In light of the movie massacre that left at least 12 dead and 38 wounded, we must consider the reopening of the state mental hospitals and reception centers.  The lack of mental health services leaves too many mentally ill walking the streets.  

The individual who perpetrated this horrible crime appears normal in behavior with exceptional intellect. However, it is not understood what behavior he may have exhibited in the past that might have allowed referral to mental health services if they were available. 

This incident aside, we read too regularly of terrible tragedies brought about by deranged persons.  Often services were requested but denied. Some mentally ill were released from jail and sent back into society with no support for their mental illness. 
 
President Reagan’s reduction of Medicaid funds to the mentally ill during the 1980s resulted in the closing of state mental hospitals nationally.  The effort to half-way-house these patients or provide services through community mental health centers failed miserably.  The result is felt today and lends itself to ongoing tragedies involving an increased mentally ill homeless population, preventable violence, and the serious weakening of community safety nets.
 
Law enforcement could no longer take obviously deranged individuals to state reception centers for psychiatric evaluation and potential placement. Previously housed individuals were lost to care and medication. Communities across the nation became less safe.  Events such as the theater tragedy occur too often in schools, businesses, and neighborhoods.  The movie catastrophe was enormous in scope but sadly, mayhem due to seriously disturbed individuals will continue.
 
One third of our homeless community are described as mentally ill, 15 percent of  the U.S. population will seek mental health services, and it is suggested that 15 million people walk the streets of America with serious mental disorders without medication or care.  This time bomb continues to go off regularly without necessary attention.
 
Drugs available for the mentally ill have never been more effective yet millions go without them.  Public safety would be best served by a state mental health facility housing properly assessed sociopathic individuals. They can be treated and cared for and require appropriate evaluation for release.  On the streets without medication and necessary follow-up, the seriously mentally ill pose a danger to themselves, children, and all citizens living in every American community.
 
It is too costly in both tragedy and resources not to reopen state mental hospitals and reception centers for adequate patient evaluation and, when indicated, placement.  Each day our communities pay a terrible price due to inadequate mental health care.

Marc J. Yacht, M.D., is a former president of the Florida Association of County Health Officials.