Improving Care of the Mentally Ill Re "For the Mentally Ill, It's Worse" (column, Jan. 25): Joe Nocera describes yet another example of a well-intentioned law that has brought about devastating unintended consequences. He writes that deinstitutionalization was "designed to liberate the mentally ill from the acknowledged horrors of mental hospitals, where they were often confined for decades." With 20/20 hindsight, we know that when sick people are released with inadequate follow-up and support, they are unable to function normally. In addition to humanizing conditions in the hospitals, it is essential to provide support services when the patients are well enough to be released. Unfortunately, in the years since the 1960s, we have not made much progress toward this end. The writer is a retired social worker. Having worked for more than a decade as a case manager dealing with the incarcerated mentally ill, I can confirm Joe Nocera's assertion that the prisons "have become today's de facto mental hospitals." Mentally ill defendants often end up in jail for relatively minor, nonviolent charges after not being able to make a small bond. Once in jail, they are likely to become more unstable and encounter disciplinary problems that could lead to more serious charges. Over the course of many years, I have interviewed hundreds of inmates whose history included state psychiatric hospitalizations before the deinstitutionalization movement. While treatment in large state psychiatric hospitals was clearly not ideal, the mentally ill fare much worse in jail. We as a society need to address this issue through more progressive and proactive interventions within the criminal justice system to divert mentally ill defendants, whenever safely possible, from ending up in jail. Joe Nocera laudably calls attention to the suffering and abandonment of patients with schizophrenia. However, in concluding that treatment will inevitably improve, he overlooks the deeply entrenched resistance to helping the mentally ill. I am a clinical psychiatrist and schizophrenia researcher and witnessed the struggles of my late father, Dr. Morton Birnbaum, a mental health advocate. My father coined the term "sanism" to describe the widespread discrimination and stigma against the mentally ill. Sanism may very well underlie the historic and continuing lack of funding for adequate treatment and services - for example the currently proposed reduction in the National Institute of Mental Health budget. The imperative to improve the care of patients with schizophrenia in the next 50 years will require legislators to increase funding to fuel clinical and research progress, and will require all citizens to recognize and challenge sanism. The writer is a research fellow at the Lieber Institute for Brain Development and the Johns Hopkins University School of Medicine. For 15 years, I was medical director of a day treatment program that cared for the most severely mentally ill. While it may have been costly, it probably ultimately contributed to savings by helping to keep people out of the hospital, jail, shelters and living on the streets. This day program was a welcoming environment and provided multiple services, but unfortunately closed in 2010 along with the inpatient beds at the facility where it was based, St. Vincent's Hospital in Manhattan. A new plan has emerged to close more state psychiatric center beds in New York. A hopeful sign last month was Gov. Andrew M. Cuomo's delaying its implementation until an evaluation of the effectiveness of expanded community services. This could reverse the failure of the past 50 years of deinstitutionalization and justify Joe Nocera's optimistic closing that the day will come when we look back in horror at the way our society treated the mentally ill. The writer, a psychiatrist, is a member of the New York State Psychiatric Association Committee on Public Affairs.