MANY people think that the era of closing large, state psychiatric hospitals and dumping the mentally ill on city streets is a thing of the past. Sadly, Oklahoma is proving them wrong and perpetuating the failure of deinstitutionalization and success of transinstitutionalization by downsizing Eastern State Hospital in Vinita.

Gravely ill Oklahomans, who were until recently provided appropriate psychiatric care, have now joined the hundreds of thousands of mentally ill Americans for whom deinstitutionalization has meant nothing more than a denial of treatment, abandonment to the streets and preventable imprisonment in jails and prisons. Patients are often discharged without a housing plan or place to go. According to Oklahoma's Department of Mental Health and Substance Abuse Service, 33.8 percent of patients discharged from Eastern State were not in independent housing within six months of discharge. Ten percent of patients tracked by the Tulsa Institute of Behavioral Sciences seven months after downsizing Eastern State Hospital had spent an average of 32 days in jail.

The primary blame lies not in Oklahoma City, however, but in Washington and in a decades- old federal policy established when severe mental illness was not universally recognized as a biologically based brain disease.

Because their illness prevents them from obtaining private insurance through employment, many people with severe mental illness rely on Medicaid to pay for their treatment. For every dollar Oklahoma spends on Medicaid, the federal government reimburses more than 71 cents -- unless the patient is between the ages of 21 and 65 and is receiving treatment in a psychiatric hospital or other "Institution for Mental Disease" (IMD). The IMD exclusion to Medicaid unfairly discriminates against patients solely on the basis of their diagnosed psychiatric disorder.

In order to shift the cost of treating the mentally ill to the federal government, Oklahoma and other states are emptying their psychiatric hospitals and providing "treatment" in general hospitals and community- based clinics. These are often ill equipped to handle their needs and quickly release them to the streets, where many fall through the cracks and receive sporadic treatment at best. Far too many receive little or no care whatsoever. This lack of treatment ultimately costs society more, not less. Studies have repeatedly shown that persons with severe mental illnesses don't get better when treatment is withdrawn; they get worse.

We have lost most of our state psychiatric hospital beds nationally since 1965 due to the discriminatory nature of Medicaid. As a result, 1.4 million Americans with schizophrenia and manic-depression go without any treatment for their illness. People with severe mental illness are not to blame for their condition. Medical research has established that severe mental illnesses like schizophrenia and manic-depression are physical diseases of the brain. They are no more the fault of the sufferer than is Alzheimer's disease, Parkinson's disease or multiple sclerosis -- yet society, or more specifically the federal government, does not accord them the same level of care.

Without early medical intervention, many of these individuals who would have been capable of living productive lives in the community become so sick that they are never able to function appropriately outside of an institution. But where do these ill citizens go when rampant psychiatric hospital downsizing creates a proliferation of "no vacancy" signs?

Rather than eliminating much-needed psychiatric hospital beds for the severely mentally ill, Oklahoma and the federal government must ensure the mentally ill receive the same basic level of health care as those who suffer from other debilitating illnesses. Closing hospitals and pushing the sick onto the streets and into jails and prisons is both inhumane and fiscally insane.