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Comment by brianmcconnell | Hacker News Reader

I moved to SF in the early 90s. I think you can pin the large homeless population on several things. One is the climate. If you had to pick a place to be homeless, this would be one of the best places. Another is it is relatively safe compared to other cities. But most importantly you can blame Ronald Reagan for dismantling the states mental health infrastructure. Institutionalizing people has its downsides, but its more humane than letting people overdose on a sidewalk. It also doesn't help that other municipalities have a habit of dumping their social services burdens on San Francisco (one way buses from Nevada, etc). I don't see anything changing until we have a national or at least regional mental health system that can actually deal with the scale of the problem.

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But most importantly you can blame Ronald Reagan for dismantling the states mental health infrastructure.

Please do some reading on this. Your comment is a gross oversimplification and ignores a lot of other factors, namely the fact that institutionalizing people against their will was regarded as inhumane. Mental health was defunded after it was decided to release these folks. Just like in most western countries.

Care to point towards any resources, authors, or links for those of us who might want to do more reading of our own? Seems like you have some knowledge on the subject, these would be much more helpful.

American Psychosis is an excellent book on this topic.

http://www.nytimes.com/2014/01/14/health/american-psychosis-...

My mother, as first a nursing resident, and then a nurse anesthetist in the '50s, saw the most important input into this process, the "major tranquilizers" AKA first generation anti-psychotics, which came into wide use in-between those two, she was astounded one day when she saw a "hopeless" patient she knew from her 3 months residency in a psych ward working in the same hospital as she was, in some custodial or runner role.

But I strongly suspect he had an informal network in that hospital, which made sure he took his nasty meds (and they are nasty, I had to take Zyprexa at full strength for a while to end a hypomanic episode caused by a doctor prescribing a drug which turned out to be a big mistake, and then not realizing it for a month until my GP noticed and mentioned this to him over lunch; if you're worried about this happening to you, and all sorts of drugs can cause it, keep a diary of your sleep, and if it e.g. has an entry of 3 periods of 30 minutes, seek competent help fast, uncontrolled like this mania is serious medical emergency, and insidious for the patient suffering from it).

See, the thing was, after millennia of psychosis being untreatable, and soon bipolar disorder falling to lithium carbonate, we'd achieved a true miracle. But the transition to a new management regime for these particularly severe disorders was utterly botched. It started with a commission in the '50s, leading to Federal legislation signed by JFK less than a month before his assassination, and only 4 years later does Reagan even come into the picture, seeing as how he wasn't even a position of power until 1967 (read the bare facts in the intro to this article: https://en.wikipedia.org/wiki/Community_Mental_Health_Act).

In short, blaming it on Reagan is Not Even Wrong; a wonderful opportunity for humane treatment of the most mentally ill was botched for a bunch of reasons, and he was only following the scheme "The Best And Brightest" came up with before its failings became all too apparent, in part due to the ACLU and willing courts eliminating the necessary force to make it work, e.g. forcing people to take their nasty meds or otherwise get fully institutionalized again.

A cynic would also note that redirecting money from mental hospitals to transfer payments was a much better way to buy votes.... And it's still happening, in the last year or two Missouri Governor Jay Nixon shut one down for the "retarded" just a bit north of me.

Thinking about this further, the ACLU and the willing courts that followed its lead were all that was required to create the current even more inhumane system for our most mentally ill:

It doesn't matter if the venue is a state mental hospital or a community mental health center, if neither can force a patent to take their meds and otherwise get necessary treatment, or in the former case even stay in the hospital, then neither has the slightest chance of working.

And once that's true, and you're only allowed to pretend to take care of them, heck, you might as well fail in the cheapest way, which would be community mental health centers.

Sort of like how outsourcing can "work" for corporate software development projects: most of them fail, either outright or by not delivering even if they're declared to be a victory, so failing more cheaply by outsourcing can make sense.

I'd start with Willowbrook, which was a rallying point for getting rid of institutional care.

https://en.m.wikipedia.org/wiki/Willowbrook_State_School

It's a really complex and sad issue.

Actually, what _you_ should do is have first hand experience of dealing with a good friend in the midst of a severe drug addiction crisis (who can't phone mommy and daddy for help with rehab). It was impossible to get him committed for any length of time, even after he set fire to someone's house. He would have been way better off if he had been on lock down for 3 to 6 months, but instead had to completely destroy himself, lose everything, get thrown in jail, etc. He's just lucky he didn't end up in our shadow mental health system also known as state prison, which happens to an awful lot of people whose only crime is to be mentally ill and poor.

