 to more than 65% today, which may indicate that too many have been released. As many as half of those discharged are now living alone, without the family support that psychiatrists think is essential for them to function. Says Talbott: "These poor patients are disorganized. They can't handle the bureaucracy. They just can't cope."
Sadly, many of them are now reduced to roaming the streets, annoying and frightening the citizenry. Some communities, even such liberal ones as Manhattan's Upper West Side, which has been flooded by thousands of deinstitutionalized patients, are beginning to cry out in anger. Says Manhattan Councilman An-.onio Olivieri, a liberal reformer: "The indiscriminate dumping of mental patients is creating new psychiatric ghettos in the cites. The policy is absurd." Psychiatrists are starting to share his concern. They fear that the increasing number of schizophrenics and other psychotics on the loose, particularly in the cities, may yet develop into an explosive political issue.
The community mental-health centers have their own headaches. Funding is short, and the goal of low-cost care is proving illusory. According to various estimates, each patient visit costs between $35 and $40, more than in private practice, for treatment that is generally of lower quality. Says Alan Stone, professor of law and psychiatry at Harvard: "Taking care of people well cannot be done in a less expensive way than just warehousing them, which was what we were doing before."
Meanwhile, the level of care at the state hospitals is getting worse. As storage centers for the hopeless, the hospitals are easy targets for cost-cutting state legislatures. Also, fewer first-rate psychiatrists want to work where the possibility of cures is so remote. Foreign psychiatrists, some of them unlicensed, have flocked to these institutions. Many, to be sure, do extremely competent work. Spanish-speaking doctors, for example, have been able to provide better levels of care for Hispanic patients. Nonetheless, the overall quality of these foreign doctors has raised a clamor for legislation by Congress that would stop the influx of poorly trained aliens. If it passes, the state institutions may be left with fewer psychiatrists of any kind. That could be calamitous; for even with these foreign-trained doctors, officials estimate that the nation will be short 9,000 psychiatrists by 1980. Right now there are 3,200 unfilled jobs for psychiatrists at the state hospitals.