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Oh lookie, an old-fashioned, carefully-crafted letter to the editor. Yes, some people still provide their full name when commenting on a news story. Shockingly, I got two this week. Here’s one about treating homeless patients into need of mental health services once they’ve been forced out of the shelter system:

Letter to the Editor
Washington City Paper
Washington, D.C.

Re: Beyond the Franklin School Shelter

So far, the lawsuit brought by advocates for the homeless to reverse the District’s decision to close the Franklin School Shelter isn’t faring well. The federal court recently refused to take up the issue until the D.C. Court of Appeals decides whether the D.C. Superior Court ruling in the District’s favor was correct .

Meantime, as part of the Housing First program, the District has found apartments and subsidized the rent for 80 of the 300 homeless men with mental illness who had to leave the shelter. They still receive services to deal with their mental illness and to help find a job.

The other 220 men who left the Franklin shelter are in other shelters, living with relatives or on the street. The District’s plan to build 300 more units is commendable but far from sufficient to house all its homeless mentally ill.

For most of them, permanent housing won’t come first. And for many with severe mental illness, treatment may not come first either because they are too ill to recognize the need for treatment. Anosognosia, a condition common to persons with schizophrenia and bipolar disorder, precludes awareness of mental illness and, therefore, any need for treatment.

Fortunately, there are 43 states, including the District, that have found a way to effectively address this need for treatment in the community through a court-ordered process called assisted outpatient treatment (AOT). Through AOT, people can live in the community while receiving case management services, medication and other forms of oversight. It is, however, a grossly underutilized resource in the District, despite the fact that numerous studies (most recently, the New York Independent Evaluation of 2009) have shown it to be the key to recovery.

The District’s Department of Mental Health already sends teams of mental-health workers into neighborhoods and shelters to offer medication and services. This is a wonderful program for those who are able to accept such services voluntarily, but cannot serve those who are the most ill. Adding assisted outpatient treatment as an option for the homeless who are severely and persistently mentally ill would ensure that these well-intended services are utilized most by those in greatest need.

Trying to restore the Franklin School Shelter as a familiar, convenient place for the homeless mentally ill is a good-hearted but uncertain effort. Restoring them to a productive life in their communities through assisted outpatient treatment is good-hearted, good science and proven.

Aileen Kroll, JD
Legislative & Policy Counsel
Treatment Advocacy Center
200 North Glebe Road, suite 730
Arlington, VA 22203