When we spoke he seemed confused. His name I learned was John. He was pale with long shaggy brown hair and sunken eyes. I judged him to be about 30. I suggested he needed to go to a warmer place; he seemed not to understand. I told him I would try to find something warm for him and returned to the supermarket.  They were closing, but a young clerk immediately understood when I explained the need to cover the guy outside. He said the man had been there for days. Just sitting and staring. The woman in the meat department said she had left him some money as she left the previous night.  The clerk noticed there was a policeman in the store at the manager’s counter buying cigarettes.  The clerk had given me some sheets of plastic used for carrying meat carcasses.  It was 8 p.m. on New Year's Day, and the shop was closing.

I spoke to the officer and explained the situation. I said the man appeared to have mental illness and required a psychiatric evaluation and shelter.  He appeared not to understand the danger he was in by sitting in the cold and that he was in danger of dying from hypothermia.  The officer said he couldn't take the man in unless there was a "code blue”; the temperature had to be below freezing before you could take someone in. He explained he couldn't violate the man's civil rights. I countered that if the man was a danger to himself by not understanding the need to seek shelter, he would die.  He said that he had orders not to bring anyone in unless they wanted to go.  We walked over to John. The policeman spoke to him briefly. "You want to go to the station?" John seemed not to hear. The policeman said as he walked away, opening the pack of Newport that he had just purchased, "He don’t want to go. There’s nothing I can do unless they call a 'Code Blue'."

There is not a good ending to this story. Calls to a crisis center at a nearby hospital were also unsuccessful.  This story is repeated across our country throughout the year as many homeless persons die on our streets, (Wind and Cold Are Blamed In Three Deaths, NY Times, Jan. 16). Unlike children who die as a result of abuse, there are rarely calls forinvestigation by our elected representatives when persons with mental illness die as to how our public mental health system has failed. Currier’s finding (Currier, Glen, Psychiatric Services, January 2000) that mortality among persons with mental illness has tripled since the onset of psychiatric hospital closing should be a wake up call. Such an astronomical increase in mortality for this group should be of concern to all.

It is good that next year we meet in Boston with a theme of Public Health and Human Rights. Perhaps we will also consider what needs to be done to repair our fragmented and dysfunctional public health system to prevent homelessness and mortality among those with serious mental illness