By Jackie Jones

New Yorkers of a certain age remember well the days of homeless people – mostly men – sleeping on sidewalk steam grates or stretched out on subway benches, panhandling on the trains, subway platforms and at the tops of stairs and escalators, as well as hanging out near bank ATMs, stores, restaurants and bars.

There was the inner turmoil over whether to give the beggar who really looked as if he could use the help some “spare change” and hope that you were not fueling an addiction, or to learn how to avert one’s eyes and avoid confrontation.

Other times, people were driven to give out of fear for their safety because of the aggression and desperation displayed.

Some of the homeless just seemed to be hustlers, unwilling to put their smarts and energies into finding real work. Then there were the ones who heard voices – and answered back, who dug through the trash dumpsters looking for food, who hauled recyclables to redemption centers, who ran up to your car with squeegees when you stopped at a traffic light to clean your windshield in exchange for small change.

Almost anywhere you turned they were there.

It was relentless.

Under a 1981 consent order requiring New York City to ensure basic shelter for single homeless men, then-Mayor Ed Koch responded by sending thousands of homeless into barracks-style shelters and single-room occupancy hotels , more commonly referred to as SROs.

During the day, the homeless were out on the streets, panhandling, collecting recyclables, wandering around aimlessly, riding the subways or hanging out in public libraries when it was too cold to stay outside. At night, many of them returned to the SROs, if they were lucky enough to get one of the limited spaces, or to the barracks where one might have to sleep with one eye open to hold on to any belongings, where fights were common. Some homeless men refused to go to the shelters because they, too, feared for their safety.

By 1987, under fire for a growing population of mentally ill homeless on the streets, Koch ordered the city to round up the homeless mentally ill and to take them to hospitals for examination and possible treatment.

The ACLU filed suit, arguing that while the city should make psychological health services available to the mentally ill homeless, it should not force them to take medication or be institutionalized against their will.

A political struggled ensued over how to assist the mentally ill and ensure public safety.

Koch ended up creating a cumbersome bureaucracy that long defied reversal, creating problems with which successive Mayors David Dinkins, Rudy Giuliani and Michael Bloomberg have wrestled with varying degrees of success.

According to the National Coalition for the Homeless, there are about 3.5 million homeless people in the U.S.; 16 percent of them have some degree of mental illness. In light of rising general homelessness caused, in part, by the current recession, the lack of affordable housing and tight local and state resources, some have begun to wonder if something like this happen again – if not in New York, then elsewhere?

Andrew Sperling , director of Federal Legislative Advocacy for NAMI, the National Alliance on Mental Illness, said the weight for addressing the homeless mentally ill is going to be on state and local governments.

Sperling, who leads NAMI’s legislative initiatives in Congress and before federal agencies, said the current health care reform debate is focusing on mental health parity – ensuring that private group health plans cover mental health treatment the same as any other illness.

“It’s not a question of what’s lacking in this bill,” Sperling said. “This legislation is about controlling health care costs for businesses and individuals and families, expanding coverage to those who don’t have it and making it affordable for those who do have it.”

Mental health coverage – especially for the homeless – is dealing with a separate set of issues, Sperling said, including affordable housing and access to treatment.

“It’s a huge state implication.  The question is how public mental health will work with people who won’t come voluntarily to mental health treatment….That’s a state issue,” Sperling said. “Most of this is outside the health care reform legislation.”

E. Fuller Torrey, M.D., founder of the Virginia-based Treatment Advocacy Center and a research psychiatrist , said he finds the lack of major mental health initiatives in the current healthcare reform debate distressing and that what he sees as a crisis in mental health will simply be exacerbated as a result.

“I’m not optimistic that it’s going to have much of any effect for people with severe mental illness,” Torrey said of various healthcare reform proposals. “None of them have addressed this issue and none of them seem interested.”

One bill, he said, would deny federal assistance to anyone being treated in a state hospital, but would provide it for anyone not receiving treatment from a state institution, “which has been a large incentive for state hospitals to dump patients into the streets.”

Interestingly enough, New York City may be in better shape than a number of places to address the issue, Torrey and Sperling both said, because of a state law that provides for court-ordered assisted outpatient treatment (AOT) for certain people with mental illness who, in view of their treatment history and present circumstances, are unlikely to survive safely in the community without supervision.

Kendra’s Law, as it’s more commonly known, was passed by the state legislature in 1999 following the death of Kendra Webdale, who was killed when a man with untreated schizophrenia pushed her in front of an oncoming subway train.

Without a national agenda on mental health treatment, Torrey predicted, many states would be wrestling with substantial increases in the number of and funding treatment for the mentally ill homeless and mentally ill prison inmates.

Part of the problem, Torrey said, is the lack of political will in dealing with a complicated and expensive issue.

“Few public officials have taken it on,” he said. “Are you going to increase your chances of being elected governor of Virginia by taking on this issue? “

Sperling said he is decidedly more optimistic that as the issue of healthcare coverage for all Americans becomes more available, that mental health and the related issues of access to treatment and affordable housing for the homeless mentally ill will also be addressed.

“I think the Democratic leadership in the House and the Senate and the Obama administration are trying to keep an eye on that.”

Jackie Jones is a freelance writer as well as a career and fitness coach for those who want to get their lives in shape.  Her website is www.jonescoaching.net.