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"Kill," he whispered.

"Kill?" I swallowed hard.

"The voices are telling me to kill . . . people."

"Anyone in particular?"


"Do you think you'd be able to control these thoughts?" My brow and palms were now beginning to sweat.

"I don't know."

Daniel had just been admitted to a hospital in New York City where I was training to be a psychiatrist. He was a muscular young man. His fists were clenched, the muscles around his eyes were taut, his eyes were fixed and glaring. His shoulders bulged beneath a lime-green tank top.

When I introduced myself to him, he shook my hand only with uneasy hesitation. I would have been terrified to meet him in the street.

Daniel was schizophrenic and homeless. Six months earlier, he had been hospitalized after stopping his medication, but he was soon discharged again and told to find his way to a shelter. He had nowhere else to go. There were long waiting lists at all of the residential programs he would have been eligible for.

I ordered Haldol for him -- a standard antipsychotic drug. Donna, a nurse, poured it into a paper cup. He stood at the counter of the nursing station and took a small sip, then put down the cup, most of the liquid drug remaining on the bottom.

"I've had enough."

"You have to finish it," Donna said.

"No, I don't. I don't want to."

We were at a loss for words. The intern and several other nurses now joined us. Patients began to gather and watch as well, some supporting him, others angry that the staff wasn't controlling him more.

"Why won't you take the medicine?" I asked him. He looked up, saw he was surrounded, reached for the cup and chugged the remaining fluid. I sighed in relief. He walked away.

During the night, he began to calm down. Over the next few days, with much encouragement, he continued to take the medication and felt better.

But after a few days, he began having stiffness and other side effects, and stopped taking the drug. I ordered another medication to control the side effects, but he refused both, and the voices started to return.

The following morning, Donna arrived at work, put her key into the lock on the stairwell door, turned the bolt, and opened the door to enter the ward.

Daniel, hearing her from the hall, suddenly raced over and barged through the narrow opening, hurling her to the ground. He flew down the stairs and out.

I phoned his mother and the police.

A few days later, we got a call from a state hospital that he had just been admitted. Luckily, he had not hurt anyone.

This incident, seven years ago, still haunts me. The problems faced by the mentally ill -- and those who care for them -- have not gone away, and they are about to get a lot worse.

Gov. George Pataki is calling for drastic cuts in the State Office of Mental Health budget as well as Medicaid.

As the Legislature takes up the governor's budget, it is vital that our representatives remember patients like Daniel and recognize the potential cost of undercutting the already fragile support system that exists for them.

Aside from calling for deep budget cuts and layoffs at hospitals and outpatient and research programs, Pataki also wants to limit Medicaid coverage for hospitalization of patients to 60 days per year at all city and not-for-profit hospitals.

Thereafter, many patients will be turned out. They can't simply be sent to state hospitals -- those are being cut back too. Yet more time is often needed for seriously disturbed patients like Daniel to become stable.

Often it seems that the mentally ill only get attention when they threaten the rest of us with their behavior.

ROBERT KLITZMAN, a psychiatrist at Columbia University, is author of "In a House of Dreams and Glass: Becoming a Psychiatrist."

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