The ACLU was pivotal in forcing through the policy changes. They even take credit for it on their website: https://www.aclu.org/other/aclu-history-mental-institutions?...

I do have first hand experience with a family member who needed real mandatory mental help. We could not do anything for years until she tried to kill herself.

Ideological organizations often lose sight of basic human realities, or fight to end one ill only to birth another.

Edit: Deleted my earlier comment, as I misread yours.

Regarding what you said: The GP is not disputing the need for mental health institutions. He is pointing out that the ones that existed were horrible, to the point that closing them down was better than running them.

At the moment, too much of mental health is being handled by prisons. Whenever I read from people who study the problem, they all agree that:

1. It shouldn't be the prisons' responsibility.

2. The prisons are doing a better job than the mental institutions that were shut down.

Your first point is correct, but your second lacks clarity of insight.

If one were to read the history behind why the Reagan administration dismantled the mental health system, one would know that, in fact, what Reagan allowed to happen was a state sponsored ignorance of block grants that were initially allotted for the purpose of establishing local administration of mental health care. Reagan's mouthpieces said this was a wiser (letting states handle the money) way than Federal action to implement the plan Kennedy had initiated after witnessing his sister's incapacitation from her own 'treatment'.

The Reagan bunch then turned their heads and coughed while states deliberately ignored the intent of the money and spent it elsewhere, and did not, in fact, build mental institutions for short term treatment and release (with periodic checkups) that Kennedy's plan had described in exquisite detail.

To malign the intent and say that prisons are somehow better than the mental health treatment that was being administered is to suggest there was no alternative, which is implicit in your defense, though certainly not directly expressed. I seriously doubt you have spent any time in a correctional facility or mental hospital because you would then know that prisons are quite literally the worst place for a mentally ill person to be. Better they be homeless an under the care of the shelters and soup kitchens than locked in a concrete cell with hundreds, if not thousands, of undernourished, maltreated, and relatively unsupervised bangers.

There is the slimmest veneer of an attempt to rehabilitate addicts and/or treat mental illness within these facilities, but God knows there have been PLENTY of attempts for several decades to realign the institutions such that they are congruent with our understanding of what constitutes psychological healing.

It truly WAS Reagan's administration that put the decision to opt-out of locally 'sourced' mental health treatment in ultra conservative governor's and their respective cabinet advisors' hands.

Let us not obfuscate what the worst ever was with what may have been were cooler heads to have prevailed.

And what you should do is have first hand experience dealing with a poor or non-white or politically active person locked up in a hospital an declared insane for backtalking to a police officer or government official.

I was born in a country where declaring people insane and involuntarily committing them to mental hospitals was standard operating procedure for the secret police to shut up dissidents.

I think America has the right idea here, frankly. You should not be imprisoned by the state unless you are openly convicted of a crime.

The evidence seems to suggest that the people the state wants out of general circulation fare no better when they're tossed in prison or otherwise hounded/destroyed.

You also require doctors acting as criminals, with weak oversight to make your fears come true, in addition to a criminal government. If a government goes really wrong, and wants you out of the way, they'll get their way. Jean Seberg for example, didn't need to be locked up to be destroyed. We didn't need to lock people in hospitals to ruin their lives, we just used a blacklist.

You shouldn't be so frightened by your personal history that you lose sight of the fact that the root cause is a government out of control, not the means they use.

Then America should stop throwing people in prison for refusing to hand over a share of the currency they receive in private trade to pay for the goods and services the homeless receive from government organizations.

You can't impose authoritarianism to force productive people to support the poor, and then act sanctimonious about committing the mentally ill and drug addicted who contribute nothing to the economy.

This literally only makes sense if money/the economy is the only thing you care about.

Refraining from throwing people who have not violated anyone's rights in prison makes sense if you care about human rights.

You seem to throw all concern for human rights out the window when the object is to take someone's money from them.

Or... y'know... I care about people as a whole more than I care about a rich minority's desire to become a bit richer.

The interests of 'people as a whole' can be used to justify both (compulsory treatment leads to less drug abuse and fewer homeless, compulsory income redistribution leads to more funding for the homeless, respectively), so really what you're saying is that it's okay to throw rich people in prison, but not poor people.

That's what your 'value system' comes down to. Knee-jerk judgments on moral value and rights based on whether a person is successful.

