William Anthony Miller, Jr., who was shot to death Feb. 8 in the Midway District after he allegedly lunged at police with a tree branch, should not have been condemned to a life of homelessness nor should he have died at the hands of officers ill equipped to deal with his mental illness. Miller, like so many before him, was victimized both by his illness and by state treatment laws too weak to help him.

Homelessness, incarceration, suicide and victimization are all cruel side effects of the two severest forms of untreated mental illness, schizophrenia and manic-depressive illness.

Thousands of vulnerable Californians are eking out a pitiful existence on city streets, under bridges, or in jails and prisons due to antiquated laws and policies that keep the severely ill out of hospitals and out of treatment. The images of these gravely ill citizens on our city landscapes are bleak reminders of the failure of deinstitutionalization and California’s Lanterman-Petris-Short Act (LPS), which governs the treatment of the state’s mentally ill. Based on outdated and nonscientific ideas rather than current scientific knowledge, the LPS Act is the chief reason our most vulnerable citizens more often face a police officer’s gun rather than the caring arms of a well-trained psychiatric team.

We see them everyday, animatedly carrying on conversations with invisible companions, wearing filthy, tattered clothing, eating out of trash cans or frightening those passing by. Worse still, we see them being carried away on stretchers as victims of suicide or violence or in handcuffs because of crimes they have committed. The LA County Jail is now the nation’s largest treatment facility for the severely mentally ill.

These reflections of neglect are doubly tragic because they can be prevented. Medication and treatment are available which can give people with severe mental illness a real chance of recovery. For those too poor to pay for it, Medi-Cal provides health care. Social Security Income – while dismally low – provides money for a place to live and food to eat. Thousands of disabled Californians have the basics they need to live in the community while they re-gain their health through these entitlements.

So why don’t more people with severe illnesses receive income and treatment? Undoubtedly, some of this is caused by the bureaucratic overload of the agencies responsible, but part of the answer lies in the nature of these brain diseases. Nearly half of those with schizophrenia or manic-depression lack insight into their illness. They simply do not realize they are sick and in need of continual treatment because their brain disease has affected their ability for self-assessment.

They cannot recognize that the symptoms of their illness – hallucinations, delusions, paranoia, and withdrawal – are, in fact, symptoms not reality. Since they do not believe they are sick, they see no reason to apply for services and medication that would allow them to recovery to a productive, normal life.

Why can’t we step in to help them? Because the current standards for involuntary treatment under the LPS ACT prevent us from helping those most severely disabled with mental illness unless they become dangerous or are verging on starvation. In other words, so long as the person knows which garbage food is not poisoned, legally we cannot intervene until he or she becomes violent or is poised on top of the Golden Gate Bridge.

Waiting for danger before intervention is too late and has had dire, expensive consequences for California:

• At least one-third of homeless individuals is severely mentally ill. In California, nearly 50,000 people with mental illness live on our streets, approximately the population of either Davis or San Rafael.
• Approximately 16 percent of inmates of California jails and prisons are severely mentally ill. Most of them were arrested for actions that were the direct consequence of their untreated illness.
• Individuals with untreated severe mental illnesses are 10 to 15 times more likely to either take their own life or have an accidental death.
• Individuals with severe mental illnesses who were not being treated are nearly 3 times more likely to be a victim of a violent crime. Severely mentally ill women are 2 to 3 times more likely to be raped.
• Each year, approximately 1,000 homicides are committed nationally by individuals with severe mental illnesses, almost all of whom are not undergoing treatment. This suggests that there are about 120 homicides each year in California committed by individuals with severe mental illnesses who are not being treated.

Society has an obligation to help those who can not help themselves before their illness escalates to tragedy. Other states have changed their legal standards to allow intervention based upon deteriorating conditions and the inability to make rational treatment decisions due to a mental illness.

This does not mean that we will have to reopen all the psychiatric hospitals that have closed as a result of deinstitutionalization. Most individuals with severe mental can live in the community with the proper medications.

For some, a legal requirement that they stay on their medication and be supervised for a period of time while doing so may be necessary for them to recover sufficiently to be capable of managing their own treatment. The fact that California does not have the legal structure to provide this level of assistance is malignant neglect.

In January, Assemblywoman Helen Thomson introduced legislation (AB1800) that can reverse California’s deadly course. Ms. Thomson, like many others around the country, rightly recognizes that mandatory treatment for those too ill to understand their need for treatment is a much more humane intervention than what we have now: mandatory non-treatment. Thomson’s proposal will bring the LPS up-to-date with medical science and help us properly care for the most severely disabled people in our communities.

We must heed the words of the late Senator Frank Lanterman, who upon witnessing the failure of the law which bears his name, declared, "I wanted the LPS Act to help the mentally ill. I never meant for it to prevent those who need care from receiving it. The law has to be changed." Perhaps then we will stop failing our most vulnerable citizens and making our police officers street-corner psychiatrists.

Jacobs, a mental health commissioner for the County of Los Angeles, is co-chair of the LPS Reform Task Force. She is also a director for the Treatment Advocacy Center and the National Alliance for the Mentally Ill. Torrey is a research psychiatrist in the field of schizophrenia and president of the Treatment Advocacy Center.