I read "Mentally ill patients stuck in E.R. limbo" (April 18) with a nod and a tear.

I am a battle-tested community-based mental health social worker. I work with clients who have been diagnosed with severe and persistent mental illness. My team includes a psychiatrist, two nurses, vocational and dual diagnosis specialists, mental health practitioners, and professionals all trying (and often succeeding) to keep patients housed, healthy and out of institutions. I provide those high-intensity community-based services that were an integral part of the deinstitutionalization plan in the 1980s.

I am supposed to be a part of the solution. But I am also part of the problem.

One of my clients is referenced in the article. He could be a poster child for a broken system. He faces four criminal charges in four metro-area counties, all related to behaviors from being un- or undermedicated. He is chemically dependent and homeless.

I check hospital and jail rosters frequently to see where he will surface next. He would benefit from having a permanent home, but due to his extensive record, few if any landlords will touch him. The overcrowded hospitals resort to "catch and release" to ease their logjam of patients.

As a result, the hospitals are quick to discharge clients who have case-management teams like mine. But once my client has been returned to the street, he will often use drugs, become more symptomatic, and end up doing something illegal that lands him back in jail and/or the emergency room. There he sits until he is released and the cycle continues. He's not getting any healthier. We struggle to be effective for him, and it costs all of us.

While our interdisciplinary team is an effective model, there are not yet the structural supports to assist us in stabilizing these high-need clients. Each of us has thought momentarily of strapping a client to our bodies to keep them safe and accessible while we try to facilitate keeping them in the community.

I am a proponent of more options for transitional-care community beds. We need someplace where people can safely restabilize on their medications, with supervision, be accessible to service providers and be off the street. This is not the end answer, but it would give everyone a chance to take a deep breath and coordinate their efforts.

I am grateful that the governor is finally allocating real money to help these problems. I believe keeping as many people in the community as possible is the right thing to do and more fiscally responsible in the long run.

Molli Slade, of Roseville, is a social worker.