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Comment by 6t6t6 | Hacker News Reader

Is there any way a person with a mental illness get a proper treatment in US?

I mean, for some one who is unable to work because he has, for instance, schizophrenia, clinical depression or alcoholism, is there any option apart from indigence?

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I think it's all but impossible.

Anecdote of one: I went through a period of un/underemployment a few years ago. So I had no health insurance. My state, Colorado, has an indigent medical care program. I went to their office, filled out the forms, and I qualified.

But in the six months that I tried, I was never seen (and I had an issue, not mental health, but it could have been anything). You cannot get any issue seen to until you've first seen an intake GP. There are not enough GPs available in the system. And there's no wait list, you have to call every day to see if there's an opening. After some months I gave up.

Fast forward, another anecdote of one: I'm in a great job with great benefits. I got depressed. I found a doctor immediately, made an appointment for the next day, and I'm now being treated. Easy peasy.

After money, the most important reason to have a job is health insurance. The ACA makes this a little easier, but you still need money to pay for your affordable policy.

Money.

If you run out of money or health insurance getting properly treated for mental illness is impossible. Once you lose your job due to mental illness you eventually go on disability and once this occurs it is a long spiral downward. This is due to the elimination of funding for the mentally ill.

Jail and/or prison. That is where many of them end up. Some judges would rather see someone get "treatment" in custody than get nothing on the street.

Jail is different from prison how?

Roughly Americans use prison to refer to places where people are held after being sentenced, and jail to refer to where people are held before sentencing. Or sometimes jail refers to short sentences.

http://www.hg.org/article.asp?id=31513

In England we'd tend to use prison or jail for prisons and "on remand" for people awaiting trial or sentencing, and "police cells" for other stuff.

In the US a lot of prisons have high populations of people with mental illness. See, for example, the use of prisoners to care for other prisoners who have dementia.

http://www.nytimes.com/2012/02/26/health/dealing-with-dement...

Jail is for pre-trial sentencing and sentences under one year. So many of the people have not been convicted. Jails spend most of their energies sorting people into various risk categories. There are few if any 'treatment' programs in jails.

Prisons are where people actually serve meaningful time. Everyone is in for at least a year and everyone is an actually convicted criminal, not just someone awaiting trial.

> Jail is for pre-trial sentencing and sentences under one year.

In California, specifically, since the recent prison realignment adopted to address Federal court orders with regard to California's overcrowded state prisons, that is substantially less true than it used to be; many non-serious, non-violent, non-sex offenders sentenced to more than one year are now sent to county jails, and population pressure resulting from that has reduced pre-trial detention in many county jails, as well.

There is some wiggle room. The one-year thing is more to do with how much time one is expected to serve, rather than the sentence. Time already served can also alter the math. So someone spending 6-months in jail pre-trial and then sentenced to 14 months would normally be sent back to jail as they only have 8 months remaining. And to your point, where it is very unlikely that someone will server their entire sentence prior to parol, they will normally do that time in a jail.

This isn't always a bad thing. Some convicts would rather not be moved to a new facility. Jails are normally closer to the place of arrest (usually near home) and by the point sentencing happens families have already developed some sort of routine for visitation. Sending them out of town, even if to a better facility, is not always in the inmate's best interest.

Depends on the jurisdiction, but generally (there may be some variation even in these high-level descriptions) in the US:

Jails are operated by counties, prisons by the State or Federal government.

Jails are for pre-trial detention and serving sentences for less-serious crimes, prisons for sentences for more serious crimes.

In context of US: http://sheriff.org/faqs/displayfaq.cfm?id=4f892698-5c5d-40f8...

There used to be, no longer. Good news in that the problem is solvable, but bad news is that the problem is political and the situation isn't likely to change.

probably not much less than in Europe. While people like to assume that these issues do not face European countries a simple search of google shows its a problem in almost every western nation.

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