Alan Mark Houseman of Hyde Park was shot and killed in an altercation with police last month [March 2003], one year after Vincent Zirakian of Deltona met a similar end. Both men had an untreated severe mental illness.

In that same time period, at least 40 people with mental illnesses were killed in encounters with police nationwide. Eight of those tragedies - 20 percent - were in Florida, although Florida has less than 6 percent of the U.S. population.

Tragic encounters with law enforcement are just one of the consequences of lack of treatment. More than 15,000 Floridians with untreated mental illnesses are homeless. Between 7,511 and 10,798 inmates with severe mental illnesses are in Florida's jails - at least three times more than are being treated in remaining state psychiatric hospitals. People with untreated severe mental illnesses are 10 to 15 times more likely to commit suicide than the general population - and severe and persistent mental illness is estimated to be a factor in 10 to 15 percent of violence.

The consequences of reforming the Baker Act are equally as compelling. In New York, of those placed in six months of assisted outpatient treatment through December 3 [2002], 77 percent fewer were hospitalized, 85 percent fewer experienced homelessness, 83 percent fewer were arrested and 85 percent fewer were incarcerated.

COSTS

Using cost data from the Department of Children and Families, doing nothing cost Florida approximately $32 million for 11,209 additional adult Baker Act cases in 2001. Proposed reform focuses on recidivists trapped in a revolving door of ineffective services. 540 individuals had eight or more Baker Act emergency examinations in one 24-month period (2000 to 2001), averaging at least one every three months. This is expensive. For instance, in 2002, just one person received 41 Baker Act examinations. The cost? Conservatively $81,000 - not including court costs, law enforcement resources, or long-term treatment.

And the number of recidivists is growing. In 2000, nearly 9,000 adults were "Baker Acted" two or more times. The number of Baker Act examinations for recidivists increased 50 percent between 2000 and 2002.

Non-treatment also costs money in lost productivity, ambulances, emergency room visits, and court, police and social services, and in intangible costs, from the deterioration of public transportation to reduced usage of public parks to human suffering.

Court-ordered outpatient treatment saves money by reducing hospitalization rates, arrests and violence - and increasing medication compliance, which can generate tremendous savings. One study calculated that nationwide, over two years, the direct cost of rehospitalization attributable to noncompliance is approximately $700 million.

CIVIL RIGHTS

People like Houseman and Zirakian had rights. They had a right to live free of psychoses, a right to treatment, a right not to be killed.

But their ability to make rational treatment decisions was compromised by brain disease.

When an Alzheimer's patient walks into the woods at midnight, we bring her home, knowing that her disease inhibits her ability to reason.

Half of people with schizophrenia and manic-depressive disorder have similarly impaired awareness of their illness.

It is not a true exercise of rights to make decisions in a state of psychosis. In fact, the majority of those who initially object to hospitalization or medication retrospectively agree with the decision to hospitalize or treat them.

Florida's proposed reform maintains all the civil rights safeguards in present law. And it goes a step further, offering court-ordered outpatient treatment as a less restrictive treatment alternative.

Legislators should swiftly pass House Bill 1197 [and Senate Bill 2748] to reform Florida's Baker Act. The price of inaction is too great, the consequences of maintaining the status quo too severe - and the civil rights of our citizens who are most ill are at stake.

E. Fuller Torrey, M.D., is president of the Treatment Advocacy Center in Arlington, Va., a national nonprofit organization working to eliminate barriers to treatment of severe mental illness.

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