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Comment by SolaceQuantum | Hacker News Reader

> If they're talking to themselves, they need more than that. They probably need to be cared for in a mental institution

The statement that they should probably need to be cared for in a mental institution isn't true. That some or several may need to be cared for is true, yes, but the probability of that need is less well know. Schizophrenia and other schizophrenia-related disorders can often 'mellow out' on their own over time. [1] It is important to give someone a stable and loving and validating environment for them to be able to recover. There are several kinds of people who, while they talk to themselves, really just have their symptoms exacerbated by stress (e.g. schizotypal personality disorder can have quasi-psychotic symptoms triggered by stress).

1. https://www.nationalelfservice.net/mental-health/schizophren... (I will also note that this has been anecdotally determined, though I understand anecdotes are not data.)

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To be clear, we're discussing homeless people with mental issues, and not people who aren't homeless. The homeless have less access to resources than a non-homeless person with family and friends.

> It is important to give someone a stable and loving and validating environment for them to be able to recover. There are several kinds of people who, while they talk to themselves, really just have their symptoms exacerbated by stress

Yes, which is why a mental institution is a good starting point for a homeless person with mental issues. Let's not confuse these institutions with the mental asylums of the past. Are there better alternatives for the mentally ill homeless that I'm not aware of? I don't feel that most if not all homeless shelters are equiped to fully deal with individuals suffering from schizophrenia.

Yes, there are. The only real difference between a mentally ill homeless person and a normal mentally ill person is the home. Why wouldn't a stable home be the answer?

A short-term stay in a mental hospital might be necessary while getting the patient adjusted to their medication. But once someone is stable, there is no need for such things. Even though the institutions have changed, they are still pretty horrible places to stay in, with all sorts of lifestyle restrictions that aren't generally needed.

A small apartment is appropriate for most folks once they are stable, along with access to someone to call. Some communities have social workers that visit once or twice a week and help with grocery shopping, bill paying, and general "how are you" sorts of things. Group homes are another option if someone chooses it: Private space with shared kitchen and whatnot, staffed with someone to help with cooking and cleaning. My ex, diagnosed with schizophrenia, would have been a candidate for such a thing. I was his primary caregiver, fair or not, and his doctor didn't want him living alone for his own protection.

Give support for family members as well - this is something seriously lacking in the US system. He had help, I didn't.

A small amount of folks might need some help for substance abuse, but many short-term mental health facilities are equipped to do this. A fair amount of folks would be helped by police that are capable of helping mentally ill folks with training and a marker on their ID so the cops know what to change in their approach.

You have some of the best ideas. I would love to get more involved in helping with programs like these. Substance abuse can be the most challenging to approach. From my experience, some people are on a self-destructive path and they forget how to take care of themselves. Some drugs are almost zombifying in that they are begin to only think about their next fix.

I would like to see more options here for medicine and research. Truly, recovery can be a long process for many and it takes time for the brain and body to heal from trauma. Some of that may be emotional trauma as well. I would love to see more options for preventive mental health services in the United States.

If you are in the US, contact the National institute for mental health. You might be able to contact your local hospital as well - that's where I ran into the social care. My ex had a person visit him for a while after we split up and I had a friend that was employed by a different hospital in the area. If anything, they might tell you where to go to get involved, depending on how much time and money you have to spare. If you are high on the time and/or money and are willing to use some of it for good use, you might be able to organize a volunteer program that works with different agencies. Even if it is just a program that makes wellness visits with or without small care packages would help some folks greatly, if they are up to that sort of thing.

What is available for drug users, I'm not sure. It seems one of the major problems in the states is that substance abuse help is difficult. Some charities help folks by donating things like hygiene items and things like that. As you said, some folks nearly forget how to take care of themselves, having fallen out of the habit for such a long time. The same can happen with some mentally ill folks.

Most importantly, though, these programs need funding. Some of these things nearly need laws to happen (like police training). Having worker protection laws that allow folks to take care of themselves would help. One of the better ways to do this is by contacting your state and local government.

> The only real difference between a mentally ill homeless person and a normal mentally ill person is the home. Why wouldn't a stable home be the answer?

if the mental illness is as serious as schizophrenia, a home isn't enough. The issue isn't just about the mentally ill person's welfare, but also if that person poses a danger to others who live nearby. There is a strong correlation between schizophrenia and violent crime. Without treatment in a controlled environment like a mental hospital, it's hard to see a mentally ill homeless person being able to safely integrate with society when they also lack a family and friends support network.

> I was his primary caregiver, fair or not, and his doctor didn't want him living alone for his own protection.

This is the issue. The homeless will not have the luxury of having a caregiver to be able to live independently at least initially. I'm sure why it's so hard for people to accept that the homeless people, who also have mental issues, just don't have access to the same resources that a non-homeless person with mental issues has access to.

A mental institution is not always a good starting point, especially if they are committed involuntarily. It can actually make things worse as the experience of being committed involuntarily is often traumatic to the individual. Inpatient treatment is not always loving or validating, especially in environments where the inpatient treatment is for poor or homeless individuals. Homeless shelters aren’t always equipped for individuals suffering from schizophrenia, but homeless shelters are not really the loving and validating spaces someone who is mentally ill may need anyways. I know there are apparently programs that House the mentally ill in small apartments or with willing caretaker families That are paid for it.

I’m not saying “you are wrong and I have the answers”, merely that thmakes perception that anyone who talks to themselves needs inpatient and medication may not be necessarily true. They could just need some time in a safe place, while inpatient treatment can actually not be safe and incredibly traumatic.

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