ABOUT three years ago, Portland police chief Michael Chitwood and his officers noticed a growing problem on the streets of this picturesque port city in Maine.
"What we started to see in the last several years has been an increase in the number of calls that our officers are responding to for people in some type of trauma situation," Mr. Chitwood says. Police encountered people threatening suicide, setting fires, or just walking along the street screaming.
The officers would often send the individuals to doctors to determine if they should be cared for at two state-run institutions: the Augusta Mental Health Institute and the Pineland Center for the mentally retarded. In most cases, "doctors were streeting the people," Chitwood says. If they were referred to the state facilities, they were usually soon released. "Some of these clients we've dealt with 20 or 30 times in the course of a year."
Chitwood began to meet with the city manager about the issue. But after he read a series of articles in the local paper focusing on a retarded man who begs for food, steals from local shops, and prostitutes himself, he decided he had to do something.
"What infuriated me was that ... the mental-health experts were saying this was the cutting edge of treatment in the state of Maine," Chitwood says. "I went to my boss, the city manager, and told him I felt that as a matter of public safety we had to bring this issue to the forefront and we should sue the state."
That's what Chitwood did. Now he and the City of Portland have been joined in the lawsuit by an unusual coalition, including two counties, two cities, a town, several individuals, and a homeless shelter. The plaintiffs charge that the state does not provide enough community services for those deemed mentally ill who have been released from state institutions.
"We're not against deinstitutionalization," the police chief explains. "What we are against ... is deinstitutionalizing people with few community resources. You can't put people on the street who can't fend for themselves."
Deinstitutionalization started in the 1960s, when states began releasing thousands of patients committed to warehouse-like environments, says John Rosser, the commissioner of Maine's Department of Mental Health and Retardation in the 1970s and now the executive director of the Spurwink School for mentally retarded individuals here.
The theory is that it is more humane and cost-effective for those diagnosed as mentally ill and retarded to live on their own in society than to languish in institutions if they are not considered a danger to others. Many states have significantly downsized their mental-care facilities or even closed them.
"It has been a trend for years," Dr. Rosser says. "I think the issue now in Maine is that they're getting to the point where you have your more extreme individuals [who may be deinstitutionalized], and people are concerned whether they can be dealt with in the community appropriately."
The Augusta Mental Health Institute, which has about 207 patients, will reduce its size to 70, plus a forensic unit, by 1995. The Pineland Center, with about 200 residents, will eventually be phased out.
In other cities and states across the country, litigation to force governments to provide better services for those deemed mentally ill has been brought by "do-gooders" - human-service or advocacy groups, says Robert Hayes, one of two lawyers handling the case for the plaintiffs.
This lawsuit is "unique in that for the first time the plaintiffs include not just the mentally ill people in distress and not just the do-gooders, but local governments and businesses," Mr. Hayes says.
Hayes, who moved here from New York City last fall, won a class-action lawsuit in 1991 requiring the Big Apple to provide housing for homeless mentally ill patients discharged from city hospitals.
The Portland suit asks the state to provide community services to people with mentally illness, such as a secure place to live and access to out-patient mental-health care. It also seeks restitution for the plaintiffs who have incurred costs for maintaining public safety and meeting the survival needs of the individuals.
"The state disputes the charges," says Richard Bergeron, assistant attorney general for the State of Maine and lead counsel for the defense. "There are community services in place that have been increased in the last few years at the same time the size of [the Augusta Mental Health Institute] was reduced."
MARK SWANN, executive director of Preble Street Resource Center, a soup kitchen in Portland, questions the state's definition of community services.
"I don't see that there's been an increase" in services for homeless mentally ill people, he says. "Maybe at other levels of mental-health services it has ... not for those on the street."
Last fall, Mr. Swann's staff conducted a one-day survey of those using the kitchen. "On that day we had 180 people here for breakfast, and around 60 were people with serious mental illness, of which less than half were receiving any ongoing mental-health services at all," he says. "Even of those receiving services, primarily it was medication monitoring and meetings with a psychiatrist every three months - hardly the kind of support some people need."
"I think a lot of people who are out there simply refuse to accept services," Mr. Bergeron says. "If they don't want to accept services and they're not dangerous, there's nothing the state can do to force them into services."
Swann says that is a traditional, clinical viewpoint. If people on the street "aren't taking their medication, not making appointments, not `compliant,' the department can say well, we've offered the services and these people are refusing them, and that's blaming the client," he says. "It's the system that's not working, it's not the clients."
Jackie, who requested that her last name not be used, says she suffers from several mental disorders and has been in and out of the Augusta Mental Health Institute. She sits in her neat one-room apartment, speaking quickly and articulately.
Although she is intelligent and not considered severely mentally disabled, Jackie complains that the state is "throwing people out and not doing anything for us when we get out here. We have no one advocate to go to in Portland, no one to turn to, no caseworkers. We have this and this and this problem, and we're falling apart."
Swann says what is needed are street-level community treatment teams that will work in soup kitchens, in shelters, and on the street to help people stay stable and functioning. "It's an old-fashioned social-work model of just ... building a relationship with people, helping them with basic services," he says.
Maine officials have acknowledged that the state's budget crisis makes it difficult to fund community mental-health programs. The state has moved to dismiss the plaintiffs' complaint.
But lawyer Hayes says creating a working system is doable in a state like Maine because of its small population. "With relatively few dollars we can get in place a system," he says. "It could be a national model."