Patrick Hahn argues in his essay (“Schizophrenia and suicide: is there a drug connection?” Sept. 23) that an increase in the suicide rate for patients with schizophrenia since the 19th century may be due to the use of anti-psychotic medications in the 20th century. An alternative hypothesis would examine the impact of de-institutionalization of tens of thousands of these patients from the long-stay state hospitals into the community unprepared to treat and care for them.
The well-documented increase in homelessness and incarceration of these patients is a public health crisis today. Suicide is only one bad outcome that may be attributed to the neglect of these patients. Dramatic decline in the number of, and access to, inpatient beds accompanied by inadequate resources devoted to community treatment has led to the failure of the public mental health system nationwide.
In contrast, there are thousands of patients who have benefited from the medications designed to treat the severe symptoms of schizophrenia who have a life in the community but need additional resources devoted to housing, employment and support for families who are the primary caregivers. I have seen many lives transformed by these medications that reduce the most disabling symptoms of schizophrenia. There are many positive outcomes today thanks, in part, to the medications we have available. Without them, our patients would be worse off.
Steven S. Sharfstein, M.D., Baltimore
The writer is president emeritus of Sheppard Pratt Health System.
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