In south St. Louis, the hallucinations of schizophrenia once
forced Dan Hiles, 36, to live on the streets for six years before
he got the care he needed.
In Wood River, manic depression put Bill Barger, 37, in the
hospital 15 times in an 8eight-year period.
In Bellefontaine Neighbors, schizophrenia and manic depression
disabled Beth Deaver, 21, leading to many hospital stays over six
Even so, Hiles, Barger and Deaver have made remarkable
recoveries. In addition to medicine, a key to their getting back on
their feet has been community programs that offer follow-up therapy
But such long-term care for the chronically mentally ill may be
in jeopardy under President Bill Clinton's plan to reform health
If the plan is passed, all Americans would get standard mental
health benefits by 1996:
Up to 60 days of hospital care a year.
A maximum of 120 days a year for rehabilitation and other
Up to 30 psychotherapy sessions a year.
Patients would also share some medical expenses, paying 20
percent of the cost of prescription drugs.
"Sixty days a year for hospital care? That's terrible," said
Hiles, who works at Peter and Paul Mental Health Services, a
program in south St. Louis for homeless men. "That's not enough for
our guys who are really sick."
Hiles spent six years among the homeless before he was taken to
the state-run Malcolm Bliss Hospital in St. Louis. There, his
schizophrenia was diagnosed and properly treated.
After two years in the Peter and Paul program as a resident, he
was well enough to work there. "If I hadn't had this place, I would
have ended up in the streets again," Hiles said. He doubted that
120 days a year for such residential programs would help many
chronic mental patients.
"Most people stay here for one or two years," Hiles said.
Barger agreed. He said he has needed daily support services for
several years to break his cycle of repeated hospitalizations.
"I have a case manager, Warren Land, who handles my finances,
helps me shop and takes me to group therapy," Barger said.
"Every day I go to the Community Counseling Center in Alton,
where I work mornings and go to therapeutic meetings in the
afternoon to teach me how to cope with my illness.
"I had been paying $150 for a three-month supply of my
medicine," sBarger said. D"It didn't leave me much money, so the
doctor dropped my medicine that prevents side effects from my main
Through a Wood River-based agency, Crisis Services of Madison
County, Barger found that he could get free medications from the
Veterans Administration because he'd served in the Marine Corps.
"That has made a big difference," he said.
"If you pay 20 percent for the cost of medicines in the new
plan, that would be hard on most people with mental illnesses," he
15,000 Chronically Ill
At any given time, 15,000 chronically ill Missouri residents
need mental services that the state provides. The state spends $205
million a year for 25 community mental health centers, which now
serve 5,000 persistently ill patients, state officials say. About
1,400 patients are in state hospitals or permanent residential-care
programs. The state pays another $18.4 million for their care.
The Illinois Department of Mental Health spends about $400
million a year for the mentally ill - most of which goes for
hospital care. Both Missouri and Illinois spend almost all their
budgets on the chronically ill. …