When asked by young psychiatric residents what I have seen over 40 years of the practice of psychiatry in Massachusetts, I respond that the abandonment of our most seriously ill patients has been the most stunning. Starting with overzealous deinstitutionalization, we have abandoned the concept of asylum in its most positive sense — the protection of those who cannot care for themselves.

Reagan-era block granting of mental health funds contributed to the fragmentation of services that previously had been provided by comprehensive mental health centers. It will take a major rethinking of how we provide and fund mental health services to correct this unacceptable situation.

Dr. Eugene J. Fierman

Brookline