It's very easy to pay taxes. People do it all the time, and it's pretty well documented how to do it. Worst case scenario, you miss something and pay a bit more than you might otherwise have to. I don't know of anyone who's paid taxes properly and been thrown in prison for paying taxes. Hell, if you look like you might be trying to make an honest effort to pay taxes and got it wrong, you can pay them after someone catches you!

It's not very easy not to have a mental illness. It's not something you choose to do. See the difference? One is putting you in prison for something you very easily could've avoided - the other is putting you in prison (because that's what compulsory treatment really is) for being a human being.

Here come the rationalizations for your favored brand of authoritarianism.

Human rights violators always think that their particular authoritarianism is justified.

It wouldn't be so bad if you didn't simultaneously admonish those who support authoritarian laws to force those who are massively abusing drugs to the detriment of themselves and the rest of society into treatment.

I think we will disagree forevermore on whether or not property and money are the most important things in the world.

No, we disagree on whether it's okay to throw someone in prison for not handing over their money to you, and whether it's okay to rationalize this form of authoritarianism, while admonishing the much more sensible authoritarian policy of forcing those with severe drug addictions to stop putting themselves and the rest of society in danger by getting treatment.

Reasonably sure we don't. We disagree mostly that your specific definition of property is a thing that should be considered a human right at all.

Unlike most other human rights, the only reason that property is considered one is to prop up capitalism and prevent experimenting with alternatives. Property doesn't exist to the extent it does today without Government intervention - the alternative is that nobody owns anything aside from that which they can defend personally by force. Property is thus subsidised by Government - Government says that in return for taxes, they'll keep some concept of property separate from the concept of whether or not you happen to have enough firepower to defend it. This, of course, doesn't actually work unless the Government is powerful enough to take down any group which might want to steal your property.

There are various alternatives to this Government-subsidised definition of property, some of which have been tried out small-scale, some larger scale. I'm not really sure why one specific definition is encoded into your definition of human rights (which, of course, doesn't match any human rights treaty currently in force anywhere).

On the bright side, with enough firepower, you can defend yourself from the Government and essentially become your own country and do whatever you want. Wee!

No we disagree on whether throwing a person in prison for refusing to hand over something they receive in private trade is a human rights violation.

It goes beyond even this. Income and sales tax laws require a person to surrender their privacy rights, and disclose how much currency they received in private trade, and from what sources, or be imprisoned. You don't consider this blatant authoritarian violation of privacy rights to be a human rights violation.

You define actions that are clearly human rights violations as not being so, because your ethics are purely designed to rationalise your political ideology, as opposed to consistently defending people's rights.

You're also not above misconstruing the debate and misframing your correspondent's position in an attempt to disparage them while evading their criticisms of your position.

So you only drive on toll roads and went to a private school?

If it had been a decision concerned with "humane" considerations, there would have been a transition to outpatient treatment, family resources and education, and generally an attempt to change rather than destroy the mental health infrastructure of a country.

The result, which is an ugly combination of the profoundly mentally ill being incarcerated in jails and prisons, often among the general population, and homelessness, is hardly a decision calculated to improve anyone's lives. The population of people with schizophrenia living rough in this country also testifies to the lack of humanity in both the decisions that were made, and total lack of concern for people once they left an institution.

Now, we have to act shocked every time the Jared Lee Laughners of the world act in a tragically predictable course and murder a group of people. It's not shocking, it's predictable; when a family can't do a thing for a loved one who is falling apart in front of their eyes it's true that most of the time it only ends badly for the sick person. Sometimes though, it ends badly for society as a whole.

> Please do some reading on this.

I really wish people wouldn't use this line in HN comments. It shuts down meaningful discussion by implying that someone would see things your way if only they were more well informed. Maybe they have done the reading and don't agree with you.

Even better, which is what prompted my comment: if you're speaking in dissent, asserting there's more to a story, please for the sake of other readers who may so be inclined to learn, do more than drop a one liner as if this concludes all counterpoints of debate.

a reference would be great!

> But most importantly you can blame Ronald Reagan for dismantling the states mental health infrastructure.

Again, with this.

Any time the "Reagan dismantled mental health!" argument comes up, all I can ever find are references to the Lanterman-Petris-Short Act - which was co-authored by Democrats, and followed the accepted medical advice of the time - and vague accusations of acts by a Congress more often than not Democrat-controlled under Reagan's tenure.

What specifically did Reagan himself do?

They all were following JFK's (and Eisenhower's) Best and Brightest, as enshrined in the Federal 1963 Community Mental Health Act (https://en.wikipedia.org/wiki/Community_Mental_Health_Act), all that done back when he was on the "rubber chicken circuit" for GE; he had no political power until becoming governor in 1967.

