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Comment by dilap | Hacker News Reader

> “treatment is a right,” and that “to withhold treatment is cruel.”

That's quite the Orwellian double-speak for incarcerating & drugging people against their will.

I agree but I have a close family member who has been struggling with something similar her whole life. Luckily between disability and family she has never been homeless but for about three decades she was only part time living in reality. It would take getting arrested for making a scene somewhere and court ordered back on medication for her to come back. Luckily she has been doing awesome for long time now, even holding a volunteer job, not sure what the change was. If she was never court ordered I don't think she would have ever came back.

Then again I'm not sure who can be trusted to decide if someone is making decisions based on reality or fantasy.

As a counter-anecdote, I know a mentally ill person (mostly functional, luckily, but he gets paranoid delusions during the worst times). His family pressed the doctors hard to have him involuntarily committed one time since he refused to go. From what I can tell, the primary effect of that is that he now has an intense distrust of doctors and those family members, and it would be a lot harder for doctors to help him now, even if they tried to approach him with more empathy.

The only people now who can sometimes talk him down when he's having problems are me and a couple of other family members that did not participate in pushing for involuntary committal.

What I struggle with personally is the question whether it is for us to decide what constitutes 'better off'. Perhaps for some homeless people the best life they can have, at least within our current, flawed system, is on the streets.

Part of the reason why I'm struggling with this question is that since about a year it also applies to me, to an extent. My problem is unrelated to homelessness, but it seems clearer and clearer that the solution that works for me (read: makes me happier and more 'functional' than anything else I've tried) could be considered by many people to be 'worse off', and consequently eligible for some degree of intervention, simply because they are not like myself.

There are no easy answers to these questions, but I feel such answers start with compassion and active engagement with and understanding of those whose lives we are 'managing'. Social workers probably qualify, and the managerial class are probably the last to do so.

Well, that enters into an existential question of what "will" is, at least when someone suffers from extreme forms of mental illness.

EDIT: Also, I haven't read the original pamphlet, but not treating chronic mental illness is often cruel to the other members of the community even if it's not cruel to the individual in question.

Regarding your edit; how so?

Because those members of the community now have to deal with the fallout of a mental patient causing problems, and they are powerless to change that situation.

It varies depending on the person, but I've seen: threats, fraud, assault, theft, and emotional manipulation. Isn't it harmful on many levels, when the smell of a person can clear out an entire train car? I'm not sure "respect" is the right attitude to take towards those forms of autonomy.

And, on a more philosophical level, I see kind and generous people grow callouses in their hearts because there's no real way for a normally-equipped private citizen to help these people. It's great for society to have people that will stop, engage with, and help literally anyone. We regularly take people like that and teach them to be jaded and to keep their distance. But their trust and generosity deserves to be protected as well, in my opinion.

Well, there is truth to this, but I'm not sure the same set of rules apply to some of the mentally distrubed people being discussed. You can find videos fairly easily of the outlier cases on Youtube, persons who patrol boardwalks and due to whatever malady decide to do things like attack people physically, defecate on people or people's property, break property, and worse. I'm not really sure that they are exercising their free will when their brains have them wired to think there's a demon in a TV display for the bus schedule.

Mental illnesses are heart breaking and they're a problem that most people don't want to deal with; those with extreme cases often are shunned by society and end up in precarious situations and fall further into the illness, making treatment even more difficult. It's a very bad situation that doesn't have a clean answer. While I understand that there is a very large air of caution around setting a precedent that the Government can just declare someone insane and remove their free will, there also has to be a practical side when said person is very clearly a danger to those around them. The penal system wants nothing to do with such cases, current mental health and homeless support doesn't have enough support or funding to help out enough of the cases.

It's just a really shitty situation to be in.

Involuntary psychiatric treatment is so problematic that is better not invoke it.

I'm tempted by this answer, too - but the death rates amongst those who are mentally ill but untreated can be pretty spectacular.

Any data on this? Would be very valuable.

Very much so, people have the right to refuse treatment though I do understand they may be thought mentally incapacitated and unable to decide. I kinda lean towards, if they're competent enough to keep themselves alive on the street then they should be able to refuse treatment.

I have mixed feelings about this, even. They don't always "keep themselves alive" in a way that healthy to both them and the rest of their communities.

You could potentially say the same for some people who live extremely unhealthy lifestyles as well. The problem is that you have to balance liberty and safety. What's the difference between a person living in the street who generally bothers nobody and a hoarder living indoors in filth, but also bothering nobody, their visibility?

I'm aware that it's oversimplifying, but we don't seem to care as much when it's out of sight.

It can be Orwellian, institutions are often self-serving and unreflective. But it isn't always.

I know of a public housing complex that took large numbers of homeless people and had a death rate far over 10% per year despite the fact that every resident had a place to be and an income. If you know people aren't mentally well and are climbing tall bridges by themselves, do you wait 'till they fall off and die? In one case from that building, it turned out the answer (from the government) was "yes."

Part of the problem may well be that high death rates are their own reward, for governments.

To say nothing of the "right" to demand action by others.

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