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Fraser Smith: Time for a difficult conversation

If image is everything, the conversation about how to treat the mentally ill just got more difficult.

Army Major Nidal Malik Hasan took care of that when, allegedly, he killed 13 soldiers and wounded dozens more at Fort Hood in Texas. The image of a mentally ill Army officer run amok may be difficult to combat.

But once again, advocates for the mentally ill are welcoming the challenge. They want what they call “a conversation,” a chance to debunk popular misconceptions and another chance to improve the lives of people who are no threat to the rest of us.

Hassan, they argue, is in the minutest minority. Nothing in the research suggests that mental illness leads automatically to killing sprees.

The mentally ill, the research shows, are more likely to be victims of violence than perpetrators.

It’s far better for society, they say, to treat the mentally ill in communities than to lock them in asylums.

“It’s what they want and it works,” says Victoria Knowlton of the Maryland Disability Law Center.

More for less

And it’s far less expensive. One year’s institutional care can cost upwards of $180,000. In the community, patients occasionally do have flare-ups but these can be managed there.

“We can get more for less, but it requires a shift from institutional care to community-based treatment,” she says. Many other states have followed that formula more aggressively, she says, than Maryland.

Though some state institutions have been closed over the last 25 years or so, the state still operates too often as if the answer is to use hospitals as lock-ups.

“It doesn’t prepare them at all for returning to the community,” says Kay Bhagat, another lawyer at the disability law center.

Well before the bloody rampage at Fort Hood, those in Maryland who speak for the mentally ill had begun a conversation. The deep budget cutting now under way in Annapolis seemed to offer unique leverage.

The conversation almost always goes to the assumed nexus of mental instability and violence. The Fort Hood shootings could be a threat to the measured policy discussion — and real change — that could still lead to less-expensive community placements.

The conversation is critically important now, they say, because the progress toward a saner policy could be set back by the current financial crisis. Every state agency is braced for reductions that threaten its core mission.

“We live in the real world. … We see what’s coming down the pike,” says Ms. Knowlton.

Taking a pounding

The issue of how to proceed with mental health issues is even more complicated than it may seem. The state was about to close an institutional facility on the Eastern Shore, for example, until an array of political interests intervened. In the face of political protest, the closing was put on hold.

Just this week, the Board of Public Works finally voted to close the center by March, but opponents of the decision vowed to fight on during the upcoming legislative session.

Comptroller Peter Franchot, a member of the board, voted against closure. Unions are also against it, worrying that some 90 jobs would be lost. Political leaders on the Shore also weighed in.

“Gov. [Martin] O’Malley was taking the right step and he got a pounding,” she said

Having such an important conversation may not be easily accomplished when there is so much pressure to economize. The O’Malley administration has already cut hundreds of millions from the current budget, and it must cut between $1 billion and $2 billion in next year’s spending plan

Such a conversation would be a rational way to proceed. Surely it must be done in a practical, realistic atmosphere.

It’s a pity, though, that these conversations may have to be done in a political environment that allow no alternatives beyond the deep cuts now contemplated.

A real conversation about this predicament should include some consideration of other options: use of the rainy day fund; prudent cuts to public education; and tax or fee increases.

With good reason, public officials seem ready to assume taxpayers would not accept any so-called revenue enhancements. But do we have a chance to say what services — like community mental care — people would be willing to support even at the cost of higher taxes?

Linda Raines, executive director of the Mental Health Association of Maryland, says her organization will push next year for a nickel-a-drink increase in the tax on alcohol — despite legislators’ fear of an election-year tax increase.

“It’s hard to imagine that people of conscience won’t override their political concerns when there are life-and-death issues,” she said.

C. Fraser Smith is senior news analyst for WYPR-FM. His column appears Fridays in The Daily Record. His e-mail address is