The president of the American Psychiatric Association is Dr. John Talbott. An article yesterday stated his first name incorrectly.
The mentally ill woman was on the floor of her Dupont Circle apartment with cockroaches crawling all over her when the Rev. John Steinbruck and his wife Erna found her. She wouldn't talk and she wouldn't eat.
The Steinbrucks called in the police to have her committed to St. Elizabeths mental hospital, where she had been treated before for paranoia. But when the police arrived, the officers said they could not have her committed because she did not pose an immediate life-threatening danger to herself or others, the District's standard for involuntary commitment.
The Steinbrucks, who run shelters for homeless persons in the District, are among those now calling for a change in standards to make it easier to carry out involuntary commitments here and elsewhere in the country. They say that people who desperately need help are not getting it.
"The pendulum is so far over on patients' rights that we're hurting people," Erna Steinbruck said yesterday, elaborating on her husband's testimony at a hearing on the homeless mentally ill held by the Senate appropriations subcommittee on the District.
Massive deinstitutionalization in the 1970s is often cited by social services professionals as a major reason for a large increase in the number of homeless persons seen living on grates and at shelters, and specialists estimate that about half of today's homeless are mentally ill.
This, they say, is largely a result of persons being released from institutional care without enough community support systems to help them care for themselves.
In addition, stringent involuntary commitment standards in about two-thirds of the states make it difficult to force treatment on those who do not seek it, social service experts say.
The District's commitment laws make it more difficult to commit a person against his or her will than do Virginia's, where recent debate has centered on whether patients can be committed too easily and whether patients" rights are abused in the process.
David Rivers, director of the D.C. Department of Human Services, said yesterday that the city is rethinking its involuntary commitment standards as part of major changes taking place in the District's mental health care system.
The D.C. police department can seek involuntary commitment of persons who present an immediate life-threatening danger to themselves or others.
"It's a hard standard to meet," said Shannon Cockett, a D.C. police spokeswoman, in a phone interview yesterday. Police cannot commit persons simply for having chronic mental problems, she said.
Officers would take such a person to D.C. General Hospital, where a physician would determine whether the person should be taken to St. Elizabeths. The law provides a strict timetable for bringing the person before a judge to determine whether the involuntary commitment can continue.
Steinbruck, chairman of Mayor Marion Barry's commission on homelessness, testified at the hearing about the difficulties he and his wife had in getting police to commit chronically mentally ill persons, "who can sit on the steps of our church for days and weeks, with open sores, deteriorating."
Sen. Arlen Specter (R-Pa.), the subcommittee chairman, said after yesterday's hearings that the District and other jurisdictions should change the laws to make it easier to commit mentally ill persons.
"In our effort to deinstitutionalize the mentally ill, we have ended up hurting them more than helping them," Specter said.
Dr. James Talbott, president of the American Psychiatric Association, testified that in addition to mental illnesses with immediate life-threatening dangers, a third standard of "grave disability" should be added as a legal basis for involuntary commitment.
Not everyone agrees the standard should be changed. Judge Gladys Kessler, presiding judge of the D.C. Superior Court family division, said at the hearing that she believes the "shocking" example of the woman lying in a catatonic state in her Dupont Circle apartment would fit the court's standards for commitment as a danger to herself.
Mitch Snyder, spokesman for the Community for Creative Non-Violence, an advocacy organization for the homeless that runs an 800-bed shelter on Capitol Hill, said there is little point in taking persons to St. Elizabeths now because the hospital's policy, he said, "is almost exclusively to send people back to the streets" after a short stay.
The Steinbrucks say they have had to resort to "creating incidents" by baiting sick persons into acting out in front of policemen, so officers have a basis for commitment. The paranoid woman, a college graduate who was married to a lawyer and has four grown children, is still sick, and with no home of her own now is staying with a friend who does not know how to handle the situation, Erna Steinbruck said. Others are living on the street.
"The people who are dying in front of us," she said, "they have to be taken against their will."