Not so sure about the mental health part. The article uses Bangkok's low homeless population as a counterpoint to San Fran's homelessness. I was born and raised in Thailand and occasionally visit or have Thai relatives over. I would say in Asia, mental health awareness is pretty nonexistant. The fact that they have a low homeless population and low mental health awareness does kind of refute your mental healthcare point imo.

I think it's the fact that in Thailand, as the article mentions, there is a lot of gray area between "poor" and "rich". There's not many super wealthy people and not many super poor people. There's more of a "middle poor", "average", and "middle-rich", and the "middle poor" get by pretty well because of how cheap everything is. Healthcare is also dirt cheap compared to America, so you can get medical care for basic stuff and pay like $20 for it. My parents have even thought of doing some medical tourism to Thailand to do dentistry stuff because its just so damn cheap. Oh, one more thing, motorcycles are the poor man's transport, and just like everything else they are also dirt cheap. Cant afford rent? Well you can just go and live in a basic shack because a lot of people do that anyway. So yeah, if you're poor in Thailand you will generally get by pretty well because everything there is relatively cheap.

In America, it's either you are above the average line or you sink to the bottom. Like, if you don't make enough money, you can't expect to pay rent and then have money for food/healthcare/car. And in America, you NEED a car. How are you gonna get from San Fran to LA if you have a job interview? Taxi is out of the question, trains are 200+, buses dont arrive early in the morning. So the only answer is a car. Oh you have a problem with drug abuse? Are you poor and cant afford health insurance? Then hospital or rehab visits will cost thousands. Cant afford rent? Guess you're homeless.

It's a brutal system we have in America honestly. Lots of tech innovations, lots of good economics in Silicon Valley, but honestly it just sucks to be poor here. You need to be hovering in the neighborhood of the high GDP per capita if you want to survive. In Thailand, the GDP per capita is low enough that most people are near it, and the rich can enjoy a luxurious lifestyle with housemaids and stuff.

>...One is the climate...

71% of homeless people were living in SF just before becoming homeless. Only 10% come from outside of California (and its climate)[0]

This pretty clearly shows homeless has alot more to do with the cost of housing relative to wages jobs then good weather.

[0]pg 33 of http://sfgov.org/lhcb/sites/default/files/2015%20San%20Franc...

It shows nothing of the kind. Perhaps, if you were living somewhere with a lethal climate, and you became homeless, you would leave.

Or perhaps you would stay, thinking "homeless presence has nothing to do with the weather", and die. In either of those cases, the weather has shrunk the homeless population.

I thought Reagan had little choice since the Supreme Court ruled forceful institutionalizations deprived people of their civil rights if they weren't an immediate threat to themselves or others.

There was a choice to fund education for families and former patients, and attempt a transition to outpatient care. Dumping them on the streets and into prisons most definitely was a choice.

None of that is specific to San Francisco.

All of South California and North California has great weather, including other big cities like LA, San Diego, San Jose.

As to crime, I don't have the stats but again I doubt SF has meaningfully lower crime rate than other cities. Generic "crime stats" are pretty meaningless anyway. I doubt anyone keeps stats that would be specific to homeless people (we have stats for "homicide rates" but not "homeless homicide rates").

And even if Reagan is to blame, it was a national thing, so doesn't explain why San Francisco has more homeless.

Reagan was governor of California before he was president.

And California has had both assembly and state senate dominated by Democrats for 50 years or so.

The republicans earned their way to obscurity with Reagan and the likes of Pete Wilson. It goes without saying that the governor can do a lot of damage in California.

SF spends $241 million on homelessness. Per year. The reason SF has so many homeless is because it provides the most services, the most programs, the best support network and a sympathetic population (not to mention rich tourists and locals to panhandle from, and a good mix of urban and park areas).

> One is the climate. If you had to pick a place to be homeless, this would be one of the best places.

My experience here in Portland OR seems to reflect the same feeling on this. During the spring/summer months the homeless population explodes... then they move down south for the fall/winter seasons.

When you don't have a home, cold and damp are literal killers.

It's been about 40 years since Reagan was governor of California. Using him as an excuse for conditions today is a bit bizarre.

I've never seen any city with a homeless population like San Francisco's and I've been to much poorer places. Side by side with the artists and web developers is a parallel tent city, and it seems to have a lot of mentally ill, people with drug problems, and traumatized military veterans. People who in any other nation would be taken care of.

Simply put Americans don't seem to care very much about other Americans.

> I've never seen any city with a homeless population like San Francisco's

The other west coast cities have massive homeless populations, too. LA has largely cleared the homeless encampments out of areas they are trying to spruce up (the revival of downtown LA and all that), but I've seen camps in LA rivaling those in SF. Portland and Seattle also get pretty large homeless populations during the spring and summer, although the homeless population drops precipitously during the rainy season up there.

Simply put Americans don't seem to care very much about other Americans

Now there's a vast oversimplification if there ever was one. Using SF, which is highly anomalous economically and socially, to extrapolate out and project it on "Americans" and their attitudes toward poverty is a lot like saying the City of London's particularities are the same as the rest of England.

It's kind of true, though. Compared to other developed nations, the US is a country that doesn't care if you get sick or die. It's about as social-Darwinist as it gets. SF is even much more liberal than the rest of the country, so it's a best-case.

Don't mean to be inflammatory, just how I see it having traveled a lot. It's wonderful to be rich in the US, you can get anything you want, but there's no sympathy for the poor or unfortunate or social underclasses (immigrant labor, etc) at all.

Having lived in chicago, DC, San Diego, and visited NY, philly, LA, honolulu and baltimore, extensively, and volunteered among the homeless in SF, SD, DC, and Fargo - SF is much worse than the rest of the country.... Except maybe Baltimore. I think the US had a long tradition of taking care of the downtrodden outside of state-run institutions. This tradition was slowly dismantled starting at the beginning of the progressive movement (1920s-1930s through FDR) in favor of having the state run things. The net result now is that the state runs things poorly, and people now think that there is no longer any need for private charitable action, because government will deal with it.

You make a point about SF/America being Darwinist. Compared to the European socialist countries, Canada, Australia, it's a stark difference.

Is America too big of a country to be able to fix this?

It'd take a dictator to fix the USA. I think I could do it, but it wouldn't be peaceful.

Simply not true. City of SF spends a lot of money on social services specifically for homeless people. So it's not that they don't care if people get sick or die. In fact, it seems like they care a lot, based on dollars spent to try and alleviate a problem that is very tough to mitigate.

Portland's homeless problem is supposedly vastly, vastly worse than San Francisco.

What does it mean to "take care of" our homeless? House them? Who is willing to pay $3k/mo rent per homeless person?

In a third world nation, the "homeless" in San Francisco would be allowed to build a shantytown and would not be considered homeless. I'm not trying to minimize the real issues of poverty, but you can't avoid the fact that part of the problem is that regulation/civilization/whatever you want to call it has disallowed poor housing.

   >Who is willing to pay $3k/mo rent per homeless person?

If someone is willing, I just because homeless.

I know, right? I've been running a entrepreneurial business for nearly ten years, and lost my payment processor (still owes me for two months of sales) because they went out of business. I'm trying to get a Patreon to bring me in $800 a month and failing, even though I'm now giving away the products for free to try and scare up quantities of people who can spare a dollar a month.

I consider myself pre-homeless at this point.

"Simply put Americans don't seem to care very much about other Americans."

You hit the nail on the head. What else do you expect from a society that won't even provide the option of healthcare to its citizens, that has massive industries whose sole purpose is to profit off the sickness and death of others, and that incarcerates over two million people at any given time, many for ordinary, everyday activities or mental health problems? It's a reflection of the people and many of the people are stupid, cruel, hateful, and puritanical to the point that they will do anything within their power to stop others from enjoying life. For example, the next time you hear someone talking about something they don't want their tax dollars going to, listen carefully to what they're saying. Rarely will it be the unjust wars we fight or other horrors like that, and often it will be others' well being and health. Or just talk to any Trump supporter (or almost any Republican at this point).

Please don't post angry political boilerplate to HN. It turns every thread into a generic shouting match.

So which part should I censor again?

Moderation is not censorship: http://www.wizzu.com/corrs/moderation.html

(I am not a moderator, of HN or of anywhere else, but it's the same principle)

"People who in any other nation would be taken care of."

The US actually spends far more than almost any other country in the world on programs for the poor. In many of the countries with less homelessness/drug-addiction, there is very little social welfare spending, and drug addicts are enrolled into compulsory treatment programs, something that has been deemed a human rights violation in the US.

Government in Thailand for example spends FAR less on social welfare programs than government in the US, but it has compulsory treatment.

I think "One Flew Over the Cuckoo's Nest" had a lot to do with this as well